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Judith Wurman 12/31/2014 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 02-03-2014 Judith Wurman 110 Washington Ave. #2421 Miami Beach, Florida 33139 SUBJECT Sustainability Committee 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, 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 Elizabeth Wheaton 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.mianUJARI or 3 PN 3: 3 8 OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk SI '� �r � UFFI Tel:(305)673-7411,Fax:(305)673-7254 T � �.I� ��, �t i.;�� TO: Judith Wurtman RE: Sustainability Committee 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: 12/3112 014. 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 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 have served. u ith Wurtman Sworn to and subscribed before me this day of , 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 providing excellent public service and safe�ty to I vVyyho live, work and play in our vibrant,.tTp' al,historic community. We ore committed to providing excellent public service and solely to a'vvho live, work,and play in our vibiani, tropica, �,isrorc commun;iy. j\VA I A t```l 1 A r a C H 0°l J 'D r.,rte._.,i 1T T r r'1 PP IC : � S; ��...•`vRs_���3;., u..jz33,��3 1 :��,-,. 9 �::...1��;�i'j r•l.i�::•r: URTrn e ri 37 Last Name First Name Middle Initial 11b Ave 1 eQ 3 .3 13 J1 �H f a k I Home Address City State Zip Code 30 s -G oy 412 G;? ® 1G-� 6 Piz` e d a (2-)M't.440 Home Telephone Work Telephone Cellular Telephone Email address 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 M or No • Demonstrates ownership/interest in a business in M' I Beach for a minimum of six months: Yes 1-ZI,or No L` • Are you a registered voter in Miami Beach: Yes M or No • I am now a resident of: North Beach E_D. South Beach Middle Beach • I am applying for an appoin me t because I have especial D abilities,know! dge and lZience. Please list below:40 JL to K 1A S C so • Are you presently a registered lobbyist with the City of Miami Beach? Yes�D_l or No L 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 bv 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 ❑Disability 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 Advisory Committee ❑Planning Board ❑Bicycle-Pedestrian Advisory Committee ❑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 I ❑Historic Preservation Board ❑Single Family Residential Review Panel Committee ❑Committee on the Homeless ❑Housing Authority APSustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee ❑Community Relations Board ❑Miami Beach Commission for Women ❑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:ICLERI$ALL12FORMSIBOARD AND COMMiTTEESIBC APPLICATION 46 BOARDS 12-16-2013.doc � a cO 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 E—D 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 IZI or No QJ If yes, please explain in detail: • Do you currently have a violaticn(s)of City of Miami Beach Code?Yes 1_zt or N ._,d<fyes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes 1—:2 or No If yes,explain in detail: • Are you currently serving on any City Board or Committee?Yes�D_or No If yes,which board/committee? • In what organization(s)in the City of Miami Beach do you currently hold membership? 1 4 D JVV a 9®x,1 Name 11-- Positio q ter+-4 Id�'1 M V S e V vYi Po / O G'PJ67 Name Position IV • List all properties owned or in whit you have interest within the City of Miami Beach: a -e. At / • Are you now employed by the City of Miami Beach?Yes EZ211 or No Which department and title? • Pursuant to City Code Sec_tion 2-25 (b): Do you have a parent ED, spouse , child Z�! brother 1_:3 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 co ly with City diversity reporting requirements. Gender: Male Female Race/Ethnic Categories What is your race? ED African-American/Black �Caucasian/White Asian or Pacific Islander Native-American/American Indian Other—Print Race: Page 2 of 4 FACLER\QALL\aFORMS\BOARD AND COMMITTEE-SW APPLICATION 46 BOARDS 12-16-2013.doc Do you ��onsider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. - No Yes Do you Ks' ider 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 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 TA T UTES ACCORDINGLY." Oceived icant's ignatu Date Name of Applicant(PLEASE PRINT) in the City Clerk's Office by Name of Deputy Clerk Control o. JUCILt 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\BALL\aFORMS\BOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013.doc A ' 1 Judith J. Wurtman, PhD 110 Washington Ave Miami Beach Judith J. Wurtman, PhD, is former Director of the Program in Women's Health at the Massachusetts Institute of Technology Clinical Research Center. She was the founder and director of the TRIAD weight management center at McLean Hospital, a Harvard University affiliated psychiatric hospital, and co-founder of the ADARA weight management center in Boston, MA . Dr. Wurtman received a BA from Wellesley College in Wellesley, Massachusetts, her MA from Harvard Graduate School of Education in Cambridge, Massachusetts, and her PhD from The George Washington University in Washington, DC. Dr. Wurtman has had articles published in many professional journals, such as Journal of Nutrition,Journal of Psychiatric Research,International Journal of Eating Disorders, International Journal of Obesity, and Journal of the American Dietetic Association, and is the author of several books.. Additionally, she is the recipient of several honors and awards from the American Dietetic Association, American Institute of Nutrition, and The American Society for Psychosomatic Obstetrics and Gynecology. Dr Wurtman' s research has focused on the relationship between emotional state, carbohydrate craving and brain serotonin. With her husband, Richard, she demonstrated that overeating is often related to the need to decrease stress. They showed that when carbohydrate-rich foods are eaten, the resulting production of brain serotonin improved emotional stability. . She discovered how the consumption of t moderate amounts of carbohydrate prior to meals could decrease subsequent food intake and thus be used as a natural means of appetite control. These discoveries led to the development of a nutritional product for the mood and appetite changes of PMS and the development of a comprehensive weight loss program. Further research on carbohydrate craving during treatment with anti-depressants lead to strategies to minimize and reverse weight gain caused by such drugs. Dr Wurtman has written several books on nutrition and weight loss including Managing your Mind and Mood Through Food and The Serotonin Solution. Her most recent book co-authored with Nina Marquis, M.D , the Serotonin Power Diet was published by Rodale Press in 2007. The book is based on her clinical experience as the founder and director of TRIAD, a weight loss center associated with Harvard Medical School and McLean Hospital.. The clinic treated clients whose obesity was caused by emotional overeating and/or treatment with antidepressant and related drugs. ADARA,the private weight loss practice co-founded with Dr Marquis , carries on a similar program. A children's book that teaches the importance of good eating habits and exercise, " Simon loses his tummy" is in press. .Dr Wurtman is steady contributor of articles on obesity, nutrition, exercise and life style for the Huffington Post,Psychology Today, Web Md and Wellsphere. She also has her own web site, www.serotoninpower diet.com and a live weekly radio program on an NPR affiliate, WHDD. She is a member of the board of directors of Temple Emanuel of South Beach and a docent at the Jewish Museum of Florida. RIVER LICENSE CLASS E : 635-430-37-784-G : 1 l = JUDITH J . i WURTMAA! t 110 WASHINGTON AVE APT 2421 .M�IA p1lhl8B/EoAH,'y.Lt.3c3V139 7239 1 _ OL16 MW -_ORGRPt(1C'1n10R fix k: y 4 ,. SAFE bRhJER �,, N opeeitibn of a motor veFiicle constitutes consent to any sobriety test required by law. MI D DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name I- ' First Name Middle Name/Initial ,oqO/3 ul jf- 1 W UP14—vy-)Ci(/) Mailing Address-Street Number,Street Name,or P.O.Box ash,��, ern ►� � � 1/� / City,State,Zip ID Number /I/ a "/ 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 S4- i>bD pu/Z v U n VZea QAb S a PY&ry ns eS `VI a in e. ob K '� 1'ea c i JS ea rt Pry.. 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 Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency.- Processed Date/initials: Scanned Date/Initials: 138-SP-1-1 2/13 c � i "H /xA1A/\A1BEAk... 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 [dame: -:SUdl+-� -;a 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 i 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 X500, 60 days in jail or both. Sig at re Date Updated: Monday, December 16,2013 i Page 4 of 4 F-.\CLER\$ALL\2FORMS\B0ARD AND COfv M1TTE`S\BC APPLICATION 46 BOARDS 12-16-2013.doc