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Debra Schwartz 12/3/2015 MIIAMIBEACH 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 03-26-2014 Debra Schwartz 5680 Pinetree Dr Miami Beach, Florida 33140 SUBJECT ' Committee on the Homeless Congratulations! You have been appointed by Mayor Philip Levine to the agency, board or committee named above for a term ending: 12/3/2015. 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, Rafael E. Granado - City Clerk cc: Saul Frances, Parking Director Maria Ruiz 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 Debra Schwartz RE: Committee on the Homeless 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 Amend- ment and Code of Ethics for Public Officers and Employees, and understand 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, following the closing of the calendar year on which I have served. Debra Schwartz Sworn to and subscribed before me this o2 day of ,*-/42014. e L Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm for additional information regarding the Financial Disclosure Requirement We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. i i I MI °"1DE e SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Na a Middle Name/Initial 0/,3 Mailing 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 I oWz /�S 5 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 t U)L -� e-AMAP Lk c lLS ( vxds a P v.A e F Lc-I _ I hereby w`eaff�(or irm a t e I formation above is a true and correct statement. ..RECEIVED.BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing t4 Print name D to signe OFFICE USE ONLY Accepted: Y / N Deficiency: °rocessed Date/Initiat- Scanned Cu=te/Initials: 138 SP-1" 2/13 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, www.miamibeachFl.aov CITY CLERK Office Cit/Clerk @miamibeachn.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 2-11.1(i) (2) Board Member name: 1 �/ I understand that no later than JULY i 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 complywith 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, 2010. 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. 4 11 33) Signature: ate: Last Name eepeA 44 . First Name Middle Initial Home Address -(q*I ami IFL• 931 kb .3 city State Zip Code 14&9 798 1—ig at t•Copt Home Telephone Work Telephone Cellular Telephone . Email address N Business Name Occupation Business Address city state Zip Code Professional Ucense(describe): Expires: Pursuant to City Code section 2-22(4)a&b: Members of agencies, boards and committees shall be affiliated with the C4; 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 ownershipfinterest for a minimum of six months in a business established in for a minimum of six months. the City I • Resident of Miami Beach for a minimum of six(6)months:Yes 10eor No D • Demonstrates ownership/interest in a business in Mimi Beach for a minimum of six months:Yes El or No •Are you a registered voter in Miami Beach:Yes liYor No M • I am now a resident of-- North Beach M South Beach El Middle Beach E;aro* am applying for use I have special a e. Please list bet y because _t bilitiy.kn9WJedge anqexqenenc 0 • VtA'� e -Wet dLW!S C1 trb•Are you presently a registered lobbyist with the City of Miami Beach?Yes ED 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 Cfty 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 Wtqn Review Board* 0 Miami Beach Sister Cities Pro g ram 0 Ad Hoc Committee Flooding Task Force 0 Disability Access Committee 0 Normandy Shores Local Government — Neighborhood Improvement ❑Affordable Houser g Advisory Committee 0 Fine Arts Board 0 Parks and Recreation Facilities Board 0 Art in Public Places Committee ❑Gay,Lesbian,Bisexual and Transgender 0 Personnel Board 0 Beautification Coffirriffee Enhancement Committee(GLBT) 0 Goff Advisory Committee ❑Planning Board ❑Bicycle-Peckstrian Adm-!§M Committee 0 Health Advisory Committee 0 Police Citizens Relations Committee ❑Board of AcrAistment 0 Health Facilities Authority Board 0 Production Ind!.aft Council ❑Budget Advisory Committee 0 Hispanic Affairr.Committee 0 SaW Committee 0 Capital Improvements Projects Oversight 0 Historic Preservation Board 0 Single Family Residential Review Panel ommittee S[2g!mfttee on the Homeless D ousing Authority 0 Sustainability Committee Committee for Quardy Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee Committee 0 Community Development Advisory Committee ❑Marine 6uthority 0 Transportation and Parkin q Committee ❑Community Relations Board ❑Miami Beach Commission fbrWomen ❑Visitor and Convention Authority 0 Convention Center Advisor y Board 0 Viami Beach Cultural Arts Council 0 Youth Center Advisory Board 0 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 FACLERWALLWORNIMBOARD AND COMMITrEES%BC 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 I No Dates of Service: 2. Present participation in Youth Center activities by your children:Yes El No El 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 0 or No IV If yes,please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes 0:or No5KIf yes,please explain in detail: •Do you currently owe the City of Miami Beach any money?Yes 0 or No 5K If yes,explain in detail: •Are you currently serving on any City Board or Committee?Yes or No 0 If yes,which board/committee? ®tr�y�lttLl VeL- .'t10 ray 15o^02> •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 0 or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent El, spouse 0., child El brother 0 or sister 0 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? 0 African-American/Black IZCaucasianNVhde Asian or Pacific Islander 0 Native-American/American Indian 0 Other—Print Race: Page 2 of 4 F:ICLER%$ALLUaFORMMBOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013_doc Do you consider yourself to be Spanish,Hispanic or Latinola?Mark the"No"box if not Spanish,Hispanic,Lafino/a. �No 0 Yes Do you consider yourself Physically Disabled? lkfNo 0 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 indirecctly 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 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 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. 1 HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION;AND 1 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." W. 44A WLtt7' J/1,6/-W 114 6BRA Ap licant's Signatu ate me of plicant(PLEASE PRINT)A. C %Received in the City Clerk's Office by: Name of Deputy Clerk C ntrol No. ate 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 FXLERWALLWORMSIBOARD AND COMMITTEES%BC APPLICATION 46 BOARDS 12-16-2013.doc I City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139: 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: 2. A"Statement of Financial Interests (Form 1)n For your convenience,the form is attached. The form can also be downloaded at: 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 $500, 60 days in jail or both. /,-go i Signature Jbate Updated:Monday,December 16,2013 Page 4 of 4 F:ICLER%$ALWFORMSIBOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013_doc RESUME DEBRA H. SCHWARTZ RESIDENCE: 5680 Pinetree Drive Miami Beach,Florida 33140 305-865-7187 MARITAL STATUS: Married Husband—Gerald K. Schwartz Three children EDUCATION: Grainger High School,Kinston,N.C., 1957 Graduate Emory University, Atlanta, Ga., 1961 —BA Degree PROFESSIONAL: Legislative Assistant, State of Florida 1993-2010 Office Manager,Medical Office 1988-1993 Teacher, Biscayne Elementary School 1961-1965 ACTIVITIES: Volunteer,Miami Beach Senior High School 2011-Present Volunteer, Mount Sinai Medical Center 2012-Present Member, Miami Beach Community Relations Board 2008-present .��'�'{� is �`-.'Vi�- y�`•ry-{{�{_' • .'�..' ��„? w -�.�a�fie.'��inC Ci4'P1TOL CONIP:LEX' EXP 11/10 DEBRA H. SCHWARTZ SENATE 34387