David Smith 12/31/2009`~'
Cit~r of Miami Bsach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachll.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
05-22-2008
David Smith
4538 Sheridan Ave
Miami Beach, Florida 33140
SUBJECT• ` Affordable Housing Advisory Commi ee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/3112009.
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,
/ ?~~'~ ti2~jz S/
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Anna Parekh
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 commined to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community
'~
Cifp of Miami d~ach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachll.gov
OFFICE OF THE CITY CLERK, Robert Porcher, Ciy Clerk
TEI: (305) 673-7411, FAX: (305j 673-7254
TO David Smith
RE: Affordable Housing Advisory 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/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 year on which I have served.
~.. --
~„_... ~ 1
~.
David Smith
Sworn to and subscribed before me this °Z~day of ~" v ~~ , 200 ,
J~.e~(.b
Silvia Prieto
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 safey to all who live, work, and play in our vibrant, tropical, historic community.
~~
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GI T ~` ~F ii~,ll i~~~GR
"~f::~ ~~MMITT~=E:: a~BRPLIa~A~ ~ l~`~N FRi
NAME: ~ M ~~ /'
Last Name ~ ~ l~
First Name Middle Initial
HOME ADDRESS: ~" ~3 ~ Sl~+\,~t ~ ~-7~.`f ,}~ `~ i ~L~L L ~ ~ ~ (~ O
No Street
City State Zip Code
PHONE: ~ ~ `J ~ u 3 S~ ~ ~ ~ 5 ~ l 3 ~ o `
Home ( ~
.aAlcrJc e ~4 Fax ~ _L~ _ _` ~ -qv~
Business Name:
Address:
No.
Professional License (describe) _
Street
State Zip Code
Expires: ~ttacta e cagy of the lecense
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 'o'f six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes i~6r NoY ^
• 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 circle one): I am now a resident of: North Beach South Beach
Middle Beach
• 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 [2j second choice, and [3) third choice. Please note that only three (3)
choices will be observed b the Ci Clerk's Office. (Regular Boards of City)
^ Art in Public Places Commit
^ Beach Preservation Board
^ Beautification Committee
^ Board of Adjustment*
^ Budget Advisory Committee
^ Capital Improvements Over<
^ Committee on Homeless
^ Committee for Quality Educe
^ Community Development Ac
^ Commumty Relations Board
^ Convention Center Advic~rv
^ C;ultural Arts Nei hborhood
^ Debarment Committee
_^ Design Review Board*
^ Disability Access Committee
^ Fine Arts Board
^ Gay Business Development
Committee
^ Health Facilities Authorit Board
~e ^ His anic Affairs Committee
^ Historic Preservation Board*
^ Housin Authorit *
^ Loan Review Committee*
^ Marine Authorit *
ht ^ Miami Beach Commission for Won
^ Miami Beach Cultural Arts Council
on in MB ~ ..:___... _.
u rvormano Shores Local Gov't Nei h.
^ Parks and Recreation Facilities Board
rd ^ Personnel Board*
ct Overla CANDO ^ Plannin Board
^ Police Citizens Relations Committee
Ad Hoc
^ Golf Advisory Committee
^ Green Ad Hoc Committee
^ Health Adviso Committee
* Board Required to File State Disclosure form
Position:
^ Production Industry Council
^ Public Safet Advisory Committee
^ Safety Committee
~ Transparency Rehabihty & Accountability Committee 'TRAC
^ Transportation and Parkin Committee
^ Visitor and Convention Authorit *
^ Youth Center Advisory Board
,~
F:1CL.Ef21$ALLIB~C AppticationlB&C App#ication Revised 051908.doc ~
Age: Program:
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: Age: program:
Child's name:
Child's name:
.Have you ever been convicted of a felony: Yes ^ or No ~It yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No B~'It yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes or No ^. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Title:
Name:
Title:
Name:
• 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 No hich 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):
ears old Gender: Male 13' Female ^
This section is "not required" but desired: Age: y
Ethnic Ori n (Check one)
White frican-AmericanBlack ^ Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Articl~/II - of the C,~ty Code "Standards of Conduct for City Officers, Employees and Agency Members:' ~
r-__
2~,-~~~
Applicant's Signature ~ ~
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Employment Status: Employed
Received in City Clerk's Office by
^ Home-maker ^ Other ^
Document Control Number (Assigned by the City Clerk's Office) ;;~-
~~ ~ ~ ~~
Name of Applicant (PLtASt rrcirv ~ ~
F:!CLf=R!SALL\B&C Appiication!B&C Applicatio~~ Revised 051908.doc