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Adrienne Krieger 12/31/2014f MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfi.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 01-27-2014 Adrienne Krieger 100 South Pointe Drive Apt. 3103 Miami Beach, Florida 33139 §Q,BJEOW Miami Beach Commission For Women Congratulations! You.have been appointed by Commissioner Joy Malakoff 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, 2.007, 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, a Rafael 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, 2-458 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. MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Adrienne Krieger 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: 12/31/2014. 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 Ofcersandunderstand 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. { Adrienne Krieger Sworn to a n d subscribed be f ore me th i s day of�� ✓ 2014 - e 4L D Silvia Prieto 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 aremmitted to pravvidinxcellen Q�bli�;service and saet�to.,911 uarhQ live, w�Ork and�la�r in ollr vibrant.trcjp�cal,historic cgmmunity. e are Corr;mllt�d!U prU I�1rlt�c°XCc Lr r U`r!C'SeNiCE3 atlt�Sai%fy f0 O. wnp Ve, lval,al'ia >I y f C?Vr vJrc7n!, tr'Ori;CC7 ;s.+orrc comrnunlry. MI D DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial Mai ing Address—Street Number,Street Name,or P.O.Box 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 on 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 I hereby rear(or afT m)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy 4--, i na ure of person disclosing °2 / J Print name 04e signed OFFICE USE ONLY Acceptamd: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 133 SP-14 2/13 M I A,Ad B A H City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.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: Kczrg,/,- e-P, 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 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.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.state.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 mor than $500, 60 days in jail or both. Signature Date Updated:Monday,December 16,2013 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc Vd�l M BIEAC H .,()ARk-1 �-,.,�#t :_ >€ns.€R Ps...IC-`-z ON FORM L�. G Last Name First Name Middle Initial b f)QQ-T� Tlernito -iLc+3163 Home Address City State Zlili Code 3 Home Telephone Work Telephone Cellular Telephone Email address %]R::t 11� � Business Name Occupation Business Address City State Zip Code Professional License(describe): Expires: Please attach 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 Uror No • Demonstrates ownership/interest in a business in Beach for a minimum of six months:Yes or No Ed •Are you a registered voter in Miami Beach: Yes o • I am now a resident of: North Beach C3 South Beach 52 Middle Beach ID • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: e. r'e-3c P- * 0 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 oniv three 3 choices will be observed by the Ci 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* 0 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 0 Parks and Recreation Facilities Board Art in Public Places Committee ❑Gay,Lesbian,Bisexual and Transgender ❑Personnel Board Enhancement Committee GLBT eautification Committee 0 Golf Advisory Committee ❑Planning Board ❑Bicycle-Pedestrian Adviso Committee 0 Health Advisory Committee Police 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 0 Committee on the Homeless ❑Housing Authority ❑Sustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee 0 Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee ❑Community Relations Board Miami Beach Commission for Women q ❑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 License License Number License Issuance Date License Expiration Date Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc —� o° 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 IJ No Dates of Service: 2.Present participation in Youth Center activities by your children:Yes No LJ 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 Lj or No If yes, please explain in detail: •Do you currently have a violation(s)of City of Miami Beach Code?Yes La or NOIA If yes,please explain in detail: •Do you currently owe the City of Miami Beach any money?Yes or No If yes,explain in detail: •Are you currently serving on any City Board or Committee?Yes or No 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 which ou h an interest within the City of Miami Beach: 1 f)o 0-rl� ro5-wt-» V 9-zu c P50} 303 FL. 331 •Are you now employed by the City of Miami Beach?Yes U or No Ui Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent spouse F child C3 brother or sister who is employed by the City of Miami Beach?Check all that apply. If"Yes,"identify person(s)and 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 City diversity reporting requirements. Gender: Male IJ Female Race/Ethnic Categories What is your race? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian Other—Print Race: Page 2 of 4 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 V N uconsider yourself Physically Disabled?o 4�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." Z!i l 0/,/ ��- Applicant's Signature Dat 3 37 Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by Name of Deputy Clerk Control No. Pate 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 Adrienne Krieger 100 South Pointe Drive Apt 3103 Miami Beach,Florida 33139 1 have lived in Miami for 35 years and at The Continuum on South Beach for the last 11 years. I am a full time resident of Miami Beach.When the season ends and most Beach residents go north I will be here to protect your interests and serve on a committee or board. I have been on the Board at the Continuum and now head up the Decorating Committee. I was instrumental in getting the CO for the Continuum and more recently redecorating the lobby. I have an undergraduate degree from Ohio State University and a Masters Degree from New York University. My husband and I founded Transcriptions Ltd of Florida which did hospital medical record transcription. We sold the company to a public company in 1998. 1 have volunteered in the community over the years for Juvenile Diabetes and Project Newborn. With my educational,business background and community service I know that I would be a great asset to a Miami Beach Committee. Thank you for your consideration, Adrienne Krieger yomama18 @aol.com 305 794-0308 r q N Eli O o N oNED n s: o ;= N'OILO_ 4:1h-n 00r, TT s CA ^ n : gym X X