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Eve Tegan M v NAME: EVE TEGAN M Last Name First Name Middle Initial HOME ADDRESS:- 155 N Shore Dr - #105 Miami Beach FL 331.41 Apt No.. House No./Street City State Zip Code PHONE: 305 - 9719 -4166 305 -284 - 5953 teve@miami . edu Home Work Fax Email address. Business Name: Position: Address: No.. Street city State Zip Code Professional License.(describe) Expires:__ Pursuant to City Code section 2-22(4)a and llb: Members of agencies,boardsl 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;orb)an individual shall demonstrate e ownersh i p/inte rest.for a minimum of six months.in a business established in the city. 6 Resident of Miami Beach for a minimum of six(6)months:YesXor No U •Demonstrate an ownership/interest in a.business in Miami Beach for a minimum of six(6)months:Yes Fj or No X •Are you a registered voter in Miami Beach:Yes •-(Please-circle one): I am now a resident of: N�� South Beach Middle Beach •I am applying for an appointment because I have s s,knowledge and experience.Please list below: •Are you.presently a registered lobbyist with the City of Miami Beach?Yes X., or No E, see attached Please list your preferences in order of ranking [I.]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 0 Marine Authority ❑Art in Public Places Committee ❑Miami Beach Commission for Women ❑Beautification Committee 0 Miami Beach Cultural Arts Council ❑Board oard of Adjustment* ❑Miami Beach Human Rights Committee ❑Budget Advisory Committee ❑Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee 9 Normandy Shores Local Government Neigh. Improvement #2 D Committee on the Homeless ❑Parks and Recreation Facilities Board ❑Committee for Quality Education in MB 0 Personnel Board 0 Community Development Advisory 0 Planning Board* 0 Community Relations Board X Police Citizens Relations Committee #3 ❑Convention Center Advisory Board ❑Production Industry Council ❑Debarment Committee 0 Safety Committee 0 Design Review Board* ❑Single Family Residential Review Panel ❑Disability Access Committee D Sustainability Committee 0 Fine Arts Board OTennis Advisory Committee #1 0 Gay,Lesbian,Bisexual and Trans ender(GLBT) 0 Transportation and Parking Committee 0 Golf Advisory Committee ❑Visitor and Convention Authority--- ❑Health Advisory Committee ❑Youth Center Advisory Board ❑Health Facilities Authority Board 0 Hispanic Affairs Committee ❑Historic Preservation Board Ej Housing Authority ❑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'Yo6th Center: 1. Past service on the Youth Center Advisory Board:Yes El No 0 Years of Service: 2.. Present participation in Youth Center activities by your children Yes❑ No ol. 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: FF •Have you ever been convicted of a felony: Yes❑or No X If yes,please explain in detail: • Do you currentlyhave a'violation(s)of City of Miami.Beach:codes:Yes E or No X If yes, please explain in detail: • Do you currently owe the Cityof Miami Beach any money:Yes-E or No X If yes,explain in detail •Are you currently serving on any City Boards or Committees:Yes;�or No X If yes;.which board? •What organizations in the City of Miami Beach do you.currently hold membership in? Name: Miami Beach Tennis Players Association Title: member Name: South Shore North Shore Neighborhood Assc Title: founding board member. • List all properties owned or have an interest in,which are located within the City of Miami Beach: 155 N Shore Dr.Apt: 105 Miami Beach,_FL 33141 - owned • I am now employed by the City of Miami Beach:Yes I:1 or NoiX Which department? • Pursuant to City Code Section 2-25(b):Do you have a parent 0,spouse child❑,brother 0,or sister r who is employed by the City of Miami Beach?Check all that apply..ldentify the department(s): NO 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: IX Male ❑Female Ethnic Origin: Check one only(1) IN White (Not of Hispanic.Origin):All persons having origins in any of the original peoples of Europe,North Africa or the Middle East. ❑African-AmericanlBlack (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 Somba. ❑American.lndian or Alaskan Native: All persons having origins in any of the original peoples of North America,and who maintain Cultural identification through tribal affiliation or community recognition. Physically Challenged: Yes[: or Novi Employment Status: Employed M 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 Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2459). o Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). • 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). • 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." Oct. 11th,2012 TEGAN M. EVE Applicant's Signature Date Name.of Applicant.(PLEASE PRINT) Received in the City Clerk's Office,by: - Date:._! 12010 Control No. Date: ame of Deputy Uflerk iv City of Miami Beach, 1700 Convention Center Drive,. Miami Beach,Florida33139, www,mid mi6eachfl: —ov CITY C*ityClerk@mi,anib.eachfi..gov CLERK Office Tel:305..673.7411 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 2-11.11(i) (2) Board Member name. TEGAN M. EVE 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 nature, are required to comply with Miami-Dade County Disclosure Requirements. This means that the members of City Advisory Boardsi whose sole or primary responsibility is to recommend legislation egisla.ti.on 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 file, 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. Oct., 11 th,.2012 Signature: Date: F:\CLER\$ALL\aF0RMS\B0ARD AND.COMMITrEES\13C Application.cloc T GAN.M. EVE 15.5 N SHORE DR. APT': 105 MIAMI BEACH, FL 33141 teve@.miazni.edu (305) 979—4166 APPLICATION.FOR TENNIS ADVISORY COMMITTEE (Additional Information) Memberships in Miami Beach Organizations: 1) Miami Beach Tennis Players Association (member) 2) South Shore North Shore Neighborhood Association (founding board member) Special Qualifying Knowledge: 1) Recreational and active tennis player for over 25 years— currently play on a weekly basis at both North Shore and Flamingo tennis centers as well as.the open access hard courts at both ends of Normandy Shores 2) On a personal note, this would be a kind of".legacy" committee appointment for me., since my father, Lindsay H. Eve, Jr., was on the Advisory Board of the Jimmy Evert Tennis Center of Holiday Park, Ft. Lauderdale for over 25 years. I learned to play tennis at and basically grew up at the Holiday Park Tennis Center. I attended a few board meetings with my father when I was a child, and it would mean a great deal to me to ".follow in his footsteps".