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Isadore Havenick 12/31/2010~/ ?~V~i r~~ ~Y 4a i ~f 'E 6 ~ 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) 673-7411, Fax: (305)'673-7254 10-24-2008 Isadore Havenick 800 East Dilido Drive Miami Beach, Florida 33139 SUBJECT: Miami Beach Cultural Arts Council Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2010. 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 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. . 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: (305j 673-7254 TO Isadore H. Havenick RE: Miami Beach Cultural Arts Council 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: 12/31/2010. 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 ~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. ~// Isadore H. Havenick Sworn to and subscribed before me this ~~ day of QC{'oi~~ , 200 Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachFl.gov under City Cleric/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. NAME: ~ Q V e~ ~ G fem.. LQast Name HOME ADDRESS: C>O~ ~ aS hC Nno.f n PHONE~UJ ' D `7 J '~ ~Dy~ Home Business Name:.. ! a- a ~~ Address: '`i ~ ~~ N ~~~ ~~ ~ 1. ~ No. Professional License (describe) ,y State Zip Expires: 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 aty for a minimum of six months; or b) an individual shall demonstrate ownership/interest for a min~im~um of six months in a business established in the aty. • Resident of Miami Beach for a minimum of six (ii) 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 ~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, experie~. Please list below: ~a5 a ~ ca In Q~d n arl a\ .~ ~ real ~tn \h ~n ~+rv~ 4S we ,~s, ~o~ Please list your preferences m oroer or ranicmg lei nrst cnolce iii secona gio~ce, ana isl m~ra choice. riease noes oral vnrv u~r~ wr choices will be observr~d by the City Clerk's Office. (Regular Boards of City) w ^ Affordable Housin Adviso Committee ^ Health Fartilities Autho ' Board Art in Public Places Committee 3 ^ His anic AtTairs Committee ^ Beach Preservation Board ^ Historic Preservation Board* ^ Beautification Committee ^ Housin Autho ^ 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 Guttural Arts Council i ^ Committee for Quali Education in MB ^ Miami Beach Florida Sister Cities ^ Common' Develo meet Adviso * ^ Norma Shores Local Gov't Nei h. Im rovement ^ Communi Relations Board ^ Parks and Recreation Facilities Board ^ Convention Center Adviso Board ^ Personnel Board* ^ Cultural Arts Nei hbofiood District Overla CANDO ^ Plannin Board ^ Debarment Committee ^ Police Citizens Relations Committee ^ Desi n Review Board* ^ Production Indus Council ^ Disabili Access Gommittee ^ Public Saf Adviso Committee Fine Arts Board 2 ^ Saf Committee ^ Ga Business Develo nt Ad Hoc ^ Trans ren Reliabil' & Accountabili Committee "TRAC ^ Golf Advi Committee ^ Trans rtation and Parkin Committee ^ Green Ad Hoc Committee ^ Visitor and Convention Autho ~ * D Health Adviso Committee ^ Youth Center Advi Board " Board Required to File State Disclosure form ~1.-S c~ o r ii Middle Initial ~~ l~ /)~ a r:~ ~c- 3313 9 City State Zip Code Email address ~ ~/'~eSl' ~.e~- ~ ~~ ` First Name 1-~~ ~~l~v~ l)'1~~ Street 30S-b~9- ~~ 30.E ~ Work Fax . Posftion: r SP/ ' 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 No 67' If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach odes: Yes ^ or No . If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ^ or No [7 1f yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes ^ or No D7' If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: Name: Title: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: ~nr~ F~ ~, ~- l~,' 11' ~~ ~ r% ~~ . I am now employed by the City of Miami Beach: Yes ^ or NoIS~Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is emptoyed by the City of Miami Beach? Check all that apply. Identify tt~e department(s): This section is "not required" but desired: Age: years old Gender: Male ~ Female ^ Ethnic gin (Check one) White 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, r+~d and will abide by Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." Applicant's Signature TSa©lo~ Q/2niC~ cant (PLEASE PRINT) Name of Please attach a copy of your resume to this application NOTE: Applications will remain on file for a period of one (1) calendar year. Fmnlnvmant Stag ~c• Fmnlnvcut n Ratirert n Hnme-maker rl Other rl ~~- ~ ~~ Date ~~ b Received in City Clertc's Office by Name of Deputy Clerk p ~ ~ ~ S A Document Control Number (Assigned by the City Clerk's Office)~~~~ Entered By ~Z~~ate !/ Revised 04N8/OB LH