Antonio Hernandez 12/31/2008f ~. ~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: {305) 673-7411, Fax: (305) 673-7254
12-21-2007
Antonio Hernandez
8230 Hawthorne Ave.
Miami Beach, Florida 33141
SUBJECT= Debarment Committee
Congratulations! You have been appointed by Commissioner Ed Tobin
to the agency, board or committee named above for a term ending: 12131/2008.
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,
1
r j
Robert Parcher t
City Clerk
cc: Saul Frances, Parking Director
Gus Lopez
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 are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.pov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Antonio Hernandez
RE: Debarment 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 1 have
been appointed for a term ending: 12/31/2008.
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/orida Commission on Ethics Guide to the 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 ich I have rued.
0 o Hernandez
Sworn to and subscribed before me this ~~ day of , 20-0-_8."
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 to providing excellent public service and safety to a!1 who live, work and play in our vibrant, tropical, historic community.
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USA TOOLS, INC
Complete line of Store flours:
Automotive Tools 8 M-F: &5:30 p.m.
Equipment Sat: 8-3:30 p.m.
. WWW.USATOOLStNC.COM
New Stmers~re.
5825 N.W. 79th Avenue 2037 N.W. 27ffi Avenue
Octal, Fbrida 33166 Miami, Fbrida 33142
Tel: (305) 716.8880 Tel: (305) 633-6852
Fax: (305) 716-8887 Fax: (305) 635-2103
Gib
NAME: t +'Cs( r \(A-r ~~ L
Last Name
HOME ADDRESS: ~ 2 3O
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First Name Middle Initial
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Stre ity State Zip Code
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Work Fax Email address f}p(•,,~~j/I
Business Nam//e~~:,, ~J~f'r,A~ll',,, ll^~(_.-~ /~ ~Ponsition:~ ^ ~~ r~S•
Address: ~~y~~ /V~CJ / ~ ~ ~'""fV-e. ~l~/(..t-R_. ~K-~'- 3
No. / S~tree~t City State Zip Code
Professional License (describe) ~~ ~~~~...(..~f 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) months: Yes or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No
• Are you a registered voter in Miami Beach: Yes or No
• (Please check one): I am now a resident of: North Beach South Beach Middle Beach
i
• I am applying for an appointment because I have specia abilities, knowledge, experience,. Please list below:
'I ~~~/i',~°SS/~//~L//JL~ ~/YI ~PS'-'~-e / ~U5/~YI~S.S L~L~~ 1e.~
2.(~ e/"i P/~'IdPs" LA,~f~i2 ..~C,16C.~ /r~/ ~
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 City Clerk's Office. (Regular Boards of City)
Art in Public Piaces Committee
Beach Preservation Board ^ Housing Authority*
Beautification Committee ~ ;>~Loan Review Committee'
Board of Adjustment ~ Marine Authority
Budget Advisory Committee ~ Miami Beach Cultural Arts Council
Committee on Homeless =Miami Beach Commission for Women
Committee for Quality Education in MB _ Miami Beach Florida Sister Cities
Community Development Advisory` C Normandy Shores Local Gov't Neigh. Improvement
Community Relations Board _ Oversight Committee for General Obligation Bond
Convention Center Advisory Board ~ Parks and Recreation Facilities Board
'Debarment Committee =Personnel Board"
Design Review Board'` _ Planning Board"
Disability Access Committee ~ Police Citizens Relations Committee
Fine Arts Board ~ Production Industry Council
Golf Advisory Committee u Public Safety Advisory Committee
Health Advisory Committee _ Safety Committee
Health Facilities Authority Board ~ Transportation and Parking Committee ~ c
Hispanic Affairs Committee =Visitor and Convention Authority" -<
7 ~
Historic Preservation Board' ~ Youth Center Advisory Board C
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* Board Required to File State Disclosure form h
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Note: If applying for Youth Advisory Board, please indicate your affiliation with the Sc;tt Rrak, ow 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 ch
ages, and which rograms. List below: i ~~7ed,t'4' ~~~~~ ~
Child's nameT~ rj ~'(°- ~ ~} ~~~~~P~4ge: 1~ Program: ~~c, ,~
Child's name:
Age:l~ ( 1°~Program:
.Have you ever been convicted of a felony: Yes r No If yes, please explain in detail:
their
• Do you currently have a violation(s) of City of Miami Beach codes: Yes or No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes
• Are you currently serving on any City Boards or Committees: Yes
If yes, explain in detail
If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:; f~Q///7e ~~,~ ~f~~ Title:
Name: T:.._.
List all properties owned or have an interest in, which are located within the City of Miami Beach:
Q~ 00 ~C~rG~ i ~ ~~U l78 S ~{'-~ ~ -0 2O ~ I'Dn ,~ rl`l 2a ~~~0
~ 220 ~4-,c~u-~-r~cj n~a~C. e 2-~ c;~'
• I am now employed by the City of Miart/ii Beach: Yes No .Which department?
• Pursuant to City Code Section 2-25 (b): Do you have aparent-, spouse ,child ,brother , or sister who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): A 1
This section is "not required" but desired: Age: ~~years old Gender: Male Female
Ethnic Origin (Check one)
White _~ African-American/Black ~' Hispanic~Asian or Pacific Islander -American Indian or Alaskan Native
Employment Status: Employed~Retired ~ Home-maker ~ Other ~~
"I hereby attest the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of a City Code " tandards of Conduct for City Officers, Employees and Agency Members."
Applic nt's igna a to Name of Applicant (PLEASE PRINT)
Please attach a c of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Received in City Clerk's Office by ~~~ ~? \ ~~C~"`-P
Date ~~- r `{ C3
Name of Deputy Clerk ~ ~ ~ I~ ' /
Document Control Number (Assigned by the City Clerk's Office) Entered By !/ -Date' ~'1 ~ ~~
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