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Tiffany Lapciuc 12.31.2017 MAMHEACH 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 December 23, 2015 Ms. Tiffany Lapciuc 4900 Pine Tree Drive Miami Beach, Florida 33140 SUBJECT: Miami Beach Commission For Women Congratulations!You have been reappointed by Commissioner Kristen Rosen Gonzalezto the above referenced, board or committee named above, for a term ending: 12/31/2017. Pursuant to City of Miami Beach Code Section 2-22 (5) a, "Notwithstanding any other provision of the City Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointment/election of the successor City Commission member." If you are unable to accept this appointment, or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations and good luck. Regards, Raf el Granado City lerk ' cc: Saul Frances, Parking Director Bonnie Stewart, City Liaison 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 Employees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community. MIAMI BEA H 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: Ms.Tiffany Lapciuc RE: Miami Beach Commission For Women 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: 12/31/2017. 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 Florida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Officers 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 1st, following the closing of the calendar year on which I have served. _ II ifeL 4 'iffany !":-rcc Sworn to and subscribed before me this 6 day of{tailo , 2016 OPP --Glare-Ea-Rasa- r 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 safety to all who live, work and play in our vibrant,tropical,historic community. ADE COUNTY SOURCE OF INCOME STATEMENT COUNTY Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2014 &A,,,, / Mailin g Ad r ss—Street Number,StreeNa me,or P.O.Box _. 960 p 1„Lo- , -—i 9 re z Di-7 ve City,State,Zip /(,/'� ID Number (2-2, 6 i 6 1 '73 If your home address is your mailing address, and your home address is exempt from public records pursuant to Ha. Stat.§119.07,read instructions on the following page and check here.: Filing as—an Frnployee n County Employee fl 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: it, � r., e Board where serving 'I ' ci D-Y) Vr)l ) v� COY- W d 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 (5800 iU60 qg G flr) .0 ar4-- i i (-it 01 1 C i 1 L. . I hereby swear(or affirm)that the information above is a true and correct statement. I RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ? ❑ Electronic Copy 1/_�/i A ht4:'2 Signae orrondi•rld7 titt. . _ ._/ _ Co 6 Print name / la signed OFFICE USE ONLY Accepted: Y i N Deficiency: Processed Date/Initials: Scanned Date/Initiais: 138_SP-14 2/13 . 8L--ARJ Ar4;., CO�Yfai,!!TEE APPLICATION L.+.A{lea'! i°lJR.ri r � G e Last Na e First Name Middle Initial C, � 3 14con -7r_ i2i9 , _�f_tV_z f-L. I I 3/lyo Home Address City State Zip Code 05-311 , vs Home T lephone Work Telephone Cellular Telephone Etnail 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 minimu f 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 or No • Demonstrates ownership/interest in a business in Mmivni Beach for a minimum of six months: Yes[_�a or No • Are you a registered voter in Miami Beach: Yes V or No.�:_3_ C--) • I am now a resident of: North Beach E.3 South Beach [-::) Middle Beach --- • I am applyin for an appointment because I have sp V bilities, knowledge and experience. Please lisgelo on I / D 7-1 o Are you presently a registered lobbyist with the City of Miami Beach? Yes 0'or No Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choices Please nffi that only three 3 choices will be observed by 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 ine 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 0 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 Over ❑Historic Preservation Board ❑Single Family Residential Review Panel Committee ❑Committee on the Homeless ❑Housing Authority ❑Sustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑M vine Authority ❑Transportation and Parking Committee ❑Community Relations Board 1114liami Beach Commission for Women ❑Visitor and Convention Authority ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board x ❑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 S F:ICLER\SALL1aFORMS180ARD AND COMM1TTEESIBC APPLICATION 46 BOARDS 12-10-2013.doc �41 °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 No Dates of Service: 2. Present participation in Youth Center activities by your children:Yes EZI 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 EZ�or No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes E-Zt or N ! If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes or Not 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 Piave an interest within the City of Miami Beach: • Are you now employed by the City of Miami Beach?Yes EZI or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent , spouse , 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 55 y with City diversity reporting requirements. Gender: Male . Female Race/Ethnic Categories What is your race? ican-American/Black E CaucasianNVhite ID Asian or Pacific Islander Native-American/American Indian Other—Print Race: Page 2 of 4 F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. Y No EI Yes Do you consider 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 88 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 STATUTES ACCORDINGLY." Applicant's i nature P Name of Applicant(P EASE PRIG'T) Received in the City Clerk's Office by ame of Dep ty Clerk Control No. D to r j 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\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc NAIAMIBEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachn.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 305.6 73.7411 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: 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.pd 2. A "Statement of Financial Interests (Form 1)" For your convenience, the form is attached. The form can also be downloaded at: http://wwvv.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 than $500, 60 days in jail or both. Signature Da Updated: Monday,December 16,2013 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 50ARDS 12-16-2013.doc i From: Mom tiffanylapciuc@bellsouth.net Subject: Tiffany Resume Date: February 6,2014,2:02 PM To: Mom tiffanylapciuc @bellsouth.net Tiffany Lapciuc Born in Miami Beach,Florida Reside in Miami Beach,Florida Graduated from University of Miami with a B.B.A. In Finance And an M.B.A. In Finance Currently raising six children ranging in age from 27 to 7. Also three grandchildren. Married to Marcos Lapciuc previous Chairman of Jackson Health Systems Served on the Commission for Women for two years _ 111011 p vv. a S11\ -tip\ £� _ h Z T ' 4 3 ?x ,1 i � z I 1 i City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK'S OFFICE CityClerk©miamibeachfl.gov Telephone: 305.673.741 1 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: /� `‘, la-AO /zia 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.qov/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 than $500, 60 days in jail or both. 7 .:/�` V t Signature e V • Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLER\SALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx m Am EAcH DIVERSITY STATISTICS REPORTING Name: /, f-tdnq - d i U c Board / Committee: A- 4,67.,44-1 zj / .4/ ajo./0.7&-J Appointment Date: / 2. -9 Pursuant to City of Miami Bea Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male I<-._. Female 1 Race/Ethnic Categories What is Y our race? PA -American/Black I,VU Caucasian/White Asian or Pacific Islander La Native-American/American Indian Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanis , Hispanic, Latino/a. No • Yes Do y-u consider yourself Physically Disabled? Pi No Yes C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015