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Lilia Medina a ' MIAMl H CITY OF MIAMI BEACH BOARD AND C�3�u MITTEE APPLICATION FORM Last am First Na a Me itial �'DU/mss #Ve id l 6 31 ' Home Address ;ty s St Zi Code , rK Home Telephone Work Telephone Cellular Telephone Email address Position:, �diJGs<I Business Name 44 e_�,P- MIA-mj 3:3/36 Business Address 1 City State Zip Code Professional License(describe)b I���/�Gl���) T F1 /�����xpires: 4AA-- 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 4 or No • Demonstrate an ownership/interest in a business inlvliami Beach for a minimum of six months: Yes I.-D or No • Are ou registered voter in Miami Beach: Yes r No Y 9 • I am now a resident of: North Beach U South Beach U Middle Beach • I am applying for an appointment because I have special abilities, knov�ledge and experience. Please list below: Nti1 �?�' S l GUG • Are you presently a registered lobbyist with the City of Miami Beach?Yes LAnr 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 ❑Fine Arts Board ❑ Normandy Shores Local Government. Neighborhood Improvement ❑Art in Public Places Committee ❑Gay, Lesbian, Bisexual and Transgender ❑ Parks and Recre.Uon Gkilities Board Enhancement Committee GLBT w ❑ Beautification Committee ❑Golf Advisory Committee ❑ Personnel Board �-- ❑ Board of Adjustment* ❑Health Advisory Committee ❑ Planning Board** ❑Budget Advisory Committee ❑ Health Facilities Authority Board ❑ Police Citizens Relatio Corrrmittee ❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑ Production Industry Council Oversight Committee ❑Committee on the Homeless ❑ Historic Preservation Board ❑Safety Committe , ❑Committee for Quality Education in MB ❑ Housing Authority ❑Single Family ResidentMI Revievv Panel ❑Community Development Advisory ❑Loan Review Committee ❑Sustainability Conitt ❑Community Relations Board ❑ Marine Authority ❑Tennis Advisory Committee ❑Convention Center Advisory Board ❑ Miami Beach Commission for Women ❑Transportation and Parking Committee ❑D barment Committee ❑ Miami Beach Cultural Arts Council ❑Visitor and Convention Authority No6esign Review Board* ❑ Miami Beach Human Rights Committee ❑Youth Center Advisory Board ❑ Disability Access Committee ❑ Miami Beach Sister Cities Program ❑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: , 4McA-yu i A)5itt tom,6r ! z� Type of Professional Licensed f , License Number , License Issuance Date �'i �r L � ,and License Expiration Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGUAGE.doc 0 y- Note: If applying fo Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board:Yes ;No: Years of'Service: 2. Present participation in Youth Center activities by your children.,Yes No U. 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 U or No IL If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes:Yes U or No 1- If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money:Yes or No Ldlf yes, explain in detail •Are yo c%ren ly se in �a ` ity E oards orr CZmmittees:Yes or 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 ropertie owned or hav an interXfl n which are located within the City of Miami Beach: C7 69,5 +Ve - o ,IM6,fig- 331 ® I am now employed by the City of Miami Beach:Yes[.--a or No Which department? e Pursuant to City Code Section 2-25(b): Do you have a parent[:),spouse , child brother , or sister ID who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): R ` � 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 only 1 Gender: Male[Z� Female White (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe, North Africa or the Middle East. frican-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,or 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 original peoples of North America,and who maintain Cultural identification throu h tribal affiliation or community recognition. Physically Challenged: Yes or No Employment Status: Employed Retired�D Homemaker 1:3 Other ED 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 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). • Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1). • 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 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." -%70 . 0_j c90 (3 M C­T(A)A A ica 's Signature Date Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by : d Name of Deput Jerk Control No. Dat F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGLIAGE.doc J )M. 1AM1BE,-.AC.H. City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, vwvw.miamibeachfl.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 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 2-11.1(i) (2) Board Member's Name: . 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 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. Signatu _ Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application NEWLY REVISED NEW LANGUAGE.doc F City of Miami Beach - Design Review Board L1LIA 1. MEDINA, AICP Home address: Work address: 2625 Collins Avenue, #910 Assistant Transportation Coordinator Miami Beach, Fl. 33140 City of Miami, Office of the City Manager Cell: 305-302-1480 444 SW 2"d Avenue, 10'h floor liliaimedina(cD yahoo.com Miami, FL 33130 Work Tel.: 305-416-1080 limedina(c miamigov.coin Lilia I. Medina is respectfully requesting an appointment to the City of Miami Beach Design Review Board. I have over twenty-five years experience working in the fields of urban design, planning and transportation in the private and public sectors. I am a property owner living in Middle Beach (Collins Waterfront Historic District), and, a registered voter since 1998. 1 have no personal interest in any business venture or involved in any lobbying effort related to the City of Miami Beach. Work Experience • City of Miami, Florida- October 1996 to present. Assistant Transportation Coordinator in the Office of the City Manager. Project Manager for several transportation projects such as the Miami Streetcar Project. Reviewed over 225 Major Use Special Permits applications (mixed-use developments over 200 dwelling units/related commercial) since 2001 as a member of the City's Large Scale Review Committee. Participates in the City Planning Department's Internal Design Review Committee. Lilia was a Senior Planner in the City of Miami Planning and Zoning Department. She managed the Miami Design District Planning Study and Rezoning, the adopted Miami Downtown Transportation Master Plan, and, participated in the Miami Beach-Miami Transportation Corridor Study/Bay Link. Since 2003, she has served on the Miami-Dade County Metropolitan Planning Organization's Transportation Planning Council. • Lilia served on the Miami-Dade County's Cultural Capital Development Grants Panel for four years, approving capital improvements grants to over twenty-five cultural facilities. She also served on the Program Committee for the Wolfsonian Museum in Miami Beach, and, served on grants panel for the City of Miami Beach Cultural Arts Council's Cultural Heritage program and the National Endowment for Arts in Washington D.C., Design program for Fiscal Year 2007. Prior to Miami, Lilia was the Principal Transportation Planner for Palm Beach County, Florida (1996). As Senior Planner for the Department of Planning, City and County of San Francisco, California (1984-95), she worked on major projects and plans that have been implemented (Mission Bay development, Fisherman's Wharf Action Plan/Zoning, Central Waterfront Plan/Zoning, South of Market Plan/Zoning), and, she was the County's demographer for the 1980 and 1990 Decennial Census. Lilia graduated from the University of California in Berkeley with a Masters in City Planning. She received her undergraduate degree in Sociology with an emphasis on Urban Studies from the University of New Orleans, Louisiana. Professional License- Certified Planner Number 018700, American Institute of Certified Planners and the American Planning Association.