Steven Zuckerman Application PackageMIAMIBEACHBOARD AND COMMITTEE APPLICATION FORM
k) CI4 X•V► 5. Enl
Last Name First Name
5 V D ( ►ti L "' ` A fit 1 /hvl c (30461 Fes- Zip Cod 3
Home Address City S 2 -QC/ eY/kiG.PE
305 5 -3Lt 3((z..2____ 7, 6 5 �o 7o -- enc r v1.
ss
dd
address
Home Telephone Work Telephone Cellular Telephone Email�� (2
f4, -Li L -ruj» fi C o, Nk/<SIWle�1 k� n
Business Name. Occupation
D a. C__45 If'� � �w
Business Address
Professional License (describe):
L iC4/lcd Gj FtroCA k F La,tdct Kw Expires:
Please attach a copy of currently effective professional license.
Middle Initial
City State
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 th or No
• Demonstrates ownership/interest in a business in iami Beach for a minimum of six months: Yes �or No
• Are you a registered voter in Miami Beach: Yes or No L_,.1]
• I am now a resident of: North Beach South Beach LA Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
No!
w'
A
• Are you presently a registered lobbyist with the City of Miami Beach? Yes LA 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 Advisory Committee
❑ Art in Public Places Committee
❑ Health Facilities Authority Boa
❑ Audit Committee
❑ Hispanic Affairs Committee
❑ Board of Adjustment**
❑ Historic Preservation Board
>5$udget Advisory Committee
❑ Housing Authority
❑ Committee on the Homeless
❑ Human Rights Committee
❑ Committee for Quality Education in MB
❑ LGBT Advisory Committee
❑ Convention Center Advisory Board
❑ Marine & Waterfront Protectic
❑ Cultural Arts Council
❑ Miami Beach Commission for
❑ Design Review Board*
E Normandy Shores Local Govi
Neighborhood Improvement
❑ Disability Access Committee
* Board members are required to file Form 1 — "Statement
*If you seek appointment to a profession I seat
Board, Historic Preservation Board or Plan i
following information:
Professional License
of Finani
(e.g., lawyer, ar
g Board, attach a
Type of
Issuance Date \OV LOA. Bet, NO*
License
O15524D
❑ Parks and Recreation Facilities Board 0O
rd
n Authority
❑ Personnel Board
❑ Planning Board**
❑ Police Citizens Relations Committee
❑ Production Industry Council
❑ Sister Cities Program
Women
rnment
❑ Sustainability Committee
0 Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
0 Visitor and Convention Authority
0 Youth Commission
;ial Interest" with the State.
chitect, etc.) on the Board of Adjustment, Design Review
copy of your currently -effectively license, and furnish the
License Number 0 1 552.40
License Expiration Date
Page 1 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
law 1 it.evt�e..
°° 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):
Pc‘
• 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:
Age: Program:
Child's name:
• Have you ever been convicted of a felony? Yes L=1 or No yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes or NoTrITVes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes LA or No
yes, explain in detail:
• Are you currently serving on any Citoard or Committee? Yesor No If yes, which board/committee?
1,-)O 9v1 S Qft�
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Position
Name
Position
Name
• List all properties owned or in which you have an interest within the City of Miami Beach:
*u_ A2 b0-55 ,
• Are you now employed by the City of Miami Beach? Yes or No >.(1 --
Which
.,
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you hav parent La spouse Z1, child brother or sister who is
employed by the City of Miami Beach? Yes Fjor 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 Female
Race/Ethnic C tegories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Page 2 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
Ei Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
No
La Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED
NOT O FOLLW LIMITED TOERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS. THESE LAWS INCLUDE,
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
nefit from Community Development Block rG antt funds for eithee and for one year rtyouer erseilf or hoserwi with
any interest in or receiving any be
you have business or immediate family ties (CFR 570.611).
o Sunshine e Law Florida'seoin Chapter 286 of the Florida Statutesment-in-the-Sunshine Law was . Thesacted en statutes establish a Sunshine Law
of access to most
government can be found p
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities. or
o Voting ee conflictad council, Form ccomfor
mission, authoe by any rity or commerson ittee. e. g at the
It applies equally toother
members of advisory andgovernment
non -advisory appointed bodies
elected board,
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 THEACCURACYANODFTRHE MIAMIVESS BEACOHFCITY CODE, ENTIITLEDAND
STANDARDS OF CORECEIVED,
NDUCREAD
T FOR
WILL ABIDE BY CHAPTER E,,ARARTICLCLE
CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ° CCORDINGLY.
Applic7s Signatur
Received in the Office of the City Clerk by:
Date Name of Applicant (PLEASE PRINT)
'/0q/(2,
Name of Deputy Clerk Control No.
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 06142016.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: 305.673.741 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: 5 t --t- 0' ,
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.
Signature
Updated: Tuesday, October 04, 2016
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
Date
STEVEN B. ZUCKERMAN, ESQ.
PROFILE
Diverse business and legal experience, including investment banking, principal investing, restructuring law, published
author, and entrepreneurship.
EXPERIENCE
Farlie Turner & Co.
Managing Director & Head of Special Situations Group: 2007 - Present
Founder and head of Special Situations Group of prominent middle -market investment bank focusing on providing merger
& acquisition, capital raising, and balance sheet restructurings for distressed middle market businesses. The Special
Situations Group is a leader in the Southeast, completing approximately $500 million in transactions and receiving several
national awards, including "Distressed M&A Deal of the Year" in 2010, 2011, 2012, and 2014.
Vatica Health, Inc.
Co -Founder: 2011 - Present
Venture -backed healthcare technology company that improves overall health and wellness of Medicare patients, enhances
quality of care delivered by physicians, and assists insurers with more accurate diagnostic coding and dramatically
improves their financial performance.
Rain Power
Author & Speaker: Released 2014 (available on Amazon.com)
Rain Power articulates an innovative and pragmatic strategy designed to help young professionals achieve professional
success, wealth, and a deep feeling of happiness and satisfaction.
Rise Up
Founder: 2015 - Present
Not-for-profit that provides entrepreneurship training and resources to individuals incarcerated in the Miami -Dade County
Corrections and Rehabilitation Department Boot Camp program.
Innovo Capital, LLC & 7615 Harding LLC
Founder & Managing Partner: 2006 — 2007
Principal investments and advisory services for underperforming lower middle market companies.
Berger Singerman, PA
Senior Associate: 2002-2006
Represented financially troubled companies in all facets of business reorganization, including debt and equity
restructurings, litigation, drafting of Plans of Reorganization, and mergers and acquisitions. Represented investors in
connection with the acquisition of distressed companies.
Gtranz.com
Vice President of Business Development & Strategy, and General Counsel: 1999-2001
Developed business model and channel strategy. Negotiated investor financing, drafted business and marketing plans.
Responsible for all legal matters. Implemented strategic partnerships and assessed M&A opportunities.
EDUCATION
UNIVERSITY OF MIAMI SCHOOL OF LAW, Coral Gables, FL
Juris Doctor, Cum Laude, May 1998
BOSTON UNIVERSITY, Boston, MA
Bachelor of Arts, Cum Laude, May 1995
AWARDS / ACTIVITIES
• Member of EO — South Florida Chapter
• "40 Under 40" Dealmaker in U.S.
• Guest Lecturer University of Miami School of Law
• Founder - Leaders of Tomorrow