Oliver Stern Application PackageMIAMI BEACH
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Last Name
70( e�51-d.;(;do dCat_
Home Address
3‘75— 53t- a 14
Home Telephone
N/A
Business Name
N/p
105 —6)L -Solt
Work Telephone
BOARD AND COMMITTEE APPLICATION FORM
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First Name Middle Initial
nti
City
305-6 Tx -soli
Cellular Telephone
Occupation
State
33134
Zip Code
0 51-ei-,- exec co.-�
Email address
L- y t. ST E'A/ a l9 od. cd,,,
Business Address
Professional License (describe):
City
State
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 IA or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes or No4_,
• Are you a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach South Beach -. Middle Beach Zi
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
p z- it ' c .r6 t osx77 4, c/ird c v
• 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.
0 Affordable Housing Advisory Committee
0 Health Advisory Committee
0 Parks and Recreation Facilities Board °O
0 Art in Public Places Committee
0 Health Facilities Authority Board
0 Personnel Board
0 Audit Committee
0 Hispanic Affairs Committee
0 Planning Board**
0 Board of Adjustment **
0 Historic Preservation Board*
0 Police Citizens Relations Committee
0 Budget Advisory Committee
0 Housing Authority
0 Production Industry Council
0 Committee on the Homeless
'Human Rights Committee
0 Sister Cities Program
0 Committee for Quality Education in MB
2-LGBT Advisory Committee
0 Marine & Waterfront Protection Authority
0 Sustainability Committee
0 Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
0 Convention Center Advisory Board
0 Cultural Arts Council
0 Miami Beach Commission for Women
0 Visitor and Convention Authority
9 Design Review Board*
0 Normandy Shores Local Government
Neighborhood Improvement
0 Youth Commission
&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 Professional License License Number
of
License Issuance Date License Expiration
Date
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°° 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 n 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 L If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes Z1 or No
„a If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes or No IZ4 If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No Zi If yes, which board/committee?
\ iSAb; (; t Y A -cc dss Gor.r►;#a c
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Pc,(, W
Name
Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
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• Are you now employed by the City of Miami Beach? Yes `. ..11 or No
Which department and title? �y
• Pursuant to City Code Section 2-25 (b): Do you havF a parent IZ1, spouse , child I brother IZ1 or sister who is
employed by the City of Miami Beach? Yes I .. nor No
I
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 rES Female
Race/Ethnic Categories
What is your race?
II
4 frican-American/Black
"t Caucasian/White
11 Asian or Pacific Islander
Native-American/American Indian
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FICLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
LI Other – Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a.
1-14/No
Yes
Do you consider yourself Physically Disabled?
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 ANDIOR STATE LAWS AND
STATUTES ACCORDINGLY."
c%,"/\i/7-116 aver sktr
Applicant's Signature Date Name of Applicant (PLEASE PRINT)
Received in the Office of the City Clerk by: dem ��i7�u 1/ / 6 Z
Name of Deputy Clerk 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.
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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: 305.673.741 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:
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.
Updated: Tuesday, October 04, 2016
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diver L. Stern
-01 East Dilido Drive
Miami Beach. FL 331.5-
305-632-5011
O.Stern@aol.com
Education
Ransom Everglades School
Coconut Grove. FL
Class of 2019
Awards and Distinctions
Effort and Honor Roll every semester
Prudential "Spirit of the Community" Award. 2015
Faculty Award, Ransom Everglades, 2015
Citizenship Award, Ransom Everglades. 2014
Outstanding Sixth Grader. Ransom Everglades 2013
City of Miami Beach. "One World Many Abilities Day". January 13. 2012
Miami Beach City Commission, "Oliver Stern Day", December 12, 2012
Featured. "You Heard it Hear". Hearing Health Seminar. January 31. 2012
Featured "Ten -Year -Old Black Belt has Two Cochlear Implants". ATA World. Vol. 18. Fall
2011
Invited Speaker before the Florida Senate. Subcommittee on Education. on the benefits of
Auditory Oral Education, March 17. 2010
Extracurricular Activities
Member. Disability Access Committee. City of Miami Beach
President, Student Government, 2014 — 2015
Drama Program, You Can't Take it With You (2015), Ocho (2015), the Hobbit (2014) and
Suessical (2013 t
Student Government Representative, 6m Grade, 7' grade, and Student Body President of the
Middle School
Founder, Our Abilities Program, which includes:
One World Many Abilities, North Beach Elementary
Oliver's Hearing Aid Bank (OHAB), University of Miami Department of Otolaryngology
http://otolaryngology.med.miami.edu/divisions/div-ear-institute/ei-olivers-hearing-aid- bank
Ambassador, University of Miami Ear Institute
Ambassador, Miami Children's Hospital Craniofacial Association
worth beach Star for efforts implementing One World Many Abilities
Summer Experiences
International Culinary Institute, New York, New York, 2015
Champion Briefs Debate Program, Nova University, Ft. Lauderdale, Florida, 2014-2015
Great Books, Amherst College, Massachusetts, 2014
EXPLO, St. Marks, Southborough, Massachusetts. 2013
Education Unlimited, Public Speaking Camp, Stanford University, California. 2013
Debate
2°d place, Congressional Debate, Bulldog Invitation, 2015
2°d place, Public Forum Debate, Flying L Invitation, 2015
Top Speaker, Public Forum Debate, Blue Key Debate Tournament, University of Florida,
201f
3R place, Public Forum Debate, Catholic Forensic League Tournament #2. 2015
Octofinalist (Top 16), Public Forum Debate, Harvard University Invitational, 2016
1' place, Public Forum Debate, Catholic Forensic League Tournament #4
Semifinalist. Public Forum Debate. Palm Beach Catholic Forensic League. 201--
Semifinalist.
0 -Semifinalist. Public Forum Debate. Florida Forensics League Novice State Tournament
2016