Jeanie Hernandez 12/31/2009
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
09-18-2008
Jeanie Hernandez
5700 Collins Ave. Apt. 12K
Miami Beach, Florida 33140
Fine Arts Board
Congratulations! You have been appointed by Commissioner Richard L. Steinberg
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,
~ ~~
U~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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.
m 11AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
TO Jeanie Lyz Hernandez
RE: Fine Arts Board
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 Officers 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.
Jeanie Hernandez ~ tJ
Sworn to and subscribed before me this 1 cl day of ~ ~=~ '~ , 200 ~~
*+~, ~
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 safety io all who live, work and play in our vibrant, tropical, historic community.
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~ NAME: _ Z
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Last Narne First Name Middle Initial
,,-.;-'.HOME ADDRESS: S~~ Q C U ~ ! { t't S aV~ _ ~`~ f ? rt INt t G-1' 1g I t3e~ ~~-7 'Fi'- 331 ~ ~
No• Street Cily State ZipLCode
PHONE: CIS Z-~8g~"~ts0~ ..SOS=~"~~~I (~ ~ed-.nr~,}/Z~ CG/}'7~CC SI G'~.Q~
Home Work Fax Email address r
Business Narne: ~_~~'~~-~'~ --- Position: ~"Y'QGC- ~ t~E'C<bf-~ ~yVQfy~t-t+'~P~~vc„~,./
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No. _ Street City State Zip Code
Profes,ional Llccnsc describe /- ~-~ ~ 2 '~
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Pursuant to City Code section 2-22(4} a and b: Members of agencies, boards, and committees shall be affifiatod with the city; this
requirement shall be fulfilled in the following ways: a) an individual shat) have been a resident of the city for a minimum of six
months; or b) an individual sl~ail demonstrate ownership/interest for a minimum of six months in a business established fn the city.
• hes.ident of Miami Beach for a mrnrmum of six (6} months Yest~1 or No (.
• Demonstrate an ownership/interest in a business in Miami Beach far a minimum of six (Fi} months: Yes 0 or No~l
i
• Aro you a registered voter in Miami beach: Yes~'?or No ',._
i
. (Please circle ono): ! am now a resident of: North Beach South Beach Middle Beach J
s I am applying for an appointment because t have special abilities, knowledge, experience. Please list below:
f~tr,1-~ Cu..t-~'tt-rte C_'Vm r~t.(at t~ 0 t.1''h-P~z.~.~ C~ (_'~Y~S
Please list your preferences in order of ranking [7J first choice [2] second choice, and [3] third choice. Please note that oniv three (3)
choices will be observed by the City Clerk's Office (Regular Boards of Cily}
~ A dable Housing Advisory Committee
_ ^ Health Facilities Authority Board
^ rt in Public Places Committee ~-----
^ His ante Affairs C
mmittee
_ _
^ Beach Preservation Board ~ o
^ Historic Preservation Board'
^ Beautification Committee ^ Housing Authorit
0 Board of AdLshnenC __ ^ Loan Revieev Committee`
^ Budget Advisor~Cammittee
~ D Capital Improvements Overs~ht ^ Marine Authority"
D Miami Beach Commission for Women
7 Committee on Haneless _ ~ 1iami Beach Cultural Arts Council
7 Committee for C.~ualit Education in MB
-- ^ Miami Beach Florida Sister Cities
-•
7 Communit Development Advisor --
u Normandy Shores Local Gov't Nei
h
Im
r
v
t
J Communi Relations Board
~ g
-
p
o
emen
^ Parks and Recreation Facilities Board
7 Convention CenterAdviso
Board ^ Personnel Board'
_
i] Cultural Arts Neighborhood District Overlay (CANDOR _
CI Plannin Board
^ Debarment Committee t:a Pofice Citizens Relations Committee
^ Desi nReview Board` u Production Industry Council
^ Disabilih/ Access Connnitiee ___ _ ^ Public Safet Adviso Committee
ine Arts Board ;Z
--- __
^ Safety Committee _
^ av Business Develo ment Ad Hoc LI Sin le Famil Residential Review Panel
^ Golf Advisory Committee _ f
^ Green Ad Hoc Committee '
--~-- ^ Transparency Reliability & Accountability Committee "TRAC"
^yransportation and Parking Committee
^ Health Advisor Committee _ _ _ ~ ~~r,~
YJ VISItOr and
Convention Authorit
_
*----------- _.-_ ! ^ Youth Censer Advisory Board
F`:CL.:=R16a,! ! lE,narri t; i_,.~m?iilr"~sir;h(; !,ppllc<:linn':(:~ cl>ie,~'.6r.;C Applicatlnn IZevis^d CE; I~Ji)o.d.~
09/17; 2008 c4LU 15: OG rax
Note: If applying for Youth Advisory Board, please indicate your affiliation with the 5coti Rakow Youth Center:
i~i002/002
1. Past service on the 1'oulh Center Advisory Cioard: Yts fl No I~Years of Service:
2. Present participation in Youth Center act(vities by your r..hildren Yes'lr~o I i. If yes, please list the names of your children, their
ages, and tvi~irh {?rograms. List below:
Child's name: Age: Program:
Child's Warne:
,. Age: Program:
•Hav? you ever been convicted of a felony: Yes I or No~f yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes t- or 1~[:. If yes, please explain in detail:
+ Qo you currently owe the City of Miami Eeach any money: Yes ! or No~lf yes, explain in detail
s Are you currently serviny on any Ciry Boards or Committees: Yes L or No l~lf yes; which board?
___ ._.
:~lNh~t orgahlzafions iri the City of Miami Beachdo yoti ciirreiipy-hotel meni6ership ih7 -
___....
Name: N~-irV irVUr 1 d Sy m~~~in
--...__ ..--- Title: Y>~-.rr1F~,tr' r!/~y~~
Name: -~2 L~VL1 {~~Un r ctrl p~ ~/lJ~~
-._ _. . __. Title: 1'Y~~1"C3Q~1'-
_ __ __.--
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• Lis# all properties owned or ve an interest in, which are locaked within he City o Miami B~.
+ I am novJ employed by the Gity of Miami Beach: Yes I or Nq~Which department?
• Pursuant to City Code Section 2-23 (b): Do you have a parent I_:I, spouse tJ, child :, brother CI, or sister ^ who is employed by the
City `VIt ia~mi [3each? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: - years old
Ethnic Origin (Check one) Gender: Male J Femaie~
White ^Afriean-American/Black D Hispanic: C Asian or Pacific Islander ^ American Indian or Alaskan Native 0
"I 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."
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plicant's Signature ~ Date Name of Applicant (PLEASE
RlN-r)
Please attach a copy of your resume to this apptication
NOTC: Applications will remain on fife for a period of one (1) calendar year.
Employment Status: Employed etired ^ Nome-maker ~ Other
_._.._--
---
Received in City Clerk's Office by_
Name of Deputy. Clerk date
Document Control Number ('Assigned by the Ciiy Clerk's Office)L '~~--..> '~/ Entered, By `/ -' ~-2LL~{ Date ~ ! ~ ~
P;CLEhS@lrlL_'ttlo,~rr1 3 C;ocuritteest6&C ~w~dic_atio::'~lo elelettl~,L,-
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