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Helen Swartz Application Package 2Swartz Helen Last Name First Name Middle Initial 1330 West Ave, Apt 1804 Miami Beach Home Address City FL 33139 State Zip Code 61063964246106396424 HomeWork miamihelen25@gmail.com Email Address 6106396424 Cellular Miami Beach Business Address City FL State 33139 Zip Code Occupation:Business Name: 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 City Clerk’s Office. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Disability Access Committee Senior Affairs Committee Committee on the Homeless BOARD AND COMMITTEE APPLICATION FORM Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below questions: Have you ever resided in one of the City's Historic Districts for at least one year?Yes N/A 1/1/2021 1/8/2021 Address From: Dates To: If you answered "Yes", please indicate: Professional License No Professional Licenses Submitted. Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: YesResident of the City for a minimum of six (6) months: Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:No AFFILIATION WITH THE CITY OF MIAMI BEACH a. ● I am resident of:N/A Or b. "Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more of the outstanding capital stock) in a business. "Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. c.Full-time employee of such a business (for a minimum of six months); and I am based in an office or other location of the business that is physically located in Miami Beach (for a minimum of six months):No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4/7th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements of section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they have met either (or both) of said affiliation requirements. The original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. Or No● Have you ever been convicted of a felony:If yes, please explain in detail: ● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail: ● Are you currently serving on any City Boards or Committees:Yes If yes, which board? Disability Access Committee ● Are you presently a registered lobbyist with the City of Miami Beach?No ● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: I have been on the DAC and understand barriers to accessibility as I use a mobility scooter. Environment impacts on disability in an expansive way and I’m looking forward to working with the committee to continue to make Miami more accessible. 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 board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). 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 equality to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes. ● In what organization(s) in the City of Miami Beach do you currently hold membership in? No Organization Information Submitted. ● List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property My home at The Waverly. If so, which department and title?No● Are you now employed by the City of Miami Beach: ● Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse, child, brother, or sister who is employed by the City of Miami Beach?No If "Yes", identify person(s) and department(s): No relative's information submitted. BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2) 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. One of the following forms must be filled 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;" or 2. A "Statement of Financial Interests (Form 1)¹ ;" or 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. _____________________________ ¹ Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the County’s financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. DIVERSITY STATISTICS REPORT The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements. WhiteRace/Ethnic Categories What is your race? No details providedOther Description: Gender:Female Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No Physically Challenged:Yes 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.” I Helen Swartz agreed to the following terms on 12/2/2021 9:10:37 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES YES YES YES I have answered all questions fully. I have uploaded a current resume, photograph, and a copy of any applicable professional license. I have completed and attached the Board & Committee Financial Acknowledgment Statement. I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone: 305.673.7411 Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph. Helen Condzal Swartz, M.Ed. 1330 West Avenue, Apt. 1804 Miami Beach, Fla. 331319 Education * Long Island University, B.A., English * Temple University, M.Ed, Counseling Psychology Volunteer Positions *2011 -2018 Disability Access Committee, City of Miami Beach *2018 Chairperson *Volunteer, Sabrina Cohen Foundation, Miami Beach *2014 Waverly Condominium, Board of Directors, Miami Beach *2015 President, Board of Directors *2016 President, Board of Directors Experience *2009 to 2017- WorkRite Consulting, LLC., provides telephonic vocational counseling services to individuals who have been released to return to work by their health care providers. Goal plans are based on individual needs, and services such as resume formulation and review, retraining options and job searching are provided. Support is given as individuals come to realize and accept the post accident or illness limitations and formulate a new future. -Labor Market Surveys formulated based on varying assignments such a job definition, availability and consistency of task performance necessary in a particular occupation. Task assignments pertaining to any aspect of vocational information needed are performed quickly and professionally. *1981-2008 Rehabilitation Planning Inc., Vocational Planning Inc., Norristown, Pennsylvania, Founder and President. Developed and provided broad range of products to the insurance industry for the disability management of individuals injured in auto and worker’s compensation accidents or receiving long term disability coverage. Through the use of national proprietary medical network, provided cost saving case management, independent medical exam, and chart review services. Developed and implemented: -Vocational and medical services including collaborative file management plans, medical and community based service providers, communications channels, and protocols based on carrier specifications- -Reviewed, strategized, and developed action/goal plans for thousands of vocational and medical files across LTD, Liability, Auto and Worker’s Compensation Coverage- -Provided clear, consistent and relevant information as liaison between caseworkers and insurance professionals- Contact Information: hswartz25@atlanticbb.net 610 639 6424