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Laura Cullen 12/31/2013| � �MNwk ~~ ��&~, ` City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida oulo9, OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk Tel: (305)6r3-74l1' Fox: (3O5)6737254 O8-01-2O12 Laura Cullen 400 Alton Rood #2002 Miami Beach, Florida 33139 Miami Beach Commission For Women Congratulations! You have been appointed by Commissioner Michael G6ngora- to the agency, board or committee named above for a term ending: 12/31/2013. Pursuant to Ordinance No. 2008-3543, commencing with banns beginning on or after January 1. 2007, the term of board rnernbeny 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 oa|| the City Clerk's (�ffioeat3O5-873-7411. Please read the enclosed rno``eria|m oanafu|/y. Congratulations again and good luck. ' (� Sinoona|y. . ^~~ Rafael E. Gnanodo City Clerk � cc: Saul Frances, Parking Director Wanda Geist ATTACHMENTS: Letter ofAppointment Oath City Code/Ordinance section applicable to agency, board orcommittee City Code Section 2'22, 2'23, 2'24, 2'25' 2'28. 2'458 and 2'458 Ordinance No. 2000'3543 '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 one committed to providing excellent public service and ozfety 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 .miamibeachfl. www ov� OFFICE OF THE CITY CLERK, Rafael Granado,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 TO: Laura Cullen RE: Miami Beach Commission For Women 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: 12/31/2013. 1 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 the Florida 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* requirements of Miami-Dade County or the State of Florida (depending on the board or committee on which I serve) on July 1, following the closing of the calendar year on which I have served. Laura Cullen Sworn to and subscribed before me this day of , 2012. Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirement. We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community. � fi /\A, �� A BEACH 1.14 NAME: Cullen Laura Last Name First Name Middle Initial HOME ADDRESS: 2002 400 Alton Road Miami Beach FL 33139 Apt No. Home No./Street City State Zip Code PHONE: 9542707720 laurac @clarkesmiamibeach.com Home Work Fax Email Address Business Name: Clarke's Position: Owner Address: 840 First Street Miami Beach FL 33139 No. Street City State Zip Code Professsional License(describe): 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 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: Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes •Are you a registered voter in Miami Beach: Yes • (Please circle one): I am now a resident of: South Beach • I 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? No 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 Housing Authority Art in Public Places Committee Loan Review Committee Beautification Committee Marine Authority Board of Adjustment* [2] Miami Beach Commission for Women Budget Advisory Committee Miami Beach Cultural Arts Council Capital Improvements Projects Oversight Committee Miami Beach Human Rights Committee [3] Committee for Quality Education in MB Miami Beach Sister Cities Program Committee on the Homeless Normandy Shores Local Gov't Neigh.Improvement Community Development Advisory Parks and Recreation Facilities Board Community Relations Board Personnel Board Convention Center Advisory Board Planning Board* Debarment Committee [1] Police Citizens Relations Committee Design Review Board* Production Industry Council Disability Access Committee Safety Committee Fine Arts Board Single Family Residential Review Panel Gay,Lesbian,Bisexual and Transgender(GLBT) Sustainability Committee Golf Advisory Committee Transportation and Parking Committee Health Advisory Committee Visitor and Convention Authority Health Facilities Authority Board Waterfront Protection Committee Hispanic Affairs Committee Youth Center Advisory Board Historic Preservation Board 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: No Years of Service: 2. Present participation in Youth Center activities by your children 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: No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of Money Beach any money: No If yes, please explain in detail: •Are you currently serving on any City Boards or Committees: No If yes,which board? •What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: Name: Title: o List all properties owned or have an interest in,which are located within the City of Miami Beach: 400 Alton Road#2002,840 First Street • I am now employed by the city of Miami Beach: No Which department? o Pursuant to City code Section 2-25(b): do you have a relative who is employed by the City of Miami Beach?Check all that apply. Identify the department(s): 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: Female Ethnic Orgin: Check one only(1) White Physically Challenged: No Employment Status: Employed 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 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,during 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. "I hereby attest to the accuracy and truthfulness of the application and have received,read and will abide by Chapter 2,Article VII—of the City Code"Standards of Conduct for City Officers,Employees and Agency Members." I Laura Cullen agreed to the following terms on 7/11/2012 2:57:58 PM U/ /2'01 v Received in the City Clerk's Office by: � per/l�i.� Date Control No. Date: / /2012 V Name of Deputy Clerk f LAURA CULLEN EXPERIENCE June 2005-Present Clarke's Miami Beach,FL Owner 1997 June,2005 Brittany Sales Company Miami,FL State Sales Manager • Manage sales of 150k case wine portfolio • Consistently meet or exceed sales and profit goals • Implement plans and programs including training and sales strategies 1996-1997 US Concepts Miami,FL Key Account Manager • Developed strong customer relationships and portfolio opportunities • Trained and managed two salespeople in South Florida region • Consistently exceeded goals for new product placements 1994-1995 Southern Wine and Spirits Miami,FL Sales Representative • Instrumental in building new territory including the top 50 on premise accounts in Dade county. • Specialized in staff training and wine list developement. • Consistenly rewarded for exceeding sales goals. EDCATION 2000 Florida International University ■ BA Hospitality Managemnet 2005 Florida Atlantic University ■ MBA International Business E-MAIL LAUARC @CLARKESMIAMIBEAI-I.COM 151 MICIIIGAN AVENUE #532 MIAMI BEACH, FI, 33139 • PHONE (954) 270-7720 /\AIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww miamibeachfl.aov CITY CLERK Office CityClerkC m i arnibeochfl.gov Tel: 305.673.741 1 , Fax:305.673.7254 Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code section 2-11.1(i) (2.) Board Member name: 02A - GG I understand that no later than July 1, of each year all members of:Boards and Committees of the City of Miami Beach, including those of a purely advisory nature, -are required to comply with Miami-Dade County Disclosure Requirements. This means-that the members of City Advisory Boards, whose.sole or primary.responsibility is to recommend legislation or give advice to the City Commission,must file,even though you may have been recently appointed. YOU must file one of the following-with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida,-by July 1 each year. 1. A "Source of income Statement' (attached) or 2. A"Financial Statement' (attached(.or] 3. A Copy of the person's current Federal income Tax Return Failure to f le, according to the Miami-Dade.County Code Chapter 1, General Provision, Section 1.5 may subject the person or firm to a fine not to exceed $500.00 or by imprisonment in the county Jail for a period not to exceed sixty days, or.both. 15 /Z Signature: Date: i M 1 A M FDADE SOURCE OF INC®ME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name: GL-) Ending: Mailing Address: A-00 QltDO RDCIJ 1+2COZ City/State/Zip: L91'aml, BCC �13 Social Security Number: - - — -- Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving: Term or Employment Began on: 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): ® Work Telephone: Home Address: Street Address 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 CAOLVIKCI I hereb f swear(or affirm)that the aforesaid information is a true and correct statement. Signature of person disclosing Date signed i