HomeMy WebLinkAboutPZAB ApplicationsCITY OF MIAMI APPLICATION FOR PLANNING, ZONING AND APPEALS BOARD
NAME: Adam
RESIDENCE:
(First Name)
Jason Gersten
(Middle) (Last Name)
(Address Linel)
{Address Line 2)
CITY: 1=1 STATE: ZIP:
HOME PHONE: CELLULAR PHONE:
EMAIL: ajgersten@gmail.com
PRINCIPLE BUSINESS/EMPLOYER: Gramps Bar LLC
BUSINESS ADDRESS: 176 NW 24th St
(Address Line].)
CITY: Miami
(Address Line 2)
STATE: FL ZIP: 33127
BUSINESS PHONE: EXT.
SHORT STATEMENT OF QUALIFICATIONS
(If you require additional space, attach additional pages.)
1. Describe the qualities, experience, expertise and abilities that you possess that would
make you an effective board member that will act in the public interest.
See Attached
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Form BoardsIMA-PABIZ8-O220 01
Page 1 of 4
2. Describe your educational background and general knowledge of planning and zoning.
See Attached
3. Describe any prior community or personal involvement that you have had that
demonstrates interest in and concern for planning and planning implementation.
See Attached
4. Describe any planning or land use or growth management seminars that you have
attended.
See Attached
5. Describe any membership in organizations having the primary aim of the furtherance
of dissemination of knowledge of and support of sound planning and implementation of
planning programs.
See Attached
6. Describe any other activity evidencing knowledge and interest in the public purposes
of planning and plan implementation.
See Attached
Form Boards)MA-PABIZ8-O224.01
Page 2of4
• I have read and understand the qualifications for members that are set forth in Sec. 62-16 of the City Code, and hereby
certify that:
(1) I do not have any interest in the profits or emoluments of any contract, job, work, or service for the city.
(2) I am in a position to represent the public interest, and do not have any personal or private interests likely
to conflict with the public interest.
(3) I do not hold any elective office in any governmental authority in the county or the city.
(4) I am not employed in a full-time capacity by any governmental authority in the county or the city.
(5) As a member or alternate member of the Planning, Zoning and Appeals Board I agree to
participate in at least one seminar on planning or zoning to be held in the state or elsewhere, and approved
by the city, during the course of each calendar year that I remain a member or alternate member of the
Planning, Zoning and Appeals Board. I acknowledge that I am subject to removal from the board if I fail to
meet this requirement each and every year after assuming board membership or alternate membership.
I am an elector of the City of Miami.
(6)
• I agree to immediately notify the city clerk if I cease to be a resident and/or an elector of the city during the term of my
office.
• I agree that if I were to become a candidate for elective political office during my term and qualify as a candidate
for elective political office, such qualification shall be deemed a tender of my resignation from the board.
• I have read, understand and agree to comply with Section 2-611 of the Miami City Code which prohibits me from
entering into any contract or transact any business with the city or any person or agency acting for the city, or from
appearing in representation of any third party before any board, commission or agency of which I am member. 'also
understand that prohibition upon activity which is set forth above remains in effect for a period of two years after I have
left city service.
• I have read, understand and agree to comply with Section 2-613 of the Miami City Code which prohibits me
from accepting, directly or indirectly, from any person, company, firm or corporation to which any purchase order
or contract is or might be awarded, any rebate, gift, money or anything of value whatsoever, except where given for the
use and benefit of the city.
• I agree to submit to the city clerk a complete itemized list of all real property owned by me, whether the title be
either legal or equitable, whether owned in whole or in part, including corporate real property in which I have a
controlling interest or I am an officer of such corporation. I agree to submit to the city clerk said information in the
required form verified and under oath within 30 days of my appointment and I shall include the following information
as to each parcel of land:
(1) The legal description and common address;
(2) The municipal or county zoning classification wherein the property is located; and
(3) The manner in which the property is presently being utilized.
• I understand that I am required to list only those real properties that are located within the corporate limits of the city
or those properties located 500 feet beyond the corporate limits of the city.
• I agree to comply with all financial disclosure requirements of the City, the County and the State including the
requirements set forth in Section 2-11.1 of the Miami -Dade County Code, and Florida Statutes Sec. 112.3145.
• I agree to comply with all ethics course requirements of City of Miami Code Section 2-38.
• I acknowledge that the code of ethics of Miami -Dade County shall apply to me as a member or alternate member of
the Planning, Zoning and Appeals Board and hereby agree to abide by all the provisionsthereof.
• I recognize that membership on the Planning, Zoning and Appeals Board requires my regul- - and
participation at board meetings.
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*************************************************
I hereby certify that all information in this application is complete, truthful, and accurate to
the best of my knowledge and that I have read and understand the qualifications and
conditions of membership listed in this application.
Print Name Adam Gersten
Signature
Date
®Yes
8/22/22
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FURTHER INT§fRUCT1ONS
Please complete this form and submit the original via mail or hand -delivery to:
Office of the City Clerk
City of Miami
3500 Pan American Drive
Miami, FL 33133
Attn: Nicole N. Ewan
Information may be copied and pasted into this form from other computer programs, i.e.
MS 'Word. information that is typed directly into the form may be "Saved as Text" and
then opened in other computer programs.
For additional information on the Planning, Zoning and Appeals Board, please contact
Ms. Olga Zamora, Chief of Hearing Boards, at (305) 416-2037 or email at:
oramora(a)miamigo v, com
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Form Boards/MA•PABfZO O22O.91 Page 4 of 4
SHORT STATEMENT OF QUALIFICATIONS
1. Describe the qualities, experience. expertise and abilities that you possess
that would make you an effective board member that will act in the public
Qualities
I am able to effectively communicate; consider problems in an ethical and
balanced way; demonstrate leadership; remain intellectually open and curious;
consider matters and ideas through a lens of what is a just, equal, and/or fair result
in the context of the social and economic realities at play.
Experience
Worked as an attorney for the State of Florida and in private practice; been
involved in real estate development, project management, and construction; served
on several non-profit and governmental boards; been a member of the Florida Bar
for over a decade; small business owner in a heavily regulatedindustry; dealt with
state, city, county and national codes and agencies on a regular basis; engaged the
community as facilitator and host for discussion.
Expertise
Creative problem solving.
Abilities
As a business owner, community leader, and 4th generation Miamian - I am
committed to serving this city in both the private and public sectors. As an attorney,
negotiator, designer, developer, and homeowner, I am able to synthesize my
multitude of life experiences to empathetically and reasonably consider matters
that affect my diverse community.
Effective communication; an ethical and balanced approach to problem
solving; strong leadership; and intellectual curiosity have served me well so far in
my pursuits, which include expanding social justice, equality, and fairness in a city
that has so much to improve. I believe that these qualities have served me well as I
have served the interests of the citizens of the City of Miami as a board member of
PZAB for the better part of the last five or six years.
2. Describe your educational background and general knowledge of planning
and toning
Educational background
High School Diploma (Theater) / New World School of the Arts; Bachelor of
Arts (Theater) J University of Florida; Juris Doctor / St. Thomas University School
of Law.
My general knowledge of planning and zoning comes from my experiences
as a bar owner and operator, as a small business owner, an atypical real estate
developer focused on creative uses and food & beverage, musician, and attorney.
All of these require the me to navigate the interwoven fabric of rules, ordinances,
regulations, laws, administrative processes, and politics to arrive at a desired result.
Additionally, I have read several items from the MIT OpenCourseWare
School of Architecture Urban Planning courses' reading lists, and read books about
planning, urban life, parking, architecture, design, and other related areas.
3. Describe any prior community or personal involvement that you have had
that demonstrates interest in and concern for planning and planning
implementation.
Whilst working in Key West for several years, I joined Reef Relief, a long-
standing, well respected environmental organization that focuses on protecting
coral reef. Reef Relief shaped policy through an education curriculum based on
sound science and through advocation for planning policy to minimize the harm
done to the water quality that our entire state relies on for drinking, swimming,
tourism, sustenance and transportation. In this respect, we participated in policy
discussions with various federal, state, and city agencies on matters pertaining to
the planning of the City of Key West and the surrounding areas.
When I opened my business in Wynwood, I became involved with (and went
on to serve as chairman of) the Wynwood Art District Association and as a
committee member of the subsequently created Wynwood Business Improvement
District. For several years, I have participated as an active voice in discussions
related to growth, sustainability, planning, and zoning in the Wynwood Cafe
District and BID boundary, which then became the Wynwood NRD.
In 2015, I was appointed to the PZAB by Commissioner Hardemon, er
prior serving on the Code Enforcement Board as an appointee of Marc Sal rr..
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4. Describe any planning or land use or growth management seminars that
you have attended.
I have not attended any planning or land use growth management seminars,
other than the presentations made by the City of Miami staff.
S. Describe any membership in organizations having the primary aim of the
furtherance of dissemination of knowledge of and support of sound
planning and implementation of planning programs.
In years past, I sat on committees of the Wynwood Business Improvement
District and participated in discussions regarding the effective use of public and
private space for public use. I have been part of very public discussions, in both the
capacity as a business owner and in my capacity as a PZAB member, about SAPs,
TUPs, public benefits, re -zonings, traffic impacts, and so much more.
Theses conversations integrate knowledge of public assemblies, pedestrian
and vehicular traffic, the arts, crowds, culture, cultural preservation, politics,
quality of life, historic preservation, and how those concerns are addressed within
the existing planning/zoning framework, and also how the current framework
might be affected or evolve and be used into the future to enhance the whole city
and its neighborhoods.
6. Describe any other activity evidencing knowledge and interest in the public
purposes of planning and plan implementation.
I currently sit on the City of Miami Planning Zoning and Appeals Board.
CITY OF MIAMI Print Form
um_ PROPERTY DISCLOSURE FORM
N, : " era (IN CONFORMANCE WITH SEC. 2-615 OF THE CITY CODE)
Legal Description
(Lot 7, Primose Sec 4, PB 52)
Common Address
(123 North East 54th St)
Title
Legal/Equitable
Ownership
Whole/In Part
Zoning
Class
Present.
Use
01-3124-013-2330
01-3124-013-2320
01-3124-013-2310
5300- 5310-5318 NW 2nd AVE
legal
whole
t-41
vacant
01-3124-013-2280
223-225 NW 53rd St
legal
whole
t-4r
residential
30-3206-028-0020
8810 NE 8th CT
legal
whole
residential
legal
whole
t3r
residential
Note: You are not limited to the space on the lines in this form. Attach additional sheet(s) If necessary.
OATH
I, Adam Gersten
do solemnly swear that the above is a true and accurate statement of my interests in real property located
within corporate limits of the CITY OF MIAMI or 500 feet beyond the corporate limits of the C(T_•Y OF MIAMI.
Adam Gersten �`� ".
NAME:(Please Print):52
TITLE/POSITION WITH CITY OF MIAMI: Board Member•
NAME OF BOARD/COMMITTEE (If applicable): PZAB Y`:: h.)+Sr;
SIGNATURE:
ii
DATE: Adam Gersten77
Sworn to (or affirmed) and subscribed before me by means of
22 day of August 2022 by Marcos Rezende
I
physical presence or ['online notarization, this
(Name of person signing and his/her title ublic officer, trustee or personal representative)
WITNESS my hand and official seal.
AAtirocs
'' - Notary PUbI C NOTARY PUBLIC, 5 rE OF FLORIDA
State of Florida 4.state +lnrida
- �IIt'-' - Commit HHf310967
Miami
County of -Dade ..-.•
Expires 6/16/2We of Notary Public: Print, Stomp, or Type os Commissioned)
NOTARY PUBLIC ❑■ Personally Known to me, or
SEAL OF OFFICE:
❑ Produced Identification:
(Type of identification Produced)
F DID Take an Oath, or
❑ DID NOTTake an Oath
Form BoardsIMA-PAB/ZB-0220.01
CITY
Form Boafis/MA-PAB/ZB-0220.01
�• Of,y
Il:
< 0,09
OF MIAMI APPLICATION FOR PLANNING, ZONING AND APPEALS BOARD
NAME: MelodY Linda Torrens
(First Name) (Middle) (Last Name)
RESIDENCE: 2080 NW 13 Street
(Address Unel)
(Address Une 2)
CITY: Miami STATE: FL ZIP: 33125
HOME PHONE: CELLULAR PHONE: 305-905-1217
EMAIL: MaiodyTorrenslaglisallcom
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PRINCIPLE BUSINESS/EMPLOYER: Realtor, London Foster Real Estate ram' m
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BUSINESS ADDRESS: 407 Lirklala Rost Sato 1OG u1 m
(Address Unel) 3 n ..13 C
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(Address Une 2) rn
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CITY: Miami Beach STATE: FL ZIP: 33139
BUSINESS PHONE: 305-514-0100 EXT.
SHORT STATEMENT OF QUALIFICATIONS
(If you require additional space, attach additional pages.)
1. Describe the qualities, experience, expertise and abilities that you possess thatwould
make you an effective board member that will act in the public interest.
As an active Realtor, I am out in the Cornrrwnity talking to residents and developers almost daily. As a result of this exposure I see firsthand the effect
of good planned development in the City of Miami. In addition, I have served on PZAB for the past 10 years, the last 4 of which I have served at Vtce-Chair.
Page 1 of 4
2. Describe your educational background and general knowledge of planning and zoning.
For over 40 years in the reel estate buisiness 1 have attended many seminars that discuss planning and zoning Including planningldevelopmentlmerketlng
of projects in the City of Miami. Additionally, I have 10 years experience with Miami 21 Zoning Code es a current member of PZAB. My education Is In
Bunkum tom _- emi Da a CAMga
3. Describe any prior community or personal involvement that you have had that
demonstrates interest in and concern for planning and planning implementation.
As a Realtor, I have sold development tracts, properties being rezoned and clients that want to modify their homes to provide a mom comfortable lifestyle.
Real Estate has always been my mein Interest and 1 feel this Is a suitable match for serving on PZAB. Whlle serving on PZAB my goal has always been
to be sure a• citizens have an opportunity to speak out on planing and zoning issues, whether or not they ere a single homeowner or a developer building a large
planned development.
4. Describe any planning or land use or growth management seminars that you have
attended.
I have attended meetings of the Downtown Autiwrfty. Dade League of Cities Conferences, Realtor Association of Miami Conferences on Growth
and Development, The Real Deal Real Estate Conferences. There have been mom In my long career in the real estate business. rm always looking to growl
5. Describe any membership in organizations having the primary aim of the furtherance
of dissemination of knowledge of and support of sound planning and implementation of
planning programs. o
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Serving on PZAB for ten years has given me a broad based knowledge. Ci hu
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6. Describe any other activity evidencing knowledge and interest in the public purposes
of planning and plan implementation.
As a dttzen living in Miami for most of my life, workbng as a Real Estate Professional and living on the Miami River, I have a tremendous interest in the purposes of
planning and plan implementation.
Form Boards/MA-PAWLS-0220.01 Page 2 of 4
• I have read and understand the qualifications for members that are set forth in Sec. 62-16 of the City Code, and hereby
certify that:
(1) I do not have any interest in the profits or emoluments of any contract, job, work, or service for the city.
(2) I am in a position to represent the public interest, and do not have any personal or private interests likely
to conflict with the public interest.
(3) I do not hold any elective office in any govemmental authority in the county or the city.
(4) I am not employed in a full-time capacity by any govemmental authority in the county or the city.
(5) As a member o r alternate member of the Planning, Zoning and Appeals Board I agree to
participate in at least one seminar on planning or zoning to be held in the state or elsewhere, and approved
by the city, during the course of each calendar year that I remain a member or alternate member of the
Planning, Zoning and Appeals Board. I acknowledge that I am subject to removal from the board if I fail to
meet this requirement each and every year after assuming board membership or alternate membership.
(6) I am an elector of the City of Miami.
• I agree to immediately notify the city clerk if I cease to be a resident and/or an elector of the city during the term of my
office.
• I agree that if I were to become a candidate for elective political office during my term and qualify as a candidate
for elective political office, such qualification shall be deemed a tender of my resignation from the board.
• I have read, understand and agree to comply with Section 2-611 of the Miami City Code which prohibits me from
entering into any contract or transact any business with the city or any person or agency acting for the city, or from
appearing in representation of any third party before any board, commission or agency of which I am member. I also
understand that prohibition upon activity which is set forth above remains in effect for a period of two years after I have
left city service.
• I have read, understand and agree to comply with Section 2-613 of the Miami City Code which prohibits me
from accepting, directly or indirectly, from any person, company, firm or corporation to which any purchase order
or contract is or might be awarded, any rebate, gift, money or anything of value whatsoever, except where given for the
use and benefit of the city.
• I agree to submit to the city clerk a complete itemized list of all real property owned by me, whether the title be
either legal or equitable, whether owned in whole or in part, including corporate real property in which I have a
controlling interest or I am an officer of such corporation. I agree to submit to the city clerk said information in the
required form verged and under oath within 30 days of my appointment and I shall include the following information
as to each parcel of land:
(1) The legal description and common address;
(2) The municipal or county zoning classification wherein the property is located; and
(3) The manner in which the property is presently being utilized.
• I understand that I am required to list only those real properties that are located within the corporate limits of the city
or those properties located 500 feet beyond the corporate limits of the city.
• I agree to comply with all financial disclosure requirements of the City, the County and the State including the
requirements set forth in Section 2-11.1 of the Miami -Dade County Code, and Florida Statutes Sec.112.3145.
• I agree to comply with all ethics course requirements of City of Miami Code Section 2-38.
• I acknowledge that the code of ethics of Miami -Dade County shall apply to me as a member or alternate member of
the Planning, Zoning and Appeals Board and hereby agree to abide by all the provisionsthereof.
• I recognize that membership on the Planning, Zoning and Appeals Board requires my regular attendance and
participation at board meetings.
}1831IWVIW 3H1 JO 331330
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Forth Boards/MA-PAH/M-0220.01
Page 3 of 4
I hereby certify that all information in this application is complete, truthful, and accurate to
the best of my knowledge and that I have read and understand the qualifications and
conditions of membership listed in this application.
Print Name
Signature
Date
(i)Yes
Melody Linda Torrens
;64(
August 3, 2022
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FURTHER INSTRUCTIONS
Please complete this form and submit the original via mail or hand -delivery to:
Office of the City Clerk
City of Miami
3500 Pan American Drive
Miami, FL 33133
Attn: Nicole N. Ewan
Information may be copied and pasted into this form from other computer programs, i.e.
MS Word. Information that is typed directly into the form may be "Saved as Text" and
then opened in other computer programs.
For additional information on the Planning, Zoning and Appeals Board, please con
Ms. Olga Zamora, Chief of Hearing Boards, at (305) 416-2037 or email at:
ozamoraamiami_uov. com
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Form BoarddMA-PAB?B0220.O1 Page 4 of 4
CITY OF MIAMI
j{EAL PROPERTY DISCLOSURE FORM
(IN CONFORMANCE WITH SEC. 2-615 OF THE CITY CODE)
Print Form
Legal Description
(Lot 7, Primose Sec 4, PB 52)
Common Address
(123 North East 54th St)
Title
LayatlEoultabla
Ownership
Wholelln Part
Zoning
Class
Present
Use
b4.R1=AM 'PA2L
1'6 4-(ol) LOT' IZ
131_I4,
.108 O ?1(4 13 ST
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Note: You are not limited to the space on the lines in this form. Attach additional sheets) ifces1ry.
CA3
OATH
/11 E2-o b '{ (t IONA-TO (t,2E-4) S
do solemnly swear that the above is a true and accurate statement of my interests in real property located
within corporate limits of the CITY OF MIAMI or 500 feet beyond the corporate limits of the CITY OF MIAMI.
N%Lot y QA ToirREniS
lee -CliAie /-?(AivZON (N5 40,P44GS BcrAb
NAME:(Please Print):
TITLE/POSITION WITH CITY OF MIAMI:
NAME OF BOARD/COMMITTEE (If applicable):
SIGNATURE:
DATE:
it..
.4,4Aeledy-LJnda-Tamana-, g Ir5, / Z z.
Sworn to (or affirmed) and su •scribed before me by means ofIphysical presence or ['online notarization, this
5 t ' day of !L 1 5
WITNESS my hand and official seal.
State of F/brn;'eta,
County of D4.dt-
NOTARY PUBLIC
SEAL OF OFFICE:
2022, by -e CIV n of 5rygn s
(Na of person signing add his/her title (public officer, trustee or personal representative)
TARY PUBLIC, STATE OF FLORIDA
(Name of Notary Public: Print. Stamp, or Type as
® Personally Known to me, or
❑ Produced Identification:
❑ DID Take an Oath, or
• DID NOTTake an Oath
NICOLE EWAN
Notary Public - State of Florida
Zr Commission 0 GO 977684
i!►9g?bonedlY Comm. Expires Jun 19, 2024
Ionded through Nations! Wary Assn.
(Type of Identification Produced)
Form BoardslMA-PAB/LB-0220.01
CITY OF MIAMI APPLICATION FOR PLANNING, ZONING AND APPEALS BOARD
NAME: Mercedes
(First Name)
RESIDENCE: 1510 NW 19th Ave, Apt G116
Librada Rodriguez
(Middle) (Last Name)
(Address Linel)
CITY: Miami
(Address Line 2)
STATE: FLORIDA ZIP: 33125
HOME PHONE: N/A CELLULAR PHONE: 786-365-2929
EMAIL: Merci0121@gmaiLcom
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PRINCIPLE BUSINESS/EMPLOYER: Miami -[lade county •
C7
BUSINESS ADDRESS: 3071 SW 38th Ave
G7
(Address Linel)
CITY: Miami
BUSINESS PHONE:
(Address Line 2)
STATE: Fi
EXT.
ZIP: 33135
SHORT STATEMENT OF QUALIFICATIONS
(If you require additional space, attach additional pages.)
1. Describe the qualities, experience, expertise and abilities that you possess that would
make you an effective board member that will act in the public interest.
have had experience monitoring zoning hearings for over two decades at a County -wide basis.
have had experience reviewing agenda items that affect different commercial or residential_ J
zoning .applications.
Served as the Policy Advisor for Miami -Dade County for several years providing a veto opinion
on .Commission _appr_aLved.Zoning or COMP application_ _
Form Ro&d fh1A-PAr1126-0220.01
Page 1 of 4
2. Describe your educational background and general knowledge of planning and zoning.
1 have had expenence with the County Planning and Loning Department procedure and policies.
CDMP applications, Development of Regional Impact applications known as DRI, construction
expansion projPrts_hyiAiami-Dade Parks Department and Miami -Davie Sr.hnol Board, etc
3. Describe any prior community or personal involvement that you have had that
demonstrates interest in and concern for planning and planning implementation.
I have had experience with monitoring zoning applications before Miami -Dade County
Community Council Hearings for several years and provided an opinion for those that were
appealed
Monitored the GOB construction projects for Miami -Dade County Parks Department for
groundbreaking and dedication ceremonies._
4. Describe any planning or land use or growth management seminars that you have
attended.
As a senior_policy advisor with Miami -Dade County I participated in several seminars
throughout the County those called EAR which stands for Evaluation and Appraisal Report.
Every (7) years we reviewed the Comprehensive Development Master Plan (CDMP) which is updated per
Florida Statutes. It is related to policies, maps and text of the CDMP and recommended changes.
5. Describe any membership in organizations having the primary aim of the furtherance
of dissemination of knowledge of and support of sound planning and implementation of
planning programs.
Member of the Miami -Dade County General Obligation Band Committee (GOB) ------- --- - -----------
Member of the Miami -Dade County,Save Neighborhood Park Bond Committee (SNP)
Trustee Board Member ofItte_Miami Zoo - Amazon and Beyond Construction Expansion
Member of..the_Miami-Dade County SpnrtsC_ommittee_Construction Marijaand Miami Heat Stadiums
.Projects .
Member of the Miami -Dade County Homeless Trust Construction of Homeless Shelters
Trustee of the Jackson Memorial Hospital South Dade Medical Campus Expansion Committee
Trustee. Memorial-kiospitaL-Children Ad Committee
-.Jackson -Hoc -Expansion
Member of the Kendall Regional Medical Center Heliport Project Committee
6. Describe any other activity evidencing knowledge and interest in the public purposes
of planning and plan implementation. c)
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Form Boards/MA-PAB2B4220.01 Page 2 of 4
• I have read and understand the qualifications for members that are set forth in Sec. 62-16 of the City Code, and hereby
certify that:
(1) I do not have any interest in the profits or emoluments of any contract, job, work, or service for the city.
(2) I am in a position to represent the public interest, and do not have any personal or private interests likely
to conflict with the public interest.
(3) I do not hold any elective office in any governmental authority in the county or the city.
(4) I am not employed in a full-time capacity by any governmental authority in the county or the city.
(5) As a member o r alternate member of the Planning, Zoning and Appeals Board I agree to
participate in at least one seminar on planning or zoning to be held in the state or elsewhere, and approved
by the city, during the course of each calendar year that I remain a member or alternate member of the
Planning, Zoning and Appeals Board. I acknowledge that I am subject to removal from the board if I fail to
meet this requirement each and every year after assuming board membership or alternate membership.
(6) 1 am an elector of the City of Miami.
• I agree to immediately notify the city clerk if I cease to be a resident and/or an elector of the city during the term of my
office.
• I agree that if I were to become a candidate for elective political office during my term and qualify as a candidate
for elective political office, such qualification shall be deemed a tender of my resignation from the board.
• I have read, understand and agree to comply with Section 2-611 of the Miami City Code which prohibits me from
entering into any contract or transact any business with the city or any person or agency acting for the city, or from
appearing in representation of any third party before any board, commission or agency of which I am member. !also
understand that prohibition upon activity which is set forth above remains in effect for a period of two years after I have
left city service.
• I have read, understand and agree to comply with Section 2-613 of the Miami City Code which prohibits me
from accepting, directly or indirectly, from any person, company, firm or corporation to which any purchase order
or contract is or might be awarded, any rebate, gift, money or anything of value whatsoever, except where given for the
use and benefit of the city.
• t agree to submit to the city clerk a complete itemized list of all real property owned by me, whether the title be
either legal or equitable, whether owned in whole or in part, including corporate real property in which 1 have a
controlling interest or 1 am an officer of such corporation. I agree to submit to the city clerk said information in the
required form verified and under oath within 30 days of my appointment and I shall include the following information
as to each parcel of land:
(1) The legal description and common address;
(2) The municipal or county zoning classification wherein the property is located; and
(3) The manner in which the property is presently being utilized.
• I understand that I am required to list only those real properties that are located within the corporate limits of the city
or those properties located 500 feet beyond the corporate limits of the city.
• I agree to comply with all financial disclosure requirements of the City, the County and the State including the
requirements set forth in Section 2-11.1 of the Miami -Dade County Code, and Florida Statutes Sec.112.3145.
• I agree to comply with all ethics course requirements of City of Miami Code Section2-38.
= I acknowledge that the code of ethics of Miami -Dade County shall apply to me as a member or alternate member of
the Planning, Zoning and Appeals Board and hereby agree to abide by all the provisionsthereof.
• I recognize that membership on the Planning, Zoning and Appeals Board requires my regular attendance and
participation at board meetings.
Form BoardsiMA-PABIZB-0220.01
Page 3 of 4
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I hereby certify that all information in this application is complete, truthful, and accurate to
the best of my knowledge and that I have read and understand the qualifications and
conditions of membership listed in thisapplication.
■ Yes
Print Name September 2nd, 2022
Signatu
Cat-, e 424t—c64-71—
Date September 2nd, 2022
FURTHER INSTRUCTIONS
Please complete this form and submit the original via mail or hand -delivery to:
Office of the City Clerk
City of Miami
3500 Pan American Drive
Miami, FL 33133
Attn: Nicole N. Ewan
Information may be copied and pasted into this form from other computer programs, i.e.
MS Word. Information that is typed directly into the form may be "Saved as Text" and
then opened in other computer programs.
For additional information on the Planning, Zoning and Appeals Board, please contact
Ms. Olga Zamora, Chief of Hearing Boards, at (305) 416-2037 or email at:
oramora[a�miamigo v. com
*************************************************
Form BoardafMA-PAB/ZB-0220-01
Page 4 of 4
REC iVEro
• AWARDS/BOARDS/HONORS AND RECOGNITIONS S -a:
P1" 05
• Y.M.C.A. Volunteer' of the Year Award C,-rC G,
Q Miami -Dade County WASA Fire Warden Program-�� +rl C�
CITY1 FNAM
• Miami -Dade County Planning Advisory 'Board (PAB)
• Community Involvement Diploma Latin`Chamber of Commerce (C.A.M.A.C.O.L)
o City of Miami Bayfront Park Trust
¢ Miami River Commission
a City of Miami District 1 Food Distribution Volunteer Program
• City of Miami Youth Advisory Board, Police Department Volunteer Thank You Certificate
• Jackson Memorial Hospital Public Health Trust (PHT) Ex -Official Member
• Jackson Memorial Hospital Children Ad -Hoc Committee
• Jackson Memorial Hospital South Dade Medical Campus Expansion Ad -Hoc Committee
• Liga Contra el Cancer Volunteer Thank You Award
® City of Miami Little Havana/Latin Quarter Association Appreciation Certificate
• Miami -Dade County Charter Review Task Force
• Miami -Dade County Sports Committee Member
• Miami -Dade County Census Member Committee Thank You Award
® Miami -Dade County Save Neighborhood Park Bond SNP Board
• Miami -Dade Cultural Affairs Council Ad -Hoc Committee Member
• Vizcaya Trust Board Ad -Hoc Committee Member
• Miami Zoo Oversight Board of Trustees
• Miami Zoo Amazon and Beyond Thank You Award
• Mia mi-Dade County Homeless Trust
• Mia mi-Dade County Community Action Agency Board Member (CAA)
• 17th Annual In The Company of Women Special Recognition Award
• United Way Miami -Dade County Leadership Cabinet Thank You Award
• United Way Mayor's Ball Thank You Award
• p M iami-Dade County Parks and Recognition Department United Way Thank You Certificate
s The Susan G. Kamen Breast Cancer Foundation Race for The Cure Gratitude Award
• Volunteer of the Year Award United Cerebral Palsy— Latin Division
• Miami -Dade County Mayor's H1V{AIDS Partnership Board
• Annual Miami International Agriculture, Horse and Cattle Show Committee
• NACIO Award (National Association of Counties) Grand Opening Crandon Golf Clubhouse
• NACIO Award (National Association of Counties) Martin Luther King, Jr. Memorial Park
Recreation Center Groundbreaking Ceremony
• NACID Award (National Association of Counties) Grand Opening Westwind Lakes Park
and Soccer Field Dedication Ceremony
• NACIO Award (National Association of Counties) 17th Annual In The Company of Women
• Miami -Dade County Parks and Recreation Department Supervisor of the Quarter Award
■ Miami -Dade County Parks and Recreation Department Employee Recognition "Embracing
Excellence" Award
• Miarni-Dade County Parks and Recreation Department Commendation For Building Better
• Miami -Dade County Communities General Obligation Bond Campaign (GOB)
■
• Miami -Dade County Employee Relation Department Cultural Diversity Certificate
o Miami -Dade County Parks and Recreation Department USA Track and Field Junior
Olympics Organizing Committee Thank You Award
• Miami -Dade County Parks and Recreation Department Special Events Recognition
• Miami -Dade County Certificate of Achievement Supervisor Certification Program