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Debi Quade j", A MIA I3 LAC ! ( CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME. dig . . / - ' 6 1 Last Name First Name Middle I .if -1 ' L / 1 HOME ADDRESS: �: _ _ a _ � # r(.4 l/ / l _ _ Apt No 1 House No. /Street ity State L Zip Co / d � ) PHONE: A. � �' rX 1 l/I 9 �/ � � � 1 1�'-�r /�/ ��!) P/� / ((jde Home k ork Fax Email address / L r p ,y Business Name _ / . &. ° A' A. / • pi . " Posdibn: / > � Address / /o a,)/ //./f r '�' fl P/?P C� i. ) l Lf ('( /yi X/,i N 4 . T/ 33 k:3 / p 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 ownership /interest for a minimum of six months in a business established in the city • Resident of Miami Beach for a minimum of six (6) months: Yessor No 0 • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yesor No ❑ • Are you a registered voter in Miami Beach Yes /or No ❑ I , • (Please circle one): I am now a resident of: North Beach South Beach Middle Beach • 1 am applying for an appointment because I have special abilities, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or No Y Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) ❑ Affordable Housing Advisory Committee ❑ Marine Authority 0 Art in Public Places Committee 0 Miami Beach Commission for Women 0 Beautification Committee 0 Miami Beach Cultural Arts Council 0 Board of Adjustment* 0 Mlarri Beach Human Rights Committee 0 Budget Advisory Committee 0 Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh improvement Committee on the Homeless 0 Parks and Recreation Facilities Board 0 Committee for Quality Education in MB 0 Personnel Board 0 Community Development Advisory 0 Planning Board* 0 Community Relations Board 0 Police Citizens Relations Committee 0 Convention Center Advisory Board 0 Production Industry Council C) N 0 Debarment Committee 0 Safety Committee -t 0 Design Review Board* 0 Sin le Family Residential Review Panel Z ❑Disability Access Committee 0 Sus ainability Committee r 4 ❑ Fine Arts Board 0 Tra sportation and Parking Committee r � i ff 0 Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Visit r and Convention Authority; __ 0 Golf Advisory Committee ❑ You h Center Advisory Board c1; - o 0 Health Advisory Committee c) 'T". ❑ Health Facilities Authority Board W 0 Hispanic Affairs Committee -- Ca 0 Historic Preservation Board - 4-)3 0 Housing Authority 0 Loan Review Committee *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 0 Years of S rvice 2 Present participation in Youth Center activities by your children Yes0 o ❑ 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 F \CLER \$ALL \aFORMS \BOARD AND COMMITTEESABC Applicnnon do:. •Have you ever been convicted of a felony Yes ❑ or No4f yes, please explain in detail • Do you currently have a violation(s) of City of Miami Beach codes Yes ❑ or No) 1f yes, please explain in detail • Do you currently owe the City of Miami Beach any money. Yes ❑ or No *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 each do you currently hold membership in? • Name /YI l i' G ' Title: ,I,/ _ 1 II 1 /. / . a'40' 5 S • Name: 3 /7/ C of ll i lti p tr itle: j ► i. 'i :�'. _ , er _/ • , — A _ - - / • List all properties owned or have an interest in, wffichS Afego>rat-. In the City of Miami Beach: �t�I 4 "- a M d awl (°/9/ /ins / 4 `7 - JDd`o /-/Si'' !n.(3 g' • 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 0, spouse ❑, child 0, brother 0, or sister ❑ who is employed by the City of Miami Beach? Check all that apply. Identify the department(s) A/0 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 Ethnic Origin: Check ne only (1) ,White (Not of Hispanic Origin) All persons having origins in any of the original peoples of Europe, North Africa or the Middle East ❑ African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa ❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. ❑ Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on the Pacific Islands This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa. ❑ American Indian or Alaskan Native: All persons having origins in any of the onginal peoples of North America, and who maintain Cultural identification through tribal affiliation or community recognition. Physically Challenged: Yes ❑ or Noo Employment Status Employed'' Retired ❑ Homemaker ❑ Other ❑ NOTE If appointed, you will be required to follow certain laws which apply to city board /committee members. These laws include, but are not limited to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459) o Prohibition from contracting with the city (Miami -Dade County Code section 2 -11 1). o Prohibition from lobbying before board /committee you have served on for period of one year after leaving office (Miami Beach City Code section 2 -26). o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2- 11.1). (re. CMB Community Development Advisory Committee) prohibition, dunng tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself , or those with whom you have business or immediate family ties (CFR 570.611). Upon request, copies of these laws may be obtained from the City Clerk. "1, ereby attest to the acc rau cy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII ,4 of the City v. de "Standards,of Conduct for City Officers, Employees and A ency Members." • /� / / /� 1 / / e - 6 / - e_ A „ plicant's Signature Dat Name of Applican SE PRINT) Received in the City Clerk's Office by J Date / /20 0 Control No)q(V Date' _/_/2010 619 ' I — Name of Deputy Clerk } Debi Quade 2301 Collins Avenue #724 Miami Beach, Fl 33139 Debi @ DebraQuade.com 305.401.2169 II I would like to offer my time to serve on the "(ommittee on the Homeless" for the City of Miami Beach. I am a homeowner in Collins Park and interact with the homeless living in our neighborhood. I would like the opportunity to learn how to assist these homeless residents in finding services available to them. I would like to assist the City of Miami Beach in their efforts to improve the quality of life for these residents. I have served on The Miami Beach Chamber of Commerce Women's Business Council as past president for 4 years. I am on the Board of Directors of The Collins Park Neighborhood Association as well as The Board of Directors for The Roney Palace Condominium Association. I will be a graduate of The City of Miami Beach Police Academy on November 16, 2011. I have also attended the City of Miami Beach Leadership Academy. These programs have provided me with an understanding of The City of Miami Beach departments. I understand the time involved in volunteering fpr this position and I am willing to offer my time and efforts to assist the committee. Please consider my application for this committee. I welcome the opportunity to serve. S cerely, 411 cz -bi Quade