Dennis Mouyios board application package('W IL Y/O 1-f ; r ' i
Last Name First Name
/`L/`�f » i U ! 6 l A / _ s / 2 i / /
Home Address _/ City
z� .�: :, M //S 9/71 g -6- l
Home Tell hone Work Telephon Cellular Telephone
Al 71 Business Name
Middle Initial
State Zip Code
G' 7 .-
mail address
Occupation
Business Address
Professional License (describe)_
City
/,/4'
State
Zip Code
Expires:
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 ownershiprinterest for a minimum of six months in a business established in the City
for a minimum of six months.
• Resident of Miami Beach fora minimum of six (6) months: Yes or No n
• Demonstrates ownershipIinterest in a busines mi Beach for a minimum of six months: Yes or No
• Are you a registered voter in Miami Beach: Ye or No
• I am now a resident of: North Beach Q South Beach Middle Beac
• I am applying for an appointment because I have special abilities, knowledge and expe ence. P1
'iy ?
Arsrie
II
ase list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ° 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
0 Debarment Committee
0 Miami Beach Human Rights Committee
0 Ad Hoc Committee Centennial Celebration
0 Design Review Board' it
❑ Miami Beach Sister C "ties Program
❑ Ad Hoc Committee Flooding Task Force
0 D sabiiity Access Committee
0 Normandy Shores Local Govemment
Neighborhood Improvement
❑ Affordable Housing Advisory CottenTree
' II Fine Arts Board
0 Parks and Recreation Facilities Board
❑ Art in Public Places Committee
0 Gay, Lesbian, Bisexual and Transgender
Enhancemerd Comte? (GLBT)
0 Personnel Board
❑ Beautification Committee
0 Golf Advisory Committee
0 Planning Board 1"r
0 Bicycle- Pedestrian Advise Committee
0 Health Advisory Committee
fl Police Citizens Relations Committee
13 Board of Adjustment * *
0 Health Facilities Authority Board
0 Production industry Council
❑ Budget Advisory Committee
0 Hspartc Affairs Corrmrrftee
0 Safety Committee
0 Capital improvements Projects Oversight
Committee
0 Historic Preservation Board
*
)(Single Family Residential Review Panel
0 Committee on the Homeless
❑ Housing Auihon'ly
0 Sustainabitity Committee
0 Committee far Dually Education in MB
0 loan Review Committee
0 Tennis Advisory Committee
0 Community Development Advisory Committee
❑ Marine Authority
❑ Transportation and Parking Committee
❑ Communi Relations Board
❑ Miami Beach Commission for Women
❑ Visitor and Convention Autho
o Gotwertiion Advisory BDaid
n Miami Beach Cultural Arts Council
0 Youth Center Advisory Board
,C,�enter
C. s-/ e ,t/, / f44, c. e776
0 Waterfront Protection Committee
* Board members are requited to tale Form 1— "Statementaf Financial Untetest' 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 Preservatilon Board or Planning Board, attach a copy of your currently -effectively license, and furnish the
following information:
Type of Professional License License Number
License Issuance Date License Expiration Date
Page 1 of 4
F:ICLER■$ALL1aFORMSIBOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12- 16-2013.doc
Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes 171 No 0 El of Service:
2. Present participation in Youth Center activities by your children: Yes 4-�J No I
If yes, please list below the names of your children, their ages and the programs in which they participate_
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony? Yes LI or N
F
If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes T or N
• Do you currently owe the City of Miami Beach any money? Yes Q or N
If yes, please explain in detail:
If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes
1 1 or N • If yes, which board /committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name
Position
Name
Position
• List all 'properties owned or in which you have an interest within the City of Miami Beach:
Pit/p /G/ 04761/ A lV 5
gad C 7 > V, tJA/i T # 2. Li6, t / /x'27' 1S -ter />
• Are you now employed by the City of Miami Beach? Yes n' or No'
Which department and title?
1
• Pursuant to City Code Section 2 -25 (b): Do you have a parent spouse .. child brother I or sister 1--I who is
employed by the City of Miami Beach? Check all that apply.
If 'Yes," identify person(s) and ds *bs)_ Nor
II
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
K1,
Female
Race/Ethnic Categories
What is your race?
1 ( African- American /Black
Caucasian/White
Asian or Pacific Islander
II
r�I Native- Amencan /American Indian
4--}` Other — Print Race:
Page 2 of 4
F: \CLER\$ALL\aFORMS\BOARD AND OOMM)TTEES\BC APPLICATKNV 4 6 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.
Do you consider yourself Physically Disabled?
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS. THESE LAWS ENCLUDE, 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 an 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 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).
o Sunshine Law - Florida's Govemment -in -the- Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
govemment can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commityris and rttner 9uverri ng bosyces of state and 4ocai governrretica'i agencies or au' noiities.
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 APPUCABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY
()Ark
Applicant's Sign
Name of Applicant (PLEASE 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.
Page 3 of 4
F:ICLERI$ALL1aFORMSIBOARD AND COMMITTEESIIC APPLICATION 46 BOARDS 12- 16- 2013.doc
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax 305.673.7254
CityClerk@miamibeachfl.gov
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:
1 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 Cleric 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.pdf
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http: / /www.ethics.stale.fl.us /ethics /forms.html
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 $500, 60 days in jail or both.
e 10,(x
Signature
Updated: Monday, December 16, 2013
Page 4 of 4
F:\CLERL$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12- 16- 2013.doc
Dennis James Mouyios
4441 Meridian Ave
Miami Beach, FL 33140
305-531-6168 (Home Office)
917-297-9758 (Cell)
dmouyios@gmail.com email
Objective: Executive
Management Position
Summary of qualifications
Work experience
Allscripts Healthcare Solutions
2010-present
Chicago, IL
Area Vice President, Client Office, Hospital Segment, East
Sales, Contracting and Account Management – representing >$180 million annual sales and
revenues; managing 9 Healthcare IT Sales Executives and > 38 health systems
President’s Club – 4 year consecutive attainment
Eclipsys Corporation
2005-2010
Boca Raton, FL
Senior Client Sales Executive
Add-on sales and Account Management – responsible for >$13 million annual sales
President’s Club – 6 year consecutive attainment
Siemens Medical Solutions, Health Services
2000-2004
New York, NY
National Director – US Customer Relationship Services & Operations
General Management - representing >$950 million annual revenues, $10 million budget, over 850
healthcare institutions, and 15 healthcare managers.
SMS Corporation
1994-2000
New York, NY
Regional Vice President – Sales & Operations
General Management – entire New York Metro Area Customer Base, representing over $85
million annual revenues, $80 million sales, $5 million budget, over 80 healthcare institutions, and
45 employees; exceeded Sales Quota 7 of 8 years in position.
RVP of the Year – top performer award - 1995; 100% Club - 1994, 1995, 1996, 2000
VJM Enterprises Inc.
1993-1994
d/b/a/ Bourbon Street Candy Company
Hilton Head Island, SC
Owner and President. Retail candy establishment.
SMS Corporation
1983-1993
New York, NY
Regional Manager – Client: New York City Health & Hospitals.
General Mgmt - Sales, Service, Implementation, Support, Contract & Budget
Chairman’s “Employee of the Year” Award – 1993 Manager Excellence Award - 1983
Submitted in Confidence
Page 2
Dennis James Mouyios
Education
New York University
New York, NY
Doctor of Public Administration (DPA) Candidate
Major study – Government, Health and Finance Administration
New York University
New York, NY
Master of Public Administration (MPA) Degree
Major study – Government, Personnel Management, Public Administration
Manhattan College
New York, NY
Bachelor of Arts (BA) Degree
Major study - Government
Professional Memberships and Associations (past & present)
National Certified Pharmacy Technician Association
HIMSS
National Association of Realtors - Connecticut Association of Realtors
Committee Chairperson: The National Conference for Community & Justice – Health Care
Industry Division
Jacobi Medical Center – For the Children
Bellevue Hospital Center – Save the Children
Publications
“IT Vendor – Customer Partnerships” – HIMSS Quarterly Journal Publication
References
Available upon request.
Availability
Available in 30 days.
Submitted in Confidence