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Laura Bruney ApplicationCITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM BruneyLaura NAME: First Name Last NameMiddle Initial 1800 Sunset Harbour FL33139 HOME ADDRESS : 1005Miami Beach Drive Home No./StreetState Apt No.City Zip Code laura@artsbizmiami.org 305-401-5676305-326-1011 PHONE : WorkEmail Address Home Fax Executive Director Business Name: Arts & Business Council of Miami Position: 1800 Florida AvenueCoral Gables FL33133 10 Address: State No. CityZip Code Street Expires: Attach a copy the license Professsional License (describe): Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated requirement shall be fulfilled in the following ways: a) an indi   months; or b) an individual shall demonstrate ownership/interest Yes No Yes South Beach circle one): I am now a resident of:  No 123Please note that only three (3) Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice. choices will be observed by the City Clerk’s Office. (Regular Boards of City) Affordable Housing Advisory CommitteeLoan Review Committee Art in Public Places CommitteeMarine Authority Beautification Committee[1]Miami Beach Commission for Women Board of Adjustment*Miami Beach Cultural Arts Council Budget Advisory CommitteeMiami Beach Human Rights Committee Capital Improvements Projects Oversight CommitteeMiami Beach Sister Cities Program Committee for Quality Education in MBNormandy Shores Local Gov’t Neigh. Improvement Committee on the HomelessParks and Recreation Facilities Board Community Development AdvisoryPersonnel Board Community Relations BoardPlanning Board* Convention Center Advisory BoardPolice Citizens Relations Committee Debarment CommitteeProduction Industry Council Design Review Board*Safety Committee Disability Access CommitteeSingle Family Residential Review Panel Fine Arts BoardSustainability Committee Gay, Lesbian, Bisexual and Transgender (GLBT)Tennis Advisory Committee Golf Advisory CommitteeTransportation and Parking Committee Health Advisory CommitteeVisitor and Convention Authority Health Facilities Authority BoardWaterfront Protection Committee Hispanic Affairs CommitteeYouth Center Advisory Board Historic Preservation BoardYouth Center Advisory Board Housing Authority Note : If applying for Youth Advisory Board, please indicate your aff 1. Past service on the Youth Center Advisory Board: No Years of Service: if yes, please list the names of your children, their No 2. Present participation in Youth Center activities by your chil ages, and which programs. List below: Age:Program: Child's name: Age:Program: Child's name: No Have you ever been convicted of a felony:If yes, please explain in detail: Do you currently have a violation(s) of City of Miami Beach code No If yes, please explain in detail: No Do you currently owe the City of Money Beach any money:If yes, please explain in detail: Yes Are you currently serving on any City Boards or Committees:If yes, which board? Miami Beach Commission for Women What organizations in the City of Miami Beach do you currently h Miami Beach Chamber Name:Title: Name:Title: List all properties owned or have an interest in, which are loca 1800 Sunset Harbour Dr #1005 No I am now employed by the city of Miami Beach:Which department? 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 departme The following information is voluntary and is neither part of yo being asked to comply with federal equal opportunity reporting r Gender:Female Ethnic Orgin: Check one only (1) White No Physically Challenged: Employed Employment Status: NOTEIf appointed, you will be required to follow certain laws which :   These laws include, but are not limited to, the following: Prohibition from directly or indirectly lobbying city personnel o Prohibition from contracting with the city (Miami-Dade County Co o Prohibition from lobbying before board/committee you have served o Beach Code section 2-26). Requirement to disclose certain financial interests and gifts (M o (re: CMB Community Development Advisory Committee):  prohibiti from having   any interest in or receiving any benefit from Co or those with whom you have business or immediate family ties Upon request, copies of these laws may be obtained from the “I hereby attest to the accuracy and truthfulness of the applica VII – of the City Code “Standards of Conduct for City Officers, I Laura Bruney agreed to the following terms on 12/13/2012 2:15: Received in the City Clerk's Office by:Date: / /2012Control No.Date: / /2012 Name of Deputy Clerk