Scott A. Needelman application package .1
MIA/V\1 BEACH BOARD AND COMMITTEE APP ICATl0N FORM
Last Name First Name Middle Initial
Home Address City tate Zip Code
3o S —1)(0 _ sa 0.4 <4' &.c s4 o\ l e Ss 0 f TTeOU67`7
Home Telephone Work Tele hone
p p Cellular lu honU P e Emall address
Aft& & [�Aghkam4
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Business Name Occupation
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Business Address City State Zip Code
Professional License (describe): rpek&rk� ) Expires:
ease attach a copy of currer6Vy effective professional license.
Pursuant to City Code section 2-22(4)a & 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 establispbd in the City
for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes or No EZ3 =~►
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: YesA or�N' '_
`
• Are you a registered voter in Miami Beach: Yes r No �l; (.0
• I am now a resident of: North Beach EZI South Beach KZ Middle Beach E_:1 -10
• I am applying for an appointment.because I have special abilities, knowledge and experience: Please fli',st.Q10W:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes Z3 or 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 bv the City Clerk's Office.
❑Ad Hoc Charter Review and Revision Board 0 Debarment Committee ❑Miami Beach Human Rights Committee
❑Ad Hoc Committee Centennial Celebration ❑Design Review Board* ❑Miami Beach Sister Cities Program
❑Ad Hoc Committee Flooding Task Force 0 Disability Access Committee ❑Normandy Shores Local Government
Neighborhood Improvement
❑Affordable Housing Advisory Committee ❑Fine Arts Board ❑Parks and Recreation Facilities Board
❑Art in Public Places Committee ❑Gay, Lesbian,Bisexual and Transgender ❑Personnel Board
Enhancement Committee GLBT
0 Beautification Committee ❑ olf,Advisory Committee &Planning Board
❑Bicycle-Pedestrian Adviso Committee ❑Health Advisory Committee ❑Police Citizens Relations mittee
Board of Adjustment* ❑Health Facilities Authority Board ❑Production Industry Council
❑Budget Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee
❑Capital Improvements Projects Oversight ❑Historic Preservation Board ❑Single Family Residential Review Panel
Committee
❑Committee on the Homeless ❑Housing Authority ❑Sustainability Committee
❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee
❑Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee
❑Community Relations Board ❑Miami Beach Commission for Women 0 Visitor and Convention Authority
❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board
❑Waterfront Protection Committee
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) 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 Licens C6 License Number o3�
License Issuance Date License Expiration Date
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°O Note: If applyirig for Youth Center Advisory ase indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Boar :Yes No, Dates of Service:
2. Present participation in Youth Center activities by your children:Yes[-�a No E
If yes, please list below the names of your children, thdVa es and the program's in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes or No If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes ZJ or No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes Zi or No 54 If yes, explain in detail:
•Are you currently.serving on any City Board or Committee?Yes EZI or No 19 If yes, which board/committee?
• In what organizati (s)in the City of Miami Beach do you currently hold membership?
V� A &Z Aerbber
Name Position
Name Position
• List all prop rties owned or in whiph you have an interest within the City of Miami Beach:
� v� ICI'
•Are you now employed by the City of Miami Beach?Yes�or No g
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent 1-:1, spouse EZI, child E—�l brother Ea or sister�=l who is
employed by the City of Miami Beach? Check all that apply.
If"Yes,"identify person(s)and departmerat(s): .4 1 /&
/V/ 1-1
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 City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories
What is your race?
African-American/Black
1'%161 E Caucasian/White
Asian or Pacific Islander
IZI Native-American/American°Indian
EZI Other—Print Race:
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
NEI
499=1T No
Yes
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:
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 the 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 Comm ittee::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).
o Sunshine Law - Florida's Government-in-the-Sunshine.Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
o Voting conflict—Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes..
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 MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDI GLY."
G n
A icant's Si n ure Dlate Name of Applicant(P EASE PRINT)
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
.:PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A
COPY OF ANY APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.: }
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MIA/\/\I BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:
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
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pd
2. A "Staterrtent of Financial'lnterosts (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fl.us/ethics/forms.htmi
3. A Copy of your 2013 Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
(2ajd
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Sicfrature I Dat
Updated: Monday, December 16,2013
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc
Scott Needelman
1455 Drexel Avenue #1
Miami Beach, Florida 33139
305-710-5584
305-673-1463
Education Bachelor of Science, Civil Engineering, May 1993
Florida State University,Tallahassee,Florida
Graduated, Miami Beach Senior High School,June 1988
Work Experience President, SAN Development, Inc., September 2002-present
Completed construction of a 2700 sq. ft.home.
Property Manager, York Towers Apartments,
May 1993-present
Responsible for the day-to-day operation of 24 apartment units and four
commercial spaces.
Assistant Project Manager,Fisher Island Holdings,LLC,
January 2005-May 2008
Managed the submittal and RFI processes for the construction of a 10 story
luxury condominium building and oversaw various other small construction
projects.
Project Supervisor,Carmel at California Club Property Owners
Association, September 2001-December 2001
Oversaw the repairs to 34 condominium buildings due to flooding.
Project/Construction Manager, York Towers Apartments
February 1995-August 2000
Conceived and executed the substantial renovation of three historic multi-family
buildings,approx. 18,000 sq. ft. Oversaw,on a daily basis,the various
subcontractors from concept to completion of projects.
Skills Microsoft Office,AutoCAD
Certifications Certified Building Contractor, State of Florida
Engineer Intern, State of Florida
Committees/Activities Member,Debarment Committee,City of Miami Beach
January 2009-December 2010
Member,General Obligation Bond Oversight Committee
City of Miami Beach,March 2003-April 2008
Member, Eleventh Judicial Circuit Grievance Committee A
State of Florida, February 2001-January 2004
Member, Safety Committee,City of Miami Beach
January 2002-December 2002
Member,Planning Board,City of Miami Beach
January 2000-December 2001
Graduate,Miami Beach Citizens Police Academy
November 2000
Member,Community Development Advisory Committee
City of Miami Beach January ry 1998-December 1999
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
Can
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
NEEDELMAN, SCOTT ALAN
SAN DEVELOPMENT INC
1455 DREXEL AVENUE #1
MIAMI BEACH FL 33139
STATE OF FLORIDA AU S 2 2 31
Congratulations! With this license you become one of the nearly one million :.DEPARTMENT OF BUSINESS AN]
Floridians licensed by the Department of Business and Professional Regulation. PRAFESSIOT 1tEGULATION
Our professionals and businesses range from architects to yacht brokers,from t� ,
boxers to barbeque restaurants, and they keep Florida's economy strong. _
CBC1250381 / 1280151
Every day we work to improve the way we do business in order to serve you better., '
For information about our services,please log onto www.myfloridalicense.com. 1 CERTIFIED-` M 'RACTOR
There you can find more information about our divisions and the regulations that NEEDELMAN.- Via,
impact you, subscribe to department newsletters and learn more about the SAN DEVEL
Department's initiatives.
I
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers. I
Thank you for doing business in Florida, and congratulations on your new license! Is CERTIFIED under the provisions of Ch.48
Expiration date: AUG 31, 2014 L120724008,
DETACH HERE
AC# 6223721 STATE OF FLORIDA
DEPARTMENT OF BUSINESS. AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L120724001
IM07124/20121128015811:• : - LICENSE NBR
'J
C AL
The BUILDING CONTRACTOR _
Named below IS CERTIFIED
Under the provisions of Chapte
Expiration date: AUG 31, 2014
i e..
NEEDELMAN, SCOTT ALAN
SAN DEVELOPMENT INC
1455 DREXEL AVENUE #1
MIAMI BEACH FL 33139
RICK SCOTT KEN LAWSON
GOVERNOR SECRETARY
AS REQUIRED BY LAW