Tobi T. Ash 12/31/2011 efl MIAMI BEAC
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,v.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -741 1, Fax: (305) 673 -7254
11 -02 -2010
Tobi Ash
4233 Sheridan Avenue
Miami Beach, Florida 33140
S BJET Health Advisory Committee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2011.
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,
O L S1
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Cliff Leonard
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.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamib
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 - 7411, Fax: (305) 673 -7254
TO Tobi Ash
RE: Health 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: 12/31/2011.
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 theFlorida Commis /on 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.
Cie
Tobi Ash
Sworn to and subscribed before me this Jz day of )lovej& 010.
"/
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 safely to all who live, work and play in our vibrant, tropical, historic community.
..... MIAMI B EACH
-s,.., L, �^ AND ��( i � CITY OF 11 IAM1 BEACH
4a ti1AMlE: ! O� { E APPLICATION FORM
Last Name
HOME ADDRESS: 23 of �T��,[ } iJ First Nam Middle Initial
Apt No. House No. /Street 3. ��
PHONE: 3 (0 3 � , (0 �j 5' City State
Home Work 2c 2-()1 306 5 �- �b cask Zip Code
Business Name: C M Fax Email address
Position: V P
Address: 233 3 ku;c6"- -Ae.. if■.4.,.:
No. U - 3.'J l �o
• D Street City
Professional License (describe) 4 t s State Zip Code
�""` IV Y Expires: .i.01.1_____)
�� �a4ttach a copy � of the license
Pursuant to City Code section 2 -22(4) a and b: Members of agencies, boar ds, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the. following ways: a) an individual shall have been a reside nt of ,the city for a minimum of six
months; or b) an individual shall demonstrate ownership /interest for inimum of six months in
.
a '
• Resident of Miami Beach for a minimum of six (6) months: Yes 04r No ❑ a business established in the city.
• Demonstrate an ownership /interest in a business in iami Beach for a minimum of six 6 m
• Are you a registered voter in Miami Beach: Yes or No ❑ () onths: Yes 0 or No 0
• (Please circle one): I am now a resident of: North Beach South Beach
• I am applying for an appgirttment becaus 1 have, pec' I abi 'ties, knowledge fiddle a lis)
• Are you presently RCN ( '�a' ? ge and expenene
Y p sently a registered lobbyist with the City .J a•• — r e list below:
ty of Miami ?
Be� C ch . Yew or No � ° �'�" '-i'` ' d
Please list your preferences in order of ranking [1] first choice [2] second choice
choices will be observed b the Ci Clerk's Office. (Regular Boards of Ci and [3] third choice. Please note that onl three 3
❑Affordable Housin • Adviso Committee
)
mittee .
❑ Art in Public Places Committee ❑Housin• Author'
❑ Beautification Committee 0 Loan Review Committee
0 Board of Ad'ustment* ❑Marine Authori
❑ Bud • et Adviso Committee 0 Miami Beach Commission for Women
❑ Ca • ital Im • rovements Pro'ects Oversi • ht Committee 0 Miami Beach Cultural Arts Council
❑Miami Beach Sister Cities Pro• ram
0 Committee on the Homeless
0 Committee for Qualit Education in MB ❑Normand Shores Local Government Nei
0 Communi Develo • ment Adviso 0 Parks and Recreation Facilities Board h. Im • rovement
❑ Communi Relations Board ❑Personnel Board
0 Convention Center Adviso Board 0 Plannin • Board*
D Debarment Committee 0 Police Citizens Relations Committee C.)
❑Production Indust Council
0 Des'. n Review Board*
❑ Disabili Access Committee =-
0 Public Safe Adviso Committee cp ❑ Fine Ms Board ❑Safe Committee A
❑ Ga ,Lesbian, 0 Sin • le Famil Residential Review Panel r _ "
Bisexual and Trans • ender GLBT 1.:
0 •If Adviso Committee 0 Sustainabili Committee
IV ealth Adviso Committee
0 Visitor . a i
❑Trans • ortation and Parkin •
0 Health Facilities Authori Board
0 Waterfront Protection Committee Committee v:. -,.-
sitor and Convention Author',,
❑ His • anic Affairs Committee -14 -
0 Historic Preservation Board ❑Youth Center Adviso Board ---
imiimminimummeasiammum *Board Required to File State Disclosure Form
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 0 No ❑ Years of
2. Present participation in Youth Center activities by Service: _
ages, and which programs. List below: Y Your children Yes❑ No a If yes, please li 1 ; r
Child's name: ? �y
• , i 1 .a.:,* - 14 their
,
Age: Program: :. rr
Child's name:
Age: Program:
- \CLER\SAL: or }RiviS\BOARD AND C C MMITTEFS \Bc Applicationo62600 NEW.cin..
. 4
f ,
,
•Have you ever been convicted of a felony: Yes or(*) If yes, please explain in detail: i
• Do you currently have a violation(s) of City of Miami Beach codes: Yes E. . - No _ If yes, please'explain in detail:
City of. Miami Beach any money: Yes o No If yes explain n detail
• Do you currently owe the y
Y
• Are you currently serving on any City Boards or Committees: Yes - • r No If yes; which board?
organizations in the City Miami Beach doyou currently hold membership in? :'. S ' .
• What or anlz nn hR•
g 1004 ^ Title: 0 ice
Name: 0 PAIth. OIL U443'1641
Orb Title: -- ' r — COor t ICY'
Name: f� 1
wned or have an interest in, which are 1g cated within the City of Miami Beach:
• List all p opertles o 1; ,.. .4 3 l qv
• 1 am now employed by the City of Miami Beach: Yes 0 or NoNPWhich department?
City Code Section 2 -25 (b): Do you have a parent C, spouse C, child D, brother o, or sister 0 who is employed by the
• Pursuant to tY de
City of Miami Beach? Check all that apply. Identify the P artment(s)' I■r0
The following information is
voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: ❑ Male ❑female
Et is Origin: Check one only (1)
Wh ite (Not Paci fic of Hispanic Islander: Origin)All p ersons : All persons having having origins origins in in any of any the of the original original peoples peoples of of Fa Europe, North Africst a or Asia the the Middle Indian East.
❑ ❑ Afr Americ
ica an AmeriIndia or Black Alaskan (Not of Hispanic Native: All persons Origin): All having persons origin h s aving in any origins of the in original any of people the Black s of racial groups of o Africa. e regardless of race.
❑ Hispanic: All pe rsons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or g 9
0 As ian o r
the Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine
Islands and North America, and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes 0 or NNo0.
Employment Status: Employed El Retired ❑ Homemaker ❑ Other ❑
NOTE: If appointed, you will be required to follow certain laws which apply to city boardlcommittee members.
These laws include, but are not limited to, the following:
o o Prohibiti Prohibition on from from directly lobbying or indirectly before lobbying city personnel you have (Mia served i Be on ch for C ity
period Co )e of section one year 2 -459). after
o Prohibition from contracting with the city (Miami -Dade County Code
board /committee leaving office (Miami
Beach City Code section 2 -26).
o Requirement to disclose certain financialAdvisory interest�m tteefts (M oh bi on� dur ng tenu�e and for year after leaving office,
(re: CMB Community Development Co )
from having any interest in or receiving any benefit from Community Doe Development Block Grant funds for either yourself ,
or those with whom you have business or immediate family ties (CFR )
Upon request, copies of these laws may be obtained from the City Clerk.
I hereby attest
to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VI of the Ci Cod "Standards of Conduct for City Officers, Employees and Agency _ em
(0/ �7adf0 '� T• AS ■ C Name of Applicant (PLEASE PRINT)
Applicant's Signature ate
Please attach a copy of your resume to this application
NOTE: Applications will remain n file for a period of one (1) calendar year. T /� 1.
O Date: /_12_12 Control No� v Date /201
Clerk's Office by : OARD A1�1� C ITTEES\BC pplication.doc
Received in the City Name of Deputy C erk F: \CLER \$ALL \aFORMS \B
4233 Sheridan Avenue 305 - 218 -2121
Miami Beach, FL 33140 Fax 305 - 675 -8444
tobiash@the-beach.net
Tobi T. Ash
Experience 1999— current Consulting Medical Marketing Miami, FL
Vice President Operations
• Create and coordinate clinical research studies in USA and abroad
• Liaise with medical facilities, physicians and Ministers of Health
• Create and implement protocols
• Prepare safety approved equipment for research in efficacy for FDA
approval
• Hire staff as needed and supervise performance
• Clients include: Accelerate Health, Care Medical, BioCard, RS Medical
Technologies, Keryx Bio Pharmaceuticals, Home Medical USA, BioSik,
Lice Free, BioRecord, BrainPod, Proteonomix, and Proteokinetix
1998 -1999 Baptist Health Systems Miami, FL
Staff Nurse
• Critical Care.
• Cardiac Intensive Care Unit.
• Surgical Intensive Care Unit.
1997 -1998 Miami Beach Maternity Center Miami, FL
Executive Administrator and Student Midwife
• Responsible for busy birth center practice and patients.
• Coordinated childbirth education classes and student midwifery classes.
• Worked with ACHA and DPR for licensed midwifery.
Education 1997 Barry University Miami, FL
• Bachelors of Science in Nursing — Graduated Summa Cum Laude
• RN license State of Florida
2001 Nova University Ft. Lauderdale, FL
• Master Business Administration - Graduated Summa Cum Laude.
PhD Candidate at Walden University in Health Policy — anticipated defense
2012
Distinctions. ICEA certified as a childbirth educator
Sigma Theta Tau — Nursing Honor Society
Sigma Beta Delta — Business Honor Society
AACN member
FNA member
Outstanding Senior Barry University 1997
Nursing Student of the Year 1998
Community
Involvement Community Kosher Food Bank
Founding Member and volunteer
Chair Everything but the Turkey (grant from Ford Foundation)
Greater Miami Jewish Federation
Jewish Volunteer Committee
Volunteer of the Year 2010
Agency Support Committee
Chaplaincy Committee
Public Policy /Lobbying for Meals on Wheels, Elder Transport, Job Vocational
Training for the Homeless
Jewish Community Services
Former Chair, Vocational and Rehabilitation Employment
$3 million division
Former Chair, Orthodox Outreach
$500,000 division
Orchard Park Neighborhood Association
Crime Watch Captain
Board Member
City of Miami Beach
Mid -Beach (Pinetree Park) Community Garden Coordinator and Initiator
Ohel Children's and Family Services
Chair of South Florida Advisory Board
Public Speaking Engagements
14 years of health /sexual education at Jewish Day Schools
4 years of nutrition /volunteering at Greater Miami Jewish Federation events
Extensive References available upon request
` . ( -` — ST/�,TE Q :' L f3A N o:.
DEPARTM Q
ACTH
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DIVISION OF MEDICAL QUALITY ASSURANCE
Z .
DATE LICENSE NO : •: :: .. .: :: GO .. :
.
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04/14/2010 RN 3285402 1207250 , z
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he REGISTERED NURSE W " co E 11 a u
amed below has metal' requirements of
le laws and rules of the state of Florida. J a a
xpiration Date :ARIL 30, 2012 W a... Z 6 a -
DBI • T ASH . u.. tu W E
233 SHERIDAN AVE o:� u o : :Wilt) ..
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Charlie. Crust ` An M. Viamonte Ros , MD MPH.
GOVERNOR
STATE SURGEON GENERAL
DISPLAY IF .. REQUIRED .BY LAW ,
,
EXPIRATION DATE, APRIL.30, 2012 `
)ur license number is RN 3285402, please use it in all' correspondence with your board /council. Each licensee is .solely responsible for not Eying the department in writing
the licensee's current mailing address and practice location address. If you have not received your renewal notice 90 days prior to the expiration date shown on this
:ense, please call (850) 488 -0595.
se this section to report name change. Name changes require legal documentation showing the name change Please Make sure that a photocopy of one of the following
:companies this form: a marriage license, a divorce decree or a court order. A driver's license or social security card is not considered legal documentation.
edical Quality Assurance offers you the convenience of several online services. These services give you the ability to renew your license, update your mailing and practice
cation addresses and update your profile information.
1. Go to www.ihealthsource.com .
2. Click on Licensee /Provider
3. Click on Practitioner Login
4. Select your profession
5. Enter the account ID and password that was provided to you on your initial 'license and click' on "Login". ' • .
6. If you do not know your account ID and password, click on "Get Login Help"; Or call our Customer Contact Center at (850) for assistance.
IAIL TO: DEPARTMENT OF HEALTH ,
DIVISION OF MEDICAL QUALITY ASSURANCE
LICENSING AND AUDITING SERVICES UNIT . .
P.O. BOX 6320 . -
TALLAHASSEE, FLORIDA 32314 -6320 '
1 NAME CHANGE (ATTACH LEGAL DOCUMENTATION) .
ROM:
LAST FIRST . ' : MIDDLE
O:
LAST FIRST MIDDLE • ' - . ' .
1H 2103. 5/98
COUNTY c►oe
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
For Tax Year
Name:
tt�� Ending: Oc
� U�
Mailing Address: 4253 -1‘52)--4 cL
City /State /Zip: SP g3(q°
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: A4 ; Term or Employment
�
Began on: l (((2 1 O
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): 0 Work Telephone:
Home Address: '*2,
Street Address 3W+0
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here:
Description of the Principal
Name of Source of Income Address Business Activity
-f+"" ikic-2 -4133 d� 4x-,r ,--$(44;v4.44grro
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Cila: 11111: /1 2 (0
Signature of pe = o disclosing Date signed
0