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Cheryl Jacobs 12/31/2014 hI M A H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfi.gov OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk Tel: (305) 673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov 03-21-2013 Cheryl Jacobs 20 Island #707 Miami Beach, Florida 33139 ,�rs SUBJECT Capital Improvements Projects Oversight Committee Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term endin 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. 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, Rafa E. Granado City Clerk cc. Saul Frances, Parking Director Fernando Vazquez 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 play in our vibrant, tropical, historic community. J� Fop, NX,ME' Jacobs Cheryl H Last Name First Name Middle Initial HOME ADDRESS: 707 20 Island Miami Beach 20 Island 33139 Apt No. Home No./Street City State Zip Code PHONE: 3058047446 3054487488 cheryl@aiamiami.org Home Work Fax Email Address Business Name: American Institute of Architects-Miami Position: Executive Director Address: 275 University Dr Coral Gables FL 33134 No. Street City State Zip Code Professsional License(describe): Expries: Aftacf�a cvp?v licanse 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. • Resident of Miami Beach for a minimum of six(6)months: Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: No 9 Are you a registered voter in Miami Beach: Yes •(Please circle one): I am now a resident of: South Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: See uploaded resume. •Are you presently a registered lobbyist with the City of Miami Beach? 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 Loan Review Committee Art in Public Places Committee Marine Authority Beautification Committee Miami Beach Commission for Women Board of Adjustment* Miami Beach Cultural Arts Council [1] Capital Improvements Projects Oversight Committee Miami Beach Human Rights Committee Committee on the Homeless Miami Beach Sister Cities Program Committee for Quality Education in MB Normandy Shores Local Gov't Neigh.Improvement Community Development Advisory Parks and Recreation Facilities Board Community Relations Board Personnel Board Debarment Committee Planning Board* Design Review Board* Police Citizens Relations Committee Disability Access Committee Production Industry Council Fine Arts Board Safety Committee Gay,Lesbian,Bisexual and Transgender(GLBT) Single Family Residential Review Panel Golf Advisory Committee Sustainability Committee Health Advisory Committee [2] Transportation and Parking Committee Health Facilities Authority Board Visitor and Convention Authority Hispanic Affairs Committee Waterfront Protection Committee Historic Preservation Board Youth Center Advisory Board Housing Authority Youth Center Advisory Board 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: No Years of Service: 2. Present participation in Youth Center activities by your children No 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: r • Haveyou ever been convicted of a felony: No If yes,please explain in detail: • you currently have a violation(s)of City of Miami Beach codes: No If yes,please explain in detail: • Do you currently owe the City of Money Beach any money: No If yes, please explain in detail: •Are you currently serving on any City Boards or Committees: No If yes,which board? •What organizations in the City of Miami Beach do you currently hold membership in? . Name: Title: Name: Title: • List all properties owned or have an interest in,which are located within the City of Miami Beach: 20 Island Avenue#707(condominium) • I am now employed by the city of Miami Beach: No 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 department(s): 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 Ethnic Orgin:Check one only(1) Physically Challenged: No Employment Status: Employed NOTE: If appointed,you will be required to follow certain laws which apply to city board/committee 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 2-459). o Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office(Miami Beach Code section 2-26). o 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." I Cheryl Jacobs agreed to the following terms on 12/11/2011 6:08:31 PM 1 t Received in the City Clerk's Office by: Date: / /20 1 Control No. d Date: /20 1 Name of Deputy Clerk OF IBAIAIMIAMI Cheryl H. Jacobs, Executive Director American Institute of Architects (AIA) — Miami As Executive Director, Cheryl Jacobs directs the nearly 650-member AIA Miami, in the development and implementation of programming that promotes architecture and design. Cheryl works closely with AIA Miami's exceptional volunteer board to create forums, seminars and events that improve awareness of the industry and that build strong community and member connectivity. With 20+ years in association and non-profit leadership experience, Cheryl's exceptional network of high-level contacts in the architecture and real estate industry in south Florida. She is a strong and inspirational leader with a talent for recruiting and motivating volunteers, and a passion for the creative industries. Cheryl has a Bachelor- of Arts in Communications from Fairleigh Dickinson University in Teaneck, New Jersey and is a graduate of Leadership Miami and Leadership Daytona Beach. Current professional and community involvement includes: • Urban Land Institute (ULI) Southeast Florida/Caribbean District Council Advisory Committee Vice Chair, Sustainability • Greater Miami Chamber of Commerce (GMCC), Board of Directors • GMCC Natural Resources Committee Chair • Miami-Dade County Art in Public Places Trustee • Commercial Real Estate Women-Miami (CREW), Program Chair • Coral Gables Chamber of Commerce Previous • GMCC Workforce Housing Committee Chair 2008—2010 • GMCC Workforce Housing Committee Vice Chair 2006 - 2008 • GMCC Go Green Task Force Founding Chair (2007-2008) • ULI Terwilliger Center for Workforce Housing Steering Committee • ULI Terwilliger Center for Workforce Housing Education/Outreach Co-Chair • Miami Beach Chamber of Commerce (MBCC) Board of Governors • MBCC Pillar Trustees Chair 2008 - 2009 • MBCC Sustainable Living Council Founding Chair 2007 • CREW-Miami, Business to Business Committee Chair (2006) • CREW-Miami Board of Directors, Program Director (2003-2005) • Miami Beach Fine Arts Board/Festival of the Arts (1997-2002) • Miami Beach Fine Arts Board Chair/Festival of the Arts (1998-2001) MIAMI BEACH! 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 TO Cheryl Jacobs RE: Capital Improvements Projects Oversight Committee 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 member of the above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2014. I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and Code of Ethics Ordinance), as well as the Florida Commission on Ethics Guide to the Sunshine Amend- ment 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 ithe State of Florida (dependi on the board or committee on which I serve)on July 1, following the closing of the calendar year/on ich I have se Seery Ja o s Sworn to and subscribed before me this day , 2013. Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm for additional information regarding the Financial Disclosure Requirement We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. r� / MI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.741 1 ,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. Tca c/o 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. �- �- r /_3 Signature: Date: M I A M I•DADE SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure C I / For Tax Year Name: :Endin L 9 Mailing Address: ICJ ! 07 City/State/Zip: Social Security Number: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving: Term or Employment 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): ® 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 of Source of Income Address A Business ivity AA tm s1 I here wear(or affirm)that the aforesaid information is a true and correct statement. 3 Signature of peroo isclosing Date signed