Kathy Bass 6/30/2009o~"
~~ i~° ~ ,
~ , F s ~"~`
Cit~r of Miami B~och, 1700 Convention Center Drive, Miami Beach, Fbrido 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEI: (305) 673-741 1, FAX: (305) 673-7254
August 25, 2008
Kathy Bass
5825 Collins Avenue, PHC
Miami Beach, FL 33140
SUBJECT: COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH
Dear Ms. Bass:
Congratulations! You have been appointed as a Representative for the Miami Beach Senior High School
to the above-referenced agency, board or committee for a term ending, 6/30/2009.
If you are unable to accept this appointment, please notify the City Clerk's Office at (305)
673-741 1.
Sincerely,
~, ~ t
~d~u%'~ ~~ ~~~~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld, Liaison
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, 2-2458, 2-459
Ordinance 2006-3543 -Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-1 1 . l -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 Employees
We are committed to providing excellent public service and safety to all who live, work, and ploy in our vibrant, tropical, historic community
u .. _tr.. ~ ~L-._! J,~. `. f,>. :.. ':'T /JJ::: 5. 1. C. E: ~^O ... t<a.,, f..~ L 1,-.. :~ h_~rk. J ~.l~I"?; C' 'Jj.i::, i,.J-'~ ..i!~~ !ij'.
I•
Cifr of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEI: (305) 673-7411, FAX: (305) 673-7254
TO Kathy Bass
RE: Committee for Quality Education in MB
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: 06/30/2009.
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.
l<C _ ___
Kati~ass
Sworn to and subscribed before me this daxof ~~'~` ~~, 200
z
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 commined to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic communiy
~~~ ~ ~;~ GtTY C7F tRfit~lMt B~AGI-i
`- t3G~iRG LAND G€;3MMtTTE~ APPt_tG6.Tl(71~ FORM
NAME: ~ A ~.~ =~ ~ A°E F-1 t~Y rJ ~
Last Name ,~^ First Name Middle Initial
HOME ADDRESS: ~6~ 3 1''IAM11~ Gc~ .~.)C. MiAi~-~1 [~M~L~°h ~L .3~ 1`°~"~
No. Street City State Zip Code
PHONE• ~®~ -~'lt-lSl 3~cet.l~ ,jv5 tac~~t-2loo 3aS- 531-t-(3"t3 kt3-~s5 Zb53~J ~~"rnc~~1
Home ~ ork •Fax E it address • Lcs'v~
Business Name:
Position:
Address:
No. Street City State Zip Code
Professional License (describe)
F~cpires: Attach a copy of the ffcense
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall lie 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; orb} an individual shall demonstrate ownershipfinterest 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 lil"Or No ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No tY
• 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 [7] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices wilt be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Health Facilities Authorit Board
^ Art in Public Places Committee ^ His anic Affairs Committee
^ Beach Preservation Board ^ Historic Preservation Board*
^ Beautification Committee ^Housin Authori
^ Board of Ad'ustment" ^ Loan Review Committee*
^ Bud et Adviso Committee- ^ Marine Autho
^ 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
^ Communi 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 Indust Council
^ Disabili Access Committee ^ Public Safet Adviso Committee
^ Fine Arts Board ^ Safet Committee
D Ga Business Develo ment Ad Hoc ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee _
^ Green Ad Hoc Committee ^ Visitor and Convention Authori "
^ Health Adviso Committee ^ Youth Center Adviso Board
* Board Required to File State Disclosure form
F:ICLERISALL\BixC ApplicationlB&C 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 D Years of Service:
2. Present participation in Youth Center activities by your children YesD No 0. 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 Nod If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or NoJ~ If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or Noy_(. If 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?
Name: Title:
Name:
Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
~~~J ~°~1~-titer,-G~ Vr.
. I am now employed by the City of Miami Beach: Yes D or Nof~'. Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother D, 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 ice''
Ethnic Origin (Check one)
White i~African-American/Black ^ 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,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
Ap is Sig re Dat Name of Applicant (PLEASE PRINT)
r
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) glendar year.
Emolovment Status: Emoloved ^ Retired ^ Home-maker t+lOther ^
Received in City Clerk's Office by Date
Name of Deputy Clerk o ~
Document Control Number (Assigned by the City Clerk's Office) ~ .~" Entered By / '`f"` ''u LiDate Ch ~` ~ ~f
Reel tl 04/78108 LN
F:1ClER1~ALL18&C Application\BS~C Application Revised Q51908.doc 2