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Regina Suarez 12/31/2015 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 - ------ ----- -- ------ ---- 1(1-0/201-4- -------- -- ---------- Regina Suarez 4410 Alton Road. Miami Beach, Florida 33140 SUBJECT: Miami Beach Commission For Women Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson to the above referenced agency, board or committee for a term ending: 12/31/2015. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, , R ael E. Granado City Clerk cc: Saul Frances, Parking Director Leonor Hernandez 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, 2-2458, 2-459 Ordinance 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 Employees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. MIAMIBEACH 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 TO: Regina S. Suarez RE: Miami Beach Commission For Women 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: 12/31/2015. 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 Amendment and Code of Ethics for Public OffIcers andunderstand 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 serve) on July 1 st, following the closing of the calendar year on which I have served. egina uarez � �� /� Sworn,to and subscribed before me this Z? day of N� �X, 2014 Maria E. Martinez 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 Requirements. We are40W,��!�E�R'� il�8i� � tl,� �� � c® jiyt�0 III�Yildtsl� iglp�aq irtp�lbr�i�p�asjib�plobrihiatmr�uci�munity. .;i • MIAMI BOARD AND COMMITTEE APPLICATION I°CiRM Last Name First Name Middle Initial Home Address C'y State Zip Code I-IL�10 A B4)-� Qs­ A-,Pt 34r-dS,3-,Md 9' )eel i VP Pe..,z (-P 4/) Home Telephone Work Teleilhone Cellular Telephone Email address Business Name Occupation Business Addr ss City State Zip Code Professional License(describe): Q I fr Expires: Please a ach a copy of currently 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 established in the City for a minimum of six months. • Resident of Miami Beach for a minimum of six (6) months: Yes Q2 or NoEZh • Demonstrates ownership/interest in a business inn Mi mi Beach for a minimum of six months: Yes[Z�or No Z • Are you a registered voter in Miami Beach: Yes or No • I am now a resident of: North Beach EZ� South Beach Zt Middle Beach UT • I am applying for an appointment b cause I have pecial abilities, knowledge and experience. Please list below: - *0-r rJ v 0 12 U I aA%d • Are you presently a registered lobbyist with the City of Miami Beach? Yes E:l 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 by the City Clerk's Office. ❑Ad Hoc Charter Review and Revision Board ❑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 ❑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 ❑Beautification Committee ❑Golf Advisory Committee ❑PJanning Panning Board ❑Bicycle-Pedestrian Adviso Committee ❑Health Advisory Committee UPnlirp Citizens Relations Committee ❑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 ustainabilit 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 ❑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: ; �.� q�`y4J 4' i J Type of Professional License * Vii_. Yp _ _ _ License Number _ , ��n ° License Issuance Date License Expiration Date Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEESI6C APPLICATION 46 BOARDS 12-16-2013.doc R,...°. i Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the 'Wo"box if not Spanish, Hispanic, Latino/a. o Tes Do you consider yourself Physically Disabled? 52(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: • 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 the 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). • 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. • 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 ACCORDINGLY." Appl' ant's gna Date Name of Applicant(P SE P INT) 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. Page 3 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc REGINA SUAREZ 4410 Alton Road,Miami Beach,FL 33140 Cellular Phone(305)283-0009 regisuarez(a aol.com QUALIFICATIONS Miami Beach Resident: Since 1961 City Boards: Miami Beach Commission for Women Member Budget Advisory Board Member Police and Citizen Advisory Board Member Miami Beach Commission for Women Chairperson Education: Florida International University MBA 2006 Florida State University MSW 1975 Barry University BA 1971 Miami Beach High School 1967 Languages: English and Spanish Licenses: LICENSED CLINICAL SOCIAL WORKER State of Florida REAL ESTATE State of Florida EMPLOYMENT HISTORY 2002-2010-MIAMI-DADE COUNTY— 2006-2010 Human Services Dept.—Rehabilitation Administrator 2004-2005 Juvenile Services Department-Revenue Maximization Administrator 2003-2004 Office of the Mayor-Director of Constituent Services 2002-2003 Human Services Department—Juvenile Services 1998-2000 MIAMI-DADE COLLEGE-Welfare to Work Supervisor 1992-1998 PRIVATE CLINICAL PRACTICE-Psychiatric Social Work 1991-1992 MIAMI-DADE COUNTY/JACKSON MEMORIAL HOSPITAL—Clinician 1986-1991 MIAMI-DADE COUNTY/JACKSON MEMORIAL HOSPITAL Clinical Social Worker 1990—Employee of the Year 1983-1986 DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER—Miami Beach Coordinator 1976-1982 UNIVERSITY OF MIAMI/Jackson Memorial Hospital-Cuban Unit 1975-1976 UNIVERSITY OF MIAMI—Adjunct Research Professor 0 c nevona Suarez MIAM19EACH DIVERSITY STATISTICS REPORTING , Name: Board 1 Committee: ion z w ti Appointment Date: Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male D Female Race/Ethnic Categories That is your race? Mark one or more races to indicate what you consider yourself"to be. African-American/Black i [YdCaucasian/White Asian or Pacific Islander Native-American/American Indian Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box il'not Spanish, Hispanic, Latino/a. No Yes Do you consider yourself Physically Disabled? No Yes F:\CLER\SALL\aPORMS\'DOAP,D AND COUMIT i EES`OC minority information form 05-20-13 Revised by Mr. Papy.doc �,A AtN t E-Al"'H City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 3 313 9, Hr�r�✓.miam i beccn9'.ccv CI IY CLERK Orrice CilyClerk@micmibeach1r1.gov Tel:305.673.741 i ,Fox:305.673.725 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: understand that no later than JULY 1 OF EACH YEAR all members of Boards and Commi Lees of the City of Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Disclosure Requirements. This meansthatthe members of Citv,^-\dvisory Boards, whose sole or primary responsibility is to recomm-end legislation or give advice to the City Commission, must isle,even though you may have been recently appointed. You rust file one of the follo,ving with the City Cleric of Miami Beach, 1700 Convention Center Drive, Miami Beach; Florida, by July 1, 2010. 1. A`'Source of Income Statement(aitached) or 2. A"Finar�cial Statem`nt(a�Lached(or1 I 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 b4 imprisonment in the county jail for a period not to exceed sixty days, or both. 1)- 2 // �ianature: Date: MI °�'DE EM SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last ame Tame Middle Name/Initial M -ailing Address—Street Number,Street Name or P.O.Box L11 / City,State,Zip ID Number If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here.❑ Filing as an Employee ❑County Employee Municipal Employee, Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as a Board Member ❑ County Board Member Municipal Board Member, Name of Municipality: Board where serving Work address Work telephone Term began an List below every source of income you received,along with the address and the principal activity of each source. Include your public salary.Place the sources of income in descending order,with the largest source first.Also, include any source of income received by another person for your benefit.However,the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here.❑ Name of Source of Income Address Description of the Principal Business Activity U v Ur rvel I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy C__ ❑ Electronic Copy Signature of persR disclosing Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/!nitials: Scanned Date/Initials: 132 SP-1= 2/13