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Sorangely Menjivar Application PackageMIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeochfl aov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov May 1, 2017 Ms. Sorangely Menjivar 14801 North Spur Drive. Miami, Florida 33161 RE: Health Advisory Committee Dear Ms. Solangely Menjivar: Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2018. 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 as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulatio again and good luck. Regar R el a do City Clerk cc: Saul Frances, Parking Director Sonia Bridges, City Liaison ENCLOSURES: Oath of Office/Oath of Civility/Acknowledgements City Code/Ordinance section applicable to agency, board or committee City Code Sections 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 Citywide 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 331 39 www.miamibeachfl,gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov Oath of Office Oath of Civility Acknowledgement Ms. Sorangely Manjivar 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: 12/31/2018. To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all actions taken and all communications made by me as a public servant. 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 that I 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. Ms. Sorangely Menjivar Sworn to and subscribed before me this____e day of -( 1 X2017 J64 - ;LDeputy Clerk We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. i if 11\1 V D' E City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, v/ww.miomibeoch'l.aov CITY CLERK'S OFFICE Telephone: 305.673.741 1 Fax: 305.673.7254 CityClerk@miamibeachfl.aov 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: e; 0'r q N C�lV /u ' _/ 1P H I I I�'Z 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 "Staternent 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 jaii or both. Siomgture Updat_ed: Monday, April 20, 2015 P3ae 4 oT 4 FACLER\SALL\aF0RiMS\B0ARD AND CGNI1%1ITTEES\6C APPLICATION REVISED 06022014.cocx M®DADS SOURCE OF INCOME STATEMENT Section 2-11.1(1) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st of every year. Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2016 j`( �N t �fa�. �j O ►^avr �� Mailing Address — Street Number, Street Name, r P.O. Box lq&o S �2. City, State, Zip F L 3 3 I 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. ❑ Filina as an Emnlovee (check one) E] County F1 Public Health Trust Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member (check one) County 1-I Municipal: O a Q. w,"' � 4? 114JI, (Municipality) Board where serving A 0 k C �h a d U (50Y Cern Oq� Alternate address (if home address is exempt) Work telephone Term began on/ended 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. Examples of sources of income include: compensation for services, income from business, gains from property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another nercnn fnr vnnr hanafit Hnwaver the inrnma of vnnr annnse or env hnsinass nartner need not he disclosed. If continued on a separate sheet, check here.❑ Name of Source of Income Address Description of the Principal Business Activity t � (ct,.n.t � o r� � 2 0 1 (�o S � (S u, ✓'J I V � c� vn �� int �� C9-rc- I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing' / % 1 Date signed RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP -14 COE 2016 MIAMIB EAC BOARD AND COMMITTEE APPLICATION FORM Menjivar _ Sorangely Last Name First Name Middle Initial 14801 North Spur thrive Miami FL 33161 Home Address City State Zip Code 305-949-3911 305-538-8835 305-992-2241 sorangelym@mbchc.com Home Telephone Work Telephone Cellular Telephone Email address Miami Beach Community Health Center Registered Nurse Business Name Occupation 710 Alton Road Miami Beach FL 33139 Business Address City State Zip Code Professional License (describe): Registered Nurse Expires: 4/30/2019 Please attach a copy of currenVy 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. r • Resident of Miami Beach for a minimum of six (6) months: Yes C-11 or No • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes FX31 or No! • Are you a registered voter in Miami Beach: Yes � or No • I am now a resident of: North Beach �7--TJ South Beach 0 Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: I am the rhiPf OpernfingDffir•.Pr at Ulamm RipaCb Cnmml lnitvT i-laaltb Gegter I have IA years of experience in healthcari� • Are you presently a registered lobbyist with the City of Miami Beach? Yes or No 13 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. D Affordable Housing Advisory Committee 1RI-iealth Advisory Committee D Parks and Recreation Facitkies Board D Art in Public Places Committee 23flealth Facilities Authority Board D Personnel Board D Audit Committee D Hispanic Affairs Committee D Planning Board` G Board of Adjustment ` D Historic Preservation Board D Police Citizens Relations Committee D Budget Advisory Committee D Housing Authority ❑ Production Industry Council D Committee on the Homeless D Human Rights Committee D Sister Cities Program D Committee for Quality Education in MB D LGBT Advisory Committee D Sustainability Committee Convention Center Advisory Board C Marine & Waterfront Protection Authority 3B4ransportatlon, Parking, & Bicycle -Pedestrian Facilities Committee D Guttural Arts Council D Miami Beach Commission for Women D Visitor and Convention Authority D Design Review Board D Normandy Shores Local Government D Youth Commission Neihborhood Improvement D 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 Page 1 of 4 C:Ulsers%CLERQueR\Desktop\BC APPLICATION.d= 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 1:1. No 0' 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: • Have you ever been convicted of a felony? Yes 4 - ! or No Q''� if yes, please explain in detail: • Do you currently have a violations) of City of Miami Beach Code? Yes ID or NoTj If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes 7-1. or No Z) If yes, explain in detail: • Are you currently serving on any City Board or Committee? Yes 7 or No M. If yes, which boardlcommittee? • 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 have an interest within the City of Miami Beach: • Are you now employed by the City of Miami Beach? Yes or No ID Which department and title? • Pursuant to City Code Section 2-25 (b): Do you nave a parent spouse child brother 1-7A or sister 0 who is employed by the City of Miami Beach? Yesor No M r 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 tw�o;; comply with City diversity reporting requirements. Gender: Ma;e C=arnage ,,. _ Race/Ethnic Categories What is your race? African-American/Black 4�J CaucasianMJhite Asian or Pacific islander .. Native-American/American Indian Page 2 of 4 CAUsers\CLERQueR\Desktop\BC APPLICATION.docx Other — Print Race: Do you consider yourself to be Spanish, Hispanic or Latinola? Mark the "No" box if not Spanish, Hispanic, Latino/a. Na Yes tDoo ,you consider yourself Physically Disabled? 4 =?: No Yes NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARDICOMMITTEE 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 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 bit 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 STATUT= ACCORDINGLY." Received in the Office of the City Clerk by: Name of Deputy Clerk Sty (CA ,qe.4Jjycat Name of Applicant (PLEASE PRINT) Control No. Date IJ 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 C:Wsers%CLERQueRXDesktop1BC APPLICATION.dccx L City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www. miamibeachfl.gov OFFICE OF THE CITY CLERIC CityClerk@miomibeachfi.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(1) (2) Board Member's Name: D (-4�^Lam{ K &.j- 1 J ot' 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. Him Updated: Thursday, December 22, 2016 Page 4 of 4 C:11JsersICLERQueRlDeskrop\BC APPLICATION.doex SORANGELY MENJIVAR, RN, MSN, LHRM 148ol N. Spur Drive I Miami, FL 33131 C: (305) 949-39111 H: (305) 992-22411 menj farn5i@ms_n...com SENIOR -LEVEL EXECUTIVE: NURSING, PATIENT CARE, AND HEALTHCARE OPERATIONS Nursing Team Leadership I Financial and GrantManagement I Patient Care and Services Executive healthcare leader with over 15 years of experience in all facets of nursing, patient care, financial management, and staff training and development within high-profile community health organizations. Skilled in collaborating with all healthcare personnel and management to achieve patient care and financial objectives. Instrumental in streamlining and improving processes, enhancing morale, and implementing safe nursing policies and procedures. Adept at overcoming challenges and taking on greater responsibility in nursing and administrative management roles, utilizing depth of expertise to make a positive difference in the lives of employees and patients. Detailed knowledge and experience with NCAA and Joint Commission Standards. • Nursing Management 0 Healthcare Management 0 Grants Management ■ Nurse Mentorship/ Training 0 Budget Development and Oversight 9 Data Analysis/Research ■ Staff Recruitment 0 Patient Centered Medical Home Standards W Bilingual: English, Spanish ■ Detail -Oriented/ Eye for Accuracy 0 Microsoft Office Suite& Intergy EHR PROFESSIONAL EXPERIENCE MIAMI BEACH COMMUNITY HEALTH CENTER, Miami, FL Chief Operating Officer (2015 - Present) Responsible for managing the daily operations of the health center to ensure administrative services are provided in alignment with organizational objectives. Provide leadership and oversight of administrative areas and supporting operations. Oversee and monitor the development and implementation of the quality improvement/risk management program. Ensure that all health center facilities are maintained to meet security, safety, and quality standards. Ensure timely submission of grant proposals. Senior Executive Vice -President of Patient Services (2007 - Present) Direct nursing staffand oversee daily operations, including oversight and leadershipof six sites and ensuring the patient care delivery model is followed. Managebudget preparation and grant reports. In charge ofthe Joint Commission accreditation process, OSHA compliance, and infection control activities. Develop, implement, and monitor Nursing Department policies and procedures. Manage support departments: Healthy Steps, Prenatal, Patient Support, Appointments, Referrals, TQM, and Environment of Care. ■ Managed the nursing and patient activities of six Joint Commission accredited centers ■ Assisted in the implementation of new electronic health record system, converting from paper to electronic health records. ■ Presented "Taking Healthy Steps in the Right Direction" at the annual Children's Mental Health Conference, May 2o08 Director of Nursing (2005 - 2007) Oversaw and managed the entire Nursing department within the community health center. Developed and implemented department budgets and reports. Collaborated with providers to facilitate exemplary patient care. ■ Received Employee of the Month in April, 2000 ■ Presented "Changing Practices, Changing Lives" and "Obstacles and Success of the Asthma Team" at the annual Collaborative Summit in Orlando, FL in 2005 ■ Implemented Healthy Steps an evidence -based practice program for children 0-3 years Nurse Manager (2003 - 2004) Supervised and implemented all patient care related activities forStanley C. Myers site.Directed and managed a nursing staffof five nurses and to medical ass istantsensuring all nursing policies and procedures were followed.Coordinated team schedules and patient care. Additional experience includes roles as a Medical/ Intake Assistant for Stanley C. Myers Community Health Center in Miami Beach, FL and a Medical Assistant/ Phlebotomy Technician for Optima Medical Group in Miami, FL. AFFILIATIONS/ INDUSTRY ASSOCIATIONS Member of the Florida Nurses Association I Member of Florida Association of Public Health Nurses I Member of the Florida Association of Community Health Centers I Member of the National Association of Community Health Centers Chair of Miami Beach Community Health Center Patient Care and Safety Committee EDUCATION & CREDENTIALS Bachelor in Science and Master in Science (Focus: Leadership & Management), Nursing,Regis University, Denver, CO Associate in Science, Nursing, Miami Dade College, Miami, FL HealthCare Risk Manager Certificate, Florida Risk Management Institute, Fort Lauderdale, FL Medical Assistant Certificate and Phlebotomy Technician Certification, Concorde College, Miami, FL Certifications: State of Florida Active Registered Nurse, Florida Licensed Healthcare Risk Manager, Basic Life Support, and Phlebotomy Technician M,1AM'B'__A`_"H Name: DIVERSITY STATISTICS REPORTING Board / Committee: ZW Wo r t /-e Appointment Date:_14c _-.- Pursuant to City of Miami Beach 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 appiicants and members to voluntarily self -identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male Cl Female Race/Ethnic Categories What is your race? I African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian Other - Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latinola. El No Yes Do you consider yourself Physically Disabled? L_j Yes C ers c !\ , .,US h..�t�!�t"fc.��.-i C)cid��...Cii:iicyE 3 tJi .5(?ii�`r"±tY�tiv"'.: j\�r8f(iC�6i�2� �,' information form 05.20-13 RINAi_./d�oc Updated. Monday, J nuary 26. 2'0115,