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Michael F. Steffens board application package V­ MAre(-- Last Name First Name Middle Initial #011 (#Jo , Of4 I M 0 Home Address City State Zip Code 505• A/16, .,57olla� 4�A A%C'5 - 1VL ml�z 1—W Home Telephone Work Telephone Cellular Telephone Email address �At(,vq%Lm;L Slaveres4-5 vx� Business Name Occupation Skcp AtIAL.L.6 Mw caliL (Aqvjs Business Address City State Zip Code Professional License(describe): Expires: AyL op i i ovL 0�&%O Please attach a copy of currently effective professional license. 1b. 44(ov, 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. e Resident of Miami Beach for a minimum of six(6) months: Yes Z31 or No�? 9 Demonstrates ownership/interest in a business in Miami Be h for a minimum of six months: Yes MIT No 9 Are you a registered voter in Miami Beach: Yes D or No & e I am now a resident of: North Beach� South Beach C3 Middle Beach e I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: 9 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. 0 Ad Hoc Charter Review and Revision Board 0 Debarment Committee [I Miami beach Human Rights Committee 0 Ad Hoc Committee Centennial Celebration 0 Design Review Board* ❑Miami Beach Sister Cities Program 0 Ad Hoc Committee Flooding Task Force 0 Disability Access Committee ❑Normandy Shores Local Government Neighborhood improvement 0 Affordable Housing Advisory Committee ❑Fine Arts Board 0 Parks and Recreation Facilities Board 0 Art in Public Places Committee 0 Gay,Lesbian,Bisexual and Transgender 0 Personnel Board Enhancement Committee(GLBT) - 0 Beautification Committee ❑Golf Advisory Committee 1hPlanning Board 0 Bicycle-Pedestrian Adviso!X Committee 0 Health Advisory Committee 0 Police Citizens Relations Committee ❑Board of Adjustment* ❑Health Facilities Authority Board 0 Production Industry Council ❑Budget Advisory Committee 0 Hispanic Affairs Committee 0 Safety Committee ❑Capital Improvements Projects Oversight Historic Preservation Board 0 Single Family Residential Review Panel Committee t- ❑.Committee on the Homeless ❑Housing Authority 0 Sustainability Committee ❑Committee for Quality Education in IVIB 0 Loan Review Committee ❑Tennis Advisory Committee 0 Community Development Advisory Committee 0 Marine Authority ❑Transportation and Parking Committee 0 Community Relations Board ❑Miami Beach Commission for Women ❑Visitor and Convention Authority 0 Convention Center Advisory Board 0 Miami Beach Cultural Arts Council ❑Youth Center Advisory Board- 0 Waterfront Protection Committee Board members are required to file Form I -"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 4aw(TaCr License Number A(. oo vo-s-1 License Issuance Date License Expiration Date 01/1va/Z���� Page 1 of 4 R CLERULWFORIVIS\BOARD AND COMMITTEES%BC APPLICATION 46 BOARDS 12-16-2013.doc °C 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 _D No L=6Dates of Service: 2. Present participation in Youth Center activities by your children:Yes'=D' NoV3 If yes, please list below the names of your children,their ages and the programs in which they participate: y 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 Nov if yes, please explain in detail: •Do you currently owe the City of Miami Beach any money?Yes 4�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 or in which you have an interest within the City of Miami Beach: •Are you now employed by the City of Miami Beach?Yes�7.a or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent , spouse , child �_..!.1 brother�Dl or sister EZ3 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 __ Race/Ethnic Categories What.is your race? African-American/Black 5Caucasian/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?Mario the "No"box if not Spanish, Hispanic, Latino/a. 4No j Yes Do you consider yourself Physically Disabled? MIN o 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 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 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 813 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 STATUT S ACCORDINGLY." Applicant' Slgnatu Date Name of Appli ant(PLEASE PRINT) Received in the Ity 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\$ALLIaFORMS\BOARD AND COMMITTEESIBC 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 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: 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 I, 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 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 $500, 60 days in jail or both. o • dco• t Signature Date Updated:Monday,December 16,2013 Page 4 of 4 F:\CLERN$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc I F. Michael Steffens P.A. ARCHITECT AA 0002904 AR 0011052 ID 4683 F. MICHAEL STEFFENS FIELDS OF SPECIALIZATION Architectural Design Historic Preservation EDUCATION Rice University, Houston, Texas Masters of Architecture 1984 University of Florida, Gainesville, Florida Bachelor of Design in Architecture 1981 REGISTRATION Florida Personal AR 0011052 Florida Corporate AA 0003466 NCARB Certificate No. 33652 EXPERIENCE F. Michael Steffens, PA was formed in 1999. For the fourteen years previous to that date, Mr. Steffens engaged in the practice of architecture, interior design, planning, and related design services with Zyscovich Inc. Mr. Steffens project responsibilities encompassed the public sector and corporate and private clients who express a desire for quality in the built environment. Mr. Steffens is a native to South Florida. He has lived in Coral Gables for the past 30 years. Mr. Steffens was formerly Vice Chairman of the Coral Gables Planning and Zoning Board and past Chairman of the City of Miami Beach Design Review Board. He is a former member of the Coral Gables Board of Architects and the Coral Gables Historic Preservation Board. Specific Projects Include: • STK Restaurant and Lounge,Miami Beach • La Goulue Restaurant, Bal Harbour • The Daily Restaurant,Miami • Yuga Restaurant, Coral Gables • Elia Restaurant, Bal Harbour • 2320 Ponce Office Building, Coral Gables • Coral Gables City Hall Renovation* • City of North Miami Beach Fire Station • St Moritz Hotel Renovation*.,Miami Beach • Bass Museum Historic Renovation Consultant*, Miami Beach • The Anchor and The Justice of The Peace Hotels Relocation and Renovation, Anchor Place Shops and Parking Garage; Miami Beach • 1688 Meridian Renovation*.,Miami Beach • Flamingo Towers Addition and Renovation*, Miami Beach • Miami International Airport Terminal Renovation* • Renovation of, and addition to, numerous historic homes in South Florida (*Projects produced while at Zyscovich, Inc.) 316 Miracle Mile Coral Gables, Florida, 33134 305.448.5299 Voice 305.444.0842 Fax mike(&-fmsarch.com email t'LUKIUA . ' D$PARTMENT OF .BUSTNESS�' AND PROFESSIONAL REGULATION BOARD OF ;ARCHITECTURE &. INTERIOR DESIGN SEW L12122701605 • LICENSE NBR 12' 27 2012 120255305 ID4683 The. INTERIOR. DESIGNER Named-below IS LICENSED ..:' ICENSED .. - Under-the.provisions of Chapter °481_ F�'� Expiration date: FEB 28, 2015 STEFFENS�, .:FRANCIS MICHAEL II, . 316 MIRACLES- CORAL GABL$S ��FL 3313`4 RICK SCOTT:' . KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW'. SECRETARY I ` DEPARTMENT OFF'BUSINEggg AND .PROFggggST:ONAL >REGULATION BOARD. OF ARCHITECTURE &, INTERIOR' DESIGN SEW L1212 2701518 .. :• LICENSE" NBR 12/27-/1.012: 112025' 5' 30:-5. RD. : AO11`052-'l. ►.., * ' The .ARCHITECT: , P ` Named.:below IS LICENSED h Under the provisions of Cap , Expiration date: FEB 28 2015 461. ZL ,STEFFEN$, P`-RANCIS MICHAEL I;Ih- 316 MIRACLE. MILE., CORAL GABLES, =.,..,::FL 3 3 1 34'% Ll, RICK 2COTT. KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY