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Susana Maroder-Rivera 12/31/2014 I\A, A NA1 B E A C 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 02-21-2014 Susana Maroder-Rivera 1250 Lincoln Road #509 Miami Beach, Florida 33139 SUW90TO Disability Access Committee Congratulations! You have been appointed by Commissioner Micky Steinberg 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, 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 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, Raf 1 E.WGranado City Clerk cc: Saul Frances, Parking Director Caroline DeFreeze 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.clov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Susana Maroder-Rivera RE: Disability Access 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 have been appointed for a term ending: 12/31/2014. I have been issued a co of Section 2-11.1 of the Miami-Dade Count Code Conflict of Interest PY Y ( 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. Susana Maroder-Rivera Sworn to and subscribed before me this day of Fejbru t, 2014 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 are committed to P�rgviding e�ccellent public gervice and$afgty to a'(jo live, work ar�d Play in our vibrant,tropipal,historic community. We are cornmi,t� o prove ing excellent public service on sa,e y to a w.alive, wor,an p ay in our vibroni, 'i'op.iCo; n,storic community. A B EACH 2 0 A R LD A ND I ON',a il°i EE A.PiPUICAT110 FLJ'R Nll I� od R;�> �. sus C4-,Last Name First Name Middle Initial 12—50 L,'v) co I in F ��3 13�c Home Address City State Zip Code V 495 ZS7 2,R S1CC Y1G� Home Telephone Work Telephone Cellular Telephone Email address Business Name Occupation Business Address City State Zip Code Professional License (describe):__ I--I RA1 e CC r1k 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 IN or No • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes�or No • Are you a registered voter in Miami Beach: Yes or No.ED • I am now a resident of: North Beach E—D South Beach Middle Beach Q' • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: - N,S0 ,1),'1i V,4 ad yoc .r..i CJA r' E-gf✓I`C G C o Are you presently a registered lobbyist with the City of Miami Beach? Yes D 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 isability 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 Adviso Committee ❑Planning Board ❑Bicycle-Pedestrian Advisory Committee ❑Health Advisory Committee ❑Police Citizens Relation Committee ❑Board of Adjustment* ❑Health Facilities Authority Board ❑Production Indust ,Couil ❑Budget Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee,,,' -C` ❑Capital Improvements Projects Oversight ❑Historic Preservation Board ❑Single Family Residentia92eviet anel Committee ❑Committee on the Homeless ❑Housing Authority ❑Sustainabili Committee-- ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Adviso _CommtFt e ❑Community Development Advisory Ccmmittee7 ❑Marine Authority ❑Transportation and Park' Co ttee ❑Community Relations Board ❑Miami Beach Commission for Women ❑Visitor and Convention ZMhori ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Adviso $eard ❑Waterfront Protection o mitt * Board members are required to file Form 1 –"Statement of Financial Interest"with the State. T %.0 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\SALL\aFORMS\BOARD AND COPS MITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc °Q 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 No Dates of Service: 2. Present participation in Youth Center activities by your children:Yes EZ) No IZI 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 or No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes or No If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes or No L 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 or in which you have an interest within the City of Miami Beach: • Are you now employed by the City of Miami Beach?Yes�D or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent , spouse , child Z34 brother E�3 or sister E-�l 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 Female QR Race/Ethnic Categories What is your race? ED African-American/Black El Caucasian/White Asian or Pacific Islander Native-American/American Indian Other—Print Race: IJ� 5QckiL&C. Page 2 of 4 FACLER\$ALL\aFORMS\BOARD AND COMMITTEESIBC 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. r ED No ayes Do you consider yourself Physically Disabled? 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 88 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." 5v Sri CA HGA1QC) (- - R.L'-C� Applicant's Signature jame::of Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by: v Dep uty erk Control N bate 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:ICLERI5ALL1aFORMS 1kBOARD AND COMMITTEES0C APPLICATION 46 BOARDS 12-16-2013.doc r e _ACH I �t /V I BE City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachn.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 305.673.7411 Fax: 305.673.7254 Acknowledgement of fines/suspension for Board/Committee M.embers for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2) D Board Member's Name: SUS Pr t.1 Pr �(It 910 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.htmi 3. A Copy of your 2013 Federal Income Tax Return iu 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. 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 Susanna Maroder-Rivera 1250 Lincoln Rd#509 Miami Beach,FL 33139 305-674-8079-305-495-2528 smaroder@gmail.com OBJECTIVE To obtain a position in line with my skills and experience QUALIFICATIONS •Over twelve years case management experience BRIEF: •Extensive experience in linking clients to mental health services •Masters degree in Rehabilitation Counseling •Bachelors degree in Special Education •Supervisory experience • Experience working in developing countries for international relief organizations and N.G.O.'s •Experience in interviewing,intake and assessment techniques •Skilled in providing referrals to appropriate local,state and national resources •Experienced in writing and implementing service plans •Skilled in conducting clinical evaluations and treatment plans •Extensive crisis intervention counseling experience •Bilingual in English and Spanish WORK Program Supervisor 08-08 to present EXPERIENCE: CFC Miami, Miami,Fl. Supervise case managers while maintaining own case load of at risk adolescents and their families Conduct comprehensive behavioral,psycho-social,developmental and home environment assessments Develop and implement short term and long term treatment plans Conduct outreach to clients homes Responsible for community education and presentations on CFC Miami programs Assist in Grant writing Participate in fund raising Organized client group activities Conduct individual and group counseling sessions Responsible for interdisciplinary staff meetings Continued Susana Maroder 2 Project Coordinator 12-04 to 06-08 Oxfam,Accra,Ghana WORK • Led local interdisciplinary team in starting a school for disabled EXPERIENCE: children and adolescents (continued) • Trained local teachers and professionals in disability awareness issues and teaching techniques for disabled youth • Assisted in developing budget and solicited funds from various international relief organizations • Conducted outreach to local parents of disabled children. • Counseled adolescents on HIV/AIDS awareness,causes and preventions • Planned and coordinated community activities and special events in the area of disability awareness and advocacy. Employee Assistance Counselor 04-97 to 11-04 Ceridian Lifeworks Services,Miami,Florida • Problem resolution counseling,clinical assessments,referral to community resources • Crisis intervention,assessment and referral to social services agencies • Risk assessment, risk management and case follow-up • Consultant for disability/accessibility issues • Medicaid/Medicare.eligibility Crisis Intervention Counselor 04-95 to 4-97 Switchboard of Miami,Miami,Florida • Crisis intervention counseling • Case documentation and follow-up • Community resource referral • Risk Management Advocacy Specialist 03-95 to 03-96 South Florida Association for Disability Advocacy,Miami,Florida • Conducted peer counseling,advocated on behalf of clients in the areas of social security benefits,housing,accessibility,employment, hospitalization,ADA,etc. • Conducted intakes,case management and assessments • Provided information and referrals,community services liaison • Coordinated volunteer programs Integrated Community Development Coordinator 04-91 to 12-94 United States Peace Corp,Costa Rica • Implemented programs to assist disabled individuals in their socio and vocational integration and to acquire occupational skills, personal independence and self—sufficiency • Taught English as a second language to community residents Susana Maroder 3 • Taught rural children basic sanitation and hygiene practices • Taught university level special education classes and developed curriculum • Planned and organized disability awareness activities and events Rehabilitation Counseling Intern 12-88 to 06-89 International Center for the Disabled,New York • Conducted vocational counseling and evaluations for individuals with disabilities • Developed vocational rehabilitation plans Practicum Participant 12-87 to 06-88 State Office of Vocational Rehabilitation,New York,New York • Provided job seeking skills,career counseling and job placement services to individuals with diverse disabilities EDUCATION: •Master of Science Rehabilitation Counseling New York University,New York,1989 •Bachelor of Science Special Education University of Connecticut,Storrs,Connecticut, 1987 •Human Resources Administration Certificate Florida International University,Miami,Florida,2005 MID SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending LastpNauie first Name Middle Name/Initial Mailing Addres - treet 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 CFC Inc-, 1616 row *4 Qvr_ oO 1 hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13 MIA/Ml BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, W,VW.miamibeachfl.aov ._-- 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 2-1 1.1 (i) (2) 4 Board S'US4A14_ ,2G,Member 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 Disclosure Requirements. This means thatthe 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, 2011. 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. 0 Signature: Date: