Michelle Ricci 12/31/2014 ; , I ,T,i e Cam,
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk @miamibeach.gov
01-08-2013
Michelle Ricci
7600 Collins Ave. #703
Miami Beach, Florida 33141
SURJECT __„� Fine Arts Board
Congratulations! You have been appointed by Commissioner Ed Tobin
to the agency, board or committee named above for a term ending: 12/31/2014.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1, 2007, the term of board members 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 call the
City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543-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 are committed to providing excellent public service and safety to all who live, work and ploy in our vibrant, tropical, historic community.
I
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfi.gov
OFFICE OF THE CITY CLERK,
Rafael E. Granado, City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
November 29, 2012
TO: MICHELLE RICCI
RE: FINE ARTS BOARD
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 of the above-mentioned board or committee of the City of Miami Beach to which I have been for
a term ending 12/31/2012.
1 have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of 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 have serve) on July 1, following the closing of the calendar year on which
I have served.
Michelle Ricci
Sworn to and subscribed before me thisjz day of 4�� 2012.
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board
and Committees for additional information regarding the Financial Disclosure Requirement.
AAIAI\Al BEACH CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
R:\cc, s
Last Name First Name Middle Initial
C) Coti ms 0) 1
Home Address 03City State Zip Code
�' r")1&(D S -3 coy m s r► CC', CD 1,ot"
Home Telephone Work Telephone Cellular Telephone Email address
Position:
Business Name
Business Address City State Zip Code
Professional License (describe) Expires:
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 0 or No
• Demonstrate an ownership/interest in a business i Miami Beach for a minimum of six months:Yes or No
•Are you a registered voter in Miami Beach:Yest or No Ca
• I am now a resident of: North Beach 1=3 South Beach 1:3 Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please.list below:
I,n�U2 r A S 'r hQ N r I ItN I Sao r \Sn\\c+:
•Are you presently a registered lobbyist with the City of Miami Beach?Yes Uor 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 Disability Access Committee Miami Beach Sister Cities Program
Art in Public Places Committee Fine Arts Board Normandy Shores Local Government
v'L I Neighborhood Improvement
Beautification Committee Gay, Lesbian, Bisexual and Transgender Parks and Recreation Facilities Board
3 Enhancement Committee GLBT
Board of Adjustment* Golf Advisory Committee Personnel Board
Budget Advisory Committee Health Advisory Committee Planning Board*
Capital Improvements Projects Health Facilities Authority Board Police Citizens Relations Committee
Oversight Committee
Committee on the Homeless Hispanic Affairs Committee Production Industry Council
Committee for Quality Education in MB Historic Preservation Board Safety Committee
Community Development Advisory Housing Authority Single Family Residential Review Panel
Community Relations Board Loan Review Committee Sustainability Committee
Convention Center Advisory Board Marine Authority Tennis Advisory Committee
Debarment Committee Miami Beach Commission for Women Transportation and Parking Committee
Design Review Board* Miami Beach Cultural Arts Council Visitor and Convention Authority
Disability Access Committee Miami Beach Human Rights Committee Youth Center Advisory Board
*Board Required to File State Disclosure Form
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: Yes Ll No U Years of Service:
2. Present participation in Youth Center activities by your children Yes U No Z3. 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:
FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc
*Have you ever been convicted of a felony: Yes L1 or NoI2� If yes, please explain in detail:
•Do you currently have a violation(s)of City of Miami Beach codes:Yes I:j or No)0. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes L1 or Nol�) If yes, explain in detail
•Are you currently serving on any City Boards or Committees: Yes I1 or 1\1011�3. If yes;which board?
•What organizations in the City of Miami Beach do you currently hold membership in?
�j
Name Title:
Name Title:
• List all properties owned or have an interest in,which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ID or No3.Which department?
• Pursuant to City Code Section 2-25(b):Do you have a parent L3, spouse 0, child 0 brother 0, or sister 0 who is
employed by the City of Miami Beach?Check all that apply. Identify the department(s):
r)Q
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: Male L] Female
Ethnic Origin: Check one only(1)
White (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
LlAfrican-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.
Z3Asian 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.
L]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 or No�
Employment Status: Employed 0 Retired[D Homemaker[Q Other
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).
(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,
EMPLOYE S AND AGENCY MEMBERS."
X -t�u 1 M ACI-y � Sc, is r- _I cc I
Applicant's Signature Date Name of ApZlint(PLEASE PRINT)
Received in the City Clerk's Office by: Date: / 2 Control No. g Date:_/_/2012
Name of Deputy Clerk
Michelle Oscier--Ricci
7600 Collins Ave.APT. 703
Miami Beach,FL 33141
Cell: (786)252-3671
misricci @hotmail.com
Certified Surgical Technologist
#71544
]EMPLOYMENT HISTORY
Aug.2009-present Baptist Health System
Surgical Technologist
All Specialties
Aug. 2003-Mar.2006 Surgical Technologist
Thoracic, Cardiac, and Vascular Surgery Services
General Surgery, Obstetrics, Opthalmology,
Otorhinolaryngology, Plastic and Reconstructive Surgery
Genitourinary, Orthopedic,Neurosurgery and Pediatric
Surgery
Jackson Memorial Hospital
Miami, FL
Sept. 2000-Sept. 2001 Surgical Technologist
Thoracic, Cardiac, and Vascular Surgery Services
General Surgery, Obstetrics, Opthalmology,
Otorhinolaryngology, Plastic and Reconstructive Surgery
Genitourinary, Orthopedic,Neurosurgery and Pediatric
Surgery
Jackson Memorial Hospital
Miami, FL
Sept. 1992-Sept. 2000 Surgical Technologist
OR Manager Dept. of Obstetrics (1992-1996)
Pediatric Cardiac Surgery
All Specialties included
Children's Hospital of Buffalo
Buffalo,NY
EDUCATION
Sept. 1990 to May 1992 Trocaire College, Buffalo,NY
Surgical Technology
Sept. 1996 to May 2000 Trocaire College, Buffalo,NY
School of Nursing
Sept. 1980 to May 1983 West Seneca Senior High School
Buffalo,NY
Graduated in 19835 Science and Business
AWARDS
1997 and 1998 Certificate of Service for Pediatric Cardiac Surgery
Medical Mission to Guatemala City, Guatemala
1995 Certificate for Recognition in Management of Pediatric
Congenital Heart Lesions and Heart Transplantation
1991 Student Choice Award,Trocaire College, Buffalo,NY
Outstanding Academic Achievement
HOBBIES AND INTERESTS
Performing Arts, art history,traveling, reading, exercising.
ASSOCIATIONS
Association of Surgical Technologists
New York State Assembly
Florida State Assembly
REFERENCES
Available upon request
AAIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeachfl.aov
CITY CLERK Office CityClerk @miamibeachfl.gov
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 2-11.1(i) (2)
Board Member name: "\cane ILVI) cc,;
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, 2010.
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.
Signature: Date:
MIAMI-
¢� SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial 'Last Name
e
Disclosure
For Tax Year
Name: /e L - C Ending: /
Mailing Address:
City/State/Zip:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving!L/xj AE � Term or Employmen
. Ag&
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): 0 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-cif-'Source of Income T. Address Business Activity
:I hereby swear(or affirm)that the aforesaid information is a true and correct-statement.
s
Signature of person disclosing Date signed