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Laura Levey Board application package MIAMI BEA BOARD AND COMMITTEE APPLICATION FORM Last Name First Name Middle Initial IJa1/ L&V (-(->" Home Addr ss City State Zip Code -3 boo-Lucy, Home Telephone Work Telephone Cellular Telephone Email address 6A,Vr _ _P2 Business Name Occupation / & 89 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 Qi or No ID • Demonstrates ownership/interest in a business in iami Beach for a minimum of six months: Yes 1.0 or No • Are you a registered voter in Miami Beach: Yes Qor No • I am now a resident of: North Beach I.J South Beach �.] Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: 1L r z • Are you presently a registered lobbyist with the City of Miami Beach?Yes�J 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 ❑Disability Access Committee 0 Miami Beach Human Rights Committee ❑Ad Hoc Committee Centennial Celebration ❑Gay, Lesbian, Bisexual and Transgender ❑Miami Beach Sister Cities Program Enhancement Committee(GLBT) ❑Affordable Housing Advisory Committee ❑Health Advisory Committee ❑Normandy Shores Local Government Neighborhood Improvement Art in Public Places Committee ❑Health Facilities Authority Board ❑Parks and Recreation Facilities Board ❑Board of Adjustment* ❑Hispanic Affairs Committee ❑Personnel Board ❑Budget Advisory Committee ❑Historic Preservation Board ❑Planning Board ❑Committee on the Homeless ❑Housing Authority ❑Police Citizens Relations Committee ❑Committee for Quality Education in MB Warine&Waterfront Protection Authority ❑Production Industry Council ❑Convention Center Advisory Board 16 Miami Beach Commission for Women ❑Sustainability Committee ❑Design Review Board* ❑Miami Beach Cultural Arts Council ❑Transportation,Parking,&Bicycle-Pedestrian Facilities Committee _ ❑Visitor and Convention Authority * 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 V// F\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx f °O 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 LJ 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: FVII • 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 U or No If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes 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 ity of Miami Beach do you currently hold m_embershi nvv\ C��-bof4� a yyti 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 U or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent 4�E, spouse [:J, child brother 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 comply with City diversity reporting requirements. Gender: Male i Female Race/Ethnic Categories What is your race? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American India Other—Print Race: Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx r Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. No Yes I Do you consider yourself Physically Disabled? 116 No LJ 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 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 STAT ES ACCORDINGLY." Z� L-0yo-Y Applicant's Signature Date Name f Applicant(PLEASE PRINT) Received in the City Clerk's Office by ✓� 3/ �� Z / Name of Deputy Clerk C ntrol No. Da e 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\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.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) n Board Member's Name: I�'(/l ayy."- ( 2�C �t ��`Q S 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.gov/elections/Librarv/source of income statement.pd 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. Signature Date Updated:Thursday,March 13,2014 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx LAURA RIVERO LEVEY CANDIDATE FOR MAYOR OF MIAMI BEACH-NOVEMBER 3, 2009, BACKGROUND AND EDUCATION ■ Miami Beach resident since 1981 t ■ Bom 1965 - Caracas,Venezuela ■ Miami Beach Senior High School ■ Miami-Dade Community College ■ Florida International University, B.A. ■ Lives on Pine Tree Drive with her husband and their 5 children 1_4 7070184 ration of f a a motor vehicle co COMMUNITY AFFAIRS ■ President of North Beach Elementary School Parent Teacher Association("PTA"), 2007- 2008 ■ Hispanic Liaison to City of Miami Beach, 2007-2008 ■ Miami Beach Senior High School PTA-Membership Co-Chair, 2006-2007 ■ Hosted Consuls General of France,Israel, Germany and East European government officials ■ Co-Chair of South Florida's Interfaith Coalition on behalf of the American Jewish Committee,November, 2006 ■ Diplomatic tour of Germany as guest of Goethe Institute as representative of the American Jewish Committee, October, 2005 ■ Founder of Miami Beach Senior High School's Marine Biology Program World Ocean Watch("WOW"), 2007 ■ Co-Chair of Immigration and Naturalization Ceremony at Miami Beach Convention Center 1999 (speaker) and 2000 ■ President of Temple Beth Sholom's Parent Teacher Organization ("PTO"), 1996-1998 ■ Cancer Link at Sylvester Jackson Memorial, Member Board of Director 1996-1998 MEMBERSHIPS ■ American Jewish Committee, Member of the Board of Directors, 1999-2009 ■ North Beach Elementary School PTA ■ Miami Beach Senior High School PTA ■ Miami Beach Gifted Association ■ National Council of Jewish Women ■ Temple Beth Sholom ■ Chabad of Venetian Islands, founding member of Womens' Circle ■ University of Miami School of Law Dean's Circle ■ Jewish Museum of Florida ■ Girl Scouts