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Clark Reynolds 12/31/2008`~r- CM~- of Miami Moth, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachA.gov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk TEL: (305) 673-7411, FAX: (305) 673-7254 05-22-2008 Clark Reynolds 1900 Sunset Harbor Dr. #2302 Miami Beach, Florida 33139 SB~E"(~iT~, ~ Affordable Housing Advisory Committee Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2008. 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 Ofhce at 305-673-7411. Please read the enclosed materials carefully. Congratulations again and good luck. Sincerely, ~~~ ~ 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 ore committed to providing excellent public service and sofey to oll who live, work, and play in our vibrant, tropicol, historic communiy [~ , City of Miami 8sach, 1700 Convention Center Drive, Miami Beach, Fbrido 33139, www.miamibeachA.gov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk TEL: ~305~ 673-7411, FAX: (305) 673-7254 TO Clark Reynolds 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: 12/31/2008. 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 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 which I have served. rk Reynolds Sworn to and subscribed before me thisZ`f y7day of e/~~ , 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 commiRed to providing excellent public service and safely to all who live, work, and play in our vibrant, tropical, historic community. ,~... --- m M I AM I B SAC H CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM f NAME: ?5 L ~/~/~,~. __ LAast Name /~ / First Name p Middle Initial c~ HOME ADDRESS: ~ ` ©C~ ~~f ~'l ~~'~ j7GfiC0 fGl~ ~ c~ . ~~~D~ ~ ~ .1.~ . ~L- 3 ~ ~ ~ / No.?~f c-~g Street /~~j r7 /City r State Zip Code PHONE: ~(7 ~~ S ) O J `~ ~ ~v J^.`J-~~- Z l ~ / f~/~/~C t-7 ~ ~~~ Y ~ d l?i~ Home Work Fax Email address Business Name: ~~- ~ ~C ~~ Position: ~~/LC/I~1 ~°/u Address: ~~~ /~~ ~~ ~ 5T• # liJ~~ ,il~r~iz~--r 1~~~- ~~ ~~l Lo/ No. Street City State Zip Code Professional License (describe) Expires: Attach a copy of the license 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 ownershiplnterest 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 ~i 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 [2] second choice, and [3] third choice. Please note that only three I'3) choices will be observed by the Citv Clerk's Office. (Regular Boards of City) ^ Art in Public Places Committee ^ His anic Affairs Committee ^ Beach Preservation Board ^ Historic Preservation Board* ^ Beautification Committee ousin Authori * ^ Board of Ad'ustment* ^ Loan Review Committee* ^ Bud et Adviso Committee ^ Marine Authorit ^ 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 Indust Council ^ Disabilit Access Committee ^ Public Safe Adviso Committee ^ Fine Arts Board ^ Safe Committee ^ 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 ^ Health Facilities Authorit Board * Board Required to File State Disclosure form F:\CLER1$ALL1B&C Application\B&C Application Revised 041808.doc Note: If applying for Youth Advisory Board, Tease indicate your affiliation with the Scott Rakow'(outh 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: .Have you ever been convicted of a felony: Yes ^ or No~.lf yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No~lf yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ^ or Noyes, explain in detail • Are you currently serving n an City~B~rds~or~,ommitte s: Yes~or No 4~ If yes; which board? G1 ~ (/t ~L ~~' ~-F? ~ i • What organizations in the City of Miami Beach do you currently hold membership in? Name: Name: Age: Program: Title: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: .~~G7 v . I am now employed by the City of Miami Beach: Yes ^ or No~ 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): 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 ^ "t hereby attest to the accuracy and truthfulness of the application and have received, read and wilt abide by Chapter 2, Article VII of the Ci Code "Stand rds of Conduct for City Officers, Employees and Agency Members." / pp icant' Slgna r Date Name of Applic t (PLEASE PRINT) Please attach a py of your resume to this application NOTE: Applications will remain on file for a period of one (1) calendar year. Employment Status: Employed etired ^ Home-maker ^ .~fD~er ^ Received in City Clerk's Office by Date ~ Z /O Name of Deputy Clerk -~ Document Control Number (Assigned by the City Clerk's Office) ~~ Entered By ~ Date ~ Z y ~ Revised 4/18/08 LH F:\CLER\$ALLIB&C Application\B&C Application Revised 041808.doc 2