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Karen Rivo 12.31.2017 MIAME \CH I Cit y 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 29, 2015 Ms. Karen Rivo 4566 Prairie Ave. Miami Beach, Florida 33140 SUBJECT: Health Advisory Committee Dear Ms. Karen Rivo: Congratulations!You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2017. 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 again and good luck. Regards, "2"11".1111111m17. 7.414urr / R ae Granado 4i City Clerk cc: Saul Frances, Parking Director Sonia Bridges, 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 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. 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: Ms. Karen Rivo RE: Health Advisory Committee 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. AO`.�. Ms. Karen Rivo Sworn to and subscribed before me this 7 day of , 201, 741110%ri —elere-6a-Rese— e Qua 7 g;,./ 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. T M IA M COUNTY aDE COUNTY SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2014 h rem 'r________ 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.0 Filing as an-Employee--- n 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 servin I-I e a l Odiq .-a 41#4, e 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.I Name of Source of Income Address Description of the Principal Business Activity ?-e---4--tr---c___A I hereby swear(or affirm)that the information above is a true and correct statement. I RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ^) a_ ) L E] Electronic Copy Signature of p son disclosing (r-4...."--00-1 K1 VO / L Print name Date signed OFFICE USE ONLY Accepted: Y i N Deficiency: Processed Date/Initials: Scanned Date/Initials: 13s SP-14 2/13 Mi AM I BOARD AND COMMITTEE APPLICATION FORM Last Name First Name Middle Initial vs_ \ I— Home Address City State Zip Code f—&C afkilk c c-cA FL S fY Home Telephone Work Telephone Cellular Telephone Email address 3DS (e-74 ci<f) &o z 7 p-e Business Name Occupation irvvck Business Address City State Zip Code Professional License(describe): Expires: 4 1 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+l or No • Demonstrates ownership/interest in a business in Mimi Beach for a minimum of six months: Yes or No • Are you a registered voter in Miami Beach: Yes 1, or No • I am now a resident of: North Beach Di South Beach 111 Middle Beach • I am applying for an appointment because I have special abilitiq.s, knowledge and experi nce. Please list below: J (/ C c v-v■ve, % I 1 e-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 Office of the City Clerk. ❑Affordable Housing Advisory Committee ❑Health Facilities Authority Board ❑Normandy Shores Local Government Neighborhood Improvement 0 Art in Public Places Committee ❑Hispanic Affairs Committee 0 Parks and Recreation Facilities Board °o ❑Board of Adjustment** ❑Historic Preservation Board * 0 Personnel Board ❑Budget Advisory Committee 0 Housing Authority 0 Planning Board** 0 Committee on the Homeless ❑LGBT Advisory Committee ❑Police Citizens Relations Committee 0 Committee for Quality Education in MB 0 Marine&Waterfront Protection Authority 0 Production Industry Council 0 Convention Center Advisory Board Miami Beach Commission forWomen 0 Sustainability Committee ❑Design Review Board** 0 Miami Beach Cultural Arts Council ❑Transportation,Parking,&Bicycle-Pedestrian Facilities Committee I 0 Djrability Access Committee 0 Miami Beach Human Rights Committee 0 Visitor and Convention Authority "Health Advisory Committee ❑Miami Beach Sister Cities Program * 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-effective license, and furnish the following information: Type of Professional License License Number -.•-'i ;,..��,, _ ��l i J mom: License Issuance Date License Expiration Date ' °I h-- ,-j- pjn, 6k .,I ♦ 5 � 1 Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06052015.docx °° Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with the Scott Rakow Youth Center and/or the North Shore Parks Youth Center: • Please describe your past service with the City's Youth Centers (include dates of service): • Present participation in Youth Center activities by your children:Yes No Zh 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 DI or No 43 If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes or No"lf 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 lror No Di If yes,which board/committee?, , • In what organization(s)in the City of Miami Beach do you currently hold membership? sly Name Position Name Position • List all properties owned or in which you have an interest within the City of Miami Beach: 4 Inc L p i 4^1 e - L-�o °•,�` e •Are you now employed by the City of Miami Beach?Yes 11 or No Z Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent 4- , spouse L, child brother Li or sister who is employed by the City of Miami Beach?Yes Dor No 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 La Female Z] Race/Ethnic Categories What is your race? E rican-American/Black Cfaucasian/White Asian or Pacific Islander Native-American/American Indian Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06052015.docx Other–Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. ca1<o U Yes Do you consider yourself Physically Disabled? INo I 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 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 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 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. 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. 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." Gil— /2AA1-t) ‘/ ' ei g I� , w Applicant Name of Applicant(PLEASE PRINT) Received in the Office of the City Clerk by: 0..a...a...,_104(....--■-- 9 Yr /d , Name of Deputy Clerk Control No. Date PLEASE 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 06052015.docx MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK 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 1, of each year. 1. A "Source of Income Statement" 2. A "Statement of Financial Interests (Form 1)" 3. A Copy of your latest 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. Cl Signature Date Updated: Friday,June 05,2015 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06052015.docx Karen Rivo, RN, MSPH 4566 Prairie Avenue Miami Beach, FL 33140 Phone: (305) 674-9480 Cell (305) 283-3897 Karenrivo @gmail.com Resume Summary Registered nurse with masters in public health and over 30 years of clinical, management, and leadership experience in hospitals, health centers, public schools and the community. Strong record of success in advocacy, operations, and project management. Education: Master of Science in Public Health, May 1985 University of North Carolina, Chapel Hill, North Carolina Concentration: Health Policy and Administration Thesis: Fitness Programs in the Work Place Bachelor of Science, May 1977, Cum Laude University of North Carolina- Greensboro, North Carolina Major: Nursing Award: Sigma Theta Tau, Nursing Honor Society RN License: Florida #1298582 -expires 4/30/17 Professional Experience: Miami-Dade County Public Schools - Office of Community Engagement 2011 - 2014 • Administrator, Florida KidCare Grant - Supervise outreach to 200 schools Home Med Solutions, Miami Beach, Florida 2009- 2012 • Home Health Nurse - Administer health care to patients in their homes Molten Immunization Clinics, Phoenix, Arizona 2009- 2011 • Flu Vaccination Nurse - Administer influenza vaccinations in the community Election Assistance Commission, Washington, DC 2009 - 2011 • Grant Peer Reviewer - Review grants for a federal Election Agency Camp Coleman, Cleveland, Georgia, - 1999 • Staff Nurse - Responsible for health care of 600 campers and staff Miami Beach Community Health Center, Miami Beach, FL 1997 • Coordinator of Professional Services - Responsible for all health service delivery provided by medical and nursing staff, including infection control and immunizations; total quality management; credentials; and employee health. Providence Hospital, Washington, DC 1986 - 1995 • Administrative Supervisor - Administratively responsible for the Department of Nursing and hospital operations for this 400-bed hospital. • Nurse Manager and Staffing Coordinator - Supervised the float pool, per diem and agency staff; Coordinated daily staffing and scheduling operations for 800+ nursing employees; implemented patient classification, recruitment, and quality assurance systems. Duke University Medical Center, Durham, North Carolina 1980- 1985 • Staff Nurse and Team Leader Supervised and administered patient care on 16 medical, surgical, and pediatric units. Karen Rivo, RN, MSPH Traveling Nurse Corps, Boston, MA 1981 - 1982 • Traveling Nurse - Staff nurse on medical -surgical units at Tulane University Hospital, New Orleans, Louisiana; Sierra Vista Hospital, San Luis Obispo, California, and North Broward Hospital, Pompano Beach, Florida North Carolina Memorial Hospital, Chapel Hill, North Carolina 1977- 1980 • Charge Nurse - Supervised care of acutely ill neurology patients; Designed new Kardex system Volunteer Service: Miami-Dade County • Vice-Chair, Florida KidCare Coalition of Miami-Dade County 2012- 2013 • Member, Steering Committee, The Children's Movement of Florida 2012 -2013 Florida Department of Health in Miami-Dade County • Member, Tobacco-Free Workforce Group, Miami-Dade County 2011- 2013 Miami-Dade County Public Schools • Chair, School Health Medical Advisory Committee (SHMAC) 2009 - 2011 • Chair, Budget Priorities Subcommittee 2009 - 2012 • Chair, Family and Community Involvement Advisory Committee 2007 - 2009 • Vice-President, Miami-Dade County Council of PTAs/PTSAs 2009 - 2010 • Chair, Health/Safety Committee, Dade County PTA 2006 - 2009 • Member, Wellness Advisory Committee 2006 - 2009 • Member, Miami-Dade Task Force for Bullying Prevention 2005 - 2009 • PTSA President, Miami Beach Senior High 2007 - 2009 • Member, Emergency Response Crisis Management Grant 2005 - 2006 • Appointee, Diversity, Equity, Excellence Advisory Council 2004 - 2005 • Member, Promoting a Safe Learning Environment Task Force 2004 - 2005 • PTSA President, Nautilus Middle School, Miami Beach 2004 - 2006 • PTA President, North Beach Elementary SchooL, Miami Beach 1999- 2000 City of Miami Beach • Chair, Health Care Task Force 2012- present • Chair, Committee for Quality Education 2010- 2012 • Chair, Governing Board, Service Partnership Grant 2008- 2009 • Chair, Committee for Quality Education 2005- 2007 • Member, Committee for Quality Education 1999- present Community • President-elect, Temple Beth Sholom, Miami Beach 2015- present • Vice-President, Temple Beth Sholom, Miami Beach, FL 2002 - 2015 • Board Member, Ayuda Inc, 2002 - 2003 Professional Affiliations: • American Nurses Association • Sigma Theta Tau, National Nursing Honor Society • Florida Nurses Association Honors: • Hannah G Solomon Award, National Council of Jewish Women, 2012 • Tobacco Recognition Award, Consortium for a Healthier Miami-Dade, 2012 • Volunteer Award, Miami-Dade County Health Department, 2010 • Adult Volunteer of the Year, Miami-Dade County Public Schools, 2008 • Honorable Mention, Miami-Dade County PTA President of the Year, 2008 • Outstanding Volunteer Award, Temple Beth Sholom, 2008 • Volunteer Hall of Fame, Miami- Dade County Public Schools, 2006 • Recipient, Woman Worth Knowing Award, City of Miami Beach, 2002 ..... . •.;.,‹< itlt,a,'';',‘ ';Ii: 4),=„:-.,,, ki9tkiP6lyg'iz"it?.. ,,,, - * F , ....... 41,, , t,. 4.... ...1.1), . .: , :."0 ..,. .A' E el*, ,i i.. . tr., - 4.... eV i:',4•1" 1 ;1,,'49fli, A• D ,. - :<-f, ' 1 n , , 0 t IS • *F 'i sidALou, , ... . ,. . ..., ' 01 /20 ' RN 22 1• .... #. - ..,..,..,.., t ''.'.k'_ : namick e v. 444 fl 4 , •,,f ,,,,i .or, ; 1 A r.,: k,.. . ,4,,,,w-: -....„; _ 7.,.t.:77..z..0.. -'-, ''''''' 1,fsfri; :, . • 49 l'''' itic„, ,,A ,, ,,,. ,.4. 1..11 opir _..__,.,,_ ,,_ _,L a ..„,, ; ,„ : 4: _-, $1,,,ff,-„i, ' /-I, " III'r .•' ..*;;;:-,f It4SEN TER P; v...4,idl. ,' : :4',...--' 7.-..,4.: 7,:-. 4588 PRAIRIE AVE ,-7,--'''-' " t r .:•-4, et ,,,...,,01:::,.., ,;;:!:,,,.. muvr, : ._:,!..,,,, ....,:,_ .; -,i r .44 ... ,•- P.' 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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 Name: 4ce', ti 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. /zt, 24) Signature Date Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx m 1 AAA { E ,A H DIVERSITY STATISTICS REPORTING Name: / a k ler • Board / Committee: 1a 1 // r U L So a e Appointment Date: / Z� / �r Pursuant to City of Miami Bea h 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 Female Race/Ethnic Categories What is your race? rican-American/Black Caucasian/White La Asian or Pacific Islander La Native-American/American Indian La Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. 21<lo Yes Do you consider yourself Physically Disabled? No D 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