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Dominique F. Bailleul Application Resume and License e CITY OF dNAM! BEACH NAIAM BOARD AND CONWAIT T EE APPLICATION FORM Last Name First Name Middle Initial 2©8 A Iry y�, , J 1 G arc ;3cr�-c c , ' , 30-S 13 of Home Addr 5 ss City State Zip Code 6;38 -q3 t 532-3-57947- Sic-372a w 507;� 't`&V Home Telephone Work elephone Cellular Telephone Email address 'B Ly c5 Lg^ iL Position: Qw,ns�-tZ Business Name cK 33 i3� eexaA ! Business Address City State Zip Code Professional License(describe) G •4 Tcc+'��gGCc�ti coy Vlyw*Cze&,%'� Expires: c3Q Lt 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 for a minimum of six months. • Resident of Miami Beach for a minimum of six(6) months: Yes N or No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six months: Yes I&or No • Are you a registered voter in Miami Beach: Yes 50 or No U • I am now a resident of: North Beach U South Beach El Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: 2 Z. S/ 25 acsS tcxcw't" —T—"up�,.r g--n-c9w I/c8S 11V W an t • Are you presently a registered lobbyist with the City of Miami Beach?Yes L.Jor 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) 0 Affordable Housing Advisory Committee 0 Fine Arts Board ❑ Normandy Shores Local Government Neighborhood Improvement 0 Art in Public Places Committee 0 Gay, Lesbian, Bisexual and Transgender ❑ Parks and Recreation Facilities Board Enhancement Committee GLBT 0 Beautification Committee ❑Golf Advisory Committee ❑ Personnel Board 0 Board of Adjustment* * ❑ Health Advisory Committee 14 Planning Board* 2 0 Budget Advisory Committee 0 Health Facilities Authority Board ❑ Police Citizens Relations Committee !St Capital Improvements Projects 0 Hispanic Affairs Committee 0 Production Industry Council Oversight Committee .� 0 Committee on the Homeless Historic Preservation Board 8 ❑Safety Committee 0 Committee for Quality Education in MB 0 Housing Authority 0 Single Family Residential Review Panel ❑Community Development Advisory 0 Loan Review Committee 0 Sustainability Committee 0 Community Relations Board ❑ Marine Authority 0 Tennis Advisory Committee ❑Convention Center Advisory Board 0 Miami Beach Commission for Women 0 Transportation and Parking Committee ❑ Debarment Committee 0 Miami Beach Cultural Arts Council ❑Visitor and Convention Authority 0 Design Review Board* 0 Miami Beach Human Rights Committee a Youth Center Advisory Board ❑Disability Access Committee 0 Miami Beach Sister Cities Program 0 Waterfront Protection Committee * Board Required to File State Disclosure Form If you seek appointment to a professional seat(e.g., lawyer, architect)on the Board of Adjustment, Design Review Board, Historic Preservation Board,or Planning Board,attach a copy of your currently-effectively license, and furnish the following information: Type of Professional License If A r1. ccn�seJ Nuvnber-1�ua a,r-7 )s ty l0 JiI•.• ^ L License Issuance Date _ �� 170 , and Licen?ftr Vn 71e 1 ; I 3J F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGUAGE.doc I e Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: A- 1. Past service on the Youth Center Advisory Board:Yes LJ No LJ Years of Service: 2. Present participation in Youth Center activities by your children Yes No 0. 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:Yes or No IjO If yes, please explain in detail: WZ00- • Do you currently have a violation(s)of City of Miami Beach codes:Yes U or No . If yes, please explain in detail: A,.--1A- • Do you currently owe the City of Miami Beach any money:Yes 0 or No 4 If yes, explain in detail • Are you currently serving on any City Boards or Committees:Yes or No 0. If yes;which board? •Whet organizations in the City of Miami Beach do you currently hold membership in? .All da Name Title Name Title • List all properties owned or have an interest in,which are located within the City of Miami Beach: 2 C3g S e���v /4 L/aryV 0- / , fit A -,e v • I am now employed by the City of Miami Beach:Yes or No .Which department? `1 - • Pursuant to City Code Section 2-25(b): Do you have a parent, spouse I-D, child EJ brother , or sister who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): p1/® 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. Ethnic Origin: Check one o%41) Gender: Male IM Female 13 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. ID 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,or the Pacific Islands. This area includes,for example,China, India,Japan, Korea,the Philippine Islands and Somoa. ID American Indian 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 Li-or No Employment Status: Employed IN Retired 0 Homemaker 0 Other O Please remember to attach a current resume and a copy of any applicable professional license. Attach additional sheets, if necessary, to provide required information. F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGUAGE.doc Y 1 NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO,THE FOLLOWING: • Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459). • 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). o Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1). o 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. HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION, AND I 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." LCc9� App icant's Signature Date Name of Applicant(PLEASE PRINT) 1 Received in the City Clerk's Office by 12V L ll Z Name of Deputy Clerk Control No. Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGUAGE.doc C#63861 8`9 STATE.OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL :REGULATION 5 CON24UNI°TY ASSOCIATION- MANAGERS ::. SEQ#L12092003528 . . :m LICENSE NBR- 09 20 2012 12805719:0 CAM23522: . The COMMUNITY'. ASSOCIATION MANAGER Named below IS LICENSED 7 i Under the provisions of Chaptier X468 k'S. - Expiration date: SEP 30, 2014: . 4 _` ' a BAILLEUL, DOMINIQUE F 208 JEFFERSON :AVENUE f # 116 Ir MIAMI BEACH FL 33139 RICK .:SCOTT:. KEN LAWSON GOVERNOR SECRETARY - DISPLAY AS REQUIRED BY LAW Dominique Bailleul 208 Jefferson Avenue#116 (305)538-9317 Miami Beach FL 33139 d1bailleul0the-beach.net RESUME PROFILE A seasoned professional and effectual leader with a proven ability to manage businesses: • Twenty years of strong inside/outside leadership experience • Passion for gaining personal relationships with clients EMPLOYMENT 2000—Present Owner—President Blue Leaf LLC A local company based in Miami Beach, managing Condominium and Homeowners Associations. A local market organization, Blue Leaf LLC employs 15 people locally. • Administration of buildings and associations • Organization of meetings and necessary requirements for Board of Directors • Physical management of buildings • Financial management of Associations 1995—2000 Sales Representative Metl-ife One of the leaders in insurance and financial products company. Performed sales presentations and conducted financial reviews for clients. Followed up with clients to answer questions and generate referrals. Key Achievements • Awarded top sales representative eight times in first year • Million dollar round table achievement • LUTCF Graduate 1990- 1995 Senior Vice President Gabelli US INC • Development of North American Subsidiary for French Company • Creation of sales forces and development of distribution networks • Marketing development 1989- 1990 Military Service French Navy military service 1987-1989 Cultural Representative-Buyer Walt Disney World Cultural representative in EPCOT Center French Pavilion; Merchandising buyer for the French stores EDUCATION Studied International Business Chamber of Commerce of Paris Studied Agribusiness, Superior Technician in Food Productions, Lycee d'Arras I