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Deborah Robins 12/31/2014 • • 1110 1110 /v\IAMIBEACH 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 03-18-2014 Deborah Robins 1800 West 24th Street Miami Beach, Florida 33140 r , ; SUBJECT. Miami Beach Sister Cities Program Congratulations! You have been appointed by Mayor Philip Levine to the agency, board or committee named above for a term ending: 12/31/20 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, S CAp L. t Rafa I E. Granado City Clerk cc: Saul Frances, Parking Director Desiree Kane 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 Deborah Robins RE: Miami Beach Sister Cities Program 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. 1 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 mu ly with the financial disclosure* requirements of Miami-Dade County or the State of Florida ( pending n the board or committee on which I serve) on July 1, following the closing of the calendar year on whi I have served. Deborah Robins Sworn to and subscribed before me this 7 day of m>4'� 2014. ' ilvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.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 � • Last N V !rst Name IUlicldt nitial ////// Home Address City State Zip Code 4&)5- 1 L- �(nS D(o O� rniA41. cam% Ho a Telephone Work Telephone Cellular Telepho Email address t 16.1 C C?CSR cn i 101 G'fi V/G Business Name Occupation Business Address City State Zip Code Professional License(describe): ���-tt �� `! -2'-1'3 3 Expires: C.C..'R kr C_ Please attach a copy of currently effective professic-ial license. Pursuant to City Code section 2-22(4)a&b: Members of agencies, boards and committees shalt 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 10 or No Or e Demonstrates ownershipinterest in a business in Miami Beach for a minimum of six months: Yes E-:j or No 0 e Are you a registered voter in Miami Beach: Yes or No e 1 am now a resident of. North Beach 01. South Beach _'`l�.-. Middle Beach e I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: a r 4. W �Nr t�rftrsrt c . •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 0 Miami Beach Human Rights Committee 0 Alt Hoc Committee Centennial Celebration Q Design Review Board' D Miami Beach Sister Cities Program O Ad Hoc Committee Flooding Task Force D Disability Access Committee 0 Normandy Shores Local Govemment Ne' hborhood Improvement ❑Affordable Housing Advisory Committee 0 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 GLB 0BeautiticationCommittee 0 Goff Adviso Committee 0 Planning Board ❑B' de-Pedestrian Adviso Committee 0 Health Advisory Committee ❑Police Citizens Relations Committee a Board of Adjustment' 0 Health Facilities Authorit Board :!Froduction industry Coe,nr ❑Bud et Adviso Committee 0 Hispanic Affairs Committee D Safe Committee _M t �� �i Ir`I'•}rr?trPsnont�e 4.,+p. Oversight unracnr;r$+or.B-cX0 s 1 Sirsnk�t Mryeehr ties erp±ta!Re-np.e r k- ... .— - Committee � — G rsrY}fr litf'e or'x } t�r`Ti?o!a$S — !,�'to s. q Authority II Committee for Quality Education in MB C Loan Review Committee f 0 Tennis Advisory Committee .}..M. .ar tom.a •s r n. »•.x- T,r _�. nr rr n. .fit. . f .{. . u-.t e•a n _ L.a,a1.il�. •rte••-• , ivi NYi.a�..rve.u iv v�i1....iNtili��.�a.i a.iv.r../...+a C.,.rwv.• .�.i...r....�.ti. 1 :oar.•.�. 1 S .a. J •.rvR 1"!Z^f. C Corivrianity Relations Board y C_%Iiarzi Beach Commission for Won.en E 0`J_isitor and ti;an antior,Autho.s:y I _C:anventiar,Oent;rAdv!s^ry Board !:hniami Beach uituratAi s Counc!' - -- -outs:.enter A-iv!SOry a0.and ao I �Vv�;i�!'frGilt�rOieGCfo�i.,Cslii�i:T«.e 2i;-me merw3em 2re i^a"-auired av rite F-c.m t ,pSi3fement.of ���:° I .1l..Et 1 L _ ..� �;�► ;_ .. _ a .. a #s 1 a Ri's•::�'1 t ...#..,\ tia.... � .i ._ a.3:....t..,` Fly.1s�.,.ryy: r e: °':7_: rr _ •:. _ _ r n �.}+ .r.-�$ :�-- � t-_0�:., .r=i:a'iir:i ._ � �•.e!_ a - _ _ _ _ _ __'}: - _�t-= ! f ~ .'�«.:�:�."C ir•ii�:.-�.re `�`-.=C >_-- ,^� :r: �.ar a:'d.-�F;s9r>j'Yr� ��a•�T3 AA,�s+:7 a_:r1: .aaP F-i rrRC�aia+s:'y ....w�o:.rr�s iy•_.iw'srt. i .�v aac."�i�•i wr is i�r...au Giii:�. 1 4 i Type of Professional License f �[ _ i..i'cense 1UuR h*r t 1114 Ni a : ,.:l.�P:+t!a lc_S :t1, i i tt;Ai jt.?7.e.r,i31.+kKi�;ti V'd Z1,6966L90C suigo�j eiggeQ do-V:90 -bl 90 qej °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[�-) No 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 5a If yes,explain in detail: •Are you currently serving on any City Board or Committee?Yes E or No If yes,which boardlcommittee? .In what organization(s)in the City of Miami Beach do you currently hold membership? /V Name OV 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�or No Which department and tide? e Pursuant to City Code Section 2-25(b)_ Do you have a parent , spouse E=J. child L-:-J- brother E3- or sister who is employed by the City of Miami Beach?Check all that apply. �� If"Yes,"identify person(s)and department(s): 41 nsE information is vN- untarry 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 J Female V j Race/r-thnic Categories I What is your race? I I African-American/Black Cauc.asi9 nM1i?h!te i Asian or Pacific Islander j i _ Nativ eArnericaruAmerican Indian I Other-Print Race: Pace 2 of 4 F-u [FV01%A1 1+mPORM.S!k[lAR!?AND('ON1NAl7TFFt APP k'ATli nA R(lARf 1 _tFi-7C[4 3 rim 9'd Z66966L90C sulgo�j eiggeo dOt,:80 t,� 90 qa_� Do you consider yourself to be Spanish,Hispanic or Latinola?Mark the"No"box if not Spanish,ffispanic,Latinala. No Yes Do you consider yourself Physically Disabled? ._:No Yes NOTE:IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARDICOMMITTEE MEMBERS.THESE LAWS INCLUDE,BUT ARE NOT UNITED 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 boardicommittee 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 governrnental 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 Cleric. 1 H Y ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION;AND I HAVE RECEIVED, READ AND L AB E BY CHAPTER 2, LE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR ITY OFFl ERS,EMPLOYE D AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND TATUTES CCORDINGLY." ROB 1,N5 Applf Signature Date Name of p ocant(PLEASE PRINT)_Lk"Received in the City Clerk's Office by: � I Na a of Deputy Ci rk Control No_ D to 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. 33 S01 Page 3 of 4 j F:%CLER%SALL1aFORMS00ARD AND COMNI TTEESSG APPLICATION 46 BOARDS 12-?6-2013.d0C 9-d Z L6966L90£ suigo�j eiggaQ d�V:90 t,� q0 qaj • Acknowledgement of fines/suspension for Board/Committee (Members for failure to comply with Miami, Dade County Financial Disclosure Code Provision Code Section 2-111.11(i)(2) Board Member's Dame: 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 a ci ial q 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.,/Iwww.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/f`orms.htm1 3. A Copy of your 2013 Federal Income Tax Return Failu to fil one of these forms, pu pant to the Miami-Cade County Code, may subject the person to a fine of n more tha $500, 60 days in j or oth. Sign ture Dat Updated:Monday,December 16,2013 Page 4 of 4 F:%CLER13ALL1aFORMSIBOAR0 AND COMMITTEESSC APPLICATION 46 BOARDS 12-16-2013.doc Z-d Z t6966Z909 suigoa eiggea d1-V:90 V l 50 gezi ® • , PO iAAAI BEACH 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) 12—a-16/ r Board Member's Name: _____.. -Q--)f3 • 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.00v/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 more tha $500, 60 days in jail or both. d ....., 2,...,41 ....--/ S-------- Signatu Date Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx Deborah Robilas 1800 West 24 Street; Miami Beach,FL 33140, 305 799 6912, Drobins%07 u gmailxom Energetic, motivated, goal and deadline oriented, excellent communication, problem solver and strong team player. FOSTER CARE SYSTEM Jan 2000 - Ongoing * Mentoring foster youth * Advocate and speaker for foster youth rights * Advocating for foster care involvement DIABETES RESEARCH INSTITUTE Jan 2004 - Ongoing Volunteer on a yearly fundraising event REAL ESTATE Sept 1990 - Aug 2009 Residential sales EDUCATION: University of Maryland Degree: English Z'd EL6966L90C suigo�j eiggaa d6£:80 -VL 50 qe_� .6 . v i SIGNATURE OF BEARER/SIGMATURE UU.Tr7ULA RE f FIRMA DELTrWIAR P Ass PORE PASAPORTE TypefType/Tip& 'CodalCo�r!Ceiliya.pa �oj Fta./,NFLCtitp�epot jNa-ttpPasepcde . .- USA - 429735233 rakt- Surname!loom/Apc ROBINS Gives Names1Pidnom!Nunbres 'DEBORAH JOY Nationality/flafici ld/Nadwalidad UNITED STATES OF AMERICA Dated birth/Dale de trais.areel Fmha de:ncirraer4* ' 07 Jun 1965 Place cf birth/Ueu de missuice ILugard^_naciveMv ScXISM/Sean FLORIDA,U.S.A. F - - Ualedi...ne/0ateded�ltvrartcelFedudeerpedeidn AufMority/Auf�ile/Aularid�d '• .45 AUq 2A07 United States'.. Oateolenpir�llan/Dated irativni"ecfuibei cidad ©eRartmeiitofState 4 Aug 2017 -. -- rner��hRentlarrs s�ix�f Anel�ciatr� •....• ..w-� t p /t • /•' I•l n1 SEE PAGE 27 `sti'r' P<USAROBI 1$< D;EBORAH:<JOY{«-«««.«««««< 42903523 33�lSAb5060..7-0*.F 1314'207686<81:74 4: 0'd Z 66966Z90C suigo�j eiggaQ d6C:90 t 90 qa� ""®°�1DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 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 F1 County Boa r d Member Municipal Board Member Name of Municipality: �Ile Board where serving '57 Ah 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 J^ hereby /ear r affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑Hardcopy ❑Electronic Copy Signature of person disclosing Print name ate signel OFFICE USE ONLY Accepted: Y / N Deficient;: Processed Dat°'Ini;ia!s: Scanned Date/1^itials: 138 SP- " 2/13 cowry IMO SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last First Name Middle Name/Initial 2014 061 :`s Mailing Add ess—Street Number,Street Name,or P.O.Box tS7 ° W City,State, ip ID Number /?/1 33/(/ 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 af unicipal Board Member, Name of Municipality 1 1 `" C Board where serving /'d eJ-, e/A7 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 I Address Description of the Principal Business Activity VOT4 I 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 --epAt La d me Date signed OFFICE USE ONLY Accepted: Y / NJ Deficiency: Processed Date/Initials: Scanned Date/initials: 13S SP-14 2/13 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, www.mismibeachfl.aov CITY CLERK Office CilyClerk @miamibeachfl.gov Tel:305.673.7411 ,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: / 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 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, 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 Cod , Chapter er 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. niA ICk QA��� na e: Date: