Roly Masferrer 05/31/2008~....
I•
Cil~- of JlAiomi iwch, 1700 Convention Center Drive, Miomi Beach, Fbrido 33139, www.miomibeochfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (305) 673-7411, FAX: 1305) 673-7254
04-07-2008
Roly Masferrer
SUBJECT: Green Ad Hoc Committee-Mayor
Congratulations! You have been appointed by Commissioner Richard L. Steinberg
to the agency, board or committee named above for a term ending: 05/31/2008.
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,
~ ~,
,~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Robert Middaugh
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 ro providing excellent public service and safety to all who live, work, and ploy in our vibront, tropical, historic community
m
City oiF Mionti Math, 1700 Convention Censer Drive, Miami Beach, Fbrido 33139, www.miomibeochA.gov
OffICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEI: (305) 673-7411, FAX: (305) 673-7254
TO Roly Masferrer
RE: Green Ad Hoc Committee- Mayor
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: 05/31/2008.
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 t~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 a on which I have served.
Rosy Masferrer
Sworn to and subscribed before me this ~ day of ~, 200_
,
Silvia Prieto
Deputy Clerk
*Ptease 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 soiey to all who live, work, and pby in our vibrant, tropical, historic community.
NAME:
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ast Name 1 ]~,, ~ Firs~t}Name G~ /~' , ~~Q Middle Initial
No. Street City State Zip Code
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Professional License (describe)
State Zip Code
F~cpires: Atiarh a copy of the Ircerrse
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 (ti) months: Yes~or No ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or Nom
• Are you a registered voter in Miami Beach: Yes `~-Qr No ^
. (Please circle one): I am now a resident of: ~ North Beach South Beac Middle Beach
• I am applying for an appointment because I have special abilities, know a ge, 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 l31
choices wilt be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Health Facilities Authori Board
^ Art in Public Places Committee ^ His anic Affairs Committee
^ Beach Preservation Board ^ Historic Preservation Board*
^ Beautification Committee ^Housin Authorit *
^ Board of Ad'ustment* ^ Loan Review Committee*
^ Bud et Adviso Committee ^ Marine Authori *
^ Ca ital Im rovements Oversi ht ^ Miami Beach Commission for Women
^ Committee on Homeless ^ Miami Beach Cultural Arts Council
^ Committee for Qualit Education in MB ^ Miami Beach Florida Sister Cities
^ Communit Develo ment Adviso * ^ Normand Shores Local Gov't Nei h. Im rovement
^ Communit Relations Board ^ Parks and Recreation Facilities Board
^ Convention Center Adviso Board ^ Personnel Board*
^ Cultural Arts Nei hborhood District Overla CANDO ^ Plannin Board
^ Debarment Committee ^ Police Citizens Relations Committee
^ Desi n Review Board* ^ Production Industr Council
^ Disabili Access Committee ^ Public Safet Adviso Committee
p Fine Arts Board ^ Safet Committee
^ Ga Business Develo ment Ad Hoc ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
reen Ad Hoc Committee ^ Visitor and Convention Authorit *
^ Health Adviso Committee ^ Youth Center Adviso Board
* Board Required to File State Disclosure form
F:ICLER;8ALL188~C Application188C Application Revised 051908.doc
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 ^ or Nq~lf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes C or Nc3~. 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: Ye~or No ^. If yes; which board?
l' c~ `"'
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: ~~ Title:
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 ^ or Nd~ 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):
i, J ~"
This section is "not required" but desired: Age: ~ `( years old Gender: M~~ Female ^
Ethnic Origin (Check one)
White ^Rfrican-American/Black ^ Hispanic~Q Asian or Pacific Islander ^ American Indian or Alaskan Native ^
"I her y attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Artic e I - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
A lic t' S na re Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
EmnlnVmant Ct~4iic• G.,,.,I,,.,e,~.cs,,.a:_,..r r, i ~_.__ ._
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Received in City Clerk's Office by Date
Name of Deputy Clerk (~ ~
Document Control Number (Assigned by the City Clerk's Office) Gr~~ 7,~,G' Entered BY ~ Date
r=:1CL>=>R1$At_L1B&C ApoiicationtB&C: G,p~Gcation Reviser' 051908.do