Robin Jacobs 12/31/2009~•
Cih- of Miami teach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEI: (305) 673-7411, FAX: (3051673-7254
03-31-2008
Robin Jacobs
3605 Flamingo Dr
Miami Beach, Florida 33140
SIiBJECT: Police Citizens Relations Committee
Congratulations! You have been appointed by Commissioner Deede Weithorn
to the agency, board or committee named above for a term ending: 12/31/2009.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
a ~ ~7 ~2~ ~~ ~L S
~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Carlos Noriega
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 -Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We ore committed -o providing excellent public service and safey to all who live, work, and ploy in our vibrant, tropical, his-oric community
m
Cify of Miatmi Mach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachll.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
TO Robin Jacobs
RE: Police Citizens Relations Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of
a member of the above-mentioned board or committee of the City of Miami Beach to which I have
been appointed for a term ending: 12/31/2009.
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as thef/o~ida Commission on Ethics Guide to 6he Sunshine
Amendment and Code of Ethics for Public ~cers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure" require-
ments of Miami-Dade County or the State of Florida (depending on the board or committee on which
I serve) on July 1st, following the closing of the calendar year on which I have served.
0~/ ~-~_ '
bin Jacobs
~~ ~ /~i~L
Sworn to and subscribed before me this ~ day of , 200
Silvia Pri o
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed ro providing excellent public service and safey ro all who live, work, and ploy in our vibrant, tropical, historic community.
GV
NAME: ~~.C...a ~j T i0171vt L~--
Last Name First Name Middle Initial
HOME ADDRESS: ~~S ~~~ t Ve. ~~~j ~ ~3 (~{~
No. reet City State Zip Code
PHONE: 3~:~--(p~Y- D631 ~~-~~ll `~ D~ .7vs'~~`I-1~ 71C~ Ct:s/i fl 1)i ~•~ ~/ ~`~~,
Home Work Fax Email address
Business Name: ~~~ Position:
Address:
No. Street City State Zip Code
Professional License (describe)
Expires:
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) month Yes or No
.Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months Ye or No
• Are you a registered voter in Miami Beac .Yes or No
• (Please check one): I am now a resident of: North Beach South Beach fiddle Beac
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please List your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the Citv Clerk's Office (Regular Boards of City)
~~ Art in Public Places Committee
L Beach Preservation Board
Beautification Committee
Board of Adjustment*
Budget Advisory Committee
C Committee on Homeless
=~ Committee for Quality Education in MB
`Community Development Advisory*
Community Relations Board
Convention Center Advisory Board
Debarment Committee
Design Review Board*
Disability Access Committee
Fine Arts Board
Golf Advisory Committee
Health Advisory Committee
~. Health Facilities Authority Board
Hispanic Affairs Committee
Historic Preservation Board*
Housing Authority*
Loan Review Committee*
Marine Authority*
Miami Beach Cultural Arts Council
Miami Beach Commission for Women
=Miami Beach Florida Sister Cities
Normandy Shores Local Gov't Neigh. Improvement
Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
Personnel Board*
Panning Board*
olice Citizens Relations Committee
Production Industry Council
Public Safety Advisory Committee
Safety Committee
Transportation and Parking Committee
Visitor and Convention Authority*
Youth Center Advisory Board
"Board Required to File State Disclosure form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes No Years of Service:
2. Present participation in Youth Center activities by your children Yes No . If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
.Have you ever been convicted of a felony: Yes o No f yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes or(No). If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes o No If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes r No Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent spouse ,child ,brother , or sister who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: ~~ years old Gender: Male Female `/
Ethnic Origin (Check one)
White ~Cfrican-American/Black - Hispanic: ~ Asian or Pacific Islander _~ American Indian or Alaskan Native
Employment Status: Employed -Retired =Home-maker ~ Other :`~
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
--~.. ~4 ~r,' U ~i
Appli nt's Signat D to
Please attach a co of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Name of Applicant (PLEASE PRINT)
Received in City Clerk's Office by Date
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) '~~ ~~ ~ Entered By ~ ~~ Date / ~'~ ~J`~
Revi ed 10/2 /2007 L. Hadfield