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Mojdeh Khaghan Application PackageMIAMI BEACH e{ BOARD AND COMMITTEE APPLICATION FORM Last Name 515<Li-)s PN1e (I 1-1Z7 Home Address First Name n F - Middle Initial �3I4131 City State Zip Code 3©5 1-1‘fr�57-7)-y-1-l-nri K(\71(1\ Co Home Telephone Work Tele honeCellular TeJ,ephone\�^ ^ I Email add s Business Name Occupation Business AddressErx _ity State Professional License (describe): CC�-1 VIEDI A / Expires: Please attach a copy of currently effective professional license. Zip Code 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 or No 111 • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes or No • Are you a registered voter in Miami Beach: YesZ) or No • I am now a resident of: North Beach Ui South Beach Middle Beach • I am p g fir an a p intment because I have special abi. ities, knowledgeand experi�ncq. Please list below: I� N q'lkf 1 /�� L) lam/ � `o"GI� • 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 0 Health Advisory Committee 0 Parks and Recreation Facilities Board °O D Art in Public Places Committee 0 Health Facilities Authority Board 0 Personnel Board 0 Audit Committee 0 Hispanic Affairs Committee 0 Planning Board** ❑ Board of Adjustment ** ❑ Historic Preservation Board* 0 Police Citizens Relations Committee 0 Budget Advisory Committee '`Housing Authority 0 Production Industry Council 0 Committee on the Homeless 0 Human Rights Committee 0 Sister Cities Program 0 Committee for Quality Education in MB 0 LGBT Advisory Committee 0 Sustainability Committee ❑ Convention Center Advisory Board 0 Marine & Waterfront Protection Authority 0 Transportation, Parking, & Bicycle -Pedestrian Facilities Committee ❑ Cultural Arts Council 0 Miami Beach Commission for Women 0 Visitor and Convention Authority ❑ Design Review Board* 0 Normandy Shores Local Government Neighborhood Improvement 0 Youth Commission 0 Disability Access 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 C:\Users\CLERQueR\Desktop\BC APPLICATION.docx Page 1 of 4 °O 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 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 Not If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes 11 or No1If yes, explain in detail: • Are you currently serving on any City Board or Committee? Yes Il or No Calf yes, which board/committee? • In what organization(s) in the City of Miami Beach do you currently hold membership? Name Position Name • List allroperties owned or i w ich yo have an interest within the City of Miami Beach: l 5 CS S Ie- l�1 V t �-b Position • Are you now employed by the City of Miami Beach? Yes or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you h_ av- a parent [D, spouse � child Ul brother Ul or sister U1 who is employed by the City of Miami Beach? Yes mor No kilal 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 Female Race/Ethnic Categories What is your race? Zi IAfrican-American/Black Ifs Caucasian/White fI� Asian or Pacific Islander Native-American/American Indian C:\Users\CLERQueR\Desktop\BC APPLICATION.docx Page 2 of 4 Other — Print Race: la Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a. No Ul Yes Do you consider yourself Physically Disabled? No I��.1 U1 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." plicant's Signai1 (01--"- I [ 4 - Date Name of Applicant (PLEASE PRINT) Received in the Office of the City Clerk by: 4 Gt We//1 C-Ywerz4/444e, Name of Deputy Clerk )itr /z/Z//‘ Control No. Date ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. C:\Users\CLERQueR\Desktop\BC APPLICATION.docx Page 3 of 4 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. iiiiii//' L -n Signature Updated: Thursday, December 22, 2016 C:\Users\CLERQueR\Desktop\BC APPLICATION.docx Page 4 of 4 J D -) c72D Ji Date MOJDEH L. KHAGHAN 5151 Collins Avenue, Miami Beach, FL 33140 305.772.4444 . mlk@morganreed.com EDUCATION Columbia University School of Law, J.D. 1991 Journal of Law & the Arts, Articles Editor Arts Law Clinic/Volunteer Lawyers for the Arts Law School Senate Parliamentarian Columbia College, Columbia University B.A. magna cum laude 1988, English Literature Phi Beta Kappa LICENSURE The Florida Bar, United States District Court, S.D. Florida 1995; New York State Bar, United States District Courts, S.D. and E.D. New York 1992; New York State Real Estate Broker 2008; Florida Real Estate Broker 2010; Florida Supreme Court Certified Circuit Civil Mediator 2013. EXPERIENCE Morgan Reed Group LLC Miami Beach, FL Principal, Counsel Officer, director and shareholder of diversified investment holding company specializing in real estate and securities; review and negotiate contracts, leases, equity offerings, shareholder agreements. 1997 to present Mojdeh L. Khaghan Miami Beach, FL Attorney Practice specializing in securities litigation, shareholder class and derivative actions, trusts and estates litigation. Extensive merger related document review and analysis for disputed transactional cases. 1996 to 2007 Goodkind Labaton Rudoff & Sucharow New York, NY Litigation Associate Concentrated in '33 and '34 Act litigation and securities class actions in federal and state courts. Handled all aspects of cases from discovery through trial and/or settlement, post -settlement distribution of recovery to clients and class members. Established Miami office of New York based law firm. 1992 to 1996 COMMUNITY Jackson Health System INVOLVEMENT Treasurer, Public Health Trust 2013-15 Chair, Audit & Compliance Subcommittee 2012-15 Financial Recovery Board Member 2012-14 Wexner Heritage Fellow Miami 2009-11 Greater Miami Jewish Federation 1999 to present Agency Support Committee, Co -Chair 2012-15 Women's Philanthropy President 2010-12 Campaign Chair 2007-09 Responsible for $7 million Women's annual fundraising effort, leadership development and training Stanley C. Myers President's Leadership Award 2008 City of Miami Beach Vice Chair, Personnel Board 2011 to present Chair, Personnel Rules Revision Committee 2012-14 Youth Center Advisory Board 2007-11 PERSONAL Languages — Farsi, Spanish, French, Italian Interests — Travel, Literature, Arts & Music / ej