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RELEASE # 1 - 01132021 - Updated 12292020 FINAL FOR NOVUS REG TO PUBLISH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Rafael E. Granado, City Clerk DATE: January 6, 2021 SUBJECT: City Commission – At-Large Nominations for January 13, 2021 – Release # 1 Below please find the City Commission At-Large Nominations received to date for the January 13, 2021 Commission Meeting. BOARD AND COMMITTEES: AFFORDABLE HOUSING ADVISORY COMMITTEE Actively Engaged in Banking/Mortgage Industry in Connection with Affordable Housing (Category # 2) One Reappointment Seat Available) • Alex Carrasco Nominated for appointment (Banking/Mortgage Industry in Connection with Affordable Housing Category) by Commissioner Góngora. (Release # 1, Page 1) (Application pending) Resides Within the jurisdiction Category (Category # 9) (One Reappointment Seat Available) • Barbara Montero Nominated for reappointment (Resides in Jurisdiction Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 13) Represents Employers Within the Jurisdiction (Category # 10) (One Vacant Seat Available) • Mohammed Rafiqul Islam Nominated for appointment (Represents Employers Within Jurisdiction Category) by Commissioner Samuelian. (Release # 1, Page 19) 001 Represents Essential Services Personnel (Category # 11) One Reappointment Seat Available) • Jeffrey M. Feldman Nominated for appointment (Represents Essential Services Personnel Category) by Vice- Mayor Meiner and Commissioners Góngora and Richardson. (Release # 1, Page 37) ANIMAL WELFARE COMMITTEE SoBe Cats Spay & Neuter Inc. Category (One Reappointment Seat Available) • Linda T. Diamond Nominated for reappointment (SoBe Cats Spay & Neuter Inc. Category) by Commissioner Samuelian. (Release # 1, Page 47) ART IN PUBLIC PLACES Art History, Architectural History, etc. Category (Two Reappointment Seats Available) • Aaron Resnick Nominated for reappointment (Art/Architectural History Category) by Vice-Mayor Meiner and Commissioners Góngora and Samuelian. (Release # 1, Page 55) • Michael McManus Nominated for reappointment (Art/Architectural History Category) by Commissioner Arriola. (Release # 1, Page 65) Art History, Architectural History, etc. Category (One Vacant Seat Available) • Megan M. Riley Nominated for appointment (Art/Architectural History Category) by Commissioners Góngora. (Release # 1, Page 75) BLACK AFFAIRS ADVISORY COMMITTEE At-Large Category (Two Vacant Seats Available) • Glendon Hall Nominated for appointment (At-Large Category) by Vice-Mayor Meiner and Commissioners Góngora and Samuelian. (Release # 1, Page 87) 002 • DJ Irie (Ian Grocher) Nominated for appointment (At-Large Category) by Commissioners Góngora and Samuelian. (Application pending) (Release # 1, Release 3) BOARD OF ADJUSTMENT (5/7 vote required) Real Estate Development Category (Category # 4) (One Reappointment Seat Available) • Andres Asion Nominated for reappointment (Real Estate Development Category) by Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 99) Law Category (Category # 1) (One Reappointment Seat Available) • Richard Segal Nominated for reappointment (Law Category) by Commissioner Samuelian. (Release # 1, Page 105) BUDGET ADVISORY COMMITTEE Certified Public Accountant Category (One Reappointment Seat Available) • Marc Gidney Nominated for reappointment (CPA Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 117) CULTURAL ARTS COUNCIL (3-year term) At-Large Category (Four Reappointment Seats Available) • Bruce Carter Nominated for reappointment (At-Large Category) by Commissioners Arriola, Góngora, and Richardson. (Release # 1, Page 127) • Britta Hanson Nominated for reappointment (At-Large Category) by Commissioner Samuelian. (Release # 1, Page 143) • Vanessa R. Menkes Nominated for reappointment (At-Large Category) Commissioner Góngora. (Release # 1, Page 153) 003 • Laurence Moser, Vice-Chair Nominated for reappointment (At-Large Category) by Commissioners Arriola, Góngora (Release # 1, Page 163) At-Large Category (Three Vacant Seats Available) • Jessica Benitez Nominated for appointment (At-Large Category) by Commissioner Steinberg. (Release # 1, Page 173) • Brian Ehrlich Nominated for appointment (At-Large Category) by Commissioner Góngora. (Release # 1, Page 183) • Christina S. LaBuzeta Nominated for appointment (At-Large Category) by Commissioner Góngora. (Release # 1, Page 193) • Sarah H. Leddick Nominated for appointment (At-Large Category) by Commissioner Góngora. (Release # 1, Page 205) • Gary Ressler Nominated for appointment (At-Large Category) by Commissioner Steinberg. (Release # 1, Page 215) • David Sexton Nominated for appointment (At-Large Category) by Commissioner Richardson. (Release # 1, Page 225) • Rachel Unger Nominated for appointment (At-Large Category) by Commissioner Steinberg. (Release # 1, Page 233) DESIGN REVIEW BOARD At-Large Category (Category # 5) (One Reappointment Seat Available) • James Bodnar, Chair Nominated for reappointment (At-Large Category) by Commissioners Arriola, Góngora, and Samuelian. (Release # 1, Page 243) 004 Architect - United States. (Category # 1) (One Vacant Seat Available) • Christina Miller Nominated for appointment (Architect U.S. Category) by Commissioner Steinberg. (Release # 1, Page 253) GENERAL OBLIGATION (G.O.) BOND OVERSIGHT COMMITTEE City Resident South Beach Area Category (One Reappointment Seat Available) • Jason Greene, Vice-Chair Nominated for reappointment (City Resident South Beach Area Category) by Commissioner Samuelian. (Release # 1, Page 263) City Resident North Beach Area Category (One Reappointment Seat Available) • Laura Veitia Nominated for reappointment (City Resident North Beach Area Category) by Vice-Mayor Meiner and Commissioners Arriola, Góngora, Richardson, and Samuelian. (Release # 1, Page 275) HEALTH ADVISORY COMMITTEE ACLF/ALF Category (Category # 3) (One Reappointment Seat Available) • Frank Mena Nominated for reappointment (ACLF/ALF Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 283) CEO/Designee from Miami Beach Community Health Center Category (Category # 2) (One Reappointment Seat Available) • Mark Rabinowitz, Chair Nominated for reappointment (CEO/Designee from Miami Beach Community Health Center Category) by Commissioner Samuelian. (Release # 1, Page 293) 005 CEO/Designee from Mount Sinai Medical Center Category (Category # 1) (One Reappointment Seat Available) • Steven Sonenreich Nominated for reappointment (CEO/Designee from Mount Sinai Medical Center Category) by Vice-Mayor Meiner and Commissioners Richardson and Samuelian. (Release # 1, Page 305) HEALTH FACILITIES ADVISORY BOARD (4-year term) Accountant Category (One Reappointment Seat Available) • Arthur Unger, Chair Nominated for reappointment (Accountant Category) by Commissioners Richardson and Samuelian. (Release # 1, Page 313) Health Provider (One Reappointment Seat Available) • Dr. Martin N. Zaiac Nominated for appointment (Health Provider Category) by Commissioner Góngora. (Release # 1, Page 321) HISTORIC PRESERVATION BOARD At-Large/Resided in One of the City's Historic Districts for at Least One Year Category (Category # 3) (One Reappointment Seat Available) • Nancy Liebman Nominated for reappointment (At-Large/Resided in One of the City's Historic Districts for at Least One Year Category) by Vice-Mayor Meiner and Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 347) Miami Design Preservation League (MDPL) Category (Category # 1) (One Vacant Seat Available) • David McKinney Nominated for appointment by the Miami Design Preservation League (MDPL Category) and Commissioner Richardson. (Release # 1, Page 363) • Sandra Scidmore Nominated for appointment by the Miami Design Preservation League (MDPL Category). (Release # 1, Page 379) 006 • Laura Weinstein-Berman Nominated for appointment by the Miami Design Preservation League (MDPL Category) and Commissioner Arriola. (Release # 1, Page 389) Note: This Category consists of one representative from the Miami Design Preservation League (MDPL) selected from three names nominated by such organization. MDPL has provided the following nominees: 1) David McKinney; 2) Sandra Scidmore; and 3) Laura Weinstein-Berman. Dade Heritage Trust (DHT) Category (Category # 2) (One Vacant Seat Available) • Kirk Paskal Nominated for reappointment by the Dade Heritage Trust and Commissioners Góngora and Samuelian (DHT Category). (Release # 1, Page 397) • Linda Chamora Nominated for appointment by the Dade Heritage Trust (DHT Category). (Application pending) (Release # 1, Page 7) Note: This Category consists of one representative from the Dade Heritage Trust (DHT) selected from three names nominated by such organization. (Category # 2) DHT has provided the following nominees:1) Kirk Paskal; Current HPB member and 2) Linda Chamora. HUMAN RIGHTS COMMITTEE Law Category (One Reappointment Seat Available) • Alan Fishman, Chair Nominated for reappointment (Law Category) by Vice-Mayor Meiner and Commissioner Góngora. (Release # 1, Page 411) At-Large Category (Five Reappointment Seats Available) • Jesse Fleet Nominated for reappointment (At-Large Category) by Commissioner Góngora. (Release # 1, Page 423) • Jessica Londono Nominated for reappointment (At-Large Category) by Commissioner Góngora. (Release # 1, Page 429) 007 • Michael Sherman Nominated for reappointment (At-Large Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 439) • Dale Stine Nominated for reappointment (At-Large Category) by Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 447) • Jonathan Welsh Nominated for reappointment (At-Large Category) by Vice-Mayor Meiner and Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 457) NEXT GENERATION COUNCIL (1-year term) Real Estate Category (One Reappointment Seat Available) • Jefferson E. Brackin, Vice Chair Nominated for reappointment (Real Estate Category) by Commissioner Arriola. (Release # 1, Page 467) NORMANDY SHORES LOCAL GOVERNMENT NEIGHBORHOOD IMPROVEMENT Executive Committee of the Normandy Shores Homeowners Association Category (Three Reappointment Seats Available) • Carmen Browne Nominated for reappointment (Normandy Shores Category) by the Normandy Shores Homeowners Association, Vice-Mayor Meiner, and Commissioners Richardson, and Samuelian. (Release # 1, Page 473) • Susanne Demmerle Nominated for reappointment (Normandy Shores Category) by the Normandy Shores Homeowners Association, Vice-Mayor Meiner, and Commissioners Richardson and Samuelian. (Release # 1, Page 483) • Diane Klein Nominated for reappointment (Normandy Shores Category) by the Normandy Shores Homeowners Association, Vice-Mayor Meiner, and Commissioners Richardson and Samuelian. (Release # 1, Page 497) Note: The Executive Committee of the Normandy Shores Homeowners Association has requested that the above three individuals be reappointed. 008 PERSONNEL BOARD At-Large Category/Not Having Same Vocation as Another Member (Two Reappointment Seats Available) • Gail Harris – Psychotherapist Nominated for reappointment (At-Large Category) by Mayor Gelber, Vice-Mayor Meiner, and Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 511) • Raquel Pacheco - Translator/Vice-Chair Nominated for reappointment (At-Large Category) by Vice-Mayor Meiner and Commissioners Richardson and Samuelian. (Release # 1, Page 523) At-Large Category (Two Vacant Seats Available) • Ricardo Barboza Nominated for appointment (International Sales Manager/Consultant Occupation) by Commissioner Góngora. (Release # 1, Page 533) • Jamie B. Laufer Nominated for appointment (Executive Director – Non-Profit Organization Occupation) by Commissioner Steinberg. (Release # 1, Page 543) PLANNING BOARD At-Large/General Business Category (Category # 5) (One Reappointment Seat Available) • Kareem Brantley Nominated for reappointment (At-Large/General Business Category) by Commissioners Arriola and Samuelian. (Release # 1, Page 553) Education/Experience in Historic Preservation Issues (Category # 4) (One Vacant Seat Available) • Tanya Bhatt Nominated for appointment (Education/Experience in Historic Preservation Issues Category) by Vice-Mayor Meiner and Commissioners Góngora and Samuelian. (Release # 1, Page 563) 009 At-Large/General Business (Category # 5) (One Vacant Seat Available) • Alex J. Fernandez Nominated for appointment (At-Large/General Business Category) by Vice-Mayor Meiner and Commissioners Góngora and Samuelian. (Release # 1, Page 575) SENIORS AFFAIRS COMMITTEE Mount Sinai Medical Center Administrator Category (Category # 2) (One Reappointment Seat Available) • Oscar Llorente Nominated for reappointment (Mount Sinai Medical Center Administrator Category) by Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 585) Note: The board of trustees for Mount Sinai Medical Center has selected Oscar Llorente for reappointment. . Four Freedoms House Resident Category (Category # 3) (One Reappointment Seat Available) • Enilda Thomas Nominated for reappointment (Four Freedoms House Resident Category) by Commissioner Góngora. (Release # 1, Page 597) Stella Maris House Resident Category (Category # 5) (One Reappointment Seat Available) • Gaby Baglietto Nominated for reappointment (Stella Maris House Resident Category) by Commissioner Góngora. (Release # 1, Page 607) Individual Selected by the Board of Directors of UNIDAD of Miami Beach Category (Category # 10) (One Vacant Seat Available) • Larissa Caijao Nominated for appointment (UNIDAD Category) by the Board of Directors of UNIDAD Miami Beach and Commissioners Góngora and Samuelian. (Release # 1, Page 615) Note: The board of directors of UNIDAD of Miami Beach has selected Larissa Caijao. 010 TRANSPORTATION, PARKING AND BICYCLE-PEDESTRIAN FACILITIES COMMITTEE Miami Beach Chamber of Commerce's Transportation and Parking Committee Member Category (Category # 1) (One Reappointment Seat Available) • Linsey Lovell Nominated for reappointment (Miami Beach Chamber of Commerce's Transportation and Parking Committee Member Category ) by the Miami Beach Chamber of Commerce and Commissioner Samuelian. (Release # 1, Page 625) Note: The Miami Beach Chamber of Commerce has selected Linsey Lovell. South Beach Business Association Member Category (Category # 3) (One Reappointment Seat Available) • Al Feola, Chair Nominated for reappointment (South Beach Business Association Member Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 631) Mid-Beach Neighborhood Association Member Category (Category # 4) (One Reappointment Seat Available) • Esteban Porcelli Nominated for reappointment (Mid-Beach Neighborhood Association Member Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 641) VISITOR AND CONVENTION AUTHORITY Hotel Industry or At-Large Category (One Reappointment Seat Available) • Christopher Rollins Nominated for reappointment (Hotel Industry Category) by Vice-Mayor Meiner and Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 651) At-Large Category (Two Reappointment Seats Available) • Steven Adkins, Chair Nominated for reappointment (At-Large Category) by Commissioners Góngora, Richardson, and Samuelian. (Release # 1, Page 661) 011 • Jeff Lehman, Vice-Chair Nominated for reappointment (At-Large Category) by Commissioners Góngora and Samuelian. (Release # 1, Page 671) DIRECT APPOINTMENTS REQUIRING 4/7 VOTE Pursuant to Section 2-22(4)c of the Miami Beach City Code, direct appointees who do not reside in the City for a minimum of six month, that do not demonstrate an ownership interest in a business established in the City for a minimum of six months, but who are full-time employees of a business for a minimum of six months and are based in an office or other location of the business that is physically located in Miami Beach for a minimum of six months are eligible to serve on a Board/Committee if approved by a 4/7th vote of the Mayor and City Commission. Request is hereby made to approve the following direct appointment(s): • Diane C. Connolly Graham Nominated for appointment to the Black Affairs Advisory Committee as Mayor Gelber’s direct appointment. (Release # 1, Page 683) T:\Agenda\2021\1_January 13\City Clerk - Board and Committtees\RELEASE # 1 - 01132021 - Updated 12292020 FINAL FOR NOVUS REG.docx 012 • Barbara Montero 013 THIS PAGE INTENTIONALLY LEFT BLANK 014 lD MIAMIBE h ~H NAME: Montero Last Name HOME ADDRESS : 1900 Sunset Harbour Drive #2208 Apt No. Home No./Street Barbara Firs t Name Mi ami Beach City CITY OF MIAMI BEACH BOARD AND COM MITTEE APPLICATI ON FORM ]d2':t:S Middle Initial Florida 33139 State Zip Code 305" 7.-1~ .. 4 {1-I PHONE: ~05j b/~26I2 'fT86j 294 6-441- Work ~lbttl j"surn b b~ ba SVh o~ +e.-ro (i) Home Email Add ress ::j h\o.,x ~~ Busi ness Name: .=6.=.a:..::fcc.:..liwPi:..:3::..iYe-___________ Position : -~-------------------- Address: ◄20 LiilC0lii Rd #6~ Miami B each Florida 33139- Street City State Zip Code Pursuant to City Code section 2-22(4) a and b : Members of agencies, boards, and committees shall be affi lia ted with the city; this re quirement shall be fulfilled in the following ways : a) an individ ual shall have been a resident of the city for a minimum of six months; or b) an ind ivid ual shall demonstrate own ership/intere st for a minimum o f six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes • Are you a reg istered voter in Miami Beach: Yes • (Please~ one): I am now a resident of: South Beach • I am applying for an appointment because I have special abilities. knowledge and experience. Please list below: • Are you presently a reg istered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking [1) first choice [2 ) second choice, and [3) third choice. Please no te that on ly t hree (3 ) ch oices will be observed by the City Cl e rk's Office . (Regular Boards of City) Choice 1: Choice 2 : Choice 3: * Board m embers are required to file Form 1 -"Stat ement of Financial Interest" with the State. If you s eek appointment to a professional seat (e.g ., lawyer, archi tect, etc.) on the Board of Adjus tment, Design Review Boa rd , His toric Preservation Boa rd or Pl anning Board, attach a copy of your currently-effectivel y license, a nd furnish the following information: Type of Professional Li cense ______________ _ License Nu mber Lice nse Issuance Date ________________ _ License Expiration Date Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past servi ce on the Y outh Center Advisory Board : No ""---''---- Years of Service: ______________ _ 2. Present participation in Youth Center activities by your children "-'N=o __ ages, an d which programs. Lisi below: Child Name Age Program if yes, please list the names of your children, the ir 015 • Have you ever been convicted of a felon1 •• IIJo 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: No If yes, which board? • What organizations in the City of Miami Beach do you currently hold membersh ip in? · • I a m now employed by th e city of Miami B each: No Which department? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Property 1900 Sunset Harbour Dr. #2208 1900 Sunset Harb our Drive #709 Gender: F emale The following information i s voluntary and is n either part of your application n or ha s any bea ring on your con sideration for appointment. It is being asked to comply with federal equal opportunity reporting requ irements. Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. White Oth e r Description : Are you Spanish/Hispa nic/ L atino? Mark the "No" box if not Spanish / Hispanic / Latino. No P hysically Challenged: No NOTE : If appointed , you will be required t o follow certain laws whi ch apply to city board/committee m embers. These laws include, but are not limited to, the following: 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 ). (re: 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 th ose with whom you have business or immediate family ti es (CFR 570 .61 1). Upon requ est, copies of these l aws may be obtained from the City Clerk. 016 "I hereby attest to the accuracy and truthk VII -of the City Code "Standards of Condu, ,; of the application and h ave received , r e ad and w'.. ;ide by Chapter 2 , Article ,r City Officer s, Employees and Ag ency Members .' I Barba ra Montero agreed to the following terms on 3/20/2014 Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 017 THIS PAGE INTENTIONALLY LEFT BLANK 018 • Mohammed Rafiqul Islam 019 THIS PAGE INTENTIONALLY LEFT BLANK 020 C Last Name First Name Middle Initial • ~FtG.U4- State Zip Code Cellular Telephone WOO< Telephone 33,41 1'"~ -3 o~-34o3: Business Name :tst..A-M t2£,4.Ljo'2- Business A(\dress t ; VE. ,.._ City State Zip Code 1.t,04, f>t~T'Z t)fll. 4t ~ ~•AM'l ~ ~1..--33141 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 Clertc.. Affordable Housing Advisory Health Advisory Cormittee Normandy Shores Local Govenvnent Cormittee Neighborhood lmpro~31 nt District Advisory Council l 3 Animal Welfare Comrrittee Health Facilities Authority Board Panes and Recreational Facilities Board Art in Public Places Cormvttee Hisoanic Affairs Comnittee Personnel Board Audit Comnittee Historic Preservation Board • PlanninQ Board L'l-\ Black Affairs Advisorv Comrrittee Housina Authoritv Police/Citizens Relations Corrmittee Board of Adiustment Hlmiln Rights Cormittee Production Industry Council Budget Advisory Cormittee LG BTQ Advisory Conmttee Program for Public Information Comrrittee Cormvttee for Quality Education in Marine & Waterfron1 Protection Senior Affairs Conmttee Miami Beach Authortty Cormittee on 1he Homeless Mayor's 41 st Street Committee Sustainabtlity Corrrnittee ~ l Convention Center Advisory Board Mayor's General Obligation Bond Transportation, Parking, and Bicyde- Oversiqht Corrrnittee Pedestrian Facilities Committee Cultual Ar1s Counct1 Mavor's Panel on Ocean Drive Visitor and Convention Authority DesiQn Review Board Miami Beach Cormission for Women Youth Corrmission Disabilitv Access Committee Next Generation Council Professional License Type of Professional License License Nt.mber State of Issuance license Issuance Date license Expiration Da1e Note: If you are seeking appointmentto a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your curr effective corr di ofessional license. Page 1 of 6 F:\ct..E R\SAll'ISOARD AND COMMITTIES DATABASE\CHECICUST MASTER'ISOARD AND COMMITTEE APPUC ATION.doclt Updated: June 2020 021 AFAUATION Will-I Tl-IE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, b, and c: Members of Agencies. Boards. and Conmittees shall be affiliated with the City. This requirement shaD be fulfilled in the foDowing ways: a. Resident of the City for a minim.Jm of six months: Yes G1or 0..No • I am a resident of: South Beach O Middle Beach D North Beach if Or b. Demonstrates an owr,¢'°hie_i.!!terest (for a minim.Jm of six months) in a business established in the City (for a minimum of six months): Yes ~ or l..JNo •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. ·ausinessA shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. Or c. Full -time employee cl such a business (for a ninimum of six months); and I am based in an office or other location of the business that is physically located in Miami Beach (fur a minimum of six months): Yes O or D No Notwtthstanding the requiremems set forth herein. the qualified full-time employee of a business must be approved by a 4/llh vOfe of the Mayor and City Commission. NOTE: Members of Agencies, Boards. and Committees shall be requ ired to demonstrate compliance with the City affiliar,on requirements of sections 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 afflliation requirements . The original affidavit shall be fifed with the Office of the City Clerk prior to be111g sworn in as a member. • I am applying for an appointment because I have special abilities. knowledge, and expertence. Please list below: Page 2of 6 F\CLER\S ALL\BOARO ANO COMMITTlES OATABASE\CttECKUST MASTER\BOARO AHO COMM m El: AP PUCA TION docx Updated: June 2020 022 • Are you a registered active lobbyist with the City of Miam Beach? Yes O or No ef ,.- • Have you ever been convicted of a felony? Yes D or No fil If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes D or N o ~ yes, please explain in detail: • Do you currently owe the City of Miam Beach money? Yes D or No i;;:;; :es. please explain in detail: • Are you currently serving on any City Board or Comrrittee? Yes ~r No D If yes, which Board/Corrmittee? • In what organization(s} in the City of Miam B~~ch ~o !ou curr~ntly_)old ~r:'1bership? s \..!>~~~,\ rt"'-cboV ~,..e..,~\ \I€,,~ (_ '"'v½~*~ Name P · · n J Name Position • List the address ~ all properties owned or in which you have an interest within the City of Miami Beach: ' ' __ ...1 004: ,_~\~v,.,.., t~-t>-rt v~ -1--H.\Ovv-_ <17Ul .kf:k~ 33 }4--l----------------------- ___ 2:-~A--=-~ rL._.J __ 55.l2!.1-_S_l.Y:~_j._~10-~_l°)~-~.k __ £1:-3~~1=tl __ _: _____________ _ • Are you now elll)loyed by the City of Miam Beach? Yes D or No~ so. which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent D. spouse D, child D brother D or sister D who is eOl)loyed by the City of Miami Beach? Y es Dor No cs;;y'" If "Yes," identify person(s) and department(s): ________________________ _ • Note: If applying for the At-Large position of the Historic Preservation Board, please answer the be low questions: • Have you ever resided in one of the City's Historic Districts for at least one year? Yes D or No D If you answered ·ves; please indicate: Address Address Page 3 of 6 From: Dates From: Dates F:\Cl£R\$AL1.'BOARD AND COMMITTIES OATABASE';CttEClQJST MASTER\BOARO ANO COMMITTEE APPLICATION.doc• Updated: June 2C20 To To 023 NOT E: IF APPOINTED, YOU WI LL BE REQUI RED T O FOLLOW CERTAJN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCL UDE, BUT ARE NOT LIMITED T O: o Prohibition from directly or indrectly lobbying City personnel. (Miami Beach City Code Section 2-459) o Prohibition from contracting with the City. (Miani-Oade County Code Section 2 -11 .1) o Prohibition from lobbying before the Board/Comrrittee you have served on for period of one year after leaving office. (Miami Be ach City Code Section 2-26) o Requirement to disclose certain financial interests and gifts. (Miami-Dade County Code section 2 -11 .1) o Sunshine L aw -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 Flonda StaMes. These staMes establish a basic right of access to most meetings of Boards, Coomissions, a nd other governing bodies of state and local governmental agencies o r authorities. o Voting conflict -Form 88 is for use by any person serving at the county, city, or other local level or government on an appointed or elected Board. Counol Conmission. Authority. or Cormittee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting conftict or interest under Section 112.3143. Florida StaMes. I HEREBY ATTEST TO THE ACCURACY ANO TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ ANO WILL ABI DE BY CHAPTER 2, ARTICL E VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFJCE RS, EMPLOYEES AND AGENCY MEMBERS ANO ALL OTH ER APPLICABLE COU NTY AND/OR STATE LAWS AND STATUTES ACCO RDINGLY." Applicant's Signature Date Nam e of Applicant (P L EASE PRI NT) Board and Committee Application Checklist: Please ensure you ha ve provided an information before applyi ng or rea~ng to any Board and Committee B I have answered all questions fully. D I have attached additional sheets. if necessary. to provide required information. D I have attached a current resume, photograph. and a copy of any applicable professional license. D I have COfll)leted and attached the Board & Coornittee Financial Acknowledgement Statement. D I have COfll)leted and attached the Diversity Statistics Report. D Submt complete application package. Via Emai1:BC@llmlilr.1M!m&B!:!!rlll§D! Via U.S. Mail or in Person: City of Miani Beach Office of the City Clenc / Board and Cormittee Section 1700 Convention Center Drive, 1st Floor Miami Beach, FL 33139 If you have any questions, please contact the Office of the City Clerk via email: BC @:':'lsr-ilbsl:!:!Hfl~ or telephone: 305.673.74 11 . Note: Florida Statutes §119.071 : The role of the Office of the City Clerk is to rece.ive and maintain forms filed as public records . If your home address, telephone numbers, ancVor photograph are exempt from disdosure and you do not wish your home address. telephone m.rnbers. 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 conlact nurrber; and 3) Do not attach a photograph. Page 4of 6 F:\CLER\SAU '8OARD AND COMMITTIES DATABASE\CHECKUST MASTER\B OARD AN D COMM ITTEE APPUCATION .docx Updated: .Jvne 2020 024 C ~elm: -•• ~ GmnxaffOII Cede,-IDM11e tirrmn·~ /Plm cdo nr:w -1TT1cumlmmrttff gov OIAF!U OF 1llH£ Ofir'f OEK &nm1l l!i!C@t:11i111'1il!:>~ lrid¥wm1:r ~ M3..74lBTI BOARD & COMMITTEE ANANCIAL ACKNOWLEDGEMENT STATEMENT 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) Last Name Rrst Name Middle Initial I understand that n o later than July 1. of each year all members of Boards and Coomittees of the City of Miami Beach, induding those of a purely advisory nature, are required to comply with Miami-Dade County Rnancial Disclosure Requirements. One of the following fonTlS 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;· or 2 . A ·S1atement of Rnancial Interests (Form 1) 1: • or 3. A Copy of your latest Federal Income Tax Return. Failure to file one of these fOfTTlS , pursuant to the Miami-Dade County Code, may subject the person to a fin e of no more than $500, 60 days in jafl, o r both. Signature Date 1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florid a , pursuant to F.S. §112.3145(1 )(a), to ffle a Statement of Rnancial 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 Supervi sor of Elections automatically satisfy the County's financial disdosure requ irement as a Miami Beach City Board/Corrmittee member and need not file an addi1ional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement Page5of6 F:\CLER\SALL\BOARO ANO COMMITTIES OATABASE\CHECICLIST MASTE R\BOARO AHO COMMITTEE APPLICATION .docx Updated: June 2020 025 C ~., .. -.. 11 ~:lllll c~ lllm111e it.«umm, ~ 9l.tradCll n -r ~ -ma:rrnrn-rn;tf P-'-" omCE OlilYOiB Ema n: B C@mia mt be:m:Ml cml>,l, Telephone : 305 .673.7.tDB Last Name DIVERSITY STATISTICS REPORT Rrst Name Middle lni1ial The following information is voluntary and has no bearing on your consideration for appoin1ment It is being asked to comply with City d iversity reporting requirements. G_e~: IS:rMale D Female D Other D I prefer not to answer. Race/Ethnic Categories: What is your race? ~mea n AmericarvBlack W Asian or Pacific Is lander 0 Caucasiarv'White D Native American/American Indian D Other -Print Race: D I prefer not to answe_r __ ----------- Do you consider yourself to be Spanish, Hi spanic, or Latino/a? ~s D I prefer not to answer. Do you consider yourself Physically Disabled? ~~s _ No D I pref er not to answer this ques1ion . Page 6 of 6 F:\CUR\$AU.'\BOARO ANO COMMITTlES DATABASE'CHECKUST MASTER'\BOARD AND COMMITTEE APPLICATION docx Updated: .bie 2020 026 RESUME Mohammed Rafiqu l Islam 1004 Biarritz [I r ive APT #3 -owner of the property Miami Beach, FL -33141 Phone 786-30:3-3407; Emil: Objective: To obtain a challenging and rewarding position in which my skill5 and experience can be utilized to contribute to the goals of an organization which offers growth and advancement opportunities. Education: B.S, in civil engineering (B ang ladesh) passing year 1985. Professional e>1 perience: I worked as professional engineer and built a lot of bL ildings, roads, bridges, and culvert back home in Bangladesh. I ~,as involved in a big project (Dam construction ) and it was under Saudi Ministry of water and irrigation and got a good r eputat on and certificate . l was site engineer in different site, such as cofferdam slurry wall, pouring, concrete1 rock excavatior, consolidation grouting. Overa ll e very site ga in huge knowl edge with practical experience it was a very big project 200 twenty nine S.R. project the consultant company was AL-Faiso( and Auxon international [ American consulting firm]. Duration of this project from 1987 to 1992. 027 Then I was be ck to my home country start work ing with the consultant co m pany (Pmax consultant). As an engineer I was involve in a rural infrastructure epically 360' long bridge funded by the U.S. Ai :i, Jaica and other foreign company . Also involve with a lot of small bridge culvert and road construction. Most project basica :ly for flood protection to save the coa sta l area from the flood . So, I gain a lot of experience about -flood protection. Business experience: Started a grocery store business i n 1997 at 7l5t, Street M iami Beach area, then the second business opened in 2001 at 71st, Street Miami Beac h area. The third business opened in 2003, named "STOP N SAVE" located at 1245-7pt, strE!et Miami Beach FL 33141. Used to be 711, closed that business in 2010. Opened farm store in Hialeah until 2012 . Finally, I opened a gas station in Key Marathon FL. Languages skil l: English, Bangla, Spa nish, Arabic, Hindu, and Urdu. Notary Public : Since 1999 working as notary public and notarized lot o-= documents such as immigration document, personal papers. Sometimes I worked as a U.S . nota r y pub li c to he l p the mobll e embassy of Bangladesh . Since 2001 i n Miami DADE county FL. Home Owner: Own some rental property mainta in the property in a nice mannE!r. 028 Marital status: M arried. Ch il dren one daughter and two sons Reference MR. Bruce Schinberg (Attorney at law) Address: 800 \JVest Avenue Suite C-1 Miami Beach , Florida 33139 Contact n umb,?.r : 305-538-7575 Admilson Pete ~son ex-employee since 1997-2010 Contact numbe r : 786-769-9345 Kamru l Hassar. Khan: Business owner Contact numbE ?r: 786-380-7817 At p r esent boa rd member City of M iam i Beach sustainab i lity a n d res;Jiency committee. Artic le : Miami Beach is a city located in MIAM I-DADE Cou nty Florida. One of the largest populations in the County 87,779 . M Jami Beach has been home to several res idents from various nationalities genders social and economics classes w ith h u ndreds and t housands of visitors from around the world trave lli ng even, y ear to tour the famous city. City of M iam i Beach has been a community to many of the US . Everyone h ere h as good re\at,ons w,th the,r neighbors and become friends. We ca n help tc keep our community safe and clean p l ace. 029 How I can improve the city In t he rainy se,,son residents of Miami Beach facing big problem w ith the drainage system due to flooding wh ich i s -major iss u e. As a profess,or al, I can say that I will propose a plan to add ress the issue and \/t rill ensure that this p lan is executed . I will do my be st to ensure th at our needs are met. 030 IUCHARO I. KROOP ALSO .lDMITTEO IN COI.OAADO BRUCE J. ~BNBERG IAWOfflCES KROOP & SCHEIN BERG, P.A. SOlllli BAY CW&. sum C·l 800 WEST AVENUE Ml\\ll lj EACH, FLORIDA33l39 AREACOOEl 538-7575 CE RTIFIED F.lM l l Y M£Dl.lTOR COUNTY ClVll COURT MEDIATOR FAX ARfAC00£J( 538-4676 March 28, 2012 Personnel Departm ;:nt Powerlink Senlem{ nt Ser vices, LP 345 R ouser Road -Building 5 Coraopolis, PA 15 I 08 Re : Mohammed R :1.tiqul Islam Position Soug 1t: otary / Closing Agent Dear Sir or Madam : I recently had the cpportuoity to work over a con s iderable period of time with membe.rs of you r company iH a rather complex maner which after much effort on everyone 's part resulted in a succe~sful closing. You provided the services of a trave ling notary public who came to my office to complete the transurjon. That prompted me to \Vrite this letter. I have been an att o rney in South Florida for over 40 years whose practice has an emphasis on both ::ommercial and residential real estate matters. My office is located on that part of Mi:1mi Beach, known as South Beach which is unique in many ways especially in the irea of real estate because it attracts a large number of fo rei gn investors who for rnany of them English is not their primary language. In my opini o n, t h1 o ugh past experience there are times when although someone at a closing w ho is obviously from another country, may speak and apparently under stand E ngli sh there can be a ques tion of whether that person understands the nuisances of the language needed to fully un d erstand the text contained in certain closing documents. 1 have for many }ears known M r . Mohammed Raifqul Islam who advises that for a considerable perioi of time has acted as a notary and closing supervisory agent in the South Florida area H is ability to spea ( English, Spanish, Bangla, Arabic, Hindi and Urdu la n guages taken together with his wi llingness to travel throughout Florida would be a ignifi cant as ct 10 assist your company in closing transactions in general and specifically when the a::,ility to converse in t hese languages wou ld make the closing process more u:1derstandable fo r the parties involved. Raco=a ndation .e~ter 32812 doc 031 Wit h Mr. Is lam's lan guage skills , I belie ve that s ituati ons wherein no n pr imal") Engl is h s peaking parties mi sht later claim that they did not understand what they were si gn ing at a closing could bC' s ignificantl y minimized if not eliminated . A l-o Mr. {slam 's larguage s kill s wo uld be beneficial in creating a comfortable and more confident atm n phere for the perso ns attending a closing who might fe e l that the y ar e at a disad vanta ge when all the documents are in English and t hat is not th e ir primary langu age. 1 !herefo re would ask that yo u consider us ing Mr. Mo hammed Rafiqul Is lam to act as a notary / cl os ing age11t in transacti ons th ro ugh out the State of Flo rida . An y arrangements y )U wi sh to make should be made directly with Mr . Is lam. Si ncerely, KROOP & S 11' BE Bv. / ., r r B JS : 032 AL-DAKHEEL COR P. & CO. lHSHA DAM PRO.JECT HEAD OFFICE -:-.1ADINAH AL-:"1UNAWARAH P.0.BOX 33!-CABLE : AL -DA I.HEEL TELEX nxm AL-DAKH EEL s. J. -C.R. 496 TEL. 8234940 -FAX. 8260525 DATE _ 11 June 1989 NO. adc SERVICE CERTIFICATE TO WHOM 1·T ,~AY CONCERN ta.:.J ~.,.,, :.--;, ~.1.--tJ~ ;J_,..1.1 '-!.>J,i _ ..,-;)• _/} J .... ;.iJI LJ J' _ 1"1" I _, ,/ t ~, .;,._,.-J .... ~-~ov .. ,T ,.rS,J; ,H ,,ou ..r5u _ ,HT'tH, -1.,..._,.: Thi s is to ce:~ify that MOHD RAFIQUL ISLAM s /o Abdul Hamid 3huiyan Naticnality Bangl~deshi by birth, h a s been serving in this company si nce 2. JJ..87 as a S -tt e Engineer at the BISHA DAM PROJECT. During this per iod he successfu lly s upervised the completion of th e s lurr.y cut-off to t he cofferdam, ( done by sub -contractor ) , & the con - c:-ete work involv ,~d, done by our own l a bour . He was also working in dr 2.l1 ing and b l asting .:or rock excavation . During ~his pe ri od he has proved tote sincere, active & hard workin~ as well dS -:rustworthy. He i s stil l working with the company on this project . I wish him ev,:ry s uccess in the future . I I ; ) I ! \ I\ ,. , J,_ Engr. Mal ek Gh a zal Executi ve Proj . Engr. 033 :'he foll ow-mg 1s the a t:tho rued Engiis h ~ra:.sla.ti.or: o: th e or1g,.na: certlf1ca:.e ar.d :s •:a::c: only with the or1gmru Bangla ~::-t1ficate MONOGRA M Bangladesh University of Engineering & Technology, Dhaka CERTI FICATE ln accordance with the statutes of the University :fflol)ammtl.l -3Ratiqul lf slam h avm g satisfac torily fu l filled al l the academic requirements an d h aving rec1:!1ved the approval of the Syndicate 1s her eby awarded , \v1th all the nghts and privileges penaining thereto. t he degree of BACHELOR OF SCIENCE IN CIVIL ENGI?'--l°EER~G h nal acadt n .ic.. sess10n 19B3-t34 SE AL OF TH :;. UNIVERSIT" Date 29tfJ jf ebr1tarv 1988 He is placed in the ii->econb <!lass D a te of passing :!:llarcb 1985 S IGN.ATU~ES V tee-Cha ncellor Regist r ar Con t r oller o f Examtnatio ns Compared and Venfied CONTROLLER OF EXAMJl~ATIO NS 034 035 THIS PAGE INTENTIONALLY LEFT BLANK 036 • Jeffrey M. Feldman 037 THIS PAGE INTENTIONALLY LEFT BLANK 038 MIAM I BEACH BOARD ANO COMMITTEE APPLICATION FORM _F_el_d_m_a_n ________________ Je_ff_r_e~y ________________ M _____ _ Last Name First Name M iddl e Initial _20_Is_la_n_d_A_ve_#_1_00_6 ___________ M_ia_m_i B_e_a_c_h _____ F_L _______ ..;_33"-1-'3'""9 ___ _ Home Address City State Zip Code _30_5_-_54_2_-54_0_0 ____ ..;_30.;;_5'----'-70.;;_9;;._-..;_30.;;...0:....:0'----_30_5_-_54_2_-_54_0_0 ___ jeff.feldman201@icloud.c om Cellular Work Home Email Address The R i naldi Group of Florida Construction Business Name: Occupation: 1444 Biscayne Blvd . #305 Miami FL 33132 Business Address City State Zip Code Please list your preferences in order of ranking [1] first choice [2] second choice, and [3 ] third choice. Please note that onl three 3 choices will be observed b the Cit Clerk's Office. (Regular Boards of City) Choice 1 : Affordable Housing Advisory Committee Choice 2: Planning Board Choice 3: Historic Preservation Board 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 cu rrently effective corresponding professional license. * Note: If applying for the At-Large position of the Historic Preservat ion Board , please answer the below questions: • Have you ever resided in one of the City's Historic Districts for at least one year? N_Q No Address in City Historic District submitted . 039 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, band c: Members of Agencies, Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: a . Resident of the City for a minimum of six (6) months: • I am resident of: Middle Beach Or Yes b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "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. Or 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): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying fo r an appointment because I have special abilities , knowledge and experience. Please list below: I have served MB for several years in search of solutions to the affordability crisis . As the Vice Chair of the Planning Board , I was appointed in 2016 to the Affordable Housing Advisory Committee. During my time on this committee I have played an important role in sending potential legislation up t • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felony: No If yes , please explain in detail: • Do you c urrently have a violation(s) of City of Miami Beach codes : No If yes. please explain in detail : • Do you cu rrently owe the City of Miami Beach any money: No If yes , please explain in detail : • Are you currently serving on any City Board s or Committees: No If yes, which board? 040 • In what organization(s) in the City of Miami Beach do you current ly hold membership in? Name Miami Beach Chamber of Commerce Miami Beach Community Development Corporation Position Pillar Board Member Vice-Chair -Board of Directors • List the address of all properties owned or in which you have an interest within the Ci ty of M iami Beach : Property 20 Island Ave #1006 • Are you now employed by the City of Miam i Beach : If so , which department and title? • 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 Bea ch? If "Yes", identify person(s) and department(s): No r elative's information submitted . 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 (Mia mi-Dade County Code section 2-1 1.1 ). 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 ce rtain financial intere sts and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida 's Government-in-the-Sunsh ine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statu tes establish a basic right of access to most meetings of Boards , Commission s, and other governing bod ies of state and local governmenta l 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 , Comm ission , Authority , or Committee. It applies equality to members of advisory and non-advisory bodies who are presented with a voting confli ct of interest under Section 112.3143 . Florida Statutes . 041 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply w ith Miami-Dade County Financial Disclosure Code Section 2-11 .1 (i)(2) I understand that no late r than July 1. of e ach 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 fo ll owing forms muc:t be filled with the City C lerk of Miami Bea ch , 1700 Co nventio n 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 . Fa ilure to file one of these fo rms, pu rsuant to the Miami -D ade County Code, may subject the person to a fine of no more than $500, 60 days in jail , or both . 1 Members of the Pl anni ng Board and Board of A djustment wi ll be notified directly by the State of Florida, pursuant to F.S. §112 .3145(1)(a), to file a Statement of Rnancial Interests (Form 1) with t he Miami-Dade County Supervisor of Elect ions by 12 :00 noon, J uly 1. Planning Board and Board of Adjustment members who file the i r Form 1 with the County Supervi so r of Elections automatically sa tisfy the County's financial disclosure requ irement as a Miami Beach City Board/Committee member and need not file an add it ion al form with the Office of the City Clerk. However, complia nce with the County disclosure requirement does not satisfy the State requ irement. DIVERSITY STATISTICS REPORT T he foll owing information is voluntary and has no bearing on your conside ration for appointment. It is being asked to comply with City diversity reporting req uirements . Gender: Race/Ethnic Categories What is your race? Male White Are you Spanish/H ispani c/ Latino? Mark the "No" box if not Span ish / Hispanic / Lat ino . N.Q Other Description: No details provided Physically Challenged : No 042 Board and Committee Application Checkl ist : Please ensure you have provided all information before applying o r reapplying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES 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. 7 411 Note : Florida Statutes 119.071 : T he 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 d isclosure and you do not wish your home address , telephone numbers, and/or photograph to be made public, please : 1) Use your office or ot her address for your mailing address ; 2) Use your office or ot her tel ephone number for your contact number; and 3) Do not attach a photograph. 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 ACCORDINGLT. I Jeffrey Fel d man ag reed to the following terms on 12/16/2020 11 :26 : 14 AM Received in the City C lerk's Office by: Name of Deputy Cle r k Control No. Date 043 Jeffrey M. Feldman 1444 Biscayne Blvd . #3 05 . Miami , FL 33132 (305) 542-5400 Profe ssional Experi e nce The Rinaldi Group of Florida , LLC C hie f Operating Officer / Principa l j feldman @rina !di norida.com • Oversight of the TRG Florida Di vision operation • Manage executive-level re lationsh ips with sub -contra ctor ·. vend ors and ,uppli ers • Bu s ine ss deve lopment and contmct negotiations • Po liti cal advoc ac y and government relations Implementa tio n o f corporate strategic plan ning and s mart growt h pro gram • Manage ment ove rsight of all const ruction projects U ribe Con s truction, Inc. Vice Pre s ident / Partner ~liami, FL 20 t 9 -Pres t nt ,1ia111i. FL 2013-2019 • Construction proj ect management maximizing co~• controls. effoctl\e use of resources and sub-contractor mana gement Lea d and supervi se project 10 timel y completion. while ovcrsccm g da y-to-day operation of the business • Mana gement of budget and sc hedu les for commercia l and re~ident1al projects res ulting in highl y profitable outcomes • Trad,mg ae ti\ 11,c~ again ~t detailed project pl a ns. budget~ and ~c hcdu le~ • Pro\ ,ding regul ar updat ing and reporting from projec t tcam(s) to clie nt owne r S&J DeSoto, LLC (DeSoto D eve lopme nt) '1iami. FL Pres id e nt / Development Co ns ult ant M iami, FL 20 12-20 13 • Le verage extensive professional network 10 identify new oppo rtun11ie s fo r comm e rcial and re sidentia l de velopment or consultancy • Pro vided project ana lysis fo r proposed 110-uni t apartment deve lopmen t and 30-tmtt condo development for fo reign owner Comp leted developme nt ana lysis for proposed 110-unil apartment development lea ding to the sale o f0.86 ac sit e for 4 .5 MM Conducted project evalua tio ns includ ing hard cost analysis. budget e t imation and market research for 8-unit and 23-umt cond os • Retained by ow ner of :!.000 ac si te in Port -au-Prince to deterrn111e fcas 1b1lity of mixed-use de velopment 111c ludmg 30.000+ homes S teve n J. Feldman , Inc. ~1i ami, FL .\Ian ag in g Direc tor / Licens ed C o mmunity Association Manag er (LC A 1) 2002 -2012 Manageme nt of\ anou re idcnti al and commercial as ociation · th roug hout out h Florida Lo\\Cred o pemt ing cxpcn~es an average of 15% aero~~ portfoli o by chan gin g vcndor~. rene gotiating cxist111 g cont racL,. prcvcntallve cure of property and ma int aining low corporate ove rhead s Provid ed detailed re view o f each associa ti on ·s vendor contracts and operatm g ctliciencics A s ociate Develo per / Project Manag e r Co-developed mno va t1 ve bus iness stra tegy and implcmcn1a t10n of business plan for 43-unit Eco-Village m Co~w Ri ca Rai cd S3 2MM o f priva te investment ca pital fo r acquisitions. ent itl ements, pcnn ini ng and development Managemen t of dail y fie ld operat io ns from land acquis it io n throu gh de ve lopment (for th ree properti es in Costa Ri ca) P&L ma nage men t of $2 MM operating bu dget in clu din g. five fu ll -time d irect reports and 42 o n-s ite em ployees Dai ly coordina tion and mana ge ment of general con tractors, s ub-contractors and vendors Developed and mainta ined st rong pe rso nal rela t ionship wi th seller throu ghout complex 19-mo nego tiation to acquire 2.887 acres Successfu ll y rai~cd S90MM in committed acqui sition capital Established a nd maintain ed criti cal political and bureaucra tic relat1 ons h1p and impro ved competitive ma rket po nionin g throughout ri goro us en tn lement proces 111 an ant1-grow1h county Unan im ously awarded fu ture . 1te o f Fl orida GulfCoa~t Uni versity cam pu ~ a ft er Im itat ion to . egot ia1c (IT ) proce~, agamst four oth cr large--ca lc regional deve lopers Commum catcd. negotiated and coordinated wi t h general con tracto~. ·ubcontmctors and material vend ors 044 C ust omer Re latio ns, ·warra n ty 'er vices & Land Scout Created and es tabl is hed rclanonsh ips wi th regional brokerage profc · io nals to ~o urce new acquisition opportun itic in fou r maJor ma rke ts thro ugh o ut Flonda ( apl e Ft. Myers. Jack onv1 ll c. Orlando, Tampa) Researched. located a nd studied land parcel s for acq uis iti on th roughout the state fo r development. home-building. flipp ing and off-book land banking opportuniti es Pl anned, coordm ated and executed d cvcl oper-controllc<l homeowner., al>:,oc 1at 1on 's ·pec ial project Re solved compl ex custome r issues as a liai son between res1den~ and developer dunng cons truction through rumo,er Education University of Florida Bac he lo r of c ie nce in Management I Mino r in Bu in ess Admini strati on Ga in eS\•ill e, FL 1994-1998 Community Involvement Boa rd o f Governors Miami Beach Cha mber o f Commeree Fmr. Vi ce. Cha im1an -C ity of Miami Beac h Pla nning Board Fmr. Chainnan -C ity o f Mia mi Beach Waterfront Protection Committee Vice Chairman Mi ami Beach Community Development Corporat ion Executi ve Board Ha111 Empowenncnt Mi ssion 50 I (c)3 Me mber -Community Emergency Response Tea m (CERT) Ad visory Council Hand in Ha nd for Haiti 50 1(c )3 A :,oc ia t ion of Bui lders & Contrac tor:, City o f Miami Beac h A ffo rdable Ho u mg.Com mittee Co-Founder I st & At Ion (for Haiti) 50 I (c)3 City o f Miami Beach Lca<lers h1p Acad emy Co-Founder I Producer Halli An Expo City of Miami Beach Citizen 's Po li ce Academy 045 046 • Linda Diamond 047 THIS PAGE INTENTIONALLY LEFT BLANK 048 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Diamond Last Name HOME ADDRESS: 1201 20th Street, 202 Apt No. PHONE: 3013709911 H ome Home No ./Street 3013709911 Won< Business Na me: Silver Platter Cons ulting, LL C Address : 425 Childers Street, 24180 Street Linda T First N ame Middle Ini tial Florida Miami Beach City State LindaTDiamond@gmal l .com Position : President Pensacola City FL Email Address State 33139 Zip Code 32534 Zip Code Pursuant to City Code section 2-22(4) a and b : Members of agencies, boa rd s, and committees s hall be affiliated with the city ; this requirem ent shall be fulfill ed in the following wa ys: a) an individual shall have been a resident of the city for a minimum of six month s; or b) an indivi dual s hall demonstrate owners hip/intere st for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months Ye s • Demonstrate an ownership/interest i n a business in Miami Beach for a minimum of six (6) month s: No • Are you a reQ istered voter in Mia mi Beach : Yes • (Pl ease circi.e. one): I am now a resident of : South Beach • I am applyi nQ for an appointment because I have speci al abilities, knowtedQe and experience. Please list below: On the Board of Directors for SOBE Cats Spay & Neuter, Inc. • Are you presently a reg istered lobbyist with the City of Mia mi Bea ch? No Please list your preferences in order of ranking [1) first choice [2 ) second choice, and [3 ) third choice . Pl eas e note that only three (3 1 ch oices w ill be observed b y the City Clerk's Office . (Regular Board s of City) Choice 1 : Anima l Welfare Committee Choice 2: Choice 3 : • Board members are requ i red to file Form 1 -"Sta tement of F i na nci al Interest" with the Stat e . If you seek appoint m en t to a professi onal seat (e.g .• lawyer , archi tect, etc.) on the Board of Adj ustment, Desi gn Revi ew Board, Histori c Preservati on Board or Planning Board, attach a copy of you r cu rrently -e ffe ctively license, and furnish th e following information: Type of Professional Li cense ______________ _ License Number Li ce nse Issuance Date ________________ _ Li cense Expir ation Date Note: If applying for Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1 . Past service on the Youth Center Advisory Board : No ~---Years of Service: _______________ _ 2. Prese nt participation in Youth Center activities by your children _N_o __ age s, and which programs. Li st below: if yes, please list the names of your child ren , their 049 Error: Subreport could not be shown. • Ha ve you ever been convicted of a felony: No If yes , please explain in detail: • Do you cu rrentl y have a violation (s) of City of Miami Beach codes: No • Do you cu rrently owe the City of Miami Beac h any mon ey: No • Are you currently serving on any City Boards or Committees: No • What org anizations in the City of Miami Beach do you currently hold membershi p in? Error: Subreport could not be shown . • I am now employed by the city of Miam i Beach : No Which department? If yes, please explain in detail: If yes, please explain in deta il : If yes, which board? • List all properties owned or have an interest in , wh ich are located within th e City of Miami Beach: Error: Subreport could not be shown. !B'ectlcuB~ co uld not be shown . The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It i s being asked to comply with federal equal opportunity reporting requirem ents . Ra ce/Ethnic Categori es What is your race? Mark one or more races to indicate what you consider yo urself to be . White Other Desc ription : Are you Spanis h/H ispanic/ Latino? Mark the "No" bo x if not Spani sh / Hi spanic / Latino. No Physically Challen~ed : No 050 NOTE: If appoi nted, you will be required to follow certain laws which apply to city board/committee members. These laws Include, but are not llmlted to, the following : o Pro hibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracti ng with the City (Miam,-Dade County Code section 2-11 1 ). o Prohibition from lobbying before board/co mmittee you have served on for penod of one year after leaving office (Miami Beach Code section 2-26). o Requ irement to disclose certain financial interests and g ifts (Miami-Dade County Code section 2-11 . 1 ). (re: CMS Community Development Advisory Committee ): proh1b1t1on, dunng t enure 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 wh om you have business or immediate family ties (CF R 570.611 ). 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 have received, read and will abide by Chapter 2 , Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Linda Diamond agreed to the following terms on 11 /26/2019 1 :09:39 PM Received in the City Clerk's Office by : Name of Deputy Clerk Control No . Date 051 November 26, 2019 Linda Diamond * 1201 20th Street, 202 * Miami Beach, FL 33139 Linda Diamond Application Resume : Animal Welfare Committee Cell: 301-370-9911 My husband, Greg, and I reside in Palau at Sunset Harbor Condominiums; our primary residence. I am currently the President of Palau's Board of Directors and the Treasurer of the Sunset Harbour Neighborhood Association (SHNA). I am the founder of Silver Platter Consulting, LLC; an investment company that spans various industries. Prior to founding Silver Platter Consulting, I was the Executive Vice President of Sales for the East Coast Division at a Fortune 100 technology company for over 15 years. Philanthropically, I operate and am on the Board of SOBE Cats Spay & Neuter, Inc.; which is a 501 c3 nonprofit that helps to control the Miami Beach stray cat population by trapping, spaying /neutering, vaccinating then releasing our stray community cats. In addition, we worked with the City of Miami Beach to establish a Community Cat Registered Feeder program. Our Registered Feeder Program allows us to help educate, support and organize those individuals that are kind enough to feed our homeless community cat population. We count on our Feeders to not only feed and provide fresh water to the cots, but to also make us aware of any cats that have not been spayed /neutered (noted by a snip in the cots left ear), so we can work with that Feeder to educate on TNVR (Trap Neuter /Spay Vaccinate Return) options and techniques so we con ensure the kitty gets fixed and is given vaccinations. In addition, our Feeders keep on eye out for injured cats that need medical attention. We count on our kind donors to help us cover veterinarian bills. Over the last 1 2 months I served as Chair for the first City of Miami Beach Animal Welfare Committee. believe that my leadership skills, results oriented focus, extensive Executive management background, people skills, and technology savvy are severa l of my attributes that will help me to excel in a continued role on the Miami Beach Animal Welfare Committee. It takes time, dedication, and tenacious follow up skills to make sure a committee runs efficiently. I am capable and willing to put in the elbow grease. I look forward to assisting the City of M iami Beach with helping to improve communication, care and coordination around the welfare of our beloved animal population. When I om not working on my business or philanthropy work; you will see me boating, paddle-boarding, riding my beach cruiser around the beach, taking a bar class up the road, or heading to a dance class. 052 053 THIS PAGE INTENTIONALLY LEFT BLANK 054 • Aaron Resnick 055 THIS PAGE INTENTIONALLY LEFT BLANK 056 MIAMI BEACH BOARD AND COMMITTEE APPLICATI ON FORM Resnick A aron R ------------------------------------ Last Name First Name Middle Initial _4_50_A_lt_o _n _R_o_a_d~1 ~U_n_it_2_2_02 _________ M_ia_m_iB_e_a_c_h _____ F_Lo_r_id_a _____ 33139 Home Address City State Zip Code _30_5_9_7_5_3_97_6 _____ .;;..3..;;..05.;;_6.;;_7....;;2;;..;.7....;4..c.9..;:;.5 ____ 3_05_9_7_5_3_9_7_6 ____ aresnick@thefirmmiami .com Cellular Work Home Email Address Law Offices of A aron Resnick P A Attorney B usine ss N ame: Occupation : 100 Biscayne B lvd, Suite 1607 Miami Florida 33132 B usiness Address City State Zip Code P lease list your p re fe re n ces in order o f ranking [1] fi rst choice [2] second choice, and [3] t hird c hoice. Please note that only t hree (3) choices will be observed by the City Clerk's Office . (Regular Boards of City) Choice 1 : Art in Public Pl aces Committee Choice 2: Cultural Arts Council Choice 3: Visitor and Convention Authority 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 effect ive corresponding professional license. * Note: If applyi ng for th e A t -Large position of the H istoric Preservation Board , please answer the below questions: • H ave you ever resided in one of the City's H istoric Districts for at least one ye ar? Yes No Address in C ity Historic Distric t submitted . 057 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, band c : Members of Agencies , Boards , and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: a. Resident of the City for a minimum of six (6) months: • I am resident of: South Beach Or fu b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6 ) months : ~ "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. Or c. Full-time employee of such a business (for a minimum of six months); and I am based in an office o r other location of the business tha t 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 b e approved by a 417th vo te 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. • I am applying for an appoin t men t be cause I have special ab ilities , knowledge and experience . Pl ease list below: Graduate of Leadership Miam i; AV Preeminent rated attorney; Commercial Litigator of the Year (Flor ida ), Business and Contract Disputes Lawyer of the Year for Fl orida "Shining Star" Award by the Arts & Business Council of Miami, In c ., co-founder the Little Lighthouse Foundation , Board of Directors • Are you presently a reg i stered lobbyist with the City of Miami Beach? No • Hav e you eve r been convicted of a fel o ny: If yes, please explain in detail : • Do you cu rrently have a violation(s ) of City of Miami Bea ch codes : If yes , please explain in detail : • Do you cu rrentl y owe the City of Miami Beach any money: If yes , please expla in in detail : • Are you currently serving on any City Boards or Commi ttees : If yes , whic h board? Art in Publ ic Places Comm ittee 058 • In what organization(s) in the City of M iami Beach do you currently hold membership in? Name Pos ition Miami Beach Bar Association Board Member and V ice President • List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property 1900 Sunset Harbor Drive, Unit 1003 . • Are you now employed by the City of Miami Beach : If so, which department and ti tle? • 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? If "Yes", identify person (s) and department(s): No relat ive's information submitted . 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 w ith the city (Miami-Dade County Code section 2-11 .1 ). No 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 Sunsh ine 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 Board s , Comm issions, and other govern ing bodies of state and local governmental agencies or authorities . o Voting conflict -Form BB is for use by any person serving at the coun ty , 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 w ith a voting conflict of interest under Section 112.3 143. Florida Statutes . 059 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Ac knowledgement of fines/suspens ion for Board/Comm ittee Members for fa ilu re to comply with Miami-Dade County Financial Disclosure Code Sectio n 2-11 .1 (i)(2) I understand that no later than July 1. of eac h 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 fill ed with the City Clerk of Miam i Beach , 1700 Convention Center Drive , Miam i 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 M ia mi-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 wi ll be notified directly by the State of Florida , pursuant to F.S . §112.3145(1)(a), to file a Statement of Rnancial Interests (Form 1) with the Miami-Dade County Supervi sor of Elections by 12:00 noon , July 1 . Planni ng Board and Board of Adjustment members who file the ir Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requ ire ment 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 Th e following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements . Gender: Ra ce/Ethnic Categories What is your race? Oth e r Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic/ Latino. No Other Description : Physi call y Challenged : No details provided No 060 Board and Comm ittee Applicati on Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES I have completed and attached the Diversity Statistics Report. If you have any questions , please contact the Office of the C ity Clerk via email : BC @miamibeachfl .gov or telephone : 305.673. 7 411 Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to re ceive and maintain forms filed as public records . If your home address , telephone numbers , and/or photograph are exempt from d isclosure 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 co nta ct number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Aaron Re snick agreed to the following terms on 12/2/2020 5: 16 :21 PM Rece ived in the City Clerk's Office by : Name of Deputy Clerk Control No. Date 061 Aar on Resnick, Esq . EDUCATION J.D., Unive r sity of Florid a L evin Colle ge o f La w , G ai n esville, F lo rid a, 1995-1997 with Honors. Universite d e Montpe llier, Montpe llier, France, 1997 with High Honors. B.A., Emory University, Atlan ta, Georgia, 1990-1994 Aaron Resnick. Esq . is a graduate of Leadership Miam i and an AV Preeminent rated attorney by Martind ale- Hubllel, which is its highest possible rating for both ethical standards and legal ability. Professionally, Mr. Resnick is an attorney, who honed his craft at one of Flori da's oldest and most prestigious firms, Gunster Yoakley, before starting his own boutique law firm in 2005 with offices now in Miam i, Boca Raton, and New York City (as well as satellite offices in Gainesville and Jacksonville). Mr. Resnick receive d his Bachelor of Arts in Political Science with honors from Emory Un iversity and a Juris Doctor w ith honors from the University of Florida. Mr. Resnick is admitted to all of the state and federal courts in Florida and the Un it e d States Supreme Court. In 2019, Lawyer International Legal I 00 named the Law Offices of Aaron Resnick, P.A. the "Best Commercia l Litigation Law Boutique -Florida." In 2018, Acqu isi t ion International Magazin e announced that Aaron Resnic k, Esq . was a winner of the 2018 Lead ing Advisor Awards and named the Best "Commercial Litigator"" for Florida. His firm was nam e the Best Commercial Litigation Boutique by Corporate USA Today for 2018. Mr. Resn ick has been recognized by Florida Trend magazine as one of its Florida Legal Elite TM and Super Lawyers Magazi ne has named Mr. Resnick a Florida Super Lawyer. Corporate America also nam e d the Law Offices of Aaron Resnick, P.A. as the "Best Sports & Entertainment Law Firm -Florida ". Mr. Resnick is on the board of directors for the Miami Beach Bar Association, and is a member of the Dade County Bar Association where he serves on a number of committees as well as the American Bar Association. He is also on the Miami Beach Chamber of Commerce's Law Council. He was elected three times to serve as a member of the Board of Directors of the Dade County Bar Association Young Lawyers Section and has served as a committee chair for the America n Ba r Associa tion Young Lawyers D ivision, an organization which recognized him as th e American Bar Association Young Lawyers Division's Star of the Quarter. The Cystic Fibrosis Foundation and South Florida Business Journal have both previously recognized him as one of the Top 40 under 40 professionals in South Florida. Mr. Resnick also received the Film, Record ing and Entertain ment Council -Entertainment Law Award. Mr. Resn ic k was awarded the "Shining Star" Award by the Arts & Business Council of Miami , Inc . This award each year honors the cop Miami business professional supporting the arts and cultural community. Mr. Resnick co-founded the Little Lighthouse Foundation, www.littlelighthouse.org, which is a South Flor ida based charity that seeks, identifies and provides support to children and their families w ith health, educational, and financial challenges, and serves on its board of directors. Mr. Resn ick was the founding 062 chairperson of the Friends of the New World Symphony, a nd now serves permanently on its Executive Committee. He also sat on the Bo ard of Directors for the Miami Design Preservation League for over I 0 years. He has served on the exe cutive committee for numerous young patron groups in South Florida including, but not limited to: Best Buddies of South Florida, Big Brothers Big Siste r 's Impact Circle, Art Crowd of the Bass Mu seum, the Green Room Society for the Center for Performing Arts, the T ropees of the Historical Museum of Southern Florida. the Jewish legal Society of Miami. and the MOCA Shakers a mongst others. He was a Regional Board Member of the Ma cca bi World Union and a member of the Ben Gurion Socie ty of the Greater Miam i Jewish Federation. Currently, he is a Benefactor of the Bass Museum , a founding member and Patron of the Perez Art Museum a nd a Donor Circle member of ICA Miam i. Mr. Resn ick's law practice concentrates on business and commercial matters, focusing on lit igation. real estate and real estate litigation. His current practice also includes the personal representation of a number of current and former professional athletes in the National Football League, the N ational Basketball l eague a nd Ma jor League Baseball, as well as members o f the arts, fashion and e ntertainment world. PRACTICE AREAS • Bus iness and Commercia l litigation • Business Law • Real Es tate and Real Estate litigation • Sports and Entertainme nt law/Art law PROFESSIONAL & BAR ASSOCIATION MEMBERSHIPS • State of Flor ida • United States Supreme Court • United States D istrict Court for the Southern. Middle and Northern Districts of Florida • United States Court of Appeals, I I th Circu it • Florida Bar -Member Business Law Committee and Sports & Entertainment law Committee • Mia m i Beach Ba r Association -Me mber of Board of D irectors • American Ba r Association -Me mber Bus iness law Committee • Da de County Bar Association • Member of the law Council of the Mi ami Beach Chamber of Commerce • Member of the United States-Mexico Chamber of Commerce The Inter-Ameri can Chapter • Member of the Ind ia-US Chamber of Commerce South Florida • Member of the America-Israel Chamber of Commerce Florida Chapter • Member of the Florid a China Chamber of Commerce • Member of the Italy-Am erica Chamber of Commerce Southeast • Member of the Panamanian America n Chamber of Commerce • Member of the Columbia n American Chamber of Commerce • Member of Canadian American Chamber of Commerce of South Florida • Past Member o f the banking committee for the Asian American Hotel Owner's Association 063 THIS PAGE INTENTIONALLY LEFT BLANK 064 • Michael McManus 065 THIS PAGE INTENTIONALLY LEFT BLANK 066 MIAMI BEACH BOARD AND COMMI TTEE APPLICATION FORM ;.;.M;.;:c.;.;;M.;.:a;;.;..n;.;;;;u.;;.s ______________ .;..;.M.;..;.ic;:;.;.h.;..;;a;..;;e.;..I ______________ .;;;;E'------ Last Name First Name Middle In itial "'"3_44_M_e_r_id_ia_n_A_v_e_n_u_e_#4_A ________ .;.;.M.;.;.ia::;.m.;..;..;..;i B::;.e::;.a::;.c;;.;.h.;....._ ____ F_lo_ri_d_a _____ .;;.3.;;.3-'-13;;;.;9'------ Home Address City State Zip Code J,.;:(3=0.;;..5 )L...:5:....:3...;..1...;;•5=0.;;..89;;_____ .... (3...;..0...;...5 )""""5_3_1-_5_08_9 __ .._(3_0-"-5._) 5'""'3_1"""·5_0_89___ m32140@bel I south . net Cellu la r Work Home Email Address NIA Retired Business Name : Occupation : NIA NIA NIA NIA Business Address City State Zip Code Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] th ird choice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Art in Pub lic Places Comm ittee Choice 2: Cu ltura l Arts Council Choice 3: Professional License No Professional Licenses Submitted . Note: If you are seeking appointment to a profess ional seat (e.g. attorney, architect, etc.), you must attach a copy of your currently effec tive co rresponding professional license . * Note : If applying for the At-Large position of the Historic Preservation Board , please answer the below questions: • Have you ever res ided in one of the C ity's Historic D istricts for at least one year? Yes No Address in City Historic District submitted . 067 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code se cti on 2-22(4) a , b and c: Members of Agencies, Boards , and Committees shall be affiliated w ith the city. Th is requirement shall be fulfilled in the following ways : a . Resident of the City for a minimum of s ix (6) months : • I am resident of: South Beach Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "Ownership Intere st" 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. Or c. Full-time employee of such a business (for a min imum of six months); and I am based in an office or other location of the business that is physical ly located in M iami 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 417th 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 (o r 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. • I am applying for an appointment because I have special abilities, knowledge and experience . Please list be low: Curator Museum of Ame rican Fo lk Art Fil m Fest ival • Are you presently a reg istered lobbyist w i th the City of M iam i Beach? No • Have you ever bee n convicted of a felony: If yes , please expla in in deta il : • Do you c urrently have a violation(s) of City of Miam i Beach co des: ~ If yes , please explain in detail : • Do you currently owe the City of Miami Beach any money: ~ If yes , please explain in detail : • Are you c urrently serving on any City B oards or Comm ittees : ~ If yes , which board? 068 • In what organization(s) in the City of Miami Beach do you currently hold membersh ip in? No Organ iz ation Information Submitted . • List the address of all propertie s owned or i n wh ich you have an interest with in the C ity of Miami Beach : Property 344 Merid ian Ave. # 49 • Are you now employed by the City of Miami Beach : If so, wh ich department and t itle? • Pursuant to C ity Code Se ct ion 2-25 (b): Do you have a parent, spouse , child , brother, or sister who i s employed by the City of Miam i Beach? If "Yes", identify person(s) and depa rtment(s): No relative's information submitted . NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APP LY TO CI TY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE , BUT ARE NOT LI MITED 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 Proh i bit ion from lobbyi ng before board/committee you have served on for perio d of one year after leaving office (Miam i Beach Code sect ion 2-26) o Requirement to disclose certa in financial interests and g ifts (M iami-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 a ccess to most meetings of Boards , Commissions, and other governing bodies of state and local governmental agenc ies or authorit ies. o Voti ng conflict -Form 8B i s for use by any person serving at the cou nty, city , or other local leve l of government on an appointed or elected Board , Counci l, Commiss io n , Authority, or Comm ittee . It applies equality to members of advisory and non-advi sory bodies who are presented with a voting conflict of interest under Section 112 .3143. Florida Statutes . 069 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 understan d that no later t han July 1. of each year all members of Boards and Committees of the C ity of Miam i Beach , including those of a purely advi sory nature , a re requ ired to comply w it h Miam i-Dade County Finan ci a l Disclosure Requirements . One. of the follow ing forms must be filled with the City Clerk of Miami B each , 1700 Convention Center Drive , Miami Beach , Florida , no later th an 12 :00 noon of July 1, of each year: 1. A "Source of Income Statement;" or 2 . A "Statement of Financia l Inte rests (Form 1 )1 ;" or 3 . A Copy of your lat est Fe dera l Inco me Tax Return . Failure t o file one of these forms , pursuant to the Miami-Dade Count y C ode , may su bject t he person to a fin e of no more than $500, 60 days i n jail , or both . 1 Members of the Planning Board an d Board of Adjust ment w ill be not ifi ed directly by t he Sta te of Florida, p ursuant to F.S . §112 .3145(1)(a), t o file a Statement of Financial Interests (Form 1) with th e Miami-Dade County Supervisor of Elections by 12:00 noon , July 1. Planning Board and Board of Adjust ment mem bers w ho fi le t heir Fo rm 1 w it h t he Coun ty Supervisor of Elections automatically satisfy t he County 's financial d isclosure requirement as a Miami Beac h City Board/Comm ittee member and need not file an add itional form w ith the Office of the C ity C lerk . However, compliance w ith the Coun ty d isc losure requ irement does not sat isfy the State require me nt. DIVERSITY STATISTICS REPORT The following informatio n is voluntary and has no b earing on your consi deration for appoint ment. It is be ing asked to comply with City d iversity reporting requ irements. Gender: Race/Ethnic Categories What is your race? Wh ite A re you S pan is h/Hispan ic/ Latino? Mark the "No" box if not Span ish / Hispan ic/ Latino . ~ Oth er Descriptio n : No deta ils provide d P hysically Cha ll e nged : No 070 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph , and a copy of any app li cable professional license . I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk v ia email : BC@miamibeachfl .gov or telephone: 305 .673 . 7 411 Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to rece ive 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 publ ic, 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 . 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 ACCORDINGL l'. I Michael McManus agreed to the following terms on 12/9/2020 10:45:43 AM Rece ived in the City Clerk's Office by : Name of Deputy Clerk Control No. Date 071 MICHAEL MCMANUS 344 Meridian Ave . #4A Miami Beach, FL 33139 305 5315089 m32140@bellsouth.net BA John Carroll University (Jesuit) MA New York University Cinema verite documentary filmmaker: CBS Specials Bill Moyers Journal 20/20 Director of Exhibit ions Museum of American Folk Art : Administration Curatorial Writer Florida Humanities Council Speakers Bureau Adjunct Professor Art Department: University of Miami Florida International University Two terms Miami Beach Cultural Arts Council Published: Knopf Viking Yale University Press Condominium owner 072 073 THIS PAGE INTENTIONALLY LEFT BLANK 074 • Megan M. Riley 075 THIS PAGE INTENTIONALLY LEFT BLANK 076 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _R_il_e __________________ M_e~g~a_n ________________ M _____ _ Last Name First Name M idd le Initial 3 Island Avenue 11 B Miami Beach FL 33139 ______ ,__ ___________ ----------------- Home Address City State Zip Code _9 _17_-_6_2_7_-8_8_9_2 _______________________ megan@meganrileyprojects .com Cellular Work Home Ema il Address meganri leyproje cts, li e Art Consultant, Arts Marketing & Sponsorship Business Name: Occupation : 3 Island Avenue , 11 B Miami Beach FL 33139 Business Address City State Zip Code Please list your preferences in order of ranking [1] fi rst choi ce [2] second choice , and (3] third choic e . Please note that onl three 3 choices will be observed b the Ci Clerk's Office. (Regul ar Boards of City) Choice 1: Art in Public Pla ces Comm ittee Choice 2 : Choice 3 : License Number Professional License Megan Marie R iley R400-553-65-75 7-0 Issuance Date 9/19/20 13 Expire Date 7/17/2022 Note: If you are seeking appointment to a professional seat (e.g. atto rney, archite ct , etc.), you must attach a copy of you r cu r rently effective corresponding professional li cense . * Note: If applying for the At-Large po sition of the Historic Preservation Boa rd , please an swer the below questions: • Have you ever resided in one of the City 's Historic Districts for at least one year? Yes No Address in City Historic District submitted . 077 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code secti on 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: a . Resident of the City for a minimum of six (6) months: • I am resid ent of: N/A Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: fu "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. Or 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): fu Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commi ssion. 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 th e City Clerk prior to being s worn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience. Please list below: I am applying once again as my 25 years of experience in the art world allows me the expert ise to work with artists and the city of Miami Beach to real ize Public Art and enhance the community. • Are you presently a registered lobbyist with the City of Miami Beach? NQ • Have you ever been convicted of a felony: No If yes , please explain in detail : • Do you currently have a violation(s ) of City of Miami Beach codes: NQ If yes , please explain in detail: • Do you currently owe the City of Miami Beach any money: NQ If yes , please explain in detail: • Are you currently serving on any City Boards or Committees: If yes , which board? 078 • In what organization(s) in the City of M iami 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 with in the City of Miami Beac h: No Owned Property Information submitted . • Are you now employed by the City of Miami Beach : If so , which department and t itle? • 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 Be ach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 Pro hibition from directly or indi rectl y lobbying ci ty 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 boa rd/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 bod ies of state and local governmental agencies or authorities. o Voting conflict -Form BB 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 Se ct io n 112.3143. Florida Statutes . 079 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines /suspension for Board /Committee Members for fa ilure to comply w ith Miam i-Dade County Financial D isclosure Code Sec tion 2-11 .1 (i)(2) I understand that no later than Jul y 1. of ea ch 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 C ity Clerk of Miami Bea c h , 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 late st Federal Income Tax Return . Failure to file one of these forms , pu rsuant 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 w ill be notified directly by the State of Florida , pursuant to F.S . §112 .3145 (1)(a ), to file a Statement of Finan ci al Interests (Form 1) with the M iami-Dade County Supervisor of Elections by 12:00 noon , July 1. Planning Board and Board of Adjustment members who file the ir Form 1 with the County Supervisor of Elections automatically satisfy the County's finan c ial dis c losure requ irement as a M iami Bea c h City Board/Committee member and need not file an add iti onal form with the Office of the City Clerk . However, compl iance with the County disclosure requirement does not satisfy the State requirement. DIVERSITY STATISTICS REPORT The following information is voluntary and has no beari ng on your consideration for appointment. It is being a sked to c omply with City d ivers ity reporting requirements. Gender: Race/Ethnic Categories What is your race? Female White Are you Spanish/Hispani c/ Latino? Mark the "No" box if not Spanish / Hispanic/ Lati no. No Other Description : No det ails provided Phys ically Challenged : 080 Board and Committee Application Checklist: Please ensure you have provided all information before applying o r reapp lying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES 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 . 7 411 Note: Florida Statutes 119.071: T he 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 fo r your ma iling address ; 2 ) Use your office or other telephone number for your contact number; and 3 ) Do not attach a photograph . I HEREBY ATTEST TO THE ACCURACY ANO TRUTHFULNESS OF THE APPLICATION ; ANO I HAVE RECEIVED , READ ANO 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 ACCORDINGLT. I Megan Riley agreed to the following terms on 12/10/2020 2:51 :56 PM Received in the City Clerk's Office by : Name of Deputy Cle rk Control No. Date 081 Megan Riley 3 Island Avenue Miami Bea ch, FL 33139 I megan@meganrileyprojects.com I 917.627.8892 Professional Experience Prin cipal/Director I meganrileyprojects, lie I New York, Chicago, Miami I 2003 -present Launched and manage cultural consulting firm specializing in PR , sponsorship, marketing, curating, art advising, and projects in the fields of art, architecture and design. Select projects include: The Red Ball Project I Chicago, IL • Secured Target Corporation as sponsor to partner with NY-based artist Kurt Pershke to realize this month-long art project. • Negotiated all aspects of PR, marketing and community affairs wi th project sponsor Target and City of Chicago Department of Cultural Affa irs. Gimme Shelter I Shelter Island, NY • Managed all aspects of this three-month-long exhibition in a private re sidence on Shelter Island . • Selected work exemplifying domesticity by 25 internationally recognized artists. • Secured sponsorsh ip to underwri te exhibition and assoc iated events. • Finali zed sa les and p lacement of select works. re:LAX I New York, NY • Curated exhibition installed at DCKT and Charles Cowles Galle ry in New York. • Included 11 established artists whose works ranged in media and all reflected and challenged the ideas su rrounding "airport cu lture." • Produced all aspects of marketing materials, contrac t s, press releases , opening reception, and sales. Artist for Aid for Aids I New York , NY • Conceived, planned and produced exhibition for fundraising initiative . • Worked with artists Guil lermo Kuitca , Tere sita Fernandez, and Az iz+ Cucher, and their respective dealers and p rintmakers in producing works for the exhibition and subsequent sales. Editions/Prints Fair I New York, NY • Developed and executed marketing and PR st rategy for the annual Fair. • Obtained sponsorship for opening night benefit fo r Printed Matter and additional events over the course of the two-year project. Director of Ext ernal Affairs I The Bass Museum of Art I Miami Beach, FL I 2010 -2019 Provided strategic leadership, oversight, implementation and management of integra ted development and communication initiatives. Managed institutional advancement and externally focused efforts of t he museum, including individual and corporate giving, marketing, public relations and commu nity affairs. 082 • Secured compatible and meaningful corporate sponsorships for exh ibitions, events, and museum overhead. Corporate partners to date have in c luded ; Chanel, Chloe, Dior, John Varvatos, Tory Burch, PUMA FIAT, Walgreens, Lifewater, and others. • Maintained on-going partner relationships with Bank of America, Duane Morris, PHILLIPS , Christie's , Sotheby's, One Sotheby's Realty, Coldwell Banker, The Cultivist, and the above. • Cultivated commu nity part ners such as: The Knight Founda tion, Th e W Hotel, South Beach Hotel Group, Collins Park Neigh borhood Assoc iation, Miami Beach Chamber of Commerce, among others. • Sou rced Board, Donor and Member relationships. • Oversaw new and annual membersh ip campaigns such as BASSARTPASS (relating specifically t o the annual A rt Basel Miami Beach art fair week that takes place in December). • Launched museum's limi ted edition program as a fundraising initiative. Worked directly with artist's gallery and/or studio to realize works of art. Represe nted museum at UNTI TLE D art fa ir with The Bass booth exhibitin g and selling works by Aaron Curry. Paola Pivi, The Haas Brothers, Ugo Rondinone, Pascale Marthine Tayou , Carlos Rolon , and others. • Established and executed museum 's new brand . website and marketing materials in 2010; including creative direction and production of 'Members' Magazine' that publish ed 3x a year. Additionally, spearheaded re -branding team for the museum 's post renov ation re-opening in Fall 2018. • Managed all aspects of the PR & Marketing efforts to effectively promote the museum's exhibitions, programming and even ts. • Maintained an extensive art and luxury world rolodex for continued outreach and professional development. Specialist in Contemporary Art/Special Projects I Wright Auction House I Chicago. IL I 2007 -08 • Researched and secured works for in-house auction house sales working with artists, galleries, priva te dealers and colle c tors locally and globally. • Cultiva ted c lient rela tions targeting specific sa les. • Faci li tated thoughtful art world connections to realize special projects such as ; working w it h photographer Todd Eberle t o produce t he limited edition catalogue for the Louis Kahn house sale. Project Direc tor I Creative Link for the Arts I New York , NY I 2004 -06 • Planned and implemented launc h of 2006 in augural $1 00,000 Ordway Pr ize for mid-career artists , cura t o rs and/or arts writers. • Served as liaiso n to PR firm , executing all press -related materials in conju nction with the prize and fou ndati on. • Organized all aspects of Prize lu nc he on fo r honorees and launch with 100+ art world guest list. • Consulted on curatorial advisory commi ttee and nomination selection panel for the 2007 Prize. Advertis ing/Marketing Sales Manager I ARTFORUM magazine I New York, NY I 1998 -2003 083 • Identified new b usiness opport unities fro m lifestyl e a nd luxury sec t ors. Secured advertising partnerships and maintained relationships with clients such as: Absolut. Deu tsche Bo nk. LVMH . Prado . Gucci. Colvin Klein . More Jacobs. Helmut Lang. Kate Spade, and others. • Initiated trade and barter relationships with high-profile art and culture publications and events. restaurants and hotels such as: The New York Observer. Art Base l Miami Be ach. The Armory Show. The Maritime. Soho Grand. Michaels, Bottino, and others. • Developed and maintained all aspects of new and established advertising account s with domestic and international galleries. museums and auction houses. Co-founder /Director I Gallery A I C hi cago. IL I 1992 -1998 • Co-founded con te mporary art gallery with a foc us on emerging artists. Exhibi tions included work by artists such a s: Tom Friedman, Kora Walker, Ed Pasc hke. Donald Sultan and others. The gallery contin ues operating today a s Carrie Secrist Gallery. Education Columbia College I Chicago, IL I 1989 B.A., Arts . En terta inment . and Media Management University of Iowa I Iowa City, IA Art History and Communications Affiliations 198 4 -86 Collins Po rk Neighborhood Associa tion . Miami Beach. FL/Boord Member Art In Public Places. City of Miami Beach. FL /Chairperso n a n d Member Soho Beach House. Miami Bea ch. FL/Founding Committee Mem ber !Cl/Independent Curators Inte rnational. New York . NY /Board Member Re na Hort Monn Founda tion. New York . NY /Benefit Committee Member Coalition f o r the Homeless. New York . NY /Benefit Committee Member Art in General, New York . NY /Benefit Committ ee Member Guild Hall. East Hampton. NY /Be nefit Commi ttee Member CADA/Chicago Art Dealers Association . Chicago. IL/Secretary 084 085 THIS PAGE INTENTIONALLY LEFT BLANK 086 • Glendon Hall 087 THIS PAGE INTENTIONALLY LEFT BLANK 088 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Hall Glendon _..;.. _______________ _ p -----------------Last Name First Name Mid d I e Initial 5748 Plnetree Drive Miami Beach .;;..;....;..;;....;.....;.;..;...:;...;.c...;;..;:;....;:;;..;...;...;_;'------------Florida ---------33140 -------- Home Address City St ate Z ip Code _30_5.;_3;....c3_1....;;..5_40.;;_2"-----_30_5_3_3_1 _54_0_2 ____ 30_5_3_3_1_54_0_2 ____ glendonhall@gmail .com Cellular Work Home Email Address City of Hallanda le Beach Economic Development Manager Business Name: Occupation : 400 South Federal Highway Hallandale Beach FL 33009 Bu siness Add ress City State Zip Code Please list your preferences in order of ranking [1 ] first choice [2] second choice, and [3] third choice . Please note that onl three 3 choices will be observed b the Cit Clerk's Office . (Regu l ar Boards of City) Choice 1 : Bl ack Affairs Advisory Committee Choice 2: Neighborhood and Quality of Life Committee Choice 3 : Personnel Board Professional License No Professional Licenses Submitted . Note: If you are seeking appointment to a professional seat (e .g. attorney , arch itect , etc .), you must attach a copy of your currently effective corresponding professional license. * Note: If app lying fo r 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 No Address in City Histori c District submitted . 089 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2 -22(4) a , b and c: Members of Agen cies, Boards, and Committees sha ll be affiliated with the city. This requirement shall be fulfilled in the following ways: a. Resident of the City for a minimum of six (6) months: • I am resident of: Middle Beach Or b . Demonstrate an ownership interest in a business established in the City fo r a minimum of six (6) months: fu "Ownership Interest" shall mean the ownership of ten percent (10%) or more (i ncluding the ownership of 10% or more of the outstanding capital stock) in a business. "B usiness" shall mean any sole proprietorship, sponsorship, corporation. limited liability company, or other entity or business association. Or c . Full -ti me employee of such a bu si ness (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): N.Q Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Ma yor and City Commission. NOTE: Members o f Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements o f 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. • I am applying for an appointment because I have special abilities , knowledge and experience. Please list below: As a an almost twenty resident/activist in Miami Beach , long time president of my homeowners association - actively engaging with the city in policy/legislation/advocacy and as part of the 4 % Black population in Miami Bea ch, I believe my extensive background/experience will provide needed insight • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felony: If yes , please explain in detail : • D o you curren tl y have a violation(s) of C ity of Miami Beach cod es: If yes , pl ease explain in detail: • Do you cu rrently owe the City of Miami Beach any money: If yes , please expla in in detail: • Are you currently serving on any City Boards or Committees: If yes , which board? 090 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name LaGorce Pinetree Home Owners Association Posit ion President • List the address of all properties owned or in wh ich you ha ve an interest within the City of Miami Beach : Property 5748 Pinetree Drive • Are you now employed by the City of Miami Beach : If so , which department and title? • 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? If "Yes", identify person (s) and department(s): No relative's information submitted . NOTE : IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAI N 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 (M iami Beach City Code section 2-459). o Prohibition from contracting with the city (M iami-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 certa in financial i nterests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunsh ine Law -Florida 's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sun shine 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 co unty, city , or other local level of government on an appointed or elected Board , Council , Comm issio n , Authority, or Committee. It applies equality to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Secti on 112.3143 . Florida Statutes . 091 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines /suspension for Board/Committee Members for failure to comply w ith Miami -Dade County Financial D isclosure Code Section 2-11 .1 (i)(2) I understand that no later than July 1. of each ye ar all members of Boards and Committees of the C ity of Miami Beach , including those of a purely advisory nature , are required to comply with Miami-Dade County Financial Disclosure Requirements. One of the followi ng forms must be filled with the City Clerk of Miam i 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 Fina ncial Interests (Fo rm 1 }1 ;" or 3 . A Copy of your latest Federal Income Tax Return . Fail ure to fi le one of these forms , pu rsuant to th e Miami-D ade County Code, m ay subj ect th e person to a fi n e 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 , purs uant to F.S . §112 .3145 (1)(a ), to file a Statement of Rnancial Interests (Form 1) with the M iami-Dade County Supervisor of Elections by 12:00 noon , July 1 . Planning Board and Board of Adjustment members who file the ir Form 1 with the County Supervisor of Election s automaticall y satisfy the County's financial disclosure requireme nt as a Miami Beach City Board/Committee member and ne ed not file an add iti ona l form w ith the Office of the City Clerk. However, compl iance with the County d isclosure requirement does not satisfy the State requ irement. -DIVERSITY STATISTICS REPORT The following information is vo l untary an d has no bearing on you r consideratio n for appoi ntment. It is being asked to comply with City diversity reporting requirements . Gender: Race /Et hn ic Ca tegories What is your race? Africa n-Ame rica n/Bla ck Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No Other Description : No deta il s provided Physically Challenged : No 092 Board and Committee Application Checklist : Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . ::===:::! YES I have uploaded a current resume , photograph, and a copy of any applicable professional license. YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES 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 . 7 411 Note: Florida Statutes 119.071: T he role of t he 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 d isclosure 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 mailin g address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Glendon Hall agreed to the following terms on 10/16/2020 4:20:32 PM Received in the City C lerk's Office by : Name of Deputy Clerk Control No. Date 093 GLE 1 DO P. HALL FRA-RP 5748 Pmctrcc Dri ve . Miam i Beach Fl 33140 Ph o ne: (305) 331-540 2 E-mail: Glcndon Hall (~gmail.com I am an accomp li hed p rofessio nal wi th extens ive economic'community dcvelopmcnL grant underwriting/manage ment , co mmercial re al c ta tc, budget. and domest ic interna ti ona l finance experience in both the public and pri vate sectors. I.B.A .. Duke University. Durham , , orth Carolina. Finance, May 1994 B.A . Mor.:hou sc Coll ege. Atlanta, Georg ia . Computer c icn ce, Ma y 19 88 ln stituto lnteramcricano De ldiomas, S.A San Jose. Costa Ri c a. ov -Dec 1995 Fl orida Redevelopment Associa tion, Redevelopment Professiona l De signatio n, Oct 2019 Accomplishments • Devel oped a nd received board approval for th e C ity of Ha ll anda le Beac h ·s Art & Cul ture in Pub li c Pl aces Pr ogram wi th an annua l budget of $800,000. • Recru it ed and received board approva l fo r the fi rst and only Mic ro Brewery in th e City o f Hallandale Bea c h wit h a 500,000 commerc ial in centive. • Struc tur.:d two of th e largest red eve lopment proj.:c ts in th e hi story of the W Fort Laud erdale Commun ity Redevelopment Arca (CRA). a $42 million mixed u.e res id ential proj ec t a nd a 15 million s tate of th e art community center. • Assi~tcd the C it y Ma nager of th e C uy or Miami B.:ach in the preparati on of the 1-'Y 2012/13 Pro posed a nd A dopted Operatin g BudgeL~ totaling $441 m1ll1on an d t he FY 20 12 20 17 Capital Improvement Pla n to talin g 209 million wh ich avcd the C ity $3.6 million. provi ded enhancements of$3 .5 mill io n in addit ion to reduc ing the mill age rate. • Fonnulated and imp leme nted the City of Miami 's Brownfie ld/La nd Revitalization Pla n th at provi ded incen t ives for redeve lopment of several hundred contamin ated s ite s that inc luded Mi d town Miami th at re u lt ed in over SI billion in rea l estate and infras tru cture invc tmcnt in the Ci ty. focused on urb an corrid ors. • egotiated wi th one o f th e oldest and largest retail commercial p ro pe rty ownertdcvclopers in Miami to comp lete a pilot fai;ade improvement program funded by the City of Miami and M iami Dade 's Commercial Revi talization Program that completed new s torefro nts fo r 11 local bus in esses and reta ined ove r 70 Jobs in lo w income areas of the city. • Sec ured and subsequen tl y man age d $2.1 Mill io n in EPA a scssmcnt, remediation an d A RRA funded Brownfield /Green Jo b training grant s that resu lted in th e development of multiple affo rdable hous in g projects. business retenllon . corporate recru itm e nt and job creat ion in hi ~torically undaserved communitics in Liberty City. Lill ie Hai t i, Wyn wood and All apa llah . Citv Of Hallandale Beach, Hallandale Beach, Florida Eco nomic Develo pment Manager. Ma y 2018 -present. Ov e rsee in g Lhe plann in g, o rgan izmg. direc tin g and exec ution o f the City's Econo mi c Devel o pm e nt Pl an , respo ns ible fo r manag mg 1mpac tful corporate relationships and promotin g effec ti ve marke ting a nd other in it iatives to enha nce th e C ity's economi c develop ment efforts. • Developing an d implemen ting mark e tin g strategics us ing economic. s tati st ica l and demographic data to attrac t. re tain and expand va lue ad ded industries. conductin g resea rch and analysis o f compe titi o n 10 id entify bu me ava ilability and demand . • Man agi ng the CRA's Comme rcial lncenti\'e In itiati ves and the p re paration of City C omm i ion agenda ite ms . RFP s. con tract . tec hnical appl icatio ns for intergovernmental aid andior private ecto r fundin g in conn ec tion with ho using and econo m ic development projects and ac t1vllies. • Developin g budgetary re commendat ions, evalu a11on 1monitonng sys te m a nd financi a l co ntrols to en sure proper program and financia l managemen t of int ergovern menta l grant agreemen t . and co ntracts related to CRA operation!.. • Man agi ng co mmun ity charettcs and c itizen part1cipa 11 on outreach in vo lved in th e planning, development. and assessment of commun ity and economic development prog ram s. Citv Of Fort Lauderdal e, Fort Lauderdale, Florida Hou s in g & Eco nomic Development Manager -'orthwest Progresso Flagler Community Red eve lopment Age nc y (C RA), August 2016 -A pril 2018 Facil ita ted , organi7ed . imp lemented , coord ina ted and ana ly;,c d hi g hly co mp lex and techn ica l profess io nal housi ng, commerc ial , communi ty, econom ic, and phys ica l deve lo pm e nt p rojects consis tent with the C RA master p la n. • Managed the C RA 's Bu s ine ss Ince nt ive Progra ms and s upe rv ised the preparat ion of technical applications fo r municipal aid and/or private sector fu nd ing in con nec tio n with housi ng and economic development projects and activities. • C reated financia l control s & budge ta ry processes to ensure proper program and fina nc ia l managemen t of grant funding. a nd a greement for succe s ful CRA operations. 094 • Supervised s taff. and provi ded administrative and technica l guidance regarding the des ig n a nd develo pment of c urrent and lo ng-range program and project plans. and the implementa tion a nd coordination of related projects and activitic . • Acted as s taff liaison to intergovernmenta l officials, private con ul tants. arch it ects and contractor . and citi zen advisory and neighborhood-based groups . • Oversa w c iti zen panic ipa t ion p rogram s in volved in th e planning. develo pment, a nd assessment of h o using and commun ity and econo mic d evelopme nt programs; coord inates these public m eetin gs, forums, and hearings. C itv Of M iami B ea c h. Mi a mi Be ach, Flo rid a R ed evelopme nt S pec ialist -Office o f T o u ri m C ultu re & Econo m ic De \ e lopm e nt . J a nu a ry 2013 -Februa ry 201 6 Facilitate d th e City· economic dev elopment and redevelopment agency (C RA) function s including th e operat ions of the divisio n . • A si tcd comp a n ies with the C ity·s development p rocess. r e ferra ls to resource providers and w ith obtain in g fin a n cial in centi ve s, supponing emergin g and leading indus tnes: e.g. green technology. c rea ti ve ans. fi lm and med ia. and 111tem ationa l busmc ~cs wit h emphasis on unde rdeveloped commcn:1a l d 1s lricL>. • Fo tcrcd p anncrsh1 ps with commumty stakeholders and maintained m a rket. economic and demographic databases for new and exis t ing bus inesses with expansion and relocat ion plans wit h t he C iry. • Served as liaison w ith Miami-Dade County o n the red eve lopme nt agen cy (CRA ). including plan approv al. budget review and monit o ring. • Ass i ted in negotiations regardin g development agreement , loans, or contracts related to real e tate , real property. d evelopment. re deve lopment, joint ventures, or other public,privatc investment. C ity Of Miami Beach, Miami Beac h, Flo rida l anag ement and Budg et An a lys t -Office o f Budget a nd P erform ance lmproHm e nt , April 2012 -D ecembe r 2013 Performed complex assignments 111 methods analysis, operations aud iting. and productiv ity analysis. to develop im provements in the efficiency. effecti veness and producti vity of City of Mi a mi Beach opera ti o ns. • A ssis ted the City Manager in pre paration of the FY 2012 113 Prop osed a nd Adopted Operating Budget includi n g Fire, Pa rk . C l P. Human Resources, Real E ·ta lc. H ousmg & Comm umty Develo p ment and RDA totaling 441 million . • A ssisted City Manager in preparation of the FY 2012 -2017 Capital Improvement Plan. includi n g funding project schedule pri o ritization fo r fac ility and public infrastructure enhan cements totaling 209 million . • Analyzed d c panmcnta l budget. purc h asi n g . pos ition. forecast requests and r ecommending approval/disapprova l of enhancement.., to th e City Manager. Ba vview Asset M a na g e me nt. Co ral G a ble s, Florida l'ni o r A sset :\1 a nager -Co mm e rci a l Loans. O ctobe r 20 IO -A pril 2012 Ma n aged portfoli o of s p ec ia l s erviced real estate assets con s1 t in g of comme rc ial mong agc-backcd securit ies (CMBS). • Instituted workout s t ra tegics with non per formi n g loan s. designed to maximize valu e fro m these as e ts and achieved I 00% recovery rate on defaulte d loans. • Loans range from S2 milli o n to S 14 million. in ventures with total costs from $3 million to over 60 m illion. The po rtfoli o con sists o f commen.:ial asset classes in the retail , multifamily, h o~p ita l ity. office a nd indu~tria l ~ec tors. C itv Of Miami. 1ia mi. Flo rid a A s ist a nt Dire ct o r -Econo m ic Deve lo pme nt D e partm ent, ~ovember 2004 -March 20 I 0 C rcatt:d policies and mitiatives to ensure M iami had a dynamic economy w he re local industry could be ~u cccssful in t he g lobal m a rk etp lace . • Involved form u lation of s trategics, coll aborating w ith p o licy makers. economic development impact groups. and th.: C1ty·s top management to market and fo tcr p ublic 'p rivatc partnerships for fu ture projcct creation. • PrcparccLmanagcd a nnual operati ng bud gets fo r th e dcpanm enl. including monitoring and a nalysis of revenue expenditures for compliance. • Developed/maintaine d financ ial models for projections of o perating and capital budgets within divis io n. • Succe !>full y implemented the City's Brown field/La nd Rev ita liza ti o n Plan to s timulatc r.:usc o f contaminated prop.:rties rcsultmg in over SI B 1ll1on 111 direct inves tment. • F.ffect1..,c ly secured and managed S2. I million in r.P/\ assessment, reme diation and Rrownfield j ob tra 111in g grant~ to e n s ure r edevelo pment in underscrvcd areas. • Procu red S 2 .4 m ill ion funding from pri vate, federal and local governme n t sources to reinves t 111 u rban comm ercial cor ridor u pgrades to p romote JO b creat io n and business development. The E PA. CDBG and ARRA funding was focused o n upgrading retaining th e rema in ing indu tr ia l,commcrc1al corrid ors of Miam i. 095 l.:'IIR Property Co rporatio n, Miami Beach , Florida Asse t Manager -Lennar Partne r s , October 2001 -November 2004 Managed portfolio of commercial rea l estate assets for one of the leadin g in st itut ions in th e world of comm ercia l mortgage-backed securi ties (CM BS) investment and oversight. re prese nting over I 02 securitizations with an original face amount of $82 billion. • Involved financial mode l ing/underwriting of investments in new no n inve tmcnt grade CMBS bond sccu riti zati ons. • Entailed monitoring poten tial property/sec tor/geographic issues across port fo li os a nd in stituting workout tratc g ics w it h no n per fom1ing lo ans. designed to maximize val ue from these asse ts. Achieved I 00% recovery rate on defaulted loans. • Loans ranged from S2 million to S75 million. in ve ntures with total costS from S3 million to over$ I 00 million. The portfolio con 1sted of commercial asset classes in the retail, multifamily. hospitalny. office and industria l sectors. Eme rging Markets Partners hip , Washington, DC (a n advi so ry con tract with th e Int er -A me ri ca n In vest m e nt C orporation) In ves tment Officer -A IG-GE Capital Latin Ameri ca n Infrast ructure Fund L.P. J a nu a ry 1998 -July 2000 Identified and developed infrastructure ventures for the large t private equity fund operating exclusively in the Latin Americ an region. wi th over USS I bil li o n investablc capnal. • Involved finan cial mode l ing/valuations o f privatizations. joint ventures and green field infrastructure projects. • Invest me nt sizes ranged from S20 m illion to $75 million. in ve ntures wi th total costs from S50 millio n to over$ I billion . • Conducted in-country due d ili gence which inc luded project appraisals. market structure and ri k analysis. The project developed in clude three privatization and five greenfield project in the power. telecom. tra n portation and natural resource ectors. Int e r -Americ an In ves tm e nt Corporation (II C). Washington, DC In ves tm ent Associate -And ean Countries & Ang lo ph one Ca ribbea n, Ma y 1996 -J a nuary 19 98 Identified and developed financial projects that co ntributed to private sector development in Lat in America and the Caribbean. • Performed financial modeling of regional projects. which in cluded direct loan and equity investments for mall and mid si7e compan ies total in g $50 mi ll ion . • Assisted in the development of project proposals up to board level approval, co fin a nced lines of c redit amounti ng to $75 milli o n for financial intermediari es . • Undertook advisory services related to th e development of local and regional capita l markets to facilitate incn:as ed trading volume~ and standard c learing and sl·tt lcm ent practlces. The projects developed include three financial in tem1cdiarics. two g reen field operations and two plant expansion . 'ation s Ba nk, Ft . Lauderdale/Miami. Florida Associate Re lations hip Manager, Ge neral Bank , Jun e 1994 -Jay 1996 Completed 15 month training program w hi c h incl uded rotations in Real Estate, Pri\ ate . Commercial. and Bus mess Bank mg. Worked directly with company principals and sen ior relations hip managers. • Assi s ted clients in devising a nd impl e me nting mutuall y beneficial long term business and financia l strategic~ for companies up to I 00 million in sales . • Received MV P award from Credit Department Manager for exceeding underwriting and departmental goab. Acti vities/I nt c res ts : Triathle te Pr es ident. La Goree -Pinctree Homeowners Association Pres id ent , Morehouse Coll ege Alumni Association . Miami C hap ler. I 00 Blac k Men of South Flo rida Board Member Mount Olive Development Corporation Board Member 20 17 Awardee South Florida Most Powerfu l & ln0uentia l B lac k Professionals in Business & Industry 096 097 THIS PAGE INTENTIONALLY LEFT BLANK 098 • Andres Asion 099 THIS PAGE INTENTIONALLY LEFT BLANK 100 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Aslon Last Name HOME ADDRESS: 1000 S Poi nte Dr Apt 2204 Apt No. Home No./Street PHONE: 305-351 -1000 Home Work Business Name: Fortune Development Sales Address : 1300 B rickell Avenue Street Andres First Name Miami Beach City Middle Initial FL State AAsion@ Fortunel ntlGroup.com Email Address Position : V ice Pre sid ent of Sal es Miami FL City State 33139 Zip Code 33131 Zip Code Pursuant to City Code section 2-22(4) a and 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 m i nimum of six months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of s ix (6) months Yes • Demonstrate an ownership/interest in a business in Miami Beach for a m inimum of six (6) mont hs· No • Are you a registered voter in Miami Beach: Yes • (Please cirde one): I am now a resident of: • I am applying for an appointment because I have special abilities, knowledge and experience. Pl ease list below· 18 years of Real Estate experience, lifelong beach resident, unde rstands concerns of residents and property owners . • Are you presently a registered lobbyist with the Crty of Miami Beach? No Please list your preferences in order of ranking (1) first choice (2) second choice , and (3) third choice. Please note that only three 131 choic s will be obs erved b the Ci Cle rk's Office. (Regular Board s of City) Choice 1: Choice 2: Choice 3 : Planning Board Desi gn Review Board Convention Center Advisory B oard Note : If applying for Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1 . Past service on the Youth Center Advisory Board : No ----Years of Service: _______________ _ 2 . Present participation in Youth Center activities by your children -'-"N=o __ ages, and which programs. List below: if yes, please list the names of your children , their • Have you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: No • Do you currently owe the City of Miami Beach any money: No • Are you currently serving on any City Boards or Committees: Yes Community Relations • What organizations in the City of Miami Beach do you currently hold membership in? Name Chamber of Commerce Title Member If yes, please explain in detail : If yes, please explain in detail : If yes, which board? • List all properties owned or have an interest in , which are located w ithin the City of Miami Beach: 101 Property 1000 S . P o inte Dr #2204 Mi a m i Beach, FL 33139 450 Alton Rd #40 04 M iami Bea ch , FL 33139 400 Alton Rd #30 07 Miami Bea ch , FL 33139 265 P alm Ave Miami Beach, FL 331 39 • I am now employed by the city of M iami Bea ch : No Which depa rt ment? The following Information is voluntary and is n either part of your applic.illoo nor has any bearing on your cons ideration for appointme nt. It is being asked to comply with federa l equal opportunity reporting requirements. Gender: Male Race/Ethnic Categories What is your race? Mark one o r more races to indicate what you co nsider yourself to be . White Othe r Descript io n : Are you Spanish/Hispanid Latino? Mark the "No " box if not Spanish / Hispanic/ La tino. Yes Physically Challenged : No NOTE: If appointed, you will be required to follow certain laws which apply lo city boa rd/committe e members . These laws include, but ar e not limited to, the following: 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 boar d/committee you have served on for pe riod of one year after leaving office (M iami Beach Code section 2-26). o Requirement to d isdose certain fi na ncial in terests and gifts (Miami-Dade County Code section 2-1 1. 1 ). (re: CMB Community Development Advisory Committee): prohibition, during tenure and for one ye ar after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself. or those with w hom you have business or immediate family ties (C FR 570.6 11 ). Upo n request, copies of the se laws may be obtained from the City Clerk. "I hereby attest to the accurac y and truthf ulnes s of the applic.ition and have received, read and will abide by Chapter 2, Artic le VII - o f the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Andres Asion agreed to the following terms on 12/9/2015 5:27 :59 PM Received in the City Clerk's O ffi ce by· N ame of Deputy C lerk Co ntrol No . Date 102 Andres Asian is a born and raised resident of the City of Miami Beach who has always lived in Miam i Beach to date. Currently sits on the Community Relations Board and looking to add his expertise in Real Estate to the City of Miami Beach Planning Board or Design Review Board . Started i n the Real Estate busi ness in 1996 and currently is V ice President of Sales for Fortune International. At Fortune. Asian oversees all development sales averagi ng $1 b ill ion in sales annually for the last 4 years . Active projects include : 1 Hotel and Homes (formally The Perry/Gansevoort), Brickell Heights. Paraiso Bay , NINE at Mary Brickell V illage , SLS Brickell , Saltus House. Jade Signature, Marea , Midtown : 4 M idtown and Midblock, Opera Tower and the Blue Hyatt Res idences. Recently sold out: Beachwalk , One Ocean, Icon Bay, Paramount Bay, Axis , Millecento, 2 Midtown, Trump Hollywood , Artech , Icon Brickell , Jade Ocean, Jade Beach and Wind. Sample of other past projects Andres has sold include: Yacht Club at Portofino, Murano at Portofino, Murano Grande, Waverly South Beach , 900 Biscayne Bay , Vue at Brickell , The Reserves at Doral, Brickell on the River, Havana Lofts . Asian also founded the Andres Asian Foundation geared towards helping needy ch ildren (Zero Admin Cost, 100% of donations go to the cause). In addition , Asian is also active ly involved with Amigos for Kids, St. Jude, Miami Children's Hospital , and Past President of Miami-Granada Rotary Club. Contact info : Andres Asian, PA V ice President of Sales / Broker Associate Fortune Internationa l 305-613-3669 Cellular 305-351 -1000 (Fortune International) AAsion@F ortune-Network . com www.AndresAsion .com 103 12/3/2020 Licensee Details Licensee Information Name: Main A dd ress: Count y: Lice n s e Ma i ling: Lice n se Location: License Information Li ce n se Type: Ra nk: License Number: Status: Li ce n sure Da t e: Expires: Special Qualifications Alternate Names DBPR -ASION, ANDRE S, Rea l Estate Broker or Sal es ASION, ANDRES (Primary Name) 41 SE 5TH STREET #5 SUITE CU 1 MIAMI Florida 33131 DADE Real Estate Broker or Sales Broker BK632335 Cu rrent,Active 11/20/1995 03/31/2022 Qualification Effective View Related License Information View License ComP-laint 1:49:00 PM 1213/2020 2601 Blair Stone Road, Tallahassee FL 32399 · Email Customer Contact Center Customer Contact Center· 850.487 .1395 fhe State of Florida 1s an ANEEO employer. CORY.!ight 2007-2010 State of Florida. Privacy Statement Under Florida law, email addresses are public records If you do not want your email address released n response to a public-records request, do not send electronic mail to this entity. Instead, contact the off,ce by phone or by trad1t1onal mail. If you have any questions, please contact 850.487 1395 ·Pursuant to Section 455.275· I), Florida Statutes, effective October I, 2012, licensees licensed under Chapter 455, F.S must provide the Department with an email address 1f they have one. The emails provided may be used for off,c1al communication with the licensee. However email addresses are public record If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public https ://www.myfloridalicense .com/Licens eDetail.asp?SI D=&id=9248503 BB20C6ADCF3 1 E6 5 E2FB CA 98 13 1/1 104 • Richard Segal 105 THIS PAGE INTENTIONALLY LEFT BLANK 106 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _S_e_ga_l _______________ Richard Last Name F irst Name Midd le Initia l 1450 Stillwater Drive Miami Beach FL 33141 ----~----------------------------- H o me Address C ity State Z ip Code _3_05_7_6_1_0_3_26 _____ -"-30.;;;..;5:...:5c...:c0....:..3.c..51-'-'2;;;.c.7 ____ 30_5_7_6_1 _03_2_6 ____ ri c h@segalzuc kerman .com Cellular Work Home Email Address Segal Zuckerman, P.A . Segal Zu c kerman , P.A. (attorney) Business Name: Occupation: 990 BISCAYNE BLVD SUITE 803 MIAMI FL 3 3132 Business Address City State Zip Code P lease list your preferenc es in order of ranking [1] first c hoice [2] second choice , and [3] third choi ce . Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Board of Adjustment Choice 2: Design Review Board Choice 3 : Historic Preservation Board Professional License License Number I ssuance Date Expire Date Florida Bar Lic ense 0057 187 10/1/20 08 Note: If you are seeking appointment to a professional seat (e.g . attorney, architect, etc.), you must attach a c opy of your currently effec t ive corresponding professiona l li c ense. * Note: If applying for the At-Large posi tion of the Historic Preservation Board , plea se answer the below questions: • H ave you ever resided in one of the City's Historic Districts for at least one year? Yes No Address in C ity Historic Distri ct submitted . 107 AFFILIATION WITH THE CITY OF MIAMI BEACH 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: a. Resident of the City for a minimum of six (6) months: • I am resident of: North Beach Or Yes b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months : ~ "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. Or c . Full-time employee of such a business (fo r a minimum of six months); and I am based in an office or o ther location of the business that is physically located in Miami Beach (for a minimum of six months): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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 . Th e original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appoi ntm ent be cause I have special abilities , k nowledge and experience. Please list below: I cu rrently chair the Board of Adjustment and very much would like to con tinue in the position I am a found shareholder of Segal Zuckerman , P.A . and a practi c ing attorney at in the commercial litigation and family law groups , assisting clients in a ran ge of business and corporate litigation matters • Are you pre sently a reg istered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felo ny: No If yes, please ex plain in detail: • Do you currently have a violation(s) of City of Miami Be ach codes: No If yes , please explain in detai l: • Do you currently owe the City of Miami Beach any money : NQ If yes , please explain in detai l: • Are you currently serving on any City Boards or Committees : fu If yes , which board? Chair of the Board of Adjustment Vice Char of th e Miami Beach Chamber of Commerce Executive Board of Governors Miami Beach Chamber of Commerce 108 • In what organization(s) i n the City of Miami Beach do you current ly hold membership in? Name M iami B each Chamber of Commerce Mount Sinai Foundation Position Vice Chair Young President • List the address of all properties owned or in which you have an interest within the City of Miami Beach : Property 1450 Stillwater Drive , Maimi Beach , FL 33141 • Are you now employed by the City of Miami Bea ch : N.Q If so , which department and title? • 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 Mia mi Bea ch? If "Yes", identify person (s) and department(s): No relat ive's informa tion submitted . 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 l obbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contractin g with the city (Miami-Dade County Code section 2-11.1 ). o Prohibition from lobbying before board/committee you have served on fo r period of one year after leaving office (M iam i Beach Code section 2-26) o Requirement to d is close certain financial interests and gifts (M ia m i-Dade County Code sec tion 2-11.1 ). o Sunshine Law -Florida's Government-in -t he-Sunshine Law was enacted in 1967. Today , the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Sta tutes. These statutes establish a basic rig ht of access to most meetings of Boards , Commissions, and other governing bod ies 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 , Comm ission , Authority, o r Committee. It applies equality to members of advisory and non-advisory bodies who are presented wi th a vot ing conflict of interest under Section 112.3143. Florida Statutes. 109 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 Boa rds 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 Cen ter Drive, Miami Beach , Flor ida , 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 )' ;" or 3. A Copy of your latest Federal Income Ta x 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 Adju stment will be notified directly by the State of Fl orida , pursuant to F.S. §112 .3145(1 )(a), to file a Statement of Rnancial 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 the ir Form 1 w ith the County Supervisor of Ele ctions automatically satisfy the County's financial disclosure requ irement 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 requ irement. DIVERSITY STATISTICS REPORT The following information is voluntary and has no bearing on your consideration for appoi ntment. It is being asked to comply with City diversity reporting requirements . Gender: Race/Ethnic Categories What is your race? White Are you Spanish /Hispanic/ Latino? Mark t he "No" box if n ot Spanish / Hispanic/ Latino. ~ Other Description : No details provided Ph ysically Chall enged : 110 Board and Committee Application Checklis t : Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume, photograph , and a c opy of any applicable professional license . I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES 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 te lephone : 305 .673 . 7 411 Note: Flori da Stat utes 119.071 : The role of the Office of the City Clerk is to rece ive and maintain fo rms filed as public reco rds . 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 conta c t number; and 3) Do not attach a photograph . I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED , READ AND WIL L ABIDE BY CHAPT ER 2 , ARTICLE VII , OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUC T FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND S T ATUTES ACCORDINGLT. I Richard Segal agreed to the following term s on 11 /19/2020 1 :00 : 13 PM Received in the City Clerk's Offi ce by : Name of Deputy Clerk Control No. Date 111 SEGAL ZUCKERMAN Richard I . Segal Attorney at Law 990 B isca y ne Blvd., Suite 803 Miami, Florida 33132 T . 305 .503.5056 E : rich@segalzu c kerma n.com Ri chard I. Segal is a fou ndin g sha reholde r of cgal Zuckem1an . Pri o r to fo und ing th e firm Richard practiced for ten years at a wel l-known li tigation fir m in Sou th Florid a. where he made partner. Ri c hard focu es hi practice o n commercia l liti gatio n and fami ly law, assi t ing clients in a range of bus in ess a nd corporate liti ga ti o n matt ers, and matrimoni a l di s put es. Ri chard's phil osoph y cent ers aro und aggres ive tac tics and inn ova tive lega l th eories a im ed at reaching a qui ck. favorable result for hi clients at a reasona bl e cost. Richard pride hi m e lf on meetin g potential new clients a nd giv in g th em the indivi du al att ent ion that the y deserve and follow in g through by provi d ing devotion and detail to th ei r cases . A pro ud Uni ver ity of Mi chi gan alum. Ric hard is a di ehard nivcrsity of Mic hi gan footba ll fanatic . GO BL UE! A an Eng lis h maj or. Ri c hard studi ed in detail fe ll ow Universi ty of Mi ch igan famous a lu m, the pl aywri ght Arthur Miller . '·Jf I see a n end ing. I can work backward"' -Arthu r M iller. Lik e Miller. Ri ch ard a lways begins by env i ioning the endin g, the be st outcome fo r hi s c lie nt . and th en works backward to get th e most favorab le res ult as quickl y as possi ble . A w ard s • Mo st Effective La wyer, Comp lex Business Liti ga tion. Dail y Business Review: 20 15 • 40 Und e r 4 0. Daily Bw,in ess Review: 2015 • Ri sing Star. Florida Super Lawyer Magazine: 2012-20 18 • Lega l Elite , Fl orid a Trend Magaz in e : 20 13 • Up and Co mer Legal Elite , Fl orid a Trend Magazine: 20 1 1-20 12 Community Acti v ity • C ha ir of t he Miami Beac h Board of Adjus tment • Vice C hair of the Mi ami Beac h Chamber of Comme rce • Board Member of th e Executi ve Board o f Governors of th e Mi ami Beach Cha mber o f Comm e rce • Board Member of th e Boa rd of Governors o f th e Mia mi Beach C hamber of Co mmerce • Bo ard Member of the Mi a mi Beach Chambe r of Co mm e rce Law Coun c il • Young Pres ident of Mo unt Si nai Medi ca l Ce nt er Fo und a ti o n Education • Un iversi ty o f Miami Sc hoo l of Law . J.D .. cum laude • Un iversi ty of Mi c hi ga n, BA . with honors Bar A dmission s • Florida Bar • United States Di st ric t Co urt , Southern Di stri ct of Fl ori da Online Bi o : https://www .sega lzuc kc rm an .com/ric hard-scga l 112 11/19/2020 Member Profile -Richard Ian Segal -The Flonda Bar MEMBER PROFILE Richard Ian Segal Bar Number: 57187 Mail Address: Sega l Zuckerman, P.A. 990 Biscayne Blvd Ste 803 Miami, F L 33132-1558 Office: 305-503-5056 Cel l: 305-761 -0326 Email: ri c h @segalzuckerman.com Member in Good Standing El igi bl e to Pra ctice Law in Florida Personal Bar URL: https://www.floridabar.org/mybarprofile/57187 vCard: 91 County: Miami-Dade Circuit: 11 Admitted: 10/01 /2008 10-Year Discipline History: None ht1ps //www. nondabar.orgl directo ries/find-mbr/profilel?num=57 187 1/2 113 11 /19/2020 Law School: University of Miami School of Law Firm: Seg a l Zuckerman, P.A. Firm Website: http://www.segalzuckerman.com Member Profile -Richard Ian Segal -The Flon da Bar Tre Fond a Lawver directory 1s prOV1ded as a publ•c service. The f'lorrda Bar ma1nta1ns limit ed oas1c 1nformat ,on about lawyers '1censed to p ractice 1n the state (e g. name, address, year of b ,rth, gender, la"' schools attended. adm1ss1on year). HO\l\ever, The Flor da Bar allows ind v1dua attorneys the oppartun1ty to add personal and profeSS1onal 1nformat1on to the directory The lawyer 1s solely respans1ble for reviewing and updat ing any add1t10na 1nformat,on 1n the direc:ory The tawyer·s added 1nformat1on snot reviewed by The Bar for accuracy and The Oar makes no warranty of any kind, express o r mphed The Florida Bar ,t s Board o f Governor s. employE'eS and agent s are not responsible tor t he accuracy o f t hat add1t ,onal ,n'ormatron Pub1rcat,on of lawyers contact 1nformat1on 1n this listing does not mean the lawyers have agreed to receive unsolicited commun1cat1ons ,n any form. Unauthorized use of this dat a may result 1n c1v1I or crimina l penalties The Find a Lawyer d irectory 1s not a la""'Yer referral service https //www.nondabar.org/d1rectories/find-rnbri profile/?num=57187 2/2 114 RICHARD I. SEGAL, ESQ . 115 THIS PAGE INTENTIONALLY LEFT BLANK 116 • Marc Gidney 117 THIS PAGE INTENTIONALLY LEFT BLANK 118 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM ""'G...;..id;;_n_;e'"'"y ________________ M_a_rc ____________________ _ Last Name First Name Middle Ini t ial -'-1..;;_0...;_10;;_1.;...=E..:;;.as.;;;.;t;._;B:..a:::.ayc...Hc..:..:::;arc.;;;bc.;;;oc...r =D...;_ri..;_ve.;;..._ _______ B_a_y _H_a_rb_o_r ______ F_lo_ri_d_a _____ ..::.3.::..3 .:..;15:..4;.__ __ _ Home Address City State Zip Code ..;;_30.;;...5;;_7...;;Bc.;;;8....;;.8..;;_32;:;_7;__ _____ 30_5_8_6_6_62_6-'6 ____ 30_5_8_6_6_62_6_6 ____ Marc@gidneycpa.com Cellular Work Home Ema il Address Gidney and Company Gidney an d Company Business Na me : Occupation : 300 7 1st Street, Su ite 620 Miam i Beach F L 3314 1 Business Address City State Zip Code Please list your preferences in order of ranking [1] first choice [2] second choice , and [3] th ird choice. Please n ote that only three (3) choices will be observed by the City Clerk's Office. (Regu lar Boards of City) Choice 1 : Budget Ad v isory C ommittee Choice 2 : Audit Committee Choice 3 : Convention Center Advisory Board Professional License License Number Issua nce Date Expire Date CPA 7110 Note: If you are seeking appointment to a professional seat (e .g . attorney, architect, etc.), you must attach a co py of your currently effective corresponding professional li cense. * Note: If applying for the At-Large pos ition of the Historic Preservation Board , please answer the be low questions: • Have you ever resided in one of the City's H istoric Districts for at least one year? No No Address in City Historic District submitted . 119 A FFI LIATIO N W IT H THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c: Members of Agenc ies, Boards , and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways : a . Resident of the City for a minimum of six (6) months: • I am resident of: N/A Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: NQ "Ownership Interest" shall mean the ownership often 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. Or 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): fu Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abili ties , knowledge and experience . Please list be low: Owning an accounting business on Miami Beach for more than 30 years I have been practicing in the areas of Nonprofit, Taxation, Audit, Government, Business Management, and consultations to name a few. My belief is to be involved and assist in the welfare of my community. It has been my pleasure to s • Are you presently a registered lobbyist with the City of Miami Beach ? No • Have you ever been convicted of a felony: No If yes , please explain in detail : • Do you curren tly have a violation(s) of City of Miami Beach codes : No If yes , please explai n 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 : fu If yes, which board? Audit and wou ld like to be reappointed to the Budget Advisory Committee . 120 • In what organization(s ) in the City of Miami Beach do you currently hold membership in ? Name Position Douglas Garden Community Mental Health Center. Board Member • List the address of all properties owned or in which you have an interest within the City of Miami Beach: No Owned Property Information submitted . • Are you now employed by the City of Miami Beach : If so , which department and title? • Pursuant to City Code Section 2 -25 (b): Do you have a parent, spouse , child , brother, or s ister who is employed by the City of M iami Beach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 w ith the city (M i ami-Dade County Code se c tion 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 (M iami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunsh ine Law was enacted in 1967. Today, the Sunsh ine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basi c right of access to most meetings of Boards , Commissions, and other governing bodies of state and local governmental agencies or authorities. o Voting confli ct -Form 8B is for use by any person servi ng at the county, c ity, 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. 121 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply w ith Miam i-Dade County F in ancial 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 M iami Be ach , inc luding those of a purely advisory nature , are required to comply w ith M iami-Dade County Financi al Disclosure Requirements . One of the following forms must be filled with the C ity Clerk of Miami Bea c h , 1700 Conve ntion Center Drive, Miami Beac h , Florida , no later than 12 :00 noon of July 1, of each year: 1. A "Source of Income Statement;" or 2 . A "Statement of Fi nan c ial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federal Income Tax Return . Fa ilure to file one of these forms, pursuant to the Miami-Dade County Code , may subject the person to a fine of no mo re than $500, 60 days in ja il , 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 Rnancial Interests (Form 1) with the M iami-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 M iami B each City Board/Committee member and need not file an additional form with the Office of the City Clerk . However, complian c e with the County disclosure requirement does not satisfy the State requ i rement. DIVERSITY STATISTICS REPORT The follow ing information is voluntary and has no bearing on your consi deration for appointment. It is being asked to comply w ith City d ivers ity report ing requirements . Gender : Ra ce/Ethni c Categories What is your race? Male Are you Spanish/Hispan ic/ Latino? Mark the "No" box if not Spanish / Hispan ic / Latino. N.Q Other De scr iption : No details provided Physically Ch allenged: 122 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully. :::::==~ YES I have uploaded a current resume , photograph , and a copy of any applicable professional license. YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES 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@miamibeac hfl .gov or teleph one: 305.673 . 7 411 Note : Florida Statutes 119.071 : The role of the Office of the C ity Clerk is to receive and maintain forms filed as public records. If your home address, teleph one 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 you r office or other address for your mailing address ; 2) Use you r office or other telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Marc Gidney agreed to the following terms on 11/3/2020 3:42:45 PM Received in the City Clerk's Offi ce by: Name of Deputy Clerk Control No. Date 123 MARC A . GIDN EY, C.P.A Profess ion a l Hi s torv, Indus try Ex pe rie nce a nd Profess io na l Ac ti viti es Hi g her Educati o n - Ce rtifi ed Public Accountant. Uni versity of Miami -Master's degree in Accounting and Florida Years of Exp e ri e nce: More than 40 years in practice as a C PA and owne r of my on C PA firm ove r 30 years. I have owned and managed commercial rea l es tate for years. Indu st ry Ex pe rience: • Manufacturing and Retail • Government and onprofits • Real Estate • Entert a inment • Professional s including Doctors, Consultants, and Attorneys Pro fessional A ctivities : • Member and Passed Chai r of City of Miami Beach -Budget Adv isory Committee and Audit Committee. • Memb er -Fl orida Institut e of Cert ifi ed Publi c Accou ntan ts • Immedi ate Past president, Florida In s titu te of C PA 's Go ld Coas t Chap ter • Tru stee/Director of many Nonprofit Organization • Member of th e Board of is Doug las Gard e n Comm unity Mental Heal th Center. S ummary Owning an acco unting business on Miami Be ac h fo r mor e than 30 years I ha ve been practicing in the areas of Nonprofit , Taxation , Audit. Government, Bu s in ess Mana gement , and consu ltations to name a few . My belief is to be in vo lved a nd ass ist in th e welfare of my community . It has be en my pl eas ure to erve o n the Boards of C ity of Miami Beach and hop e to co ntinue to do so in the future. 124 125 THIS PAGE INTENTIONALLY LEFT BLANK 126 • Bruce Carter 127 THIS PAGE INTENTIONALLY LEFT BLANK 128 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM C a rter Bruce A ------------------------------------Last Name First N am e M id d I e Initial 1649 W . 22nd Street M iami B each Flori da 33140 --------'-----------------------------Home Address C ity State Zip Code .... (7_0_3.._) _40_3_-_0 _71_2 ___________ .._(7--"0...;.3,._) 4_0"-'3'---0"'"'"7_1_2 ___ carterbruce@me .com Cellu lar Work Home Emai l Address New York Universit y Re search P rofessor in Arts Education Business Na me : O ccupation : 82 Was hin gton Sq E New York New York 10003 Bus iness A ddress C it y Stat e Zi p Cod e Please list your preferences in order of ranking [1] fi rst c h oice [2] second choice , and [3] third choice. Please note that only three (3) choic es will be observed by the City Clerk's Office. (Re g ular Boards of City) Choice 1: C ultural Arts Council Choice 2: Choice 3 : Professional License No Professional Licenses Submitted . Note: If you are seekin g appointment to a professional seat (e.g . attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. * 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 Histor ic D istricts for at least one year? ~ No Add ress in City Historic District submitted . 129 AFFILIATION WITH THE CITY OF MIAMI BEACH 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 : a. Res ident of the C ity for a m inimum of six (6) months: • I am res ident of: South Beach Or b. Demonstrate an ownership i nterest in a business established in the City for a minimum of six (6) months : No "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. Or c. Fu ll-tim e emp loyee of such a bus iness (for a m inimum of s ix months); and I am based in an office or other location of the bus iness that is physica ll y located in Miami Bea ch (for a minimum of s ix months): No Notwithstanding the requirements set forlh herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abil it ies, knowledge and experience. Please list below : In 2014 , I was appointed to the National Council for the Arts by President Obama , and confirmed unan imously in the United States Senate . Serving on the council continues to provide v ital ins ights into the nations arts ecology and specifica lly the role of the arts and human learn ing . During my tenure • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicte d of a felony : If yes, please exp la i n in detail : • Do you currently have a violation(s) of City of M iami Bea ch codes: ~ If yes , please explai n in deta il: • Do you currently owe the City of Miami Beach any money : If yes , please explain in detail: • Are you currently serving on any C ity Boards or Committees : If yes , wh ich board? Cultura l Arts 130 • In what organization(s) i n the C ity of Miam i Beach do you currently hold membership i n? No Organization Information Submitted . • List the address of all properties owned or in wh ich yo u have an in terest w ith in the City of M iami Beach : Property 1649 W . 22nd St. • Are you now employed by the C ity of M iam i Beach : If so , which department and t itle ? • Pursuant to City Code Section 2 -25 (b): Do you have a paren t , spouse, child , brot her, or sister who is employed by th e City of Miami Beach? If "Yes", identify person (s) and department(s): No relative's information submitted . 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 d irectly or i nd ire ctly lobbying city personnel (M iam i Beach City Code section 2-459 ). o Proh ibition from contracting w ith the city (Miami-Dade County Code section 2-11 .1 ). o Proh ibition 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 g ifts (Miami-Dade County Code section 2-11 .1 ). o Sunshin e Law -Florida's Government-in-the-Sunshine Law was ena cted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes . These statutes establish a basic r ight of access to most meetings of Boards , Comm issio ns , and other govern ing bo dies of state and local governmenta l agencies or authorities . o V oting conflict -Form BB is for use by any person serving at the county, city , or other local level of government on an appoi nted or elected Board , Council , Comm ission , Authority, or Committee . It appl ies equal ity to members of advisory and non-advisory bod ies who are presented with a votin g conflict of interest under Sectio n 112.3143 . Florida Statutes . 131 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 tha t no later than J uly 1. of each year a l l membe rs of Boards and Committees of the City of M iami Beach , including those of a purely advisory nature , are requi red to comply w it h M iami-Dade County Fi nancial Di sclosure Requirement s. One of the foll owi ng forms must be filled with the C ity Cl erk of M iami Beach , 1700 Convention Center Drive , M iami Beach , Florida , no later than 12 :00 noon of July 1, of each year: 1. A "Source of Income Statement;" or 2 . A "St ate me nt of Financial Interests (Form 1 )1 ;" or 3 . A Copy of your la test Fede ra l Inco me T ax Return . Fa ilure to file on e of t hese fo r ms , purs ua nt t o th e Mia mi-D ade County Cod e, may subj ect th e p erson to a fi ne of no more than $500, 6 0 days in jail, o r both . 1 Membe rs of th e Planning Board and Board of Adjustment will be notifi ed directly by the S tate of F lori da , pursuant to F.S . §112 .3145(1)(a ), to fil e a Statement of Rnanci al Interest s (Form 1) w ith the M iami-Dade County Supervisor of E lect io ns by 12 :00 noon , July 1. Plann ing Board and Board of Ad justm e nt members w ho file their Form 1 wi th the Coun ty S upervisor of Elections au tomatically satisfy the County's fin ancia l disclosure requirement as a M iam i B each C ity Board/Comm ittee member and need not file an add it ional form w ith t he Office of the City Clerk . However, compl iance w ith the County disclosure requ iremen t does not satisfy th e State requ irement. DIVERSITY STATISTICS REPORT The fo llowing information is volun tary and has no bearing on your considerat ion for appointment. It is be ing asked to comply w ith City d iversity reporting requirements . Gender: Race/Ethnic Categor ies What is your race? Male Wh it e Are you Spanish/Hispanic/ La t ino? Mark th e "No" box if not Spani sh / Hisp ani c/ Latino . No Other Descri ption : No det ails prov ided Ph y s ica lly Challenged: N.Q 132 Board and Committee Application Checklist: Please ensure you have provided all information before app lyi ng or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume, photograph , and a copy of any applicable professional license. I have completed and attached the Board & Committee F inancial Acknowledgment Statement. YES I have completed and attached the Diversity Statist ics Report. If you have any questions, please contact the Office of the City Clerk v ia 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 rece ive and maintain forms filed as public records . If your home address, telephone numbers, and/or photograph are exempt from d isclosure and you do not w ish your home address , telephone numbers, and/or photograph to be made publ ic, please : 1) Use your office or other address for your ma il ing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; ANO I HAVE RECEIVED, READ ANO WILL ABIDE BY CHAPTER 2, ARTICLE VII , OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR C ITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS ANO ALL OTHER APPLICABLE COUNTY ANO/OR STATE LAWS ANO STATUTES ACCOROINGLT. I Bruce Carter agreed to the following terms on 11 /3/2020 3 :23 :30 PM Received in the City Clerk's Office by : Name of Deputy Clerk Control No. Date 133 Persona l In for m a tio n : ame: Bruce Allen Carter, Ph .D . CU RRJ CULUM V IT AE Bruce Allen Carter 1649 W . 22nd St. Miami Beach, FL 33 140 703-403-0712 carterbruce@ me.com T he Coll a b orative fo r Art s R esearc h (CF AR), Founder and Director. One of many projects includes a recent patent for 3D printed violins that further string study for children and cost two dollars each. Flo rida Inte rn a ti o n a l Unive rs ity, Dean 's Distinguished Fellow, 2014 to present. C ouncil Membe r, Nati o nal C ouncil o n th e Art s . Presidential Appointment, Nominated by Pres ident Obama September 12 , 2012. Confirmed by the U.S. Senate, January Jst 2013. E ducatio n a l Background: 2008 Ph.D . North weste rn University 1999 M .M . Th e Peabody Conservatory of The Johns Hopkins University Major Area: Composition 1995 B.M. Virginia Poly technic i nstitute and State Unive rsity Major: Music Education Employm e nt Backgro und : 2014-Present Dean's Di sting ui shed Fellow, Florida International U niversity 2008-2012 Univers ity of Maryland, College Park. 2006-2008 Lecturer; Un iversity of Maryland, College Park. 2004-2006 Graduate Re search Assistant; Northwestern University. 1997-2000 Graduate Teaching Assistant; Peabody Conservatory. 1999-2004 Orchestra Director, Teacher; Fairfax County Public Schools , Reston, Ya . Researc h, S cho la rly, a nd C r eati ve Acti v ities a. C hap ter s in B ooks Carter, 8 . (Oxford Press, 20 I 6). The "Safe" Classroom: Reconsidering Mus ic Education and The Fundamental Principles of De mocratic Practice. Ed. Lorenz o , L. In Giving Voic e to De mo cracy in Music. Education. Carter, 8 . (Oxford Press, 2015). Intersectionalities and Social Justice: Marginali z ed Communities and Arts Ed ucation . Ed . Conway, C. In Th e Handb ook/or Mu s ic Education Research. Carter vita (p. I ) 134 Carter, B. (Oxford Press, 2013). Is a Virtual Composer In the Classroom an Oxymoron? In Selected Essays in Honor of Northwestern University's Rethinking th e Musical Exp erie nce. Carter, B. (Oxford Press , 2012). Digital Natives and Composition: From Imagination to Music." In Ka schub, M. and Smith, J. Composing Oursel ves, Preparing Mus ic Tea chers to Teach Compos ition. b. Articles In Refereed Journals Carter, B. (April , 2013). Nothing better or worse than be ing black, gay, and in the Band:" Th e counterstories of three African American g ay undergraduates attending His torically Black Colleges and Universities. Journal of Research in Music Education. Carter, B. & Hoffman , A. (April , 2012) Repr esent in ' and Disresp ect in ': African American Students' Engagement in S chool Mu sic and Implications for Tea cher Education. Music Ed ucation Research Carter, B. (May, 2011). A safe place/or all: Harassment in the Mu sic Education Class room. Music Ed uc ators Journal. Carter, B. (Spring, 2010). "And that is why g irls do not write mus ic:" A qualitative examination of undergraduate compos itional identity. American Research Education Research Special Interest Group in Mu s ic Education. Carter, B. & Hoffman , A. (A pril , 20 I 0). A virtual composer in every classroom. Music Educators Journal. c . Editorial Committees i. In vited editorial comm ittee American String Teachers As sociation Editorial Committee. Four y ear editorial position that began Augu st I , 2009. Invited reviewer and editor for Oxford Press: New York . ii . Editorial committee Music Educator s Journal-Four year editorial position that began July, 2010. d. Refereed Conference Proceedings. Carter, B. (Spring, 2013) Bullying Among Arts Participants: A Review of th e 20/ 2 Crime and Carter vita (p. 2) 135 Victimization Data. A E RA Annual Meeting. Social Context of Education Division. San Francisco, CA. Carter, 8. (2012 National A ssociation for Music Education ational Conference). Beginning al the Recapitulation: LGBT Studies and Mu s ic Education. Carter, B. (2012 National A ssociation for Music Education National Conference). Creating an Ecology of Composition within Schools. Carter, B . (20 11 ME C Eastern Conference). Who We Are Mailers: H ow to Recognize and Prevent Bully ing in th e Music Classroom . Baltimore, MD . Carter, B . & Hoffman , A . (Spri ng, 2011 Conference). Rewriting the score: Improvisation and compos ition as too ls for changing the social context of a middle scho o l band classroom . AERA Annual Meeting. Social Context of Education Division. ew Orleans, LA . Carter, B. (Spring, 2011 Con ference). Th e co unterstories of three African American gay undergraduates a/lending Hi storically Black Co lleges and Univers ities. AERA Annual Meeting. Social Context of Ed ucatio n Division . New Orleans, LA. Carter, B. & Hoffman , A . (20 I 0 , October). Compositio n as a culturally r espons ive approach to th e secondary instrumental music curric ulum. Race, Erasure a nd Equ ity in Music Education: A Symposium Sponsored by the International Consortium for Re searc h on Equity in Mu sic Education. Madison, WI. Carter, B . & Hoffman, (2009, Jul y). "You play music, but do you make music:" Composition, performance, and identity among African American middle school band students. In ternational Symposium on the Sociology of Mu sic Education , Limerick, Ireland. Carter, B . & Fitzpatrick-Hamis h , K . • (2009, May). Do Yo u Hear What I Hear? Th e Developm ent of Te chniques to Guide Students' Perceptions of Mu s ic Rehearsals and P erformances" Biennial Colloquium for Teachers of In s trumental Mus ic Methods; Mt. Sterling, OH . Carter, B. (2009, July)"And That Is Why Girls Do No t Co mpose:" Hearing th e Voices of Young Wom en Co mposers. Paper Pres ented at th e Ame ri can Education Research Association ational Conference. San Di ego; CA. Carter, B . (2008 , Feb.) I Am a Composer, I Think : Th e Developm ent of a Co mpositio nal Id entity. Pa per presen ted at the arrative Soundin gs Confere nce; Phoenix, AZ. Carter, B. (2008 , April). Th e Effects of Compositi on o n the Mu sical Understanding of Secondary In strumental Students. Poster Presented at M ENC: The ational Association for Mus ic Education Annual Con ference, Milwaukee, WI. Hewitt, M . & Carter, B. (2007, May). Selecting Prospecti ve Mu sic Education Majors: Ob serving Group Dy namic to Identify Mark ers for Su ccess.fa/ Mu sic Education Majors. Presentation with Dr. M . Hewitt at the 2nd Biennial Colloquium fo r Teachers of In strumental Music Method ; Mt. Sterling, OH . e. Compositions Carter vita (p . 3) 136 i. Commissioned Works. Soundsca p e for Dancer and C horeograph er Sharon Mansur-Commissioned Dance work . Premiered February I 6-l 9 th , 20 11. Virginia Council fo r the Arts. (2009). A Rock , A Ri ver, A Tree. A commissioned work for Douglas Wilder Middle School Band with funding fro m the Virgin ia Council for the Arts. Date o f Premiere: May 19, 2009. Royal Academy of the Arts . Commission of Trombone Quartet for the Huddersfield Conte mporary Music Festival. Premiere performed on BBC R adio . October 5 , 2001. g. Talks, Abstracts, and Other Professional Papers Presented. i. Invited talks, etc. Winning an Arts Grant : Markers for Success when applying for a grant from government a nd private organizations. Florida In ternation al U n iversity. ov. 20 14 . Me tapho r and Meaning in Mu sic. Invited presenter at the Int ernational Philosophy of Music Ed ucation Conference. April 20 13: New Y ork: NY. Mu s ical Ide ntities and Th e ir Role in Composer Development. Invited to g uest lecture at th e University of London by Dr. Lu cy Green. D ecember 2008 ; London ; Eng land. Th e Top 20 Mistak es Made Wh en Preparing Yo ung Orch estras/or Festival. Presentation a t the Maryland Music Edu cators Association Fall In -Service Day, October 2008; Col umbia, MD. In corporating Alternative Sty les in Your Or chestra Class roo m. Presen tat ion at the Maryland Music Educators Association Fall In-S ervice Day, October 2008 ; Columbia, MD. Th e Top 15 0 Pieces for String Orc hestra . Presentation at the Maryland Music Educators A ssociation In-Service Con ference, February 2008 ; Baltimore, MD. Recruiting Students in Your Secondary Instrumental Musi c Program . Presen tation a t the Virginia Tech Alumni Conference, Apri l, 2007 ; Bl acks burg , VA. Th e Effects of Co mpos itional Train ing of Hig h School Students Performanc e Abilities. Po ster Presented at the Big Ten Conference fo r Music Educators . October 2006 ; Bloomington, I h. Fellowships, Prizes, and Awards. Virginia Counci l For the Arts . (2009). Working with middle sch ool director Dr. Adria Hoffman we obtained a grant to begin a composer in residence program from urban middle schools. 3. Teaching, Mentoring, and Advising Cart er vita (p. 4) 137 a. Courses taught in the last five yea rs. i. Undergraduate. • Elementary Instrumental Methods (7-15), 2003-2012 • Secondary Instrumental Methods (7-15), 2003-2012 • Student Teacher Seminar (6-10), 2003-2012 • String Pedagogy I ( 15 -30), 2003-2012 • String Pedagogy II (16-30), 2003 -2012 ii. Graduate • Advanced Instrumental Methods (6-1 0), 2008/09/10 • Music Education C urri culum (6 -10), 2009//0 • Foundations of Music Education (6-1 0), 20 I 0/11 • String Pedagogy (6-12), 2010 • Philosop hy of Mus ic Education (6-12), 201 1/12 ii. Independent Study, Tutorial, Internship Supervision. • In strumenta l Music Field Experie nces (4-15), 2006-presenl • Supervisor of Student Teachers (2-6/semester), 2006-presenl • Sup ervisor of Pre -Student Teachers (2-6/semester), 2006-presenl i. U ndergraduate. • Advised 15-20 music education majors each semester regarding course selection and academic matters, 2006-20 I I . iii. Other advising activities • Organized and reinitiated a student chapter of the American String Teachers Association • Advisor to student chapter of the Music Educators ational Conference. b. Advising. ii. Masters. • Matthew Heist (20 10 ) • Amy Hairston (20 I 0) • Matthew Johnston (2009) • E lizabeth Cuhna (2009), chair • Jonathan Kurtz (2009), c hair • Allen Leung (2009) • Dawn Farmer (2008) • Erin Cheste r (2008) • Keny Phelps (2008) • Leah Berlin (2008) • icole Stanleigh (2007) Carter vi ta (p. 5) 138 • Ray Chaney (2007) • Kerri Barone (2007) • Melissa Wittnebe l (2007) • Alex Silverbook (2007) iii. Doctoral. • Tzu-ching Tai (2006-2010) • Randy Rumpf (2008-20 12 ) • Karen Ko n er (2009-20 12) • Maggie Corfi eld-Ad a ms (20 I I -Present), C hair 4. Service a. Profess ional. i. Offices and committee memberships held in professional organizations. • MENC: Th e Na tional Ass ociation f or Music Education Music Teacher Educati on Special Research Interest Group (2008-2009). • ASTA : Member of the Maryland State Board. (2008-2009). ii. Reviewing activities for agencies. • Proposal Reviewer, Am erican Educati on Research Association Annual In -S ervice Conference, San Di ego, CA (2009). • Proposal Reviewer, American Education Research A ssociation Annual In -S ervice Co nference, San D iego, CA (20 I 0). • Proposal Reviewer, Am erican Education Research A ssociation Annual In -Service Conference, San Diego, CA (20 I I ). iii. Other unpaid services to local, state, and federal agencies. • Pres enter, Baltimor e County Public Schools Mus ic In -service, Owings Mills, MD ; August 2008. • P resider, MMEA A nnua l In -service Con fere nce; Ba ltimore Coun ty, MD ; October, 2008. iv. Paid con sultancies. • Adjudicator, Fairfax County Pu blic Schools, Arlington , VA; March 20 12 . • Adjudicator, Baltimore Co unty Public S chools, Balt imore MD; March 201 1. • Adjudicat o r , Fairfax Co unty Public Schools, Arling ton, VA ; M ar c h 20 I 0 . Carter vita (p. 6) 139 • Conductor, Baltimore All-County Hi gh School Orch estra , Baltimore, MD; ovember 2009. • Conductor, District 12 Hig h School Orch estra , Arlington, VA ; February 2009. • Adjudicator, Fairfax Co unty Public Sc hools, Reston, VA; March 2009. • Adjudicator , All Stale Maryland Assessme nts, Bel Air, MD; Marc h 2008. • Adjudicator, Fairfax Co unty Public Schools District 11 Orchestra, Burke, VA ; March 2008 . • Cli ni cian, Lak e Braddock Hig h Sch ool Orch estra , Springfield, VA ; January 2009. • Clinician , Sou th lakes Hig h School, Re ston VA ; September 2008 . • C lini cian , Centennia l Hig h School, Howard County, MD; Marc h 2009. v 11. Memberships • American String Teachers Associat ion • AERA The American Educational Research Association , Divi s ion G: Social Context of Education . S IGs: C riti cal Exami na tio n of Race, Ethn ic ity, Class & Gender in Education ; Music Education; Q ualitative Research • a ti o nal Association for Music Education b . Campus. i. D e partmental. • Unde rgradu ate Committee, School of Musi c, 2008 -present. • Library Committee, School of Mu s ic, 2008 -present. • Choral Music Education Search Committee, S chool of Mu s ic, 2009-20 I 0 . • C horal Music Educati o n Search Committee, Schoo l of Mu s ic, 20 I 0-20 I I . • Fac ul ty Advisor for Student Music Educati ons National Conference, Sch oo l of Mu s ic, 2009- present. ii. U niversity • Task Force on ed ucating graduate students in Responsible Conduct of Research a nd Schola rly Ethics across disci plines iii. S p ec ial a dminis trative assignments. Carter vita (p. 7) 140 • Summer Youth Music Camp. Orchestra director of a day camp for middle school band, orchestra and vocal musicians in 2003. Caner vita (p. 8) 141 142 • Britta Hanson 143 THIS PAGE INTENTIONALLY LEFT BLANK 144 ,------------ MIAMI BEACH a BO A RD AN D COM M! TEE APPLICATION FOR M o,J Last Name First Name \Q C) ,.s~~£~,(l}OrJ f;:Ne- Home Address (~\~$' l3 2z-gg Home Te~one Work Telephone N1~.tv11 City f\ State Professional License (describe):·-------------------------,--Expires: _________ _ Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees sha ll be affiliate d with the City; th is req uirement shall be fulfilled in the following ways : a . An individual sha ll have been a res ident of the City for a minimum of six months; or b . An individual sha ll demonstrate ownershi p/i nterest fo r a minimum of s ix months in a business es tabli shed in the City for a minimum of six month s . ~ • Re sident of Miami Beach for a minim um of six (6) months: Ye~ or No 0 • Demonstrates ownership/interest in a business i~each for a min imum of six mo nths: Yes O or N,o.la--· • Are you a register ed voter in Miami Beach: Y~ or No 0 • I am now a resident of: North Beach O South Beach~ddle Beach 0 • I am applyi ng fo r an appoin tment because I have special abilities , knowledge and experience . Please list below: • Are you presently a registered lobbyist with the City of Miami Beach ? Yes O o r N~ Plea se list yo ur pr eferences in order of ranking [1] first choice [2] second ch oice, and (3] third c hoice . Please note that onlv three (31 choices will be observed by the Citv Clerk's Office. D Ad H oc Charter Review and Revision Board D Debarment Committee D Mia mi Beach Human Rights Committee D Ad H oc Committee Centennial Celebration D Desi on Review Board' * D M1am, Beac h Sister Cities Program D Ad Hoc Committee Flooding T ask Forc e D Disability Access Committee D Normandy Shores Local Government ~ Neighborhood Improvement o Affordable Housing Advi s ory Committee / l1 f ine Arts Board :::J Parks and Recreation Facili tie s Board _;J,Art in Public Places Comm ittee \... j.,{l Gay, Lesbian, Bisexual and Transgender D Person nel Board Enhancement Committee (GLBn D Beautification Committee D Golf Ad viso rv Committee D Plannin a Board _!-!' D B icyd e-Pedestnan Advisory Committee D Health Advisory Committee □ Pohc e Citi zens Relations Committee D Board of Adjustment • ,::r D Health Facili ties Authority Boa rd D Production Industry Co uncil D Budget Adviso ry Corrvrnttee D H ispanic Affairs Committee D Safetv Committee D Capi tal Improvements Projects Ov ersigh t D Historic Prese rva tion Board D Single Family Resi dential Review Panel Committee * D Committee on the H omeless D Housina A uthoritv D Sustainability Committee D Committee for Quality Education in MB □ Loan Review Committee D T ennis Advi so ry Committee D Community Development Advisory Committee D Marine Authority D Transportation and Parking Committ ee D Community Relations Board D Miami Beach Commission for Women D Visito r and Conven tion Authority □ ConventJon Center Advisorv Board D Miami Beach Cultu ral Arts Council D Youth Center Advisory Board ,. D Waterfront Protec ti on 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 F;I C LERISALL\aFORMS \BOARD AND COMMITTEESIBC APPLI CATION 46 BOARDS 12 -16-2013.doc 145 00 Note: If applying for Youth Center Advisory Board , please indicate your affi liation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board : Yes □ No □ Dates of Service : _______________ _ 2 . Present participation in Youth Center activities by your children : Yes O No D If yes , please li st below the names of your children , the ir ages and the programs in which they partici pate: Child's name: _________________ _ Age : ___ Program : ______________ _ Child's name: _________________ _ Age : ___ Program : ______________ _ • Have you ever been convi cted of a fe lony? Yes If yes , please explai n in detail : • Do you currently have a violation(s) of City of Mi ami Be ach Code? Yes O or N If yes, please explain in detail: • Do you currently owe the Ci ty of Miami Bea ch any mone y? Yes D or No If yes . explain in detail : or No O If yes . wh ich board/committee? • In what organization(s) in the City of Miami Beach do you cu rrently hold membership? Name Posi tion Name Posi tion • List all properties owned o · · · Miami Beach : 1 QC I M ~ .,.._~..:.....:L-!........:....~.__~_____..._...,..__-+_ _ • Are you now employed by the Ci ty of Miami Beach ? Yes O or NP,-- Which department and title?------------------------------------ • Pursuant to City Code Section 2-25 (b): D o you have a pa rent a . spo use D . ch il d D brother Dor sister D who is employed by the City ot Miami Beach? C heck all that apply . 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 c ply with City diversity reporting requirements. Gender: Male Race/Ethnic Categories What is your race? QAtrican-American/Black ~ Caucasian/White 0 Asian or Pacific Islander 0 Native-American /American Indian D Other -Print Ra ce ·------------------------------------ Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COM MITTEES\BC APPLIC ATION 46 BOARDS 12-16-20 13 doc 146 ----------- ~o you consider yourself to be Span ish , Hispanic o r Latino/a? Mark the "No " box if not Spanish , Hispanic, Latino/a . .,......_ ,,!~]No Oves Do you consider yourself Physically Di sabled? /e:r;;: Uves 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 personne l (Miami Beach City Code section 2-459). o Prohibition from con tracting 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 (M iami-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 interes t in or receivi ng any benefil from Community Deve lopment Block Grant funds for either yourself, or those with whom you have business or immediate family ties (C F R 570 .611 ). o Su nshine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. Today , the Su nshine Law regarding open govern ment can be found in C hapter 286 of the F lorida Stat utes. These statutes establish a basic right of access to most meetings of boards. commiss ions and other governing bodies of state and local governmental agencies or authorities . o Voting conflict -Form 8 B 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 reques t , copies of these l aw s 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, PLOYEES AND AGENCY MEMBERS AND A L L OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STAT ACC DINGLY." ' Received in the City Clerk 's Office by : -----~-----1.:,<----------::-----,-----,f--..J.--+----,,.'---- Name of Deputy Cle PLEASE REMEMBER TO 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 I CLERISALL\aFORMSIBOARD AND COMMITTEES\8C APPLICATION 46 BOARDS 12-16-20 13.doc 147 ,_ MIAMI BEACH City of Miami Beach 1 700 Convention Center Drive, Miami Beach, Florido 33139, www miamibeochfl gov CITY CLERK'S OFFICE Telephone : 305.673.7411 Fox : 305 .673.7254 CityClerk@m iomi beach A .gov Acknowledgement of fines/suspension for Bc,ard/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: ------------------------------- 1 understand that no later than July 1, of each year all members of Boards and Committees of t he City of M iami Beach , including those of a purely advisory nature, are required to comply with Miami-Dade County Financial Disclosure Requirements. T his means that the members of City Advisory Boards , whose sole or primary responsibility is t o recommend legislation or give advic e 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 Miam i Bea ch , 1700 Convention Center Dri v e , Miami Beach , Florida , no lat er than 12 :00 noon of Ju l y 1, of each year. 1 . A "Sourc e of Income Statement" Fo r your conven ience, the form is attached . The form can also be downloaded at: http://www.miamidade.gov/elections/Library/source of income statement. pdf 2 . A "Statem ent of Financial Int erests (Forni 1 )" For your convenience , the form is attached . Th e form can als o be d ownloaded at: http://www.ethics.state .fl .us/ethics/forms.html 3 . A Copy of your 2013 Federa l Income Tax Return Failure to file one of these form s, pursuant to the Miami-Dade County Code , may subj e ct the perso n to a fin e of no more than $500 , 60 days in jail or both . Signature Date Updated· Monday, December 16 , 2013 Page 4 of 4 F \CLERISALL\aFORMSIBOARO ANO COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013.doc 148 • Britta Hanson 100 Jefferson Ave. Apt 10008 Miami Beach, Fl 33139 Cell (312) 813-2888 Fine Arts Board I have been very active in the art community in Miami , Chicago, and South America. I have been collecting art since 1987 and served on several boards involving the arts both here and in Latin America. I had a business that worked with indigenous arts in Venezuela, Colombia, Ecuador, Peru, Bolivia, and Brazil from 1990-2004. In Chicago I served on the board of the Aldo Castillo gallery from 2002-2004. I was art director for the Shadows art project and the Children's Art Fundraiser at Temple Beth Schmuel from 2008-10. I was art director for SPE Faces project at the Bass Museum in Miami Beach in 2010 and I also served as Art Director and Curator for the Haiti Expo during Art Basel in 2010. Since 2013 I have acted as one of the artistic directors for One Billion Rising which is a world wide event to stop violence against women. 149 • • I currently teach Fine Art and 3D Art at South Pointe Elementary and at North Beach in the enrichment program. I majored in Latin American studies with minors in art and anthropology. 150 151 THIS PAGE INTENTIONALLY LEFT BLANK 152 • Vanessa R. Menkes 153 THIS PAGE INTENTIONALLY LEFT BLANK 154 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM .;.;.M.;..;:e;.;..n;.;.;k.;;;.e.;;;.s ________________ v _an_e_s_s_a ________________ R _____ _ Last Name First Name Middle Initial 951 West 47th Court M iami Beach FL 33140 -----------------------------------Home Address C ity State Z ip Code _3_05_4_9_0_4_49_4 ______ 30_5_4_9_0_4_4_9_4 ___ ..a.3.;..05"--4"""'9--'0_4_4.;..94 ____ vanessa@vanessamenkes.com Cellu lar Work Home Email Address Vanessa Menkes Communications public relations Business Name: Occupation: 951 West 47th Court Miami Beach FL 33140 Business Address City State Z ip Code Please list your preferences in order of ranki ng [1] first choice [2] second choice, and [3] th ird choice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of C ity) Choice 1 : Cultural Arts Council Choice 2: Choice 3: Professional License No Professional Licenses Subm itted . 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. * 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 No Address in City Historic District submitted . 155 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards , and Committees shall be affiliated with the city. Th is requirement shall be fulfilled in the following ways : a. Res ident of the C ity for a m inimum of s ix (6 ) months : • I am reside nt of: Midd le Beach Or b. Demonstrate an ownership i nterest in a bus iness established i n the City for a min i mum of six (6 ) months : No "Ownership Interest " shall mean the ownership of ten percent (10%) or more (in cludi ng 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 oth er entity or business association. Or c. Full-time employee of such a bus iness (for a mini mum 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}: Yes Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appo intment because I have specia l ab ili ties, know ledge and experience . Pleas e list be low: I am a longtime publ ic re lations professional w ith experience in promoting key entities and events in our city ranging from hosp itality, events and destinations . My expertise includes traditional med ia , social media and marketing . • Are you presently a reg istered lobbyist with the City of Miami Beach ? No • Have you ever been convicted of a felony: If yes , please explain in detai l: • Do you current ly have a violation(s) of City of Miam i Beach codes : If yes , please expla in in detail : • Do you current ly owe the City of Miami Bea ch any money : If yes , please explain in detail : • Are you cu rrently serving on any City Boards or Comm ittees : If yes , wh ich board ? Cultura l Arts Council 156 • 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 i n which you have an interest w ith in the City of Miami Beach : No Owned Property Information submitted. • Are you now employed by the City of Miami Beach : NQ If so , which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse , child , brother, or s ister who is employed by the City of Miami Beach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 Proh ibition from directly or ind irectly lobbying city personnel (Mi am i Beach C ity Code section 2-459). o Proh ibi ti on from contracting with the ci ty (Miami-Dade County Code section 2-11 .1 ). lli2 o Proh ibi tion from lobbying before board /committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requ irement to disclose certain financial in terests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunsh ine Law was enacted in 1967. Today , the Sunshine Law regard i ng 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 loca l governmental agencies or authorities. o Voting conflict -Form BB is for use by any person serving at the county , city, or other local level of government on an appointed or elected Board , Council , Commiss ion, 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. 157 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 M iami Beach , including those of a purely advisory nature , are required to comply with Miami-Dade County Fi nancia l Disclosure Requ irements. 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 Finan cial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federa l Income Tax Return . Failure to file one of these forms , pursuant to the Miami -D ade County Code , may subject the person to a fine of no more than $500 , 60 days i n jail, or both. 1 Members of the Plann ing Board and Board of Adjustment wil l be notified directly by the Stat e of Florida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnancial Interests (Form 1) w ith the Miami-Dade County Supervisor of Elections by 12:00 noon , Ju ly 1. Planning Board and Board of Ad j ustment members who file the ir Form 1 w ith the County Superv isor of Elections automatically satisfy the County's financ ial d isclosure requirement as a M iam i Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk . However, compl iance w ith the County disclosure requirement does not satisfy the State requirement. DIVERSITY STATISTICS REPORT The fo ll owing information is voluntary and has no beari ng on your consideration for appoi ntment. It is be ing asked to comply with City d iversity reporting requ irements . Gender: Race /Ethn ic Categories What is your race? Female White Are you Span ish /Hispanic/ Latino? Mark the "No" box if not Span ish / H ispanic / Latino . No Other Description : No details provi ded Physically Challenged : No 158 Board and Comm ittee Appl ication Ch eckl ist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES 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. YES I have comp leted and attached the Diversity Statist ics Report. If you have any questions , please contact the Office of the City Clerk v i a ema il: BC@mia m ibeachfl.gov or te lephone : 305.673. 7 411 Note : Florida Statutes 119.071 : T he role of the Office of the City Clerk is to rece ive and maint ain forms filed as public records. If your home add ress, telephone numbers, and/or photograph are exempt from d isclosure and you do not wish your home address , te lephone numbers, and /or photograph to be made public, please: 1) Use your office or other address for your ma ili ng address; 2) Use your office or other tel ephone number for your cont act number; and 3) Do not attach a photograph. 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 ACCORDINGLT. I vanessa Menkes agreed to the fol lowin g terms on 12/31 /2020 5 :35 :06 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 159 VANESSA MENKES 305.490 .44 94 • 951 West 47 th Court • Miami Bea ch, FL 33 140 • v menkes@yahoo .com A native of Wellesley, Massachusetts, Vanessa Menkes has more than fifteen years of entertainment, hospitality and lifestyle public relations experience . With a Bachelor of Science in Communications from Boston University, Vanessa worked at Manhattan 's top public relations firms , Ketchum and Dan Klores Communications, with clients such as Ian Schrager Hotels , The MTV Video Music Awards , Henri Bendel and Philippe Stark among others . With deep roots in the Miami market , Vanessa worked with The Opium Group , one of the nation's largest nightlife groups , where she oversaw media relations , select programming , partnerships, and governmental relations . Vanessa launched her own communications firm in 2015 , with clients from Nikki Beach (Miami and Global), Kiki on The River , Novikov Miami , Native Sons Hospitality venues Ariete and Baby Jane, and hotspots Sidebar and Moka i among others . She regularly secures coverage for these clients in publications such as The Miami Herald, New York Post, Travel+ Leisure, USA Today and others . Vanessa also represents various music and entertai nment clients including iconic rock group Foreigner, whose renaissance she catapulted with appearances on programs like The Tonight Show with Jimmy Fallon and CBS Sunday Morning, and publ ications like The New York Times, and Vanity Fair, Graham Nash of Crosby Stills & Nash , Dee Snider of Twisted Sister and others . Vanessa works in tandem with colleague Ashlie Rolfe who has an extensive grassroots marketing and events background . Ashlie 's overseen thousands of events on behalf of clients such as Royal Caribbean , SBS Entertainment , Food Network and Cooking Channel's South Beach Wine and Food Festival , Walt Disney World Resorts , ESPN Wide World of Sports , Revolution Live and America 's Backyard , and many more. Vanessa lives in Miam i Beach with her husband and daughter. Her philanthropic interests include The Miami Holocaust Memorial , The Cushman School , and The Little Lighthouse Foundation . 160 161 THIS PAGE INTENTIONALLY LEFT BLANK 162 • Laurence Moser 163 THIS PAGE INTENTIONALLY LEFT BLANK 164 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Moser Laurence ;..;.;..;;='----------------E -----------------Last Name F irst Name M id d I e Initia l 4 767 A lton Road M iami Beach Florida ----------------------------33140 -------- Home Address City State Z ip Code _30_5_-_7_85_-_1_1 _38 _____ .;;..30"'-5;;...-_7..;;.8.;;..5-_1_1..;;.3..;;.8 ____ 3_05_7_8_5_1_1 _38 ____ Lmoser@gatewaysunl im ited .com Cellular Work Home Email Address Gateways Unlimited Marketing Consultant Business Name: Occupation : 4767 ALTON RD MIAMI BEACH FL 33140 Business Address City State Zip Code Please list your preferences in order of ranking [1) first choice [2) second choice, and [3) third choice . Pl ease note that only three (3) choices will be observed by the City Clerk's Office . (Regular Boards of City) Choice 1: Cultural Arts Council Choice 2: Art in Public P laces Committee Choice 3 : LG BTQ Advisory Committee License Number Not App licable Professional License Issuance Date Expire Date 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 . * Note: If applying for the At-Large position of t he Historic Preservation Board , please answer the below questions: • Have you ever resided in one of the City's H istoric Districts for at least o ne year? NQ No Address in City Historic District submi tted. 165 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , band c: Members of Agencies , Boards, and Committees sha ll be affiliated w ith the city. Th is requ i rement sha ll be fulfilled in the following ways : a . Res ident of the City for a m inimum of six (6) months: • I am resident of: Middle Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of s ix (6) months: Yes "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. Or c . Full-time employee of such a business (for a mi ni mum of six months); and I am based in an office or other location of the business that is physically located in Miam i Beach (for a m inimum of si x months): Yes Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have specia l abilit ies , knowledge and experience. P lease list be low: In depth knowledge of the cultural arts establ ishments and offeri ngs on Miami Beach . Twenty two years of experience in marketing , promotions, advertising. Avid art col lector. • Are you presently a registered lobbyist with the City of Miami Beac h? No • Have you ever been convicted of a felony: No If yes , please expla in in detail: • Do you currently have a v iolation(s) of City of M iami Beach codes: i:::I.Q If yes , please expla in in detail : • Do you currently owe the C ity of Miami Beach any money: If yes , please expla in in detail : • Are you currently serving on any City Boards or Commi ttees : If yes , which board? Cultural Arts Council ; V ice-Chair. 166 • In what organization (s) i n the C ity of M iam i Beach do you currently hold membership i n? Name M iami Beach Democratic Club Pos it ion Member • List the address of a ll properties owned or in which you have an interest w ith in the City of M iam i Beach : Property Re si dence at 4767 A lton Road / Miami Beach , FL 33140 • Are you now employed by the City of M iam i Beach : If so , which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse , ch ild, brother, or sister who is employed by the C ity of Miami Beach? If "Yes ", identify person (s) and department(s ): No re lative's information submitted . 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 Proh i bit ion from d i re ctly or i nd irectly lobby ing c ity personnel (M iam i Beach C ity Code section 2-459). o Prohi bition from contra ct ing w ith the city (Miam i-Dade County Code section 2-11 .1 ). o Proh ibition from lobbying before board /comm ittee you have served on for period of one year after leaving offi ce (M iam i Beach Code section 2-26) o Requirement to disclose certain financ ial interests and g ifts (M iami-Dade County Code sec tion 2-11.1 ). o Sunshine Law -Florida's Government-in-the-Sunsh ine Law was enac ted in 1967. Today, the Sunshine Law regard i ng open government can be found in Chapter 286 of the Florida Statutes. These statutes establ ish a bas ic right of access to most meetings of Boards , Commissions, and other governing bod ies of state and loca l governmental agenci es or authorities . o Voti ng conflict -Form BB i s for use by any person serving at the county, c ity, or other loca l level of government on an appointed or elected Board , Counci l, Comm ission , A uthority , o r Comm ittee . It applies equality to members of advisory and non-advisory bod ies who are presented w ith a voting c onflic t of inte rest unde r Section 112 .3143. Florida Statutes . 167 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 M iami Beach , includ ing those of a purely advisory natu re , are requ ired to comply with M iam i-Dade County Fi nan ci al Disclosure Requ irements. One of the foll owing forms must be filled w ith t he C ity C lerk of M iami Bea ch, 1700 Convention Ce nter Drive , M iam i Beach , F lorida , no later than 12:00 noon of July 1, of each year: 1. A "Sourc e of In come Stateme nt ;" or 2 . A "Statement of Fina nci al Interests (Fo rm 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 Adj ustment will be notified d ire ct ly by the State of F lo ri da , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervisor of Elect ions by 12 :00 noon , Ju ly 1. Plann ing Board and Bo ard of Adjustment member s who fil e their Form 1 w ith the County Supervisor of Elections automaticall y satisfy the County's finan ci a l di scl osure requ i rement as a M iami Bea ch City Board/Committee member and need not file an add it ional form w ith the Offi ce of the C ity C lerk. Howeve r , compli ance w ith the County d isclosure requ irement does not satisfy the State requ i rement. DIVERSITY STATISTICS REPORT The fo ll owing information is voluntary and has no bearing on your consideration for appointment. It is be ing asked to comply w i th C ity d ivers ity reporti ng requ irements . Gender: Race /Ethn ic Categories What is your race? White Are you Spanish/Hispan ic/ Latino? Mark the "No" box if not Span ish / Hispanic / Latino. No Other Descri ption : No details provided Physica ll y Ch allenged : No 168 Boa rd and Comm ittee Appli cation Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YE S YES I have uploaded a current resume, photograph , and a copy of any applicable professional license. I have completed and attached the Board & Committee F inancial Acknowledgment Statement. YES I have completed and attached the D iversity Statistics Report. If you have any questions, please contact the Office of the C ity Clerk v ia email : BC@miamibeachfl .gov or telephone : 305.673. 7 411 Note : Florida Statutes 119.071 : The ro le of the Office of the C ity Clerk is to receive and ma intain forms filed as publi c records. If your home address, telephone numbers, and/or photograph are exempt from d isclosure and you do not w ish your home address , telephone numbers , and/or photograph to be made publi c , please: 1) Use your office or other address for your maili ng address ; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Laurence Moser agreed to the f ollowing terms on 1 1/15/2020 2 : 16: 17 PM Received in the Cit y Clerk's Office by: Name of Deputy Clerk Control No. Date 169 Laurence Moser 4767 Alton Road , Miami Beach , Flor ida 33140 Home: 305-785-1138 • Cell: 305 -785 -1138 LMoser@gatewaysunlimited.com SUMMARY I have worked with Gateways Unlimited as a consultant in the Advertising Specialties field since 1997. My focus has been in recommending, sourcing, procuring, packaging, delivering branded promotional and retail products via direct mail, trade shows, corporate and public events . HIGHLIGHTS • Sourcing promotiona l products domestically and overseas . • Artwork graphics programs including Adobe Illustrator,\ and Adobe Photoshop. • Creating multi-media and Excel programs of custom branded product offerings to work within stated client budgets. • Well versed in entire gamut of visual marketing and advertising signage i ncluding direct mail, street marketing, building banners, meeting presentations, automobile wrapping, trade shows, corporate functions. • Employee incentives, recognition and awards . ACCOMPLISHMENTS Born and raised in Miami. Miami Beach resident and homeowner for close to 20 years. World traveler having visited 6 continents, over 100 countries and thousands of cities . Avid photographer and writer. EXPERIENCE Advertising Specialties Consultant, 04/1 997 Gateways Unlimited -Miami, Florida Identified, developed and evaluated marketing strateg ies based on knowledge of company objectives and market trends. Collaborated with advertising and promotion managers to promote products and services.Developed and executed integrated marketing plans on a monthly and quarterly basis . Collaborated with marketi ng and communications teams on standardization, design and production of marketing materials. Increased client sales through strategic marketing campaigns multi-media products, signage and events. Helped create company stores and advised clients on most effective product offerings for online and retail sales. Analyzed performance of all marketing programs to identify the best opportunities for optimization. Managed inventory on new product and content releases.Developed innovative promotional product solutions grounded in clear understanding of customer needs. EDUCATION Bachelor of Arts: English, 1984 Tulane University -Coral Gables, Louisiana, United States Major in Literature; Minor i n Shakespeare. J.D.: LAW, 1987 University of Miami School of Law -Coral Gables, Florida, United States 170 171 THIS PAGE INTENTIONALLY LEFT BLANK 172 • Jessica Benitez 173 THIS PAGE INTENTIONALLY LEFT BLANK 174 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM .;;;.B...;;.e.;..;n.;.;;.ite=z;;;..... ______________ .::..Je.::...s::...:s:..:..ica::.=,. ______________ ;;;;;cl _____ _ Last Name First Name M iddle Initial _42_5_5_P_ra_ir_ie_A_v_e ______________ M __ ia=m--i--B--e;;...;a--c--h ____ --F~L _______ ..;..3-'-3_14-'-0.;;.__ ___ _ Home Address City State Zip Code _30--5_-7_9--0---_82_0_2 _____________________ jessicabenitez@gmail .com Cellular Work Home Email Address 3us iness Name : Occupation : Business Address City State Zip Code :>lease 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 Board s of City) Choice 1: Cultural Arts Council Choice 2 : Choice 3: Professional License No Professional Licenses Submitted . ote: 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. * Note : If applying for the At-Large position of the Historic Preservation Board , please answer the below questions : • Have you ever res ided in one of the City's Historic Districts for at least one year? No No Address in Ci ty Historic District submitted . 175 AFFILIATION WITH THE CITY OF MIAMI BEACH 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: a. Resident of the City for a minimum of six (6) months : • I am resident of: Middle Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "Ownership Interes t" 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. Or c. Full-time employee of such a business (fo r 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): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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, s tipulating th at 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. • I am applying for an appointment because I have special abilities, knowledge and experien ce . Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been conv icted of a felony: If yes , please explain in detail: • Do you currently have a viola tion (s) of City of Miami Bea ch codes: If yes, please explain in detail : • Do you currently owe the City of Miami Bea ch any money: If yes, please explain in detail : • Are you currently serving on any City Boards or Committees: If yes, which board? 176 • 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 w ithin the City of Miami Beach : Property 4255 Prairie Ave, Miami Beach , FL 33140 • Are you now employed by the City of Miami Beach: If so, which department and title? • 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 M iami Beach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 ind irectly lobbying city personn el (M iami Beach City Code section 2-459). o Proh ibition from contracting with the city (Miami-Dade County Code section 2-11 .1 ). o Proh ibition from lobbying before board/committee you have served on fo r 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 bod ies of state and local governmental agencies or authorities . o Voting conflict -Form 8 B is for use by any person serving at the county, city , or other local level of government on an appointed or ele cted Board, Council , Commission , Authority, or Committee. It applies equality to members of advisory and non-advisory bodies who are presented w ith a voting conflict of interest under Section 112.3143 . Florida Statutes. 177 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 D isclosure Requ irements. One of the following forms must be filled with the City Clerk of Miami Beach , 1700 Convention Center Drive, Miami Bea ch, Florida , no later than 12:00 noon of July 1, of each year: 1. A "Source of Income Statement;" or 2 . A "Statement of F inancial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federal Income Tax Return . Fa il ure 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 Rnancial 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 w ith the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. DIVERSITY TATISTICS 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 . Gender: Race/Ethnic Categories What is your race? Female White Are you Span ish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic/ Latino . No Other Description : No details provided Physically Challenged : 178 3oard and Committee Application Checklist: Plea se ensure you have provided all information before applying or eapplying to any B oard and Committee. YES I have answered all questions fully. ======~ YES I have uploaded a current resume , photograph , and a copy of any applicable professional license . YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES I have completed and attached the Di ve rsity Statistics Report. f you have an y questions, please contact the Office of the City Clerk via email : BC@miami beachfl .gov or ~lephone: 305 .673 . 7 411 lote: Florida Statutes 119.071: The role of the Office of the City Clerk is to re c ei ve and maintain forms filed as ublic records . If your home address , telephone numbers, and/or photograph are exempt from disclosure and you o not wish your home address , telephone numbers, and/or photograph to be made public, please : 1) Use you r office or other address fo r your mailing address ; 2) Use you r office or other telephone number for you r contact number; and 3) Do not attach a photograph. HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE ~ECEIVED , READ AND WILL ABIDE BY CHAPTER 2 , ARTICLE VII , OF THE MIAMI BEACH CITY CODE, :NTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ~LL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGL "t'. I Jessica Ben itez agreed to the following terms on 12/7/2020 5 :14:41 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 179 JESSICA BENITEZ I like to create . I lik e to work . Twenty-one years experi ence working as a graphic desig ner Extensive knowledge of Adobe crea t ive products Accustom to designing a variet y o f print based materials -from advertisements, broch ures and logo design to large scale displays, Journals and b illboards Proven abili t y to work for and with a clien t to conceptualize, brand and beautify t heir marketing materials. Pos1 t 1ve attit ude, sel f-st arter, quick learner, patient teacher. MY EXPERIENCE SENIOR ART DIRECTOR Brand Poets Apri l 2003 -Pre sent Craft a wide range of materials, from e -blas ts, broc hures and brand logos to large -scale displa ys , advertisements and billboards. Works with clients to con ceptuali ze , brand and beautify their marketing materials and ultimately exceed their c reative vision . GRAPHIC DESIGNER Self-employed Ap ri l 2003 -March 20 18 Create logos, corporate packages, newsletters, eblasts, graphics, white papers, invitation , brochures, fl yers, high -end residential floorplan packaging, tradesho w booths, journals, poster , advertisements, menus ... Work closely with varied clients to meet and exceed their cre ative needs. Met iculous, self-motivated and diligent. o stranger to tight deadlines. MY SKILLS STUDIO MANAGER/ GRAPHIC DESIGNER Marc USA Advertising March 200 1 -Apri l 20 03 Worked with a diverse group of clients, coworkers and vendors throughout the entire project cycle, often juggling everal large projects simultaneously. Coordinated the logistical ne eds of each proj ect t o e n ure smooth flow from inception to completi on. Developed a keen ability to anticipate the unexpected. Strong project management kills , including scheduling and allocating resources for optimum performance a nd client satisfac tion. Close attention to detail and dedication to fo ll ow up on projec ts , are areas I excel. PRINT PRODUCTION ARTIST Cri sp in, Porter + Bogusky Aug ust 1999 -March 2001 Studio slave at o ne of the busiest and biggest ad age ncies in this region . Very familiar with a high stress work environment. Mac preferred. PC tolera ted . Fluent in Adobe Creative Suite (In Design , Photosh o p, Illustrator), Acrobat , Microsoft Offi ce, Google, Asana , DropBox. Knowledge of print/pre-press produc tion . MY EDUCATIO N Bachelo r of Science in Communicatio n, Speciali z ing in Adverti ing Minor in Graphic Des ign Florida State University, I 994 -1998 SUNNY MIAMI BEACH IS HOME CALL ME (305) 790-8202 I EMAIL ME jess1cabenitez@gmail.com I STALK ME www.jessicabenitez.net 180 181 THIS PAGE INTENTIONALLY LEFT BLANK 182 • Brian Ehrlich 183 THIS PAGE INTENTIONALLY LEFT BLANK 184 MIAMI BEACH BOARD AND COMMITTEE AP PUCA T ION FORM ,;:;E.;.;.h.;.;.rli;.;;.c.;.;.h ________________ B_r i_a _n _____________________ _ Last Name F i rst Name M iddle In it ia l _45_2_0_N_o_rt_h _B_a-y_R_o_a_d ___________ M_ia_m_i B_e_a_c_h _____ F_L _______ 3 3140 Home A ddress C ity State Zip Code -'-1..;;;..30.;;.;5""'7...;;3"""3.;;;.8.;;;..87'-'0;...._ _____________ 1 _30_5_7_3_3_8_87_0 ____ brian@p arad igm01 .com Cellu lar Work Home Email Address Paradig m 0 1 Hotel and Real Estate Investments B usiness N a m e : Occupation: 5 Island Avenue #11 H M iami Beac h FL 331 3 9 B usiness A d dre ss C ity State Z ip Cod e P le a se l ist your preferences in order of ranki ng [1] first choice (2) second choice , and [3 ) t h ird choice . Please note that only three (3) choices will be observed by the City Clerk's O ffi ce. (Regular Boards of C ity) Choice 1 : C ult ural A rts Council Choice 2: D esign Review Board Choi ce 3: Board of Adj ustment Professional License No Profess ion al Li censes Su bm itted . Note: If you are seeki ng appo intment to a pro fess ional seat (e .g . attorney, architec t , etc .), you mu st attac h a c opy of your currentl y effect ive c o rrespo ndi ng professional l icense. * Note: If applyi ng for the At-Large position of the Historic Preservation Board, please answer the below q uest ions: • Have you ever resided in one of the C ity's H istoric D istricts f or at least one year? Yes If you answered "Yes", please i ndica te : 1200 Ocean Drive From : 5/1/2005 To: 6 /2/2007 Address Dates 185 AFFILIATIO N WITH THE C ITY OF MIAMI BEACH Pursuant to C ity Code sec tion 2-22(4) a , b and c : Members of A gencies, Boards, and Committees s hall be affili ated w ith the city . Th is requ irement sha ll be fu lfilled in the fo ll owing ways : a. Resident of the C ity for a minimum of six (6 ) months : • I am res ident of: South Bea ch Or b. Demonstrate an ownership interest in a business establi shed in the City for a minimum of six (6 ) months: Yes "Ownership Interest" shall mean the o wnership o f ten percent (10%) or more (including the o wn ers hip o f 10% or more of the outstanding capital stock) in a business. "Busin ess" shall mean any sole proprietorship, sponsorship, corporation , limited liability company, or other entity or b usiness association. Or c. Fu ll -time emp loyee of such a business (for a mi nimum of six mo nths); and I am based in an office or other location of the busin ess t ha t is physically located in Miam i Bea ch (for a minim um of six months): No N ot withstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with th e City affiliation requirements of section 2-22 (4) a and b of the Miam i Beach City Code by executing an affidavit, stipulating that they have met eith er (o r both) of said affiliation requirements . The origi nal affida vit shall b e filled with the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appo intment because I have special abil ities, knowledge and experience. Please li st below: Commun ity engagement is a passion of mine , and I serve on the Board of Directors of the Bass Museum of Art, where I chair the Strateg ic Plann ing comm ittee . From 2012-2014 , I also spearheaded the strateg ic obje ct ives of the Fairho lme Fo undation , an arts foundat ion /fam il y office ; and collaborated w ith • Are you presently a reg istered lobby ist with the City of Miam i Beach? No • Have you eve r been convicted of a felony: If yes , please exp lain in deta il: • Do you cu rren t ly have a viola tion(s) of Ci ty of Miami Beach co de s : If yes, please explain in detail : • Do you currently owe the City of Miami Beach any money: If yes, please exp lain in detail : • Are you currently serving on any City Boards or Comm ittees : If yes, wh ich board ? 186 • In what organization(s) in the City of Miami Beach do you currently hold membership i n? Name Pos ition Bass Museum of Art Board of Directors • List the address of all properties owned or in which you have an interest with in the City of Miami Beach : Property 450 Alton Road Apt. 1705 Miami Beach Fl 33139 • Are you now employed by the C ity of Miam i Beach : If so , which department and t itle? • Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse , child , brother, or sister who is employed by the C ity of Miami Beach? If "Yes", identify person(s) and department(s): No relative 's information submitted . 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 c ity personnel (Miami Beach C ity Code section 2-459). o Proh ibition from contracting w ith the city (Miami-Dade County Code section 2-11 .1 ). o Proh ibition from lobbying before board /committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requ irement to disclose certa in 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 Voti ng conflict -Form 88 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 . 187 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 J uly 1, of each year a ll members of Boards and Committees of the C ity of Miam i Beach , including those of a purely advisory nature , are requ ired to comply with Miam i-Dade County F inancia l Di sclosure Requ irements. One of the fol lowing forms must be filled w ith the C ity Cl erk of Miam i Beach , 1700 Convention Center Drive , M iami 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 Financia l Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federa l Income Tax Return . Fa il ure 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 Planni ng Board and Board of Ad justment w ill 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. Plan ning Board and Board of Adjustment members who file their Form 1 w ith the County Supervisor of Ele ctions automatically sati sfy the County's financial disclosure requ i reme nt as a M iami Beach C ity Board/Committee member and need not file an additional form with the Office of the City Clerk . However, compliance with the County disclosure re qu irement 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 w ith City d ivers ity reporting requirements . Gender: Race/Ethn ic Categories What is your race? White Are you Spanish/H ispanic/ Latino? Mark the "No" box if not Span ish / Hispanic / Latino . Yes Other Descript ion : No deta ils provided Physically Challenged : 188 Board and Committee Application Checklist : Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fu ll y . :=:::::==::: YES I have uploaded a current resume , photograph , and a copy of any applicable professional license. YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk v ia email : BC@miam ibeachfl.gov or telephone : 305 .673 . 7 411 Note : Florida Statutes 119.071: The role of the Office of the City Clerk is to rece ive 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 , p lease : 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 . 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 MIAM I 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 ACCORDINGLT. I Brian Ehrl ich agreed to the following terms on 1/5/2021 7 :41 :15 PM Received in the City Clerk's Office by : Name of Deputy Clerk Control No. Date 189 BRIAN EHRLI CH PARADIGM I 01 2017 to Present bnan@parad1gm01 com Co-Founder 4520 N Bay Road M1am1 Beach FL 33140 Tel 305 733 .8870 M1am1 Beach Paradigm 01 is the real estate & hotel advi sory company I co-founded to create progressive real estate Some of our products include alternative hosp1tal1ty p roiects & co-l1v1ng concepts Through this company, I 've also assisted o t her startups to scale across a wide range of deal types, from conceptual1zat1on through permitting to final execution We also provide comprehensive advisory support on hote l and other real estate investment s and transactions, tenant select,on, fnanc1ng and debt adv,sory Our real est ate consulting servoces help maximize the value and use of r,:,al Pstate hol dings and help propr•etors make nt1ol bus,ness decisions with con'1dence We incorporate a spec1f1c comb1nat1on of trad1t1onal and innovative real estate prof1c 1enc1es designed for each of our cloents' spec1f 1c needs Our professional s complete a comprehensive data review and provide advice o n both pre-and post-transaction decisions. Paradigm O 1 also directly capitalizes multi-family apartment buildings and hotel properties. With our extensive experience and knowledge in the vacation rental industry we aim to acquire properties directly or with st rategic partners to operate as flexibl e accommodation products. SONDER 2016 to 2017 Dtre<:tor of Real Estate San Franosco Led acqu,sItIons team for venture-backed 51I,con Va lley hosp,tal1ty startup Scaled portfol,o nearly 15x. growing supply from 200 to 2500+ units Managed fundra,s1ng efforts and investor p,tches for Series C, raised on excess ot $135 m1ll,on over course of two years M<1naged & l everaged relat1onsh1ps with real estate developers, investors, PE family offices. REITs & other 1nst1tut1onal players. ldent1f1ed and qual1f1ed prospective properties/leads and designed soph1st1cated large-scale partnerships to close these opportunities Managed and grew supply p ipeline with 1nst 1tu t 1onal players focused with multi-family p layers Crafted marlcet expansi on strategy & npw locations on collaboration with CEO, operating In an environment of s1gn1f1cant deal velocity Provided reporting and track,ng to senior management/investors Assessed and evaluated f,nanc,al v,ab1l1ty of new opportun,t,es. leading a cross-functional nternal sta1<eholders (acqu1s1t,ons. finance, operations, design, & data sc,ence teams) and external stakehol ders (attorneys. developers. equity partners, munic,pal partners & th,rd-party consultants) Proposed ,n1t1al bus,ness terms and negotiated agreements, 1nclud1ng structuring term sheets, letters of ,ntent & management agreements, and oversaw marlcup execut,on of def,n1t1ve documents Structured deal s leveraging underwnt,ng team, applicable market analysis, and on collaboration with data science team, designed data-driven frameworlc to evaluate new opportunItIes Oversaw proiect memos for internal approval, prepared and reviewed preliminary proiect budgets/schedules Oversaw developmen t of detailed hotel operat ing p ro forma models with underwrot ,ng teams to meet ,ntemal requiremen ts. analyzing financial data Led public policy advocacy & strategy de11elop1ng collaborative pol1c,es to align ,nterests of company and publ,c stakeholders M anaged and oversaw proIect approval. entitl ement and perm,ttIng process and coordination NOth local government off1c1als to officials to del,vN max,mum Incent1ves including tax cred,t s etc FAIRHOLME CAPITAL MANAGEMENT Otre<:tor of Investor Relat,ons 2009 to 2015 Built business development unit serv,ng over 200,000 high net worth onstItut,ons and 1nd1v,dual s represent,ng $12 b1ll1on ,n assets Oversaw all external company proiects, negotiat<'d mult,-m1ll1on dollar revenu.-,-gpnerat,ng partnNsh1ps Des,gned growth strategy oversPeIng a 37% In assets dunng tenure Drove business strategy and pos,tIonIng for new hedge fund product, prospecting and clos,ng $250 million ,n new assets over 10 month period Spearheaded deal process from strategy/negot1at,on to contract/1mplementat,on Increas,ng avadabd,ty of all investment products on external channels Collaborated w,th internal research team to track and ma,nta•n data of portfolio compan,es, produce collateral for dents on portfolio compan,es and leverage such knowledge for strategic partner shi p s and new cl,ent acquisition Created and managed roll-out of all p ublic announcement s and press releases, investor presentations, shareholder letters and commentaries for p roducts Served as chief communicat ions officer, handling PR 1nclud1ng media strategy (CNBC and Bl oomberg) for Founder/President, led partnership with Bank of America managing roll-out of Joint investor call fe.itunng CEO Br<an Moynihan reaching 10,000+ sharehol ders to educate investors about sto(k performance. Spearheaded & Orchestrated $20 m,ll1on real estate transaction for f,rm HO. aggregated & 1cquored 10 1nd1v1dual sites & perm med three-acre urban site Coord,nated architects and consultants dur,ng design development and conducted all related due d,ligence Spokesperson for firm al ,ndustry events/conferences, evangelist dr,v,ng business outcomes at cl,ent meet,ngs and w,th senior execut,vcs of Fortune 500 companies, and key l1a1son between senior management and dents Orchestrated key company-wide & ,nvestor events Board meetings and presentations, and produced creative custom expenences Designed and exewted strategic plan for firm's $200 m1 ll1on foundation, spearheading key partnership w ith Warren Buffett through Secret Millionaires, an organization that produces f1nanc1a l literacy education for children culminating In our sponsorship of a yearly compeU1on/event ,n Omaha, Nebraska THE RELATED GROUP 2006 to 2009 Otrector of Hotel Development M 1am1 Promoted to serve as head of hot el developmePt for newly created ,nternat1onal subs1d,ary of the U S's largest devel oper o f luxury mult1-fam,l y housing, after successfully developing $400 million of real estate In first year of employment with Beach Club I, II , & Ill In Hall andale Beach & Ocean -I 190 ldent1f1ed, evaluated, and structured agreements for 12 proiects representing $1 billion of res1dent1al and hotel development 1n Mexico, Panama, Colombia, and the Caribbean led all aspects of deal execution, selection of partners, structuring transaction terms, and negot1at1on with local land partners, consumer hotel brands, and sales groups/investors Developed and implemented growth strategy for Latin American d1v1s1on by recru1t1ng and bu1ld1ng local teams 1n respective countries, and managing key relat1onsh1ps with mayors, local land partners, and sa l es teams Devised sales strategy for St Regis Bal Harbor Jointly with Starwood Hotels, and increased average sales/square foot by 20% after deployment o f broker incentive p rogram, focusing on key relat1onsh1ps w i th brokerage arms in Brazil , Panama and Colombia Proiect Manager (2006) Managed and coordinated development of two luxury bu1ld1ngs (1,500 units), and devised and implemented sales strategy with Latin American brokerage community to ensure units closed, achieving 95% closing rate even as sales had slowed considerably on macro level Designed, developed, constructed, and sold properties Jointly with consumer hotel brands such as St Regis, Managed operations and f1nanc1al aspects of homeowners associations and negotiated with city government and condominium boards to support business 1nit1at1ves Managed construction of key resort amenItIes, food and beverage outlets, and sales centers EDUCATION HARVARD UNIVERSITY, John F. Kennedy School of Government Cambridge, MA 2004 to 2006 Masters in Public Policy, concentration 1n Business and Government Policy Coursework 1n economics, stat1st 1cs, negot1at1ons, policy analysis and design Harvard Business School courses in real estate, finance, operations, marketing, and business va luation and analysis, Co-Chairman, Harvard Real Estate Consortium FULBR IGHT FELLOWSHIP, U.S. DEPARTMENT OF STATE Fellow "Evaluating poverty-reducing education policies, the "Educational Assistance Card" 1n Santo Domingo, Dominican Republic. Collaborated with Supreme Court Justice Berges & Department of Education to reduce 1neff1c1enc1es and reform federal program 1n the Dominican Republic 1999 to 2002 2002 LEADERSHIP 2012 to Present 2011 to Present 2011 to 2013 2008 to 2014 2011 to 2014 2009 to 2013 2006 to Present 2011 to Present UNIVERSITY OF PENNSYLVANIA, College of Arts and Sciences Philadelphia , PA Bachelor of Arts, summa cum laude, 1n Pol1t1cal Science & Spanish (minor); Dean's List all four years UNIVERSIDAD DE SEVILLA Seville, Spain Bass Museum of Art Soho Beach House M,am1 Voice City of M1am1 Beach Jorge M Perez Art Museum of M 1am1 (PAMM) Adrienne Arsht Center for the Performing Arts 819 Brothers 819 Sisters Make Art Not Casinos Member of the Board of Directors I Co-Chair o f Strategic Planning Committee Founding Member Co-Founder, a not-for-profit to empower youth through the sk,11 of public speaking Board Member, (Board of Adjustment 08-10, Capital Improvements, 10-14) Collector's Council Green Room Society Board Member Mentor to Moises Matute Co-Founder Founded and managed politica l movement defending interests of artists, real estate owners, activists, and gallery and restaurant owners t o ensure that downtown M1am1 ,s free of mega casino development 191 192 • Christina S. LaBuzeta 193 THIS PAGE INTENTIONALLY LEFT BLANK 194 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME : LaBuzetta Last Name HOME ADDRESS: 301 Ocean Dr .. Unit 304 Apt No. Home No./Street PHONE: 305-794-2873 305-604-8888 Home Bu siness Name: Locat ion Resou rces, Inc. Address: 311 Lincoln Rd ., Suite 305 Street Work Christina First Name Miami Beach City FL s Middle In itial Stale chrlstina@ locationresources.com Email Address Position : Miami Beach Busi ness o wner Miami Beach FL City Stale 33139 Zip Code 33139 Zip Code Pursuant to City Code section 2-22(4) a and 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; orb) an individual shall demonstrate ownership/i nterest for a mini mum of six months in a business established in the city. • R esiden t of Miami Beach for a minimum o f six (6) months Yes • Demonstrate an ownership/interest i n a business in Miami Beach for a minimum of six (6) months: Yes • Are you a reQistered voter in Miami Beach : Yes •(P lease~ one): I am now a resident of : South Beach • I am applyinQ for an appo intmen t because I have special abilities, knowledQe and experience. Please list below: My 25 + years of experience in the film , photo and event industri es qualify me to conti nue to serve on the Productio n Industry C • Are you presently a registered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking [1] first c hoice [2 ] second choic e. and [3] third choice. P lease note t hat only three (31 choi ces will be obse rved by the City Clerk's Office . (Regular Boards of City ) Choice 1: Choice 2 : Choice 3 : Producti on Industry Council Cu ltural Arts Counci l Art in Public Places Committee • Board members are required to file Form 1 -"Statement of Financial Inte rest" with the State. If you seek appointment to a professional seat (e .g., lawye r, architect, etc .) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board , attach a copy of your currently-effectively lice nse, and furnish th e following information : Type of Professio nal Li cense _______________ Li cense Number Li cense Issua nce Date ________________ _ License Expiration Dat e Note : If applying for Youth Advisory Board, please ind icate you r affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board : No .;.;;..:. __ _ Years of Service: _______________ _ 2. Present participati o n in Youth Center acti viti es by you r children '""'N-'-o __ ages, and which programs. List below: if yes, please list the names of your chi ldren, their 195 Error : Subreport could not be shown. • Have you ever been convicted of a felony : No If yes, please explain in detail: • Do you currentl y have a violation(s) of City of Miami Beach codes : No • Do you currently o we the City of Miami Beach any money: No • Are you currently serving on any City Boards or Committees: No • What organizations 1n the City of Miami Bea ch do you currently hold membership in? Error : Subrep o rt could not be sh own . • I am now employed by the city of Miami Beach: No Which department ? If yes, please explain in detail: If yes, please explain 1n detail: If yes, which board? • List all properties owned or have an interest in, which are located within the City of Miami Bea ch: The following informati on is voluntary and is neither part of your application nor has any b earing on your consideration for appoint ment. It is being asked to comply with federal equal opportunity reporting requirements. Race/Ethnic Categones Wh at is y ou r race? Mark one or more races to 1nd1cate what you consider you rself to be . none Other Description : Are you Spanish/Hispanic/ La tin o? Mark the "No" box if not Spanish / Hispanic / Latino. No Physically Challenqed : No 196 NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws Include, but are not limi ted to, the following : .., Proh1b1tlon from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). Proh1b1tion from contracting with the city (M iami-Dade County Code section 2-11 1 ). ,., Proh1b1tion from lobbying before board/committee you have served on for penod o f one year aft er leaving office (Miami B each Code section 2-26) . .., Requirement to disclose certa in financial interests and gifts (M1am1-Dade County Code section 2-11 1 ). (re: CMS Community Development Ad visory Committee)· proh1bIt1on, dunng tenure and for one year after leaving office. from having any interest in or receiving any benefit fr om Community Development Block Grant funds for either yourself. or those with whom you have business or immediate family ties (CFR 570.611 ). Upon request, copies of these laws may b e obtained from the City Clerk. "I hereby attest t o the accura c y and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Membe rs." I Christi na LaBuzetta agreed to the following terms on 11 /26/2019 10:35 :56 PM Received In the City Clerk's Office by· N ame of Deputy Clerk Control N o . Date 197 Professional Ex erieoce Owner Location Resources , Inc. 1989 -Pre~ent Christina LaBuzetta Miami Beach, FL 305-604-8888 Fully staffed lor,Hinn libra ry ,e r.ir e ,t·n1ng print. T\', mw,il ,·ideo and katurc lilm procl11ni011-. One of the Southca,t's lar,!{l'S t and mo,t d in 'r,c film lot,Hion li brarie,. Photographer, 1980 -presc111 C ommercial and fine art pho tography. Location Scout / Mana er 1988 -Prc~clll 28 y,·..J"' or c-xpnin11T :i-ICI( at ion ,11n11 /111,111ag<T \'cry <'ilt·1 ti, 1· in undrr,tanding :111d nm1n1t1nica1io11 of' ,·i,ual conu·pts. \\"ell wr,ecl in finding unique. ,isuall y strong location, and photographmg Llwm dferti,·c l~ to ,how the po,,ihilit ic~ often m ·<.:r,ct·n nf particular loratiom. \ ·er: pro licient in location management: rrcatinc; and working within a budget. negot ia ting. 101.,ri st in, faci li tating ,i ll prod 1111 io n need, o f all unit.,, protcning locations, r 1Tati,-e problem snh-i n g. abi li t} to confro nt c h a lle n gi n g situat iom while m a int ,iini n g a composed and prolcs,ional allituck. Long-term relat ion,hips ,,·ith go,·ernmcnt oflicia ls a n d location m,·ners. Strong team bui lding and management ,kill s .. \bk 11110111rnunica1e in Sp.111i,h 2 nd Unit O erator / D.P. 1997-Prc,l'llt Camera Assistant 19~1'.! -I ~19-l Education: --,. University of Southern California. Los .\ngcle, -Sc h 110I ol'Cinema and T cln i,io n ,. The Maine Film & Television Workshops -C:i11rn1,11ography Program , Miami Dade Community College -\lotion P iuure P roduction , Florida Keys Conununity College -Commercial. Fine .\n. and L'n ckrwatcr Photo!{r,tph): Businc~, \l anagTment ► State University of New York at Plattsburgh -(~on1n1rrr i a l and Fi ne .\n Phu1o~raph~. Production lndustr Advocac / Com.rnuni Activism / Architectural Preservation , Pa,1 hoard member ofthl' City of Miami Beach Production Industry Council. Th i, ad,·i~Pr: hoard i, thl' conduit lwt\H'l'll 1h1· lilm and print inrl,a-tri,·, and t hl' City Co111111i,~irn 1. r (:o-foundl'r/pre"ide tll O cean Drive Preservation Association. \\'ith the l!_"ual of p1 e,t..-, ing du .. · unique· hi ,t,>ric arc-hitl'nurc of \ I iami Bl'al h. P roposed and ,ucLl'~«fully "·orkt·cl "ithin t he ~y,tem to create a nr,,· City ordinan ce rcs 11icting the hei ght of new high-rises on O cran D r. R erci,Td 2 historic prl',cn·ation a,,·arcb. , Board member Miami Des ign Preservation League. T he 01iginal org-a11i1:atin11 credited with c r ea ting-international rec-o~nitiun 111'. \rt D eco arrhitl'Cturc 0 11 \I iami Beach . ·uc n·,sful in enacting hi,tori 1 prl'~l'IYation urdi 11 a 11 n ·s and pr, 11noting prcsen·ation dfons ► Bo,ird \l emhcr City of Miami B each Hispanic Affairs Committee 198 Credits/References Location Scoutin / Location Mana ement Paramount Studios, Lo, .\n ~cle~ '"lip in the .\ir'" Blind Decker Productions, I .os Angeles ·· D t·xtt-r .. Sony Pictures Television, I .o, Angele, --Blut1dli11e '· Dream 0 rls Productions. UniH·r~al C i ty. CA ·· n rl'amg irl,'" '.2 11rl unit Alcon Entertainment, Lo, .\ne;de, ·· Ba.,tarc1,·· MV Productions. \l iami. F L ··\t iami \'ice·· CBS Productions, I ,os .\n gc lcs ··CS I: \l iami··. CB. T \' "erie, TVM Productions . \l ia mi ··Burn :\otirc"" Sea Side Productions, Pari~. Fran ce. \l iami. Fl . ···1·r a n,portn ~-· Son Pictures. Los .\ne;\'11 ·, "Random H ean~"-Fc.itur e Fi lm P aramount/Viacom I .os A n ge le s .. Father Ldiy'', C HS P il o t Touchstone Pictures Lm .\11 g d 1·, ··T he Crl'w'". feature film Warner Brothers/ Lorimar Television, I .os . \ngl'k s "Cmitll'd \l iami P ilot", C:BS Series Starz Mianu, Productions, LLC., \l iarni ··.\t agic Cit\" .. A.C.C. Productions, \l i.im i ··en l ndil'n D am La \"illc". French Feature Film ·'Cracked :\ut". F r l'nch Frature Film Alexandre Films, Paris •·Gran d Pardon II ". Frenc h F caturl' Fil 111 Carnival Films, London/ Fddlltt & Cu. H o llywood , Fl. "Priml' 'u spcrt", Fl'ature Fil111 Dis n ey Films, H o ll ~'\\'Ood ··up C lose and Per,01 1a l .. , F1·at UIT fi lm Metro Films I .us :\1t~l'b "D ead!~ R i\·a l.. Feature Film Lo eval Productions, I...\. "\ l <1rooncd". ftaturl' lilm Screenventures, Los .\11 gdcs "Sim, of t he City". L'S.\ T\' ,cri c:, S a d Productions Pari,. \l iami "\l ic hacl K aci" Fre nrh Fe ature Fi lm Pol am Television, Bt'\Trly Hi lls "\lo n do Picasso". Pi lot U nive r sal Pictures / Alan Barnette Production Co .. Lo~ .\nl(ek "Rl'd \\'ind". CS.\ Cable Ch,111nel \I m ie "l.ouis i.111a Black, L'S .\ Cable Channel \l oY ic Killer Films, :\cw Yo rk .. B,tllad of Benic Pae;e ... H BO \ l o\·i e 199 Client List artial list Annie Leibovitz Studio, :'\L'\\' Y ork The Bedford Falls Com an :\c\\' Yo rk E o c h Films :\c\\ Y ork E.U.E / Scr een Gems . :\t'w Y ork Film o . .\l ilan Fl ·n Ti e r Productions Santa .\l o nica GMS Produc tions, \\·est H oll~ \\OOcl Joe Pitka, \\·nice Bl'ach Gartner/Grasso . Los Angele~ H .S .I., :\cw Y ork. Cuhu C ily Gibson, Lefe bvre, Gartne r Productions (GLG), Giraldi Suarez Productions , :\c \\ Y ork. Los A n ~elcs FM Rocks,. a nta .\l onica Lo es Produc tions :\e\\ Y o r k Mars Media, \'c·ni cc, C:A Morton Jankel Zander (MJZ ), Los :\n~l'ks Mougin H enry Films Inc .. :\c,\· York Moxie Pic tures, H o ll ywood Murray & Blum Moving Pic ture s, Lo~ ,\ngcks NFL Films .\I t L a ura l. l'\j N Ur E y e Films. i\'cw Y ork 0 rah Winfre Show Chicago One Such Films :\cw York Partne rs & A o s tine lli, :'\c\\' York The Partners ' Film Co .. T oron to,. cw Y ork. Los Ang-des P e tterss on & Akerland, Stoc kho lm Pfeife r Lo es Production Co. :\c,\· York Pia ho Ma azine Chicago RSA Film Co., R iclky Srn11 ) l ,o ndon, l .os :\ngclc~, :\I'\\' York Sc reamin Tantrum Productions , I l o ll y,rnocl Serious Pic tures . I ,oncl o n Stev e & Linda Horn Inc . :\rn· York Stie fel & Com an · l'\\' Y ork Stri o rk Sports Illus trated Vani azine, :\\' Peggy Siro ta, :\cw York Wild Scientific . I ,m An ge-Ir . Will Van D e rVlu · roductions :\m~t crdam. l .ondon 200 Advertised Products . \cur a . \mcrir:111 Expre,,-Supn Bm, I .\n thn>polof{it' Barn1d i Ka in l k Solcil 8,\1\\" Burl{er K in~ Cadillac Carni\·;il C:n1i sr Li ne, Che\TO ll't Chr:,la C:iro c Coca Cob Coor~ Lite D e Beers .Jl'\\ elns D ewar, Di n,·I J 1·,rns Li-tman K odak ESP:\ ,\laga;,inc Kodi e, I,,uc E ,tLT l .;n1der Ford H eine kl'n Beer H onch .\u tn Co. [8,\f Intiniti .\lllo C o. j<"<'p I :Oreal I .inu>ln -,\ lercur·y ,\kDorultb \IC I ,\ I erredc, ( :-Cla,se ,\ I il ler Iker \l izunn Gol rCiubs ,\ I ol,, 111 Beer Chc \Tokt : ,\l ontc Carlo :\"ik c :\" okia :\"orwcg-ian Cruise 1.im·, O ,rar ck La R cnta Pep,i R alph I .aurcn R eebok S.iab Sclmcppes S011~ Sp1in1 T ,11{ H curc T np Flitc T oyota \ ·1s. \ C.ird \·i,it Flo rida \·olb"agen artial list 201 Music Video Artists 50 C e nt ,\ko 11 Bab) C:ri ,1i11a .\g uiln,1 B l ')OIICC &J ay Z DJ K,1lt-d Dr,1kc Gloria E,1ef a11 Fi n Ri eb J a h R ui c J amie Foxx .J ay Z J l .o J ulio lgk,ia, Lenny Kr,l\"il"I LI. Cool j and Bm ·s '2 :\Icn l .il'J ohn Li l' \\'a\"lll" I .udat ri , :\Ian ,\mhony ~on·a g;i P. D iddy Pharrcll Qun·n I .a 1ifah Ric k) :\l ;irtin R obi n Th icke Sh,1ki ra T.I. T o ni Braxton \\'hi111 n H ou,1011 artial list 202 203 THIS PAGE INTENTIONALLY LEFT BLANK 204 • Sarah H. Leddick 205 THIS PAGE INTENTIONALLY LEFT BLANK 206 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Led dick Sarah H -----------------------------------Last Name First Name Mid d I e Initial .;..44"""6;;..;9;....;_;R..;;;_o.,_ya=I_P....;a=lm~A...;.v.;..;e;;.;.n.;_;;u;_;;e _________ .;..;;.M;.;.;ia=m.;..;;.i....;B;;;_e;;..;;a;.;..;;c....;h ____ ""'F.;_;;lo"""n;_;;·d..;;;_a _______ 33_1_4_0 ___ _ Home Address City State Zip Code __________________ 30_5_._4_50_._2_0_33 ____ sleddi98@bellsouth .net Cellular Work Home Email Address =>ainting Chicks Artist 3usiness Name: Occupation : i469 Royal Palm Avenue Miami Beach Florida 33140 Business Address City State Zip Code =>lease list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note :hat only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Cultural Arts Council Choice 2: Animal Welfare Committee Choice 3: Affordable Housing Advisory Committee Professional License No Profess ional Licenses Submitted . ote: 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. * 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? No No Address in City His toric District submitted . 207 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c: Members of Agencies, Boards, and Committees shall be affiliated with the city. Th is requ irement shall be fulfilled in the following ways: a. Resident of the City for a minimum of six (6) months : • I am resident of: N/A Or b. Demonstrate an ownership inte rest in a business established in the City for a minimum of six (6) months: Yes "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. Or 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 forlh herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abilities , knowledge and experience. Please list below: I've been involved fifteen years in animal rescue . I have rescued over 1 ,000 dogs and cats and re-homed. I have been involved in real estate renovation for 30 years and have worked as a rental property manager. I am a small business owner based in Miami Beach. I have a MA in painting and a BA in art • Are you presently a registered lobbyist with the City of Miami Beach? 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 M ia mi Beach codes: If yes , please explain in detail : • Do you currently owe the City of Miami Beach any money: If yes, please explain in deta il : • Are you currently serving on any City Boards or Committees : If yes, which board? Was on The Affordable Housing committee from Jan ., 2005-Jan.2021 208 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Miami Beach United Miami Design Preservation League Pos ition Board Board • List the address of all properties owned or in wh ich you have an interest w ithin the City of Miami Beach : Property 4469 Royal Palm Avenue , Miami Beach , FL. 33140 • Are you now employed by the City of Miami Beach : If so, which department and title? • 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? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 88 is for use by any person serving at the county, city , or other local level of government on an appointed or elected Board , Coun cil , Commission , Authority , or Comm ittee. It applies equality to members of advisory and non-advisory bodies who are presented with a voting confl ict of interest under Section 112 .3143 . Florida Statutes. 209 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 M iami Bea ch , including those of a purely advisory nature , are required to comply with Miami-Dade County Financial Disclosure Requ irements . One of the following forms must be filled w ith the City Clerk of M iami Beach , 1700 Convention Center Drive , Miam i 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/Comm ittee 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. Gender: Race/Ethnic Categories What is your race? Female White Are you Span ish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic/ Latino . No Other Description : No details provided Physically Challenged : 210 3oard and Committee Applicati on Checklist: Please ensure you have prov ided a ll information before applying or eapplying to any Board and C ommitt ee. YES I have answered a ll questions fully . YES YES I have uploaded a current resume , photograph , and a copy of any applicable professional license. I have completed and attached the Board & Committee F inancial Acknowledgment Statement. YES I have completed and attached the D i versity Stati stics Report. f you have any questions, please contact the Office of the C ity Clerk vi a email : BC@mi amibeac hfl .gov or ?lephone : 305 .673.7411 lote: Flori da Statutes 1 19.071 : The role of the Offi c e of the C ity Clerk is to r e c e i ve and maintain forms filed as ublic records. If your home addr ess, telephone numbers , and/or photograph are exempt from disclosure and you o not w ish y our home address, telephone numbers, and/or photograph to be made public , please: 1) Use your office or other addr ess for your mai ling address; 2) Use your office or other telephone number for your conta c t number; and 3) Do not attach a photograph . HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE tECEIVED, READ AND WILL ABIDE BY CHAPTER 2 , ARTIC L E VII, OF THE MIAMI BEACH CITY CODE, :NTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS , EMPLOYEES AND AGENCY MEMBERS AND ~L L OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLT. I Sarah Leddick agreed to the following terms on 1/5/2021 11 :18:28 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 211 Sarah Leddick 4469 Royal P a lm Ave. Miam i Beach, Fl. 33140 E duca ti o n •Master of Arts in Painting from San Diego State University ( 1974-1976) 0 4.0 GPA 0 Studied under John Baldessari , Joan Snyder, Joan Jonas, Joan Thome, Lynton Wells, Eleanor Anton , D avid Anton and Robin Bri g ht •Bachel or of Arts in Art from San Di ego State Un iversity ( 1970-1974) 0 3.9 GPA with Highest Honors •W .C Crawford High School class of 197 1 W ork Ex perie nce •Painting Chicks (1995-present) 0 0wner 0 Specializing in decora ti ve pa intin g, faux finishes , a rt restoration, Ven eti a n pl ast er , metallic leaf, murals, hi storic building fini s hes res torati o n e tc. •Commercial Hair and makeup art is t ( 1984-present) 0 Experience in commercials, editorial , fas hi o n an d beauty, and advertisi ng . °Client li st includes Bruce W eber , Cartier , C ha ne l, Victori a 's Secret, Burberry, orwegian C ruise Lines, American Airlines , ct al. •Modeling career ( 19 76 -1 986) °Client li s t includes Vogu e, Re v lon, L'Oreal, Glamour, La Pe rla et al. •Instructor at San Diego State U ni versity ( 1975-1976) 0 Taught drawing, painting and design , vi d eo tape , conceptua l a rt , performance a rt, a rt history, film a nd photography. Ex hib i ti on s •Cal/Hawaii Exhibition at The Museum of Art, San Diego 197 6 •San Diego State University Graduate exhibition Art Gallery SDSU 1976 •Larry Urrutia's Floating Wall Gallery, Escondido , Calif. 1976 •Cedar-Creigh Ga ll ery in Coro nado, Calif. 19 77 •Cassat Gall ery, LaJolla, Calif. 1977 •Orr's Gallery, San Diego, C alif. 1977 V oluntee r Wo rk *Involved in Animal Re scue fro m 1995-present *Formed Green Mile Rescue of South Florida 2012 (Dog and cat rescue) *Serves on board of 5013 c Animal R escue "Animal Care ow" si nce 20 14 to present *Works as a volunteer with "Save Miami Beach eigh bo rhoods" * Affordable Housi ng Committee board m e mber fo r City of Miami Beach 20 16-202 1 * B oard member and committee ch air for Mi ami Beach United 20 I 7 -present * Board member and committee chair for M iami Des ign Preservation League 20 18-present 212 References •Dr. Sean and Rosalie Shea (clients) 0 305 968-7085 *Raelene Mercer (graphic designer & owner of Sublime Miami Graphic Design) 0 305 720-5805 *Jeannette Brandt (client/Villazzo property manager) 0 305 926-5565 *Ray Hoafat (supplier/Eco Wall Coatings) 0 305 793-4693 *Kristen Ros en Gonzalez-( ex-commissioner City of Miami Beach) 305 673-7035 * Saul Gross (ex-commissioner City of Miami Beach) saul @ stream-line.com *Matti Bauer (ex-mayor City of Miami Beach) (305) 984-2879 *Michael Gongora (current commissioner of City of Miami Beach) 213 214 •Gary Ressler 215 THIS PAGE INTENTIONALLY LEFT BLANK 216 MIAMI BEACH Ress le r Ga -----------------Last Name Fi rst Name BOARD AND COMMITTEE APPLICATION FORM M iddle I ni t ia l _5_10_1_N_o_rt_h _B_a~y_R_o_a_d ___________ M_ia_m_i B_e_a_c_h _____ F_lo_ri_da ______ 3 3 140 Home Address C ity State Z ip Code _7_86_2_5_1_5_49_5 _____ ..;;..30.;;..5.;_7_7_7_1"""6 __ 2_1 ___________ gressler@til iaventure .com Cellular Work Home Email Address TILIA Cos. Real Estate Development & Management Business Name: Occupation: 169 East Flagler Street PH Miami F lorida 33131 Business Address City State Z ip Code Please li st your preferences in order of ranking [1] first choice [2] second choice , and [3] th i rd choice . Please note that only three (3) choices will be observed by the City Clerk's Office . (Regular Boards of City) Choice 1: Cu ltural Arts Council Choice 2 : Choice 3: Professional License No Professional Licenses Subm itted . 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 li cense. * Note : If applying for the At-Large position of the H i storic Preservation Board, please answer the below questions: • Have you ever resided in one of the C ity's Historic D istri cts for at least one year? rn No Address in City Historic Distr ict submitted . 217 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , band c: Members of Agencies, Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: a . Resident of the City for a minimum of six (6) months: • I am resident of: Middle Beach Or b . Demonstrate an ownership interest in a business established in the C ity for a mini mum of six (6) months: ~ "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. Or c. Full-t ime employee of such a business (for a minimum of six months); and I am based in an office or other locat ion of the busi ness that i s physically located in Miami Beach (for a minimum of six months): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abi li t ies, knowledge and experience. Please l ist be low: Holds a degree in Theater Arts & Communication, Wh ittier College , 1996 Former Theater Director, NYC, 1996-1999 Walt D isney Feature Animation, Creative Affairs Department 1999-2001 Founder & Curator of TILIArts (www.dioramaproject.com ) Co-Founder, BUSKERFEST MIAMI (www.buskerfest miami.com) Co-Fo • Are you presently a registered lobbyist with the City of M iami Beach? No • Have you ever been convicted of a felony: • Do you c urrently have a violation(s) of City of Miami Beach codes : N.Q • Do you currently owe the City of Miami Beach any money: No • Are you currently serving on any City Boards or Committees: No If yes , please explain in detail: If yes, please explain in detail: If yes, please explain in detail : If yes, whi ch board? 218 • In what organization (s) in the City of M iam i Beach d o you c urrently hold membersh ip in? Name Temple Beth Sholom Miam i Beach JCC Position Member Member • List the address of a ll properties owned or i n wh ich you have an interest w ith in the City of M ia mi Beach : Property 5101 North Bay Road • Are you now employed by the City of Miami Beach : If so , wh ich department and t itle ? • 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? If "Yes", identify person(s) and department(s): No relative's in formation submitted . 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 w ith 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 leavi ng offi ce (M iam i Beach Code section 2-26) o Requ i rement to disclose certa in financia l interests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunsh ine Law was enacted in 1967 . Today, the Sunsh ine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a bas ic right of access to most meetings of Boards , Commissions, and other governing bod ies of state and local governmental agencies or authorities. o Voting conflict -Form SB i s for use by any person servi ng at the county, city , or other local level of government on an appointed or e lected Board , Council , Comm ission , Authority, or Committee . It appli es equality to members of ad vi sory and non-advisory bod ies wh o are presented w ith a voting confli ct of i nterest under Section 112 .3143 . Florida Statutes . 219 BOARD & COMMITTEE FINANCIA L ACKNOW LE DG EMENT 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 eac h ye ar all members of Boards and Committees of the City of M iami Beach , including those of a purely advisory nature , are requ ired to comply with Miami-Dade County Finan ci a l Disclosure Requirements . QM of the following forms mu st 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 Miam i-Dade County Code, may subject the person to a fine of no more than $500 , 60 days in ja il, or both . 1 Members of the Planning Board and Board of Adjustment w ill be notified directly by the State of Florida , pursuant t o F.S . §112.31 45(1)(a ), to file a St at ement of Rnanci al Interest s (Fo rm 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon , July 1. Planning Board and Board of Adjustment members who fi le thei r Form 1 w ith the County Supervisor of Elections automatica lly satisfy the County's financia l disclosure requ irement as a Miam i Beach City Board /Committee member and need not fi le an add itional form w ith the Office of the City Clerk . However , compli ance w ith the County d isclosure requ irement does not satisfy the State requ irement. DIVERSITY STATISTICS REPORT T he following information is voluntary and has no bea ring on your consideration for appointment. It is be ing asked to comply with City d iversity reporting requirements . Gender: Race/Ethnic Categories What is your race? Wh ite Are you Spanish/Hispanic/ Latino? Mark t he "No" box if not Spanish / Hispan ic / Latino . ~ Other Description : No det ails provided Physically Challenged : 220 Board and Committee Application Checklist: Please ensure you have provided a ll i nformation before applying or reapplying to any Board and Comm ittee. YES I have answered all questions fully. YES YES I have uploaded a current resume , photograph , and a copy of any appli cable professional license . I have completed and attached the Boa rd & Committee Financial Acknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the C ity Clerk v ia email : BC@miamibeachfl.gov or telephone : 305.673. 7 411 Note: Florida Statutes 119.071 : The role of the Office of the City C ler k is to receive and maintain forms filed as public records. If your home address , telephone numbers , and/or photograph are exempt from d isclosure and you do not w ish your home address, telephone numbers , and /or photograph to be made publ ic , please: 1 ) Use your office or other address for your mail ing address; 2 ) Use your office or other te lephone number for your contact number; and 3 ) Do not attach a photograph . 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 ACCORDINGLT. I Gary Ressler agreed to the following terms on 11 /13/2020 11 : 11 : 14 AM Received in the City Clerk's Office by : Name of Deputy Clerk Contro l No. Date 221 iJia THE TILIA FAMILY OF COMPANIES CORPORATE BIOGRAPHY Gary Ressler PRINCIPAL Gary Ressler holds a BA in Communications & Theatre Arts from Whittier College in Los Angeles, CA. Prior to joining TILIA , he worked in Studio City, CA in the Creative Affairs Department of Walt Disney Feature Animation (WDFA.) Mr. Ressler moved to Miami in 2001 to assume operations of TILIA REAL ESTATE (formerly ABC Management Services, Inc.,) a family-owned and operated commercial real estate management and development firm. Mr. Ressler launched the TILIA Lifestyle Companies in 2002 with the opening of THE HISTORIC ALFRED I. DUPONT BUILDING Special Events Venue -an award-winning event venue in the heart of downtown Miami -followed by TILIA EVENTS , a full service Event Production Company. THE TILIA FAMILY OF COMPANIES expanded again in 2011 , adding TILIA TRUST COMPANY, a South -Dakota-based Private Family Trust Company (PFTC), and TILIA MANAGEMENT, LLC. a specialized firm providing customer-focused, detail-oriented back-office support serv ices to professional and financial firms in both regulated and unregulated industries. In 2012, TILIA REAL ESTATE expanded once more into residential development, launching and completing CENTRO CONDOMINIUMS, a 350+-unit workforce condo tower in the heart of Miami's Central Business District. Mr. Ressler currently serves as a Trustee o f The Miami Foundation, President of the Board of Directors of The Flagler Business Improvement District (FLAGLER BID,) and on the Board of Directors of Miami's Downtown Development Authority (ODA.) A Rua HITUIE 222 iJia THE TILIA FAMILY OF COMPANIES CORPORATE BIOGRAPHY Gary Ressler PRINCIPAL FOR FURTHER INF ORMATION REGARDING THE TILIA FAMILY OF COMPANI ES, PLEASE CONTACT COMMUNICATIONS@TILIAVENTURE .COM. l 1sJia H I TUIE 223 224 • David Sexton 225 THIS PAGE INTENTIONALLY LEFT BLANK 226 lD MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Sexton David Last Name First Name M iddle Initial HOME ADDRESS: 1255 Marseille Drive #126 Miami Beach Florida 33141 Apt No. Home No ./Street City State Zip Code PHONE : 305-495-2879 305-495-2879 davidsxton@gmail.com Home Worl< Email Address Business Na me: Normandy Art LLC Position : Owner Address : 932 71 st Street Miami Beach Fl 33141 Street City State Zip Code Pursuant to City Code section 2-22(4) a and b : Mem bers of agencies, boa rds, and committees shall be affiliated with the city; this requirement shall be fulfill ed in th e following ways : a) an ind ividual shall have been a resident of th e city for a minimum of six months; or b ) an individual shall demonstrate ownership/i nterest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months Yes • De monstrate an ownership/interest in a business i n Miami Beach for a minimum of six (6) months: Yes • A re you a reQi ster ed voter in Miami Beach : Yes •(Please~ one): I am now a residen t of : North Beach • I am applyinQ for an appointment because I have special ab1lit1es , knowledQe and experience . Please list below: I have been a resident of Miami Beach since 1993. I have been a resident of North Beach since 2002 . I have been a business ow • Are you presently a registered lobbyist with the City of Miami Beach ? No Please list you r preferences In order of ranking [1) first choice [2) second choic e , and [3) third choice. Please n ote that only three (3) c h oices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Choice 2 : Transportation , Parking and Bicycle-Pedestrian Faci liti es Committee LGBTQ Advisory Committee Choice 3 : Cultural Arts Council • Board members are required to file Form 1 -"Statement of Finan cial Interest" with the State . If you seek appointment to a professional seat (e .g., lawyer, architect, etc.) on the Board of Adjustment, Design Rev iew Board, Historic Preservation Board or Planning Board , attach a copy of your currently-effectively license, and furnish the following information : Type of Professiona l Li cense ______________ _ License Number Li c ense Issuance Date ________________ _ License Expiration Date Note: If applying for Youth Advisory Board , please indicate your affiliation with the S cott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No ----Yea rs of Service: _______________ _ 2 . Present participation in Youth Center activities by you r children '--N'"'o __ _ if yes, please list the names of your ch ildren , their ages, and which programs. List below : 227 Error: Subreport could not be shown. • Have you ever been convicted of a felony : No If yes. please expla in in detail: • Do you currently have a violat1on(s) of City of Miami Beach codes: No • Do you curren tl y owe th e City of M1am1 Beach any money No • Are you currently serving on any City Board s or Committees : No • What organiza tions in the C ity of Miami Beach do you currently hold membership 1n? Error: Subreport could not be shown. • I am now employed by the city of Miami Beach: No Which department? If yes, please explain in detail : If yes, please explain 1n detail: If yes, which board? • List a ll properties owned or have a n interest 1n , which are located within the City of Miami Beach : The following informat ion is voluntary and is neither part of your application nor has any bearing on your consid eration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. R ace/Ethnic Categories What is your race ? Mark one or more races to indicate what you consider yourself to be Wh ite Other Description : Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / His panic / Latino. No Physically Challen!jed · No 228 NOTE: If appointed, you will be required to follow certain laws which apply to city board/commi ttee members. These laws Include, but are not limited to, the followi ng: •-Proh1b1t1on from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). , Proh1b1tion from contracting with the city (Miami-Dade County Code section 2-1 1 1 ). Prohibition from lobbying before board/committee you have served on for penod of one year after leaving office (Miami Beach Code section 2-26). " Requirement to disclose certain financ,al interests and gifts (Miami-Dade County Code section 2-11 1 ). (re: CMB Community Development Advisory Committee)· proh1b1t1on, dunng tenure and for one year after leaving office. from having any interest in or receiving any benefit rrom Community Development Block Grant runds for either yourself. or those with whom you have business or immediate f amily ties (C FR 570.611 ). Upon request, copies of these laws may be obtained from the City Clerk. "I hereby attest to the accuracy and truthfulness o f the application and have received, read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers , Employees and Agency Members." I David Sexton agreed to the following terms on 1f7/2020 12:32 :23 PM Received 1n the City Clerk's Office by: Name of Deputy Clerk Control No. Date 229 Saturday Celebrit TD Bank 8:00am Emily Estefan Set Up 9:00AM 10:00am Emily Estefan Sound Check 11.00AM Celebrity Cruise Sound Check Noon CD Alex Infinity 12 Sp 12 30 SoulCycle 12 .30P 1:00 till 4 · 15 DJ Tony Y Not 2.30 Brody Ray 2P 3·00 Jay Thomas 3P 3-30 Miss Miami Beach Pride 4:00 Celebrity Cruise Performance La Linea Band 4p 4.15 to 7.00 DJ Lady Bunny Power Infinity 5 to 8 5·00 6 ·00 AHF Dance Party 7 ·00 to 9 15 OJ HotPants w i th DJ Enc Vilar 6p • !Op 7 ·45 Wyn wood Drag 9 :15 Emily Estefan Sunday Celebrity TD Bank 2 1,11 3 30 DJ M uk DJ Gunn & Daniella Sea 2p · 4p 2:30 Opening Ceremonies (Gelber.Cook, Sheperds,Sanchez) 3 :00 Beth Sacks 3:30 DJ Sus hi DJ Bill James 4p -7 30p 4:00 Celebrity Cruise Performance Nardiel Ram os 4 .30 5 00 House of Lords Pose Mantnn1 5 30 530 Brenda K Starr 6 30p 6 00 Jeanie Tracy 7 00 DJ Kidd Madonny Yolo Mayor 730p 8·00 8.30 Toto Puente Jr 8 :30p 9:00 lcona Pop 9.45 Fireworks 230 231 THIS PAGE INTENTIONALLY LEFT BLANK 232 •Rachel Unger 233 THIS PAGE INTENTIONALLY LEFT BLANK 234 MIAMI BEACH BOARD ANO COMMITTEE APPLICATION FORM ..;..U_n,..g..;..e _r ________________ .;..R.;;;;a;.;;.c.;.;.h..;;.el'--_______________ M _____ _ Last Name First Name Middle In it ial 4244 Post Avenue M iam i Beach ...c=...;...;....;....;;~'-'-'-..;;..;.;..:;..:;... __________ _ FL ---------33140 -------- Home Address City St ate Zip Code _1 (""'3""'"0-'-5.t..,;;)9_2-'-6....;-8;....4""'"8_2 _____________ 1.._(3_0"'"'"5 ... )9_2_6_-8;....4""'"8_2 ___ ungerita@yahoo.com Cellular Work Home Email Address Business Name: Occupation : Business Address City State Z ip Code Please list your preferences i n 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 C ity) Choice 1: Cultural Arts Council Choice 2 : Personnel Board Choice 3: Marine and Waterfront Protection Authority 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. * 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 C ity's Historic D istricts for at least one year? No No Address in City Historic District submitted . 235 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be affiliated with the city. Th is requ irement shall be fu lfilled in the following ways: a. Resident of the City for a minimum of six (6) months: • I am resident of: Middle Beach Or b. Demonstrate an ownership interest in a business established in the C ity for a m i nimum of s ix (6) months: No "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. Or c . Fu ll-time employee of such a business (for a m in imum of s ix months); and I am based in an office or other location of the business that is physically located in Miami Beach (for a min imum of six months): No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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 (o r 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. • I am applying for an appo in tment becau se I have special abilit ies, knowledge and experience. P lease list below: I am a devoted citizen of the C ity of M iam i Beach! I am hardworking and looking forward to be engaged and actively involved in a committee that will help encourage progress in Miami Beach. I am capable of contributing positively and actively in any committee that I w ill join . I have a un ique persp • Are you presently a reg i stered lobbyist w ith the City of M iami Bea ch? No • Have you ever been convicted of a fe lony: No If yes, please explain in detail : • Do you currently have a violation(s) of City of Miami Beach codes : NQ If yes, please expla in in deta il: • Do you currently owe the C ity of Miam i Beach any money: NQ If yes, please explain in detai l: • Are you currently serving on any City Boards or Committees: No If yes, which board? 236 • In what organization(s) i n the C ity of Miami Beach do you currently hold membership in? No Orga nization Information Submitted . • List the address of a ll properties owned or in which you have an i nterest with in the City of M iami Beach : No Owned Property Information submitted . • Are you now employed by the C ity of M ia m i Beach : NQ If so , wh ich department and title? • Pu rsuant 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? If "Yes", identify person(s) and departme nt(s): No relative's information submitted . NOTE: IF APPOINTED, YOU W I LL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMM ITTEE MEMBERS. THESE LAWS INCLUDE , BUT ARE NOT LIMITED TO: o Proh ibition from d irect ly or in d irectly lobbying city personnel (M iami Beach City Code section 2-459). o Proh i bition 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 (M iam i Beach Code sect ion 2-26) o Requ irement to disclose certa in finan ci a l interests and g ifts (M iami-Dade County Code sectio n 2-11 .1 ). o Sunshine Law-Florida's Government-in-the-Sunshine Law was enact ed in 1967. Today, the Sunshine Law regard in g open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basi c right of access to most meetings of Boards, Commissions , and other govern i ng bodies of state and local governmental agencies or authorities. o Voting confl ict -Form 88 is for use by any person serving at the county, city , or other local level of government on an appointed or e lected Board , Council , Commiss ion , Authority, or Comm ittee . It appli es equal ity to members of advisory and non-advisory bod ies who are presented with a voting conflict of interest under Section 112.3143 . Florida Statutes. 237 BOARD & COMMITTEE FINANCIA L ACKNOW LEDGEMENT STATEMENT Acknowledgement of fines/suspens ion for Board/Comm ittee Members for failu re to c omply with Miami-Dade County F inancial Disclosure Code Secti on 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 adv isory nature , are required to comply with Miami-Dade County Fina ncial Disclosure Requirements. One of the following forms must be filled with the C ity 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 d irectly by the State of Florida , pursuant to F.S . §112 .31 45(1)(a), to fil e a Stateme nt of Fi nancial Inte rests (Form 1) w ith t he Miami-Dade County S upervi so r 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 financ ial d isclosure requirement as a M iami Beach City Board/Commi tt ee member and need not file an add itiona l form with the Office of the City C lerk . However, compliance with the County disclosure req uiremen t does not satisfy t he State requirement. DIVERSITY STATISTICS REPORT The following information is vo lun tary and has no bearing on your considera tion for appointment. It is being asked to compl y w it h City diversity reporting req ui rem ents . Gender: Race/Ethn ic Categories What is your race? Female Whi te Are you Span ish/Hispanic/ Lati no? Mark the "No" box if not Spanish / Hi spanic / Latino . No Other Descript io n : No details provided Physically Ch a llenged: No 238 Board and Committee Application Checklist: Please ensure you have provided a ll i nformation before applyi ng or reapplying to any Board and Committee . YES I have answered all questions fully. YES YES I have uploaded a c urrent resu me, photograph , and a copy of any appli cable professiona l license . I have completed and attached the Board & Committee F inancial Acknowledgment Statement. YES I have completed and attached the D iversity Statistics Re port . If you have any questions, please contact the Office of the C ity Clerk v i a email: BC@miamibeachfl.gov or tel ephone: 305.673.7411 Note: Florida Statutes 119.071 : The role of the Office of the C ity Clerk is to rece ive and maintain forms filed as public records . If your home address, te lephone numbers, and/or photograph are exempt from disclosure and you do not w ish your home address, te lephone numbers, and /or photograph to be made publ ic , p lease: 1) Use your office or other address for your ma iling address ; 2) Use your office or other telephone number for your contact number; and 3 ) Do not attach a photograph . 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 ACCORDINGLT. I Ra c he l Unger agreed to the fo ll owing terms on 12/7/2020 12 :21 :25 PM Received in the C ity Clerk's Office by : Name of Deputy C lerk Control No. Date 239 RACHEL MOSTKOFF UNGER rachel mostkoffunger@gmail.com I M iam i Beach, FL I 3 05.926.8482 Teacher & Community Leader Commitment to Students Through Excellence in the Classroom and Social Justice Advocacy in the Community. "Education is the passport to the future, for tomorrow belongs to those who prepare for it today." -Malcolm X Passionate educator dedicated to excellence in and outside the classroom . 15+ years of cla ssroo m expe rtise w i th emphasis o n r ead i ng; exp erience t eaching stude nts with lea rning disa bilities, En gl ish for Sp e ake rs o f Othe r La nguages (ESOL), and gi fted stude nts. Design and fost er innova t i ve learnin g e nvi ronments that promote diversity and chall e nge studen t s t o apply critica l thinking. Cultivate po sitive parent and co llegial r elationships to sup port students' so cial and emotional needs. Awarded by Miami Beach Chamber of Commerce for Excellence in Educa t ion as a "Woman Wort h Knowing." Sole reci pient of the 2016-2017 Coun tywi de "Values M att er Kin dness Award." '-' Speak er at CLE O Inst itute Cli m at e Chan ge Summit t o add r ess issues of food wa st e and the effect on cli m ate cha nge. Appoi nted Ch ai r of Communi t y Servi ce Com mittee for Nat ional Council of Jew ish W o men (NO W) t o Develop Comm unity Engagement for social just ice causes . Successfully lobbied Miami-Dade County to adopt new research-based gun violence p revention programs through PACT. 'oi PACT Executive Co mmittee Member and VP of Public Rela t ions an d M edia ALTERNATIVE EDUCATION ➔ DEVELOPMENTALLY APPROPRIATE PRACTICES ➔ DIFFERENTIATED INSTRUCTION ➔ CLASSROOM CULTURE DEVELOPMENT COMMUNITY INVOLVEMENT➔ TECH IN TliE CLASSROOM ➔ FAMILY ENGAGEMENT ➔ CHILDREN'S ADVOCACY INSTRUCTIONAL EXPERIENCE NORTH BEACH ELEMENTARY SCHOOL, M ia m i Beach, Fl Fifth Grade: Teacher of the Gifted Fifth Grade: General Education Teacher Thi rd Grade: Teacher of the Gifted Developed unique community partnerships to create hands-on experiences for students. ✓ Head of Reading and Language Arts for 5th Grade. ✓ Create and initiate all activities for the "Kindness Club ." ✓ Leader of the Green Team in conjunction with ''The Green Schools" initiative. ✓ Leader of school a dvisory council, "Education Excellence." TEMPLE BETH SHOLOM FOUNDATION SCHOOL, Miami Beach , Fl Preschool Teacher Parent/Child Center Teacher & Curri culum Coordinator Utilized Regg io Emilia philosophy approach to create an atmosphere of collaborative innovati on. ✓ Managed team of 6 t eachers for Parent/Child program . ✓ Serve d a s Languag e and Li t eracy e.xpert for pre-k indergarten classes. ✓ Develope d the curricu lum for the school's "parent child " pr ogram. 2013 to Present 2016 to Prese nt 2014 to 20 16 2013 to 2014 2008 to 2013 2011 to 2013 2008 t o 20 13 ✓ Sele cted to observe various preschools throughout the U.S. in order to integrate new programs and i deas to the Foundation School. ✓ Increa sed enrollment in parent-child programs. SOUTH POINTE ELEMENTARY SCHOOL, M iami Bea ch, Fl Third Grade Teacher ✓ Taught students of all aca d em ic levels wh il e si gni ficantly increasi ng proficiency in ESOL stude nts. 2005 to2007 Please continue for highlights of commu nity service initiatives, earlier teaching experience, and educational qualifications. 240 NORTH MIAMI ELEMENTARY SCHOOL, North Miami, FL Third Grade Teacher Earned "Teacher of the Year'' and, "Rookie Teacher of the Year'' at a Title 1 School. RACHEL UNGER rachelmostkoffunger@gmail.com I 305. 926.8482 PG 2 of 2 2000 to 2005 ✓ Taught T.E.A.M . cla sses , regular e ducati on cl asses, and alternative education clas ses comprise d entir el y of st u den ts r etained in the third grade . ✓ Increased Accelerated Rea der t est scores 200% compared to other classe s; utilized behavior management, structured learni ng e nvironment, and READ 180 software . COMMUNITY LEADERSHIP & BOARD SERVICE National Council of Jewish Women I Chair of Community Service Committee I 2019 to Present Appointed to serve 2-year term in organization focuse d on empowerment, advocacy, and social justice. Develop community programs and participate in efforts to lobby U.S. Congress o n social justice iss ues. PACT: Executive Committee Member I Gun Violence Prevention Task Force I Spokesperson I 2016 to Present Serve as key liaison and spokesper son to city and government officials. Conducted resea rch to support initiatives, sec ured relatio nships with nonprofits, and success fully lobbied Miami-Date County to adopt new r es earch -base d gun violen ce prevention program s. Temple Beth Sholom I Social Justice Network Co-Chair/Board of Trustees Member I 2015 to Present As Co-Chair: Collaborat e with Temple leadership on community education initiatives; coordinate with subcommittees to pla n events, cr ea t e ta sk forces, and campaigns for justice reform . As Board Member: Appo inted to hiri ng committee, elem entary sch ool t as k force, and w elco ming co mmittee. Volunteer with Food Rescu e US to r esc ue food from W hole Fo ods and deliver t o Lotus Ho use (women's shelter ). Al so initiat ed food r escue fro m South Beach Food an d Win e festival. Invited as guest speaker at CLEO Institute Climate Change Summit to discuss food waste and the relationship to climate change . EDUCATION & ENDORSEMENTS MS.Ed , Specification in Read i ng & Learning Disabilit ies, University of Miami, 2002, graduated with honors and, "Top Education Student Award" BS .E d , Elementary/ESOL, State of Flori da NCATE approved teacher education program, University of Miami, 2000 Endorsements: Reading, ESOL, Gifted 241 242 • James Bodnar 243 THIS PAGE INTENTIONALLY LEFT BLANK 244 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM ..;;..B...;;..o..;;..dn"'""a'--r ________________ Ja'--m---'-e-'-s ______________ -"L _____ _ Last Name First Name Midd le Initial ~3...;;..0_1~O~c~e...::.a'--n~D~r~iv~e~1 ~A=p'--t5..;;..0~7 _________ M_ia_m_i B_e_a_c_h _____ F_lo_ri_d_a _____ 33139 Home Address City State Zip Code .;;..9_17_-....;;..6_73'----1...::.2_12;;;__ _____ 21_2_-_79_4_-_07_4_4 ____ 3_05_-_6_95_-_9_4_51 ____ jbodnar-drb@jbodnar.com Cellular Work Home Email Address Architect Business Name : Occupation : Business Address City State Zip Code 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 O ffice . (Regular Boards of City) Choice 1 : Design Review Board Choice 2 : Choice 3 : P rofessio na l 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 . * 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 Distri cts for at least one year? fu No Address in City Historic District submitted . 245 AFFI LIATION WI TH THE CITY OF MI A MI BEACH Pursuant to City Code sect ion 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 : a . Resident of the City for a minimum of six (6) months : • I am resident of: So uth Beach Or b . Demonstrate an ownersh ip interest in a business established in the City for a min i mum of six (6) months : ~ "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 . Or 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): ~ Notwithstanding the requirements set forth herein , the qualified full-time employee of a business must be approved by a 417th 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 Bea ch 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. • I am applying for an appointment because I have special abilities , knowledge and experience . Please list be low: I am an Architect, and I currently serve as the Chair of the Design Review Board • Are you presently a registered lobbyist with the City of Miami Beac h? 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: If yes , please expla in in detail : • Do yo u c urren tly owe the C ity of Miami Beach any money: If yes , please explain in detail: • Are you currently servi ng on any City Boards or Comm ittees : If yes , which board? Design Review Board 246 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Position • List the address of all properties owned or in which you have an interest within the City of Miami Beach : Property 301 Ocean Drive , Apartment 506-507 3 11 Meridian Avenue , Apartment PH-1 • Are you now employed by the City of Miami Bea ch : If so, which department and title ? • 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 M iami Bea c h? If "Yes", identify person (s) and department(s ): No relative's information submitted. NOTE: IF APPOINTED , YOU W ILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS . TH ESE 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 ). N.Q 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 in terests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-S unshine 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 . 247 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines /suspension for Board/Committee Members for failure to comply with Miami-Dade County Fin ancial Disclosure Code Section 2-11 .1 (i)(2) - I understand that no later than Ju ly 1. of each year all members of Boards and Committees of the City of Miami Beac h, 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 . Fa ilure 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 Rnancial 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 w ith the County Supervisor of Elections automatically satisfy the County's financial disclosure requ i rement as a Miami Beach City Board/Committee member and need not file an add itional form w ith the Office of the City Clerk. However, complianc e with the County disclosure requirement does not satisfy the State requ i rement. 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 . Gender: Ra c e/Ethnic Categories What is your race? White Are you Spanish/Hispan ic/ Latino? Mark the "No" box if not Spanish / Hispan ic / Latino. ~ Other Description : No details provided Physically Challenged: 248 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all quest ions fully. YES YES 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. YES I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk via email: B C@mi amibeachfl .gov or telephone: 305.673. 7 411 Note : Florida Statutes 119.071 : T he role of t he Office of t he City Clerk is to receive and maintain forms filed as public recor ds. 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 ma iling address; 2) Use you r office or other telephone number for your contact number; and 3) Do not attach a photograph. 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 ACCORDINGLT. I James B odnar agreed to the following terms on 12/1/2020 5 :20:25 PM Received in the City C lerk's Office by: Name of D eputy Clerk Control No. Date 249 J AMES L. BO D , AR, A I A , RIBA EDUCATIO'.'J EXPERI E ·cE PROFESS IONAL PRO FESS IO AL ORGA!'II ZATIONS AWARD S TEACHI NG American Academy in Rome, lt3ly Post Graduate Fe ll owship, I 979-1980 Yale University. , cw Haven. CT Mas ter of Archite c ture . 19 79 Catholic Un iversi ty o f Ame n ca, Wa~hington. DC Bac helor of Arch it ectu re, 1974 Eco le des Beaux Arts, Fon ta in ebleau. France Su mmer Program, 197'2. James Bodna r Ar c hitect. cw Yor k. Y Principa l, 1990 to present kid morc. Owi ngs & Memll London . ew York a nd Washington . DC Associate Partner. Designer. 1982 to 1990 Associate, Designer, 1980 to 1982 Designer, 1974 to 1977 I.M. Pe i and Pa rtn ers New York. NY Designer. 1978 Registered Professional Architect. New Yo rk Arc hitectural Registration Council of the United Kingdom at iona l Counc il of Architectura l Regis tration Boards Ame rican lns tiru te of Arch itects Roya l Inst itu te of Briti sh Arc h itects Ameri can Acade my in Ro me, rd luw. Tru stee Eme rit us oc iety of Fe llows. AA R. Pr es id e nt Emeritus Scu lp tu re Cent er. Board of Trus tees. Cha ir Emeritus ociety of Arch it ec tural l·fatonan~ Miami Beach Design Review Board . C hai r American Academy in Rome. Rome Prize Fellowship. 1979-19 0 tcedman Travel ling Fellows hip. 1979 AIA chool Medal. Yale UnM:rsity. 1979 All School Design Competitio n, Yale Un ivers ity, 1977 Uni vers it y o f Texas, Aust in. Department of Archi tec t ure. I isiring Critic, 1992 Harva rd Univers it y. Graduate Schoo l of Des ign, Visi ri11g Critic. 199 1 Massac huse us In t it utc of Techno logy, School of Arc h iti:cturc. The~i.1 Adl'iser. 199 1 University of 1ary land. Department of Archi tectu re. Visiti11g Criric, 1982 250 251 THIS PAGE INTENTIONALLY LEFT BLANK 252 • Christina Miller 253 THIS PAGE INTENTIONALLY LEFT BLANK 254 MIAMI BEACH BOARD AND COMMITTEE APPLI CATI ON FORM _M_il __ le_r _______________ ..;;;;C.;...h.;...ri .;;.st=in.;.;;a.;.__ ___________________ _ Last Name First Name M iddle Initial 20 Island Ave 511 Miami Beach FL ---------------------------------- Home Address City St ate ..;;..30.;;_5;;_7--9--8..;;.5..;;..89.;;_8;;.__ _____________________ C MMV@outlook.com Cellular Work Home Email Address MAPS D esig n Studio , LLC Business Name: 20 Isla nd Ave B usiness Address architect and planner Occupat ion : Miami Beach FL City State 33139 Z ip Code 33139 Zip Code Please list your preferences in ord er of ranki n g [1] first choice (2] second c h oice, an d (3] third choice . Please note t hat only three (3) choices will be observed by t he City Clerk's Office. (Regular Boa rds of C ity) Choice 1: Design Review Board Choice 2 : Choice 3 : License Number Arc h itect AR9 700 5 Professional License Issuance Date 4/6/2014 Expire Date 2/28/2021 Note: If you are seeking appoint ment to a professional seat (e.g . attorney, architect, etc.), you must attach a copy of your currently effective correspond ing professional license. * Note: If applying for the At-Large posit ion of the Historic Preservation Board, p lease answer the below quest ion s : • Have you ever resided in one of the City's Historic D istricts for at least one year? Yes If you answered "Yes", please indicate : 1524 Euclid Aven ue F rom : 8/15/2001 T o : 10/31/20 10 Address D ates 255 AFFILIATION WITH THE CITY OF MIAMI BEACH 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: a . Resident of the C ity for a mi nimum of s ix (6) months : • I am resident of: South Beach Or b . Demonstrate an ownership i nterest in a business establ ished in the City for a minimum of six (6) months : Yes "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. Or 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 Bea ch (for a minimum of six months): Yes Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appoi ntment because I have special abi li ties, knowledge and experience . Please list below: • Are you presently a registered lobbyist w ith the City of Miami Beach? No • Have you ever been convicted of a felony : No 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 servi ng on any C ity Boards or Committees : No If yes, which board? 256 • In what organ ization(s) i n the C ity of Miam i Beach do you c urrently hold membership i n? No Organization Information Submitte d . • List the address of a ll properties owned or in wh ich you have an i nterest w ith in the City of M iami Beach : Property 20 Island Avenue #511 • Are y ou now employed by the City of M iam i Beach : No If so , whi ch department and t itle? • Pursuant to City Code Section 2 -25 (b): Do you have a parent, spouse , child , brother, or sister who is employed by the C ity of Miami Beach? If "Yes", identify person(s) and department(s): No re lative's information sub mitted . 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 P roh ibition from d i rectly or indi re c tly lobbying c ity personne l (M iam i Beach C ity Code section 2-459). o Prohibition from contracti ng with the city (Miami-Dade County Code section 2-11 .1 ). N.Q o Prohibition from lobbying before board /committee you have served on for period of one year after leavi ng office (M iam i Beach C ode section 2-26) o Requirement to d isclose certai n financi a l interests and g ifts (M iami-Dade County Code section 2-11 .1 ). o Sunshi ne Law -Florida's Government-in-the-Sunsh ine Law was enacted in 1967. Today, the Sunsh ine Law regarding open government can be found in Chapter 286 of the Florida Statutes . These statutes establish a basi c right o f access to most meetings of Boa rds, Comm issions , and other governi ng bodies of state and loca l governmenta l agencies or authorit ies . o Voting conflict -Form 8B is for use by any person serving at the county, city, or other local level of government on an appoint ed or elected B oard , Cou ncil , Commission , Au thority, or Committee . It applies equal ity to members of advi sory and non-advisory bod ies who are presented with a voting c onflict of interest under Section 112.3143 . Florida Statutes . 257 BOARD & COMMITTEE FINANCIAL ACKNOW LEDGEMENT 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 un derstand that no later than July 1, of each year all membe rs of Boards and Comm ittees of the City of M iami Beach , incl uding t hose of a pure ly adv isory nature , a re requ ired to comply w ith Mia m i-Dade County Finan ci al Disclosure Requirem ent s. One of the foll owing forms must be filled w ith the City Clerk of M iam i Beach , 1700 C o nvention Cente r Dri ve , M iam i B each , Florida , no later than 12:00 noo n of July 1, of each year: 1. A "S ource of Income Statement;" or 2 . A "Statement of F ina ncial Interests (Form 1 )1 ;" or 3 . A C o py of your latest Federa l Incom e T ax Return . Failu re to fil e o ne of these fo rms , pursua nt to t he M iam i-Dade County Code , may su bject the person t o a fi ne of no mo re than $500 , 60 days in jai l , or both. 1 Me mbe rs of the Pla nn ing Board a nd Board of Ad justment w ill be notified directly by the State o f Florida , pursu a nt to F.S. §112 .3145(1)(a), to file a Statement of Financial Interests (Form 1) w ith the Miami-Dade County Supervisor of Elect ion s by 12 :00 no on , J uly 1. Planning Boa rd and Board of Adju stment membe rs w ho file th e ir Form 1 w it h the Coun ty S upervisor of Election s automati ca ll y sa tisfy the County's fin a nci al discl osure requ irem ent a s a Miam i Bea c h City Boa rd/Comm ittee member and need not fil e an add itional fo r m w ith the Office of the C ity Cl erk . However, compliance w ith the Cou nty di sclo sure requ irement does not sat isfy the State re quirement. DIVERSITY STATISTICS REPORT T he follow ing i nformation is volun t ary and has no beari ng on y our consideration for appoi ntment. It is be ing asked to comply w it h City d iv ers ity reporting re q ui rements . Gender: Race/Ethnic Categori es What is your race? Fe ma le none A re y ou S pan ish/His pani c/ Lati no? Ma rk the "No" box if not Spanish / Hispa ni c / La t ino . No Oth e r Descri pt ion : No deta i ls provided Ph y sicall y Challe nged : No 258 Board and Committee Appl ication Checkl ist: Please ensure you have provided all information before applying or rea pplying to any Boa rd and Committee. YES I have answered all questions fu lly. YES YES I have uploaded a current resume , photograph , and a copy of any applicable professional license . I have completed an d attached the Board & Committe e Financial A cknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you have any qu e stions, please contact the Office of the C ity Clerk v ia ema il : BC@miamibeachfl.gov or telephone : 305 .673 . 7 411 Note: Florida Statutes 119.071: The role of the Office of the C ity Clerk is to receive and maintain forms file d a s public records . If your home address, t e lephone numbers , and /or photograph are exempt from disclosure and you do not wish your home address , tel e phone numbers, and/or photograph to be made pub li c, plea se : 1) Us e your office or other address for your mailing add ress ; 2) Use your offi ce or other telephone number fo r yo ur contact number; and 3) Do not attach a phot ograph . 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 ACCORDINGLT. I Christina Miller agreed to the following terms on 12/21 /2020 5 :19 :15 PM Received in the City Clerk's Office by: Name of Depu ty C lerk Control No . Date 259 MAPS Desi£n Studio, LLC Chr istina Miller NC'ARB , AICP, LEED AP Qu a lifi cation s Florida Architect NCARB Certification AICP Certification AR97005 78215 030652 LEED Accred ited Professional Education Universi ty of M iami Master of Architecture Graduate Student Award Award for Student Service Master of Urban Des ign Knight Scholar Connecticut College Bachelor of Arts in Econo mics St. Edmund Hall , Oxford , UK Choate Ro se mary Hall Exp erience MAPS De sign Studio, LL C Princi pal Duany,Plater-Zyberk & Co . 05 -19 Senior Project M anager Allan Shulman Architect 03-05 Intern Architect New London Dev. Corp. 99 -00 Downtown Revitalization Coard . Arcosanti (Paolo Soleri) 97-98 Construction Crew, l ea der Affili a tions American Plan ning Association Congress for the N ew Urbanism Nat'l Council of Architectural Registration Boards (NCAR B) Christina Miller is a licensed archi tect, urban designer and registered planner working to create vibrant and healthy, economically, environmentally and soc1ally-res1lient com- munities. Her experience includes private-sector and publtc-sector clients and ranges from regional, large-scale, transit-oriented master plans to local infill projects supported by conventional, hybrid or form-based regulation s. A creative thinker, Christina's design philosophy emphasizes IntensIve study of local tradition s, context and culture as a basi s for sustainable architectural desig n and master planning. She Is an advocate for healthy living, alternative hou si ng and transportation options, better food production practic- es, and land and seas stewardship. She has taught several studios at the University of Miami and been a visiting design critic at UM and Harvard 's Graduate School of Design . Christina's early career includes construction work on Paolo Soleri's ideal city Arcosa nti in Mayer, AZ, and serving as Project Coordinator for the New London [Connecticut] De - velopment Corporation, where her dedication and focus on downtown revitalization, economic development and historic preserva tion earned her a Mayoral Plaque of Ap- preciation . Determined to work to improve our built and lt ving environments, she came the University of Miami at the time the SmartCode was emerging, earning dual masters degrees in architecture and urban design as well as several recognitions. From 2003-2005 Christina interned for architect Allan Shulman whose practice special- izes in historic Art Deco and Mi Mo buildings and design. With core architectural licens- ing hours completed , Christina joined Duany, Plater-Zyberk & Company (DPZ) in 2005, where sh e worked directly with Principals Andres Duany and Elizabeth Plater-Zy berk on notable architectural project s and environmental initiatives including : the Un1vers1ty of M1am1 President's House; the Collection Residences; the M1am1 Design District; the Seven50 Regional Plan for Southeast Flo ri da; the Clima te Cha nge Action Task Force ; and substantial contributions to the firm's work with Agrarian Urbanism . At DPZ, Christina was involved with significant local public sect o r coding projects includ- ing the ground-breaking Form-Based Code, M1am121 , wh ere she participated in publi c outreach and the transformation of existing thoroughfares into more walkable, bike- able and transit-ready corridors; Coco nut Grove's Business Improvement District Action Plan; and se veral Transit-Oriented and transi t -rea dy (TOD) projects in Browar d . She also managed public sector master planning and vIsIoning work In Bonita Springs, Fl and for the Baton Rouge Redevelopment Authority to retrofit historic buildings and encourage infill along transit. Private, developer-based projects she managed include: the Miami Design Di strict Ma ster Plan and Spe cial Area Plan and several Caltforn1a new towns for upwards o f 20,000 residents, for which she was also a prime designer and code autho r. Christina built lasting positive rela tionships with clients, which often yielded repeated work . Beyond design, coding and sustainabiltty expertise, Christina's skills include com- plex management and oversight, including the organization of "mega" charrettes to foster rapid fe edback loops of different discipltnes working concurrentl y, resulti ng in highly-informed and readily implemen table plans and codes. Her ability to work from personal ex perien ce with hands -on construction and an architectural d esign and bui ld - i ng code sca le -to an urban desig n and zoning code scale -to a regional and co mpre- hensive plan scale and from publtc or private perspectives Is rare. She has a drive an d determination for a thorough understanding at each level. In 2019, Christina laun ched MAPS Des ign Studio, LLC, a Florida-regi stered, woman- owned business ba se d in M1am1 Beac h . She is orienting her firm toward s more archi- t ectural design w ork, and looking to identify ways in which more sustainable dec1st0ns are not more cost demanding, particularly to smaller owners and businesses . M1llerstud1o@outlook com (305)798 -5898 20 Island Avenue Miami Beach, FL 33139 260 261 THIS PAGE INTENTIONALLY LEFT BLANK 262 • Jason Greene 263 THIS PAGE INTENTIONALLY LEFT BLANK 264 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _G_re_e-'-n_e'------------------_J_as_o_n _________________ D _____ _ Last Name First Name Middle Initial ~9~0_A~lt=o-'-n_R~o~a~d~#-'-1~8~0~3 ___________ M_ia~m_iB~e~a~c~h _____ F_L _______ 33139 Home Address City Sta te Z ip Code __________________ 3_05_5_3_2_6_9_98 ____ jgreene90alton@gmail.com Cellular Work Home Email Ad dress Town of Surfside Ass is tant Town Manager / CFO Business Name: Occupation: 9293 Harding Ave nue Su rfside F L 33154 Business Address City State Zip Code Please list your preferences in order of ranking [1] first choice [2] second choice , and [3] third choice. Pl ease note that only three (3) choi ces will be observed by the City C lerk's Office. (Regular Boards of City) Choice 1 : General Obligation (G .O .) Bond Overs ight Committee Choice 2 : C hoice 3: 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. * 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? fu No Address in City Historic District submitted. 265 AFFILIATION W ITH T H E CITY OF MIAMI BEAC H Pursuant to C ity 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: a . Resident of the City for a minimum of six (6) months: • I am resident of: South Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "Ownership In terest" 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. Or 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): ~ Notwithstanding the requirements se t forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the Cit; 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. Th e original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience. Please list below: Capital Planning , Government Finance, Engineering , Budgeting • Are you presently a registered lobbyist with the City of Miami Beach? 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: If yes, please explain i n 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 Ci ty Boards or Committees : fu If yes, which board? GO Bond Oversight Committee -Currently 266 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Yacht Club Condo Assoication Position Secretary • List the address of all properties owned or in which you have an interest within the City of Miam i Beach : Property 90 Alton Road # 1803 • Are you now employed by the City of Miami Beach : If so , wh ich department and ti tle? • Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse , c hi ld , brother, or sister who is employed by the City of Miami Beach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 Pro hi bition from directly or indirectly lobbyi ng ci ty 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 boa rd/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 inte rests and gifts (Miami -D ade County Code section 2-11 .1 ). o Sunshine Law -Fl orida's Government-in-the-Sunshine Law was enacted in 1967. T oday, the Sunshi ne Law regard i ng open governm ent can be found in Chapter 286 of the Florida Statutes. T hese statutes establish a basic right of access t o most meetings of Boards , Commissions , and other governing bodies of state and local govern mental agencies o r 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 an d non-advisory bodies who are p resented with a voting conflict of interest under Section 112.3143 . Fl o r ida St atutes. 267 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 Julv 1 of each vear all members of Board s and Committees of the City of Miami Beach , including those of a purely advisory nature , are requ ired to comply with Miami-Dade County Fi nancial Disclosure Requirements . One of the following forms must be filled with the City Clerk of Miam i Beach , 1700 Convention Center Drive, Miami Bea ch, 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 Fl orida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnan cial 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 requ irement as a Mia mi 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 requ irement. DIVERSITY STATISTICS REPORT The following informati on is voluntary and has no bearing on your consideration for appo intment. It is being asked to comply with City diversity reporting requirements . Gender: Race/Ethnic Ca tegories What is your race? White Are you Spanish/Hispan ic/ Latino? Mark the "No" box if not Spanish / Hispan ic/ Latino . No Othe r Description : No details provided Ph ysically Challenged : No 268 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES 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. YES I have completed and attached the Diversity Statistics Re port. If you have any questions, please contact the Office of the City Clerk via email : BC@miamibeachfl .gov or telephone : 305 .673 . 7 411 Note : Florida Statutes 119.071: The role of the Office of the City Clerk is to re ceive 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 . 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 ACCORDINGLT. I Jason Greene agreed to the following term s on 11 /30/2020 3:32:48 PM Received in the City Clerk's Office by: Name of Dep uty Clerk Control No . Date 269 JASON D. GREENE , CGFO , CFE, CPFIM , CICA EXPERIENCE 90 Alton Road # 1803 Miami Beach , FL 33139 (30 5) 532-6998 Ass istant Town Manager/ Ch ief Financial Officer -Town of S u rfside , FL (5/20 -Current) • Under the direction of the Town Manager serves as the key designee of the Town's leadersh ip team . Performs a variety of professional and administrat ive work directing , coordinating and overseeing the operative initiatives and policies. Provides general assistance to the Town Manager. Serves as the Town's chief financial officer performing professional work in planning, organizing , supervisi ng , and administering all financial functions including accounting , budgeting , reporting , investing , debt management, banking , treasury management, fixed asset management, multi-yea r capital planning , purchasing , internal support, and pension plan support for the Town . Serves as the Acting Town Manager in the absence of the Town Manager, as directed . Finance Director -Town of Surfside, FL (7/19-5/20) • Serves as the Town's financial officer performing professional work in planning , organizing , supervising, and administering all financia l functions including budgeting , reporting , investing, debt management, banking , treasury management, fixed asset management, multi-year capita l planning , purchasing , internal support, and pension plan management fo r the Town . • Responsible for planning an d coordinating the preparation of the Comprehensive Annual Financia l Report (CAFR) and Annual Budget. • Responsible for the administ ration of the Finance Department that includes accounting functions of accounts payable , payroll , bank reconciliation , risk management of insurance policies and coverage, and management of certain Town-wide administrative/office management contracts. • Responsible for the all aspects of the Information Technology Department excluding the Town's broadcasting and website content. • Responsible for develop ing and maintaining a comprehensive accounting and financial management system for the Town in accordance with generally accepted accounting pri nciples . Financial Controls & Budget Manager-Miami-Dade Expressway Authority (MDX) (12/06 - 7/19) • Responsible for the planning , development and management of the annual budget. • Manage the annual financial audit and preparation of the annual financial statements , CAFR, and Financial Risk Assessment. • Preparation of the monthly Treasurer's Report. • Assist with the development of the Authority's financial plan and Five-Year Capital Work Program . • Responsible for the approval of the availabili ty of funding for all contracts and task authorizations . • Responsible for approval of all vendor payments including payrol l. • Responsible for the approval of closed capital project information and capital wo rk in progress. • Responsible for compl ia nce as it relates to the State/Federal Single Audit Act and grants management. • Responsible for the prepa ration and coordination of alternative fund ing applications such as State Infrastructu re Bank (SIB) and Toll Facility Revolving T rust Fund (TFRTF) loans . • Responsible for the management of the Authority's right-of-way leasing program and assistance with new business development activities . • Responsible for the development of the A uthority's finance/accounting policies and procedures . Capital Assets Manager -Miami-Dade Expressway Authority (11 /04 -12/06) 270 • Responsible for the planning , development and management of the annual budget. • Responsible for the maintenance and control of the Authority's cap ital assets including the payment approva l of all capita l asset add itions through the Construction , Revenue, General and /or SIB Funds. • Assist CFO and financial advisors on the timing of investments for cash balances. • Responsible for reporting requ irements for SIB loans, TFRTF loans and various grants. • Responsible for properly account ing for all ret irements/transfers/deletions of capital assets . • Responsible for the Authority's right-of-way prope rty leas ing program . • Responsible for supervising and reviewing periodic capital asset physical inventories. • Prepare analyses of capital project budgets and overall capital plan budget performance. Controller -Miami-Dade Expressway Authority (6/03 -11 /04) • Responsible for preparing financial reports /statements and analyses . • Responsible for rev iewing . approving and issuance of payment for vendor invoices. • Responsible for preparing the Authority's annual operating budget. • Oversee all accounting and auditing functions . • Responsible for the management of the Authori ty's financial management system . • Coordinates the Authority's annual audit and preparation of the Authority's annual report . • Responsible for t he development of the Authority's finance/accounting policies and procedures. Marketing Director -San Martin Associates (1 /01 - 6 /03) Program Controller (Dade Transportation Consultants) (5/01 -6/03) • Responsible for manag ing a $1 .5 Billion 10-year Transportation and Capital Improvement Program's costs (TIP/CI P), cash flows , fore casts, consultant task authorizations , and construction fund requ isition s for MDX. • Perform database admin istration , including responsibil ity for managing the Financial Database, CIPrTIP Track ing Database , and Constru ction Program Database. Lead team to develop all program databases . • Responsible for tracking proje ct cost estimates and budgets of the Five-Year Work Program . • Responsible for tracking and processing all invoices pertaining to the CIP/TIP . Earth Tech , Inc./ San Martin Associates (8 /99 - 5/01) Program Controller (lnfiltration/Exfiltration/lnflow Reduction Program) • Respons ible for managing a $200M municipal infrastructure rehabilitation program's costs , cash flows , schedules , and forecasts for the Miami-Dade Water & Sewer Department (MDWASD). • Responsible for Earth Tech's fiscal year budget ($3M yearly revenue), invoicing , and personnel forecasts. • Performed database admin istration , includ ing full responsibility for managing the Program Finan ci al Database and Invoice Trac king Database . Lead team to develop the Invoice Tracking database . • Client interactions pertaining to budgets , authorizations , and payments , and in v olvement with Request for Qualifica tions (RF Q) and Request for Proposals (R F P). Nova Consulting (5/98 - 8 /99) Project Controls Manager (Pump Station Improvement Program) • Responsible fo r managing a $250M municipal infrastructure rehabil itation program's cost s, cash flows , and fo recasts for the MDWASD. • Performed database administration , including full responsibility for managing the Project Con t rols Database. • Deve loped and managed proj ect scheduling system . • Coordination with design consultants on proposals , authorizations, and invoices and recommendati on of invoice payment for client. San Martin Associates (8 /97 -5/98) 271 Project Engineer (Consent Decree/Settlement Agreement Program) • Responsible for monitoring and coordinating issues related to Consent Decrees/Settlement Agreements between MDWASD and the USEPA and the Florida Department of Environmental Protection (FDEP ). • Responsib le for preparing and submitting the monthly report to the client, USEP A Quarterly Progress Report, FDEP Annua l Report and any correspondence to regulatory agencies related to tracked projects . • Responsible for track ing and reporting on the progress of projects related to the Comprehensive Performance Evalua tion Program , Public Access Reuse Program , and the On-site Reuse Program . • Coordination wi th design consultan ts on proposals , authorizations and invoices and recommending payment of invoices for client. EDUCATION University of Miami Coral Gables, FL Master of Bu siness Administ ration , 2001 Master of Scien ce, Civil Eng ineering , 1998 Bachelor of Science, Environmental Toxicology, Minor, Politica l Science , 1995 EXECUTIVE Wharton Transportation Executive Program @ UPenn Wharton Sc hool of Business TRAINING GFOA Ad vance d Government Finance Institute @ U. of Wiscons in -Madison CERTIFICATIONS Certified Government Finance Officer (CG FO) Certified Fraud Examiner (CFE) Certified Pub lic Funds Investment Manager (C PFIM ) Certified Internal Controls Auditor (C ICA) ACTIVITIES/ Government Finance Officers Association (G FOA) ORGANIZATIONS •vice-chair -Standing Committee on Economic Development & Capital Planning Fl orida Government Finance Officers As sociation (FGFO A) Association of Certified Fraud Examiners (ACFE ) Association of Publ ic Treasurers of the Un ited States & Canada (APT) Institute fo r Internal Controls Nationa l Society of Professional Engineers (NS PE ) Fl orida En gineering Soci ety (FES ) Mia mi Beach General Obligation Bo nd Oversight Committee Miami-Dade Transportation Aesthetic Review Committee (T ARC-TPO ) -(2003-2015) 272 273 THIS PAGE INTENTIONALLY LEFT BLANK 274 • Laura Veitia 275 THIS PAGE INTENTIONALLY LEFT BLANK 276 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Veitia Laura -----------------------------------------------Last Name First Name Middle In itial HOME ADDRESS: 1545 Bay Drive Miami Beach FL 33141 ---~---------------------------------------Apt No . Home No./S treet City State Zip Code PHONE: 305-798-4646 Home 305-403-8686 Work laura@ urbanresource.com Email Address Busi ness Name: =-U=-=rbc.:a:.:..:nc...:.R.:.::e:..:s=-o=-ur=-=cc::e __________ Position : Real Esta te Broker Address : 1193 71 st Street Miami Beach FL St reet City State 33141 Z ip Code Pursuant to City Code section 2-22(4) a and 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; orb) an individual shall demonst rate ownership/inter est for a minimum of six months in a business established in the city. • R esident of Miami Beach for a minimum of six (6) months Yes • D emonstrate an owner ship/interest in a business in Miami Beach for a m inimum of six (6) months: Yes • Are you a re~istered voter in Miami Beach : Yes • (Please~ one): I am now a resident of : North Beach • I am applyinq for an appointment because I have special abilities, knowledqe and experience . Please list below: Homeowner, business owner and investment property owner in Miami Beach • Are yo u presently a reg istered lobbyist w ith the City of Miami Beach? No Please list your preferences in order of ranking [1] first choice (2) second choice , and (3) third choice . P lease note that o nly three (3 ) c hoices will be observed by the City Clerk's Offi ce . (Regular Boards of City) Choice 1: Mayor's Gene ral O blig atio n (G .O .) Bond Oversig ht Co mm itt ee Choice 2: Choice 3 : * Board members are required to file Form 1 -"Statement of Financial Interest" with the State. If you seek appointment to a profes sional seat (e.g ., lawyer, arc hitect, etc .) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, atta ch a copy of your currently-effectively license, and furnish th e following information: Type of Professional Li cense ______________ _ Li cense Number Li cense Issuance Date _________________ _ Lice nse Ex piration Dat e Note: If applying for Youth Advisory Board. please indicate your affiliatio n with the Scott Rakow Youth Center: 1 . Past servi ce on th e Youth Center Adviso ry Board : No ~---Years of Service : _______________ _ 2 . Present pa rticipation in Youth Center activities by your childr en _N_o __ _ if yes , please list the names of your children, their ages, and which programs. List below: 277 • Have you ever been convicted of a felony: No 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 M iami B each any money: No If yes, please explain in detail: • Are you currently serving on any City B oards or Committees: No If yes, which board? • What organizations in the City of Miami Beach do you cu rrently hold membership in? • I am now employed by the city of Miami Beach : No Which department? • List all properties owned or have an interest in , which are located within the City of Miami Beach: Property 1900 Sunset Harbour Dr 1701 , Miami Beach, FL 33 139 1545 Bay Drive, Miami Bea ch , FL 33141 6969 Collins Av 1502, Miami Bea c h, FL 33141 117 S Shore Drive , Miami Bea ch, FL 331 4 1 119 1 71stStreet. Miami Beach , FL 33 141 1205 71st Street Miami Beach , FL 331 41 Gender: Female 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 federal equal opportunity reporting requirements. Race/Ethnic Categor ies What is your race? Mark one or more races to indicate what you consider yourself to be . Wh ite Other Description: Are you Spanish/Hispa ni c/ Latino? Mark the "No" box if not Spanish / Hi spanic / Latino . Yes Physically Challenqed: No NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following : o Prohibition from directly or indirectly lobbying city pe rsonnel (Miami Beach City Code section 2-459). v Prohibition from contracting with the c,ty (Miami-Dade County Code section 2-11.1 ). •J 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 Requ irement to disclose certain finan cial interests and gifts (Miam i-Dade County Code section 2-11 .1 ). (re : CMB Community Development Advisory Committee): prohibition, during tenure and for one yea r after lea vi ng 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 ). Upon request , copies of these laws may be obtained from the City Clerk. 278 "I hereby attest to the accuracy and truthfulness of the appli cation and have recei ved, read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Laura Veitia agreed to the following terms on 1/18/2019 5:05:49 PM Received in the City Cler1<'s Office by: Name of Deputy Clerk Control No . Date 279 Laura Veiti a 1545 Bay Drive Miami Beach, FL 33141 305-798-4646 lauraveitia@gmai l.com Born in Queens, NY 1970 Resident of Miami, FL since 1972 Resident of Miami Beach since 1995 Florida State University, Bachelor of Science in Finance, 1993 Real Estate Career Bret Taylor Real Estate 1995-1999 -420 Lincoln Road , Miami Beach FL EWM Rea ltors. 1999-2012, Broker-Associate 2004 -419 Arthur Godfrey Rd M iami Beach FL Awarded Chairman's club Saphire level 2001-2003 Highest # of closed transactions 2004-2011 Awarded Chairman's club Emerald level 2004-2011 Recognized in top 1 % of realtors nationwide Urban Resource, 2012-present -1193 71'' Street, Miami Bea ch, FL Vice President, Broker, Owner Total Sales Volume : $242 Mill ion thru 2018 Community Service & Boards Previous Member: LGBT Advisory committee, C .M .B . 2008-2018 Commission on the Status of Women, C.M.B 2008 Graduate, MB Leadership Academy 2007 Graduate. MB Citizen's Police Academy 2010 Ownership interest or past resident: South Beach: 16 Island Av -homewner -1995-1999 1117 Meridian 1996 1361 Meridian 1996-1999 1345 Lincoln Rd homeowner 2004-2008 1900 Sunset Harbour 1701-homeowner 2004-2016, investor 2016-present Commercial Investments : 1191 & 1205 71"' Street , 2015-present 117 S Shore Drive, 2007-present Lincoln West Re sident Association (previous member) Sunset Harbour Resident Association (previous member) Miami Beach Gay Prid e -2008-2014 North Beach: 1826 B1arntz Dr -homeowner 1999-2001 525 S Shore Dr -2002 6969 Collins homeowner-investor 2003-present 1545 Bay Drive homeowner 2016-present When I started my Real Estate Career in 1995 in Miami Beach , I focused on the sale of condos within the Art Deco District. I fell in love with M1Mo Architecture & Danish Modern design through my first home purchase at Belle Towers . Early on, I volunteered for several local events, including Winter Party, and the Gay & Le sbian Film Fe stival. After residing in the Deco District for several years, I moved to North Beach from 1999-2003 , then moved back to South Beach, and resided in Lincoln West, before moving to Sunset Harbour, where I r esi ded for 14 years. I became a member of the Commission for Women in 2007, then joined the Mayor's LGBT AdHoc committee in 2008 . One of our main goals in this committee was to create Miami Beach Gay Pride . In 2008, my wife and I registered as Domestic Partners, and we married in 2013 . We have been together for 15 years now, and have 2 children. We purchased our home in 2016 1n Normandy Isle to give our fam ily a unique quality of hfe that can be experienced in a single-family neighborhood located se aside . In my professional life, the maionty of my sa le s have been within the boundaries of our great ci ty . I've witnessed the birth of the South of Fifth neighborhood, the renovation of Lin coln Road (ci r ca 1996), the creation of the Sunset Harbour neighborhood, and th e public improvements in North Bea ch. In 2003, my brother and I began our team, Urban Re source, and focused in North Beach , primarily working with property owners who conve rted t heir bu ildings to condos. In 2008, we started offering property management services and opened our first office in Normandy Isle . In 2012, we started a full service real estate brokerage division in Urban Re so urce, where we help reside nts find their home in the area , either for rent or for sale, and assist investors purchase mul t ifamily properties. 280 281 THIS PAGE INTENTIONALLY LEFT BLANK 282 • Frank Mena 283 THIS PAGE INTENTIONALLY LEFT BLANK 284 MIAMI BEACH Mena Last Name 1621 Collins Avenue, Unit 1005 Home Address 305-776-097 1 786-600-3970 Work Telephone Frank First Name Miami Beach C ity Home Telephone BOARD ANO COMMITTEE APPLICATION FL State C Middle Initial 33139 Zi p Code fmena@lynkventures.com Email address Cellular Telephone Lynk Ventures Business Name Attorney, Healthcare and Assisted Living F aci lity Consultant Occupation 1621 Collins A venue, Unit 1005 Miami B each FL 33139 Business Address City State Zip Code Please list you r preferences in order of ranking : [1] first choice, [2] second choice , and [3] th ird choice . Please note that only three (3} choices will be observed by the Office of the City Clerk. Affordable Housing Advisory Committee Animal Welfare Committee Art in Public Places Committee Audit Committee Bl ack Affairs Advisory Committee Board of Adiustment Budget Advisory Committee Committee for Quality Education in Miami Beach Committee on the Homeless Convention Center Advisory Board Cultural Arts Council Desian Review Board Disability A ccess Committee 1 . 2 . 3 . Health Advisory Committe Health Advisory Committee Health Facilities Authority Board Hispani c Affairs Committee Historic Preservation Board • Housing Authority Human Rights Committee LGBTQ Advisory Committee Marine & Waterfront Protection Aut hority Mayor's 41 st Street Committee Mayor's General Obligation Bond Oversiqht Committee Mayor's P anel on Ocean Drive Miami Beach Commission for Women Next Generation Council Professional License Normandy Shores Local Government Neighborhood Improvement District Advisory Council Parks and Recreational F acili ties Board Personnel Board Planning Board Police/Citizens Relations Committee Production Industry Council Program for Public Information Committee Seni or Affairs Committee Susta inability Committee Transportation , Parking , and B icycle- Pedestri an Facilities Committee Visitor and Convention Authority Youth Commission Assisted Living Facility Administrator Control #: 990028520 Type of Professional License Florida State of Issuance 12/8 /2007 License Issuance Date License Number 7 /25/2021 License Expiration Date Note: If you are seeking appointment to a professional seat (e.g. attorney , architect, etc.), you must attach a copy of your current! effective corres ondin rofessional license. Page 1 of 6 F:\CLER\SALL\B OARD AND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE A PPLICATION.docx Updated: June 2020 285 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, b , and c: Members of Agencies , Boards, and Committees shall be affiliated with the City. Th is req uirement sha ll be fulfilled in the following ways : a. Resident of the City for a min imum of six months : Yes IZJ or D No • I am a resident o f: South Beach ~ Middle Beach O North Beach 0 Or b . Demonstrates an ownershi~terest (fo r a minimum of six months ) in a business established in th e Ci ty (for a minimum of six months): Yes O or ~No •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" s hall mean any sole proprietorship, sponsorship. corporation, limited liability company, or other entity or business association. Or c . Full-time emp loyee of such a business (for a minimum of six months); and I am based in an office or other location of the bus iness that is physical ly located in Miami Beach (for a minimum of six months): Yes [Zl or O No Notwith standing the requiremen ts se t forth herein, the qualified full-tim e employee of a business must be approve d by a 411th vote of the Mayor and City Commission . NOTE: Members of Agencies, Boards, and Committees shall be requ ired to demonstrate compliance with the City affiliation requirements of sections 2-22 (4) a and b of th e 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 file d with th e Office o f the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special ab ili ties , knowledge , and experience . Please list below : I have been involved with Assisted Living Fa cili ties and working with th e e lderly for well over 1 O+ years. I have been a re si dent of Miami Beach for 20 years . Page 2 of 6 F \CLER\$ALLIBOARD AND COMMITTIE S DATABASEICHECKLIST MASTERIBOARO ANO COMMITTEE APPLICATION docx Updated· June 2020 286 • Are you a registered active lobbyist with the C ity of Miami Beach? Yes O or No IZl • Have you ever been convicted of a felony? Yes O or No [ZJ If yes, please e xplain in detail : • Do you currently have a violation(s) of City of Miami Beach Code? Yes O or No (ZJ If yes, pl ease expla in i n deta il : • Do you c urrently owe the City of Mi ami Bea ch money? Yes O or No [Zl If yes, please explain in detail : • Are you currently serving on any City Board or Committee? Yes !Zl or No O If yes, which Board/Committee? Health Advisory Committee • In what o rganization(s) in the City of Miami Beach do you currently hold membership? Health Advisory Committee Member Name Position Name Posit ion • List the address of all properties owned or in which you have an interest within the City of Miami Beach : 1621 Collins Ave , Units 903,907, and 1005. 1623 Collins Avenue , Unit 916 • Are you now employed by the C ity of Miami Beac h? Yes O or No !ZJ If so, which department and title ? • Pursuant to City Code Section 2-25 (b): Do you have a parent 0 , spouse 0 , child O brother O o r s ister 0 who is employed by the City of Miami Beach? Yes Oor No l&:l If "Yes," identify person(s) and department(s): __________________________ _ * Note: If applying for the At-Large position of the Historic Preservation Board , please answer the below questi ons: • Have you ever resided in one o f the City's Historic D istricts for at least o ne year? Yes O or No 0 If you answered "Yes ," please indicate : Address Address Page 3 of 6 From: Dates From: Dates F:ICLERISALLIBOARO ANO COMMITTI ES OATABASEI CHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION.docx Updated: June 2020 T o To 287 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 financ ial interests and gifts . (M iami-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 governmen t can be fou nd in Chapter 286 of the Florida Statutes. T hese statutes establish a basic right of access to most meetings of Boards , Commissions , and other governing bodies of state and local governmental agencies or authoriti es . 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, Commissi on , Authority , or Comm ittee . 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. 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 R STATE LAWS AND STATUTES ACCORDINGLY ." 11 /5/2020 Frank Mena Date Name of Applica nt (PLEASE PRINT) Board and Comm ittee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee fZI I have answered all questions fully. 0 I have attached additional sheets , if necessary, to provide required information . g I have attached a current resume , photograph , and a copy of any applicable professional license . ~ I have completed and attached the Board & Committee Financial Acknowledgement Statement. ~ I have completed and attached the Divers ity Statistics Report . g Submit complete application package . Via Email: BC@mia mibeachfl .gov Via U.S. Mail or in Person: City of Miami Beach Office of the City Clerk / Board and Committee Section 1700 Convention Center Dr ive , 151 Floor Miami Beach , FL 33139 If you have any questions, please contact the Office of the City Clerk via email: BC@miam ibeachfl.gov o r 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 publ ic , please : 1) Use your office or other address for you r mailing address ; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . Page 4 o f 6 F :\CLE RISALLIBOARD A ND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COM M ITTEE APPLICATION.docx Updated : June 20 20 288 MIAMI BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach , Florida 331 39 www.miamibeochA.gov OFF ICE O F THE CITY CLE RK Email : BC@miamibeachfl .gov Telephone : 305 .673.7 4 1 1 BOARD & COMMITTEE FI NANCIAL ACKNOWLEDGEMENT STATEMENT 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) Mena Frank C La st Name Fi r st Name M iddle In itial I understand that no later than July 1 1 of each year all members of Boards and Committee s of the C ity of M iam i Beac h , including those of a purely advisory nature . a re required to comply with Miami-Dade County Finan ci al Disclosure Requirements . One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive , Miami Beach , Flori da, n o late r than 12:0 0 noon of July 1, of each year: 1. A "Source of In come Statement;" or 2. A "Statement of Financia l Interests (Form 1 )1;" or 3. A Copy of your latest Federal Income Tax Return . Failure to file one of th ese forms , pursuant to the Miami-Dade County Code , may subject the person to a fin e of no mi?ore th ~:500, 60 days in jail , o r both . _-;;--_ 11 /5/2020 Signatu re Date 1 Me mbers of the Planning Boa rd and Board of Adjustment wi ll be no tified dire ctly by th e State of Florida, pu r suant to F .S. § 112.3145( 1 )(a ), to file a Statement of Financia l In terests (Form 1) with the Miami-Dad e County Supervisor of Elections by 12:00 noon, Ju ly 1. P lanning Board and Board of Adjustment members who file their Form 1 with t he Count y Su pervisor of Elect ions automatically satisfy t he Coun ty 's financia l d isclos ure requir ement as a M ia mi Beach Cit y Board/Committee member and need not fi le an additional form wit h t he Office of the Ci ty Cler k . However, c ompliance with the County disclosure requirement does not satisfy the State requ irement. Page 5 of 6 F :ICLER\SALLIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIBOARD AND COMMITTEE APPUCATION.docx Updated· June 2020 289 MIAMI BEACH City of Miami Beach 1700 Conventio n Center Drive Miam i Beoch , Flori do 33139 www.mjamibeachA .gov O FFICE O F THE CITY CLERK Email : BC@miamibeachfl .gov Telep hone: 305 .6 73.741 l Mena Last Name DIVERSITY STATISTICS REPORT Frank C First Name Middle In itial The following information is voluntary and has no bearing on your conside ration for appointment. It is being asked to comply with City diversity reporting re qu irements . Gender: ~Male 0 Female Oother 0 I prefer not to answer. Race/Ethnic Categories: What is your race? 0 African American /Black 0 Asian or Pacific Islander 0 Caucasian/White 0 Native American/American Indian IZJ Other -Print Race : Brown ------------□ I prefer not to answer. Do you consider yourself to be Spanish, Hispanic , or Latino/a? l&lves □No 0 I prefer not to answer. Do you consider yourself Physically Disabled? O ves ~No 0 I prefer not to answer this question . Page 6 of 6 F:ICLERISALLIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION.docx Updated June 2020 290 Fra n k C. Me na, Esq . Frank acquired hi s first elderl y healthcare company in 2007. Since th e n, Frank has owned . operated and/or managed multiple health care and residential prope rties and companies throughout Florida. Frank has also owned, operated and/or served as a Board Member to multiple health care ent iti es including Assisted Living Faciliti es (ALFs), Adult Da ycare , Primary and Specia lty Care Medical Ce nt ers, Management Services Organi zations (MSOs), Ph ysician an d Ph ysic ian Extender Homecare, Hom e Hea lthcare (Nurs in g. Physical Therapy, Home Health Aides), Durabl e Medical Equipment (DM E) and health care s taffing companies. Frank is a member of the Florida Bar and received hi s Juri s Doctorate from Columbia Unive rsity School of Law in 2000, where he was awarded the Parker Cert ifi cate for Achievement in Intern ati onal a nd Com parati ve Law , was se le cted to the Columbia Jou ma/ of Transnati onal law, and was the Pres ident of the Latin American La w Student Association . Frank began hi career at one of the mos t pre s tigious law firm s in th e State of Florida where he re presented state and foreign government entiti es, bank and pri vate multi-n ational companies. Frank then ac cepted a job as Execu ti ve Vi ce-Pre ·ident and Genera l Counsel fo r a finance company with approximate ly 250 locations throughout the country. Frank tran s itioned into healthcare in 2007 when he acquired the ALF where hi s grandmo ther was a re s ident at the time . Since then , Frank opened a n additional four ALF s and pro vided care to hundreds of elderly re idents throughout South Florida. Frank is li cen ed by the Florida Agency for Hea lth Care Adminis tration (''A HCA") as an ALF Admini s trat or. Frank so urced th e properties, arranged the financing. led the design and renovati ons/cons tructi on, ha ndled the zo nin g and land use requireme nts, sec ured the licensing, and managed the s tart-up, stabili za ti on and continued operation of th e faci liti es. The fac iliti es ha ve included Limited urs111g Services Licen s in g. Mental Health Licens ing . and contracted Ho spice care services. The healthc are entities ha ve handled ove r 50 governmenta l and qua s i-gove rnmental a udits and in spections by AH CA , Medicaid Department of C hildren and Families (DCF), Florida Department of He a lth (DO H), Ombudsman , and Miami- Dad e Fire Department. For over IO years, Frank has also served o n the Board a nd prov ided general consultin g to one of the largest pri vatel y owned non-h ospit a l based home health co mpanies in Miami-Dade County. Frank is a l o a principal and Board Member for lllumina Medical Centers LLC. Frank 's pass ion for hea lthcare is driven by a lifelong affinity with the e lderly. He believes that ens uring th e best healthcare se rvices to the elderly will allow him to do we ll by d oing good . Hi s vis io n is to provide the best care poss ible to th o e who cared for u . 291 THIS PAGE INTENTIONALLY LEFT BLANK 292 • Mark Rabinowitz 293 THIS PAGE INTENTIONALLY LEFT BLANK 294 IAMI BEACH Rabinowitz Last Name 1550 NE Quayside Terrace Home Address 7862886674 Cellular Telephone 3055388835 Work Telephon e Miami Beach Community Health Center Business Name 71 0 Alton Road Business Address Mark First Name Miami City 7862886674 Home Telephone Physician Occupation Miami Beach C ity BOARD AND COMMITTEE APPUCA TION F lorida State L Middle Initial 33138 Zip Code mrabinowitz@mbchc.com Email address Florida 33139 State Z ip Code P lease list your p references in order of ranking : (1) fi rst c hoice , (2) second choice, and (3] th ird choice. Please note that onty three (3) choices will be observed by the Office of the City Clerk. Affordable Housing Advisory Health Advisory Committee Normandy Shores Local Government Committee Neighborhood Improvement District X Advisorv Council Animal Welfare Committee Health Facilities Authority Board Parks and Recreational Facilities X Board Art in Public Places Committee Hispanic Affairs Committee Personnel Board Audit Committee H istoric Preservation Board • Plannina Board Black Affairs Advisory Committee Housina Authontv Police/Citizens Relations Committee Board of Adjustment Human Riahts Committee Production lndustrv Council Budget Advisory Committee LGBTQ Adviso,y Committee Program for Public Information Committee Committee for Quality Education in Marine & Waterfront Protection Senior Affa irs Committee M iami Beach Authority Committee on the Homeless Mayor's 41 st Street Committee Sustainability Committee Convention Center Advisory Board Mayor's General Obligation Bond Transportation, Parking , and Bicycle- Oversight Committee Pedestrian Facilities Committee Cultural Arts Council Mavor's Panel on Ocean Drive V isitor and Convention Authority Desian Revi ew Board Miami Beach Commission for Women Youth Commission Disability Access Committee Next Generation C ouncil 1. Health Advisory Committee 2 . Health Facilities Authority Board 3 . Professional License Physician ME 36822 Type of Professional License Florida 07/01/1980 License Number 01/31/2022 State of Issuance License Issuance Date License Expiration Date Note: If you are seeking appointment to a professional seat (e.g . attorney, architect , etc.), you must attach a copy of y our c urrent! effective corres ndin rofessional license. Page 1 of6 F \C LERISALLIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION docx Updated: J une 2020 295 AFFILIATION WITH THE CITY OF •AMI BEACH 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: a. Resident of the City for a minimum of six months: Yes O °' ~o • I am a res ident of: South Beach D Middle Beach D North Beach 0 Or b . Demonstrates an ownershie_Jnterest (for a minimum of six months) In a business established in the City (for a minimum of six months): Yes Dor WNo ·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, oorporation, limited liability company, or other entity or business association Or 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): Yes l!l or DNo Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4nth 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 sections 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 shaH be filed with the Office of the City Cieri< prior to being swom in as a member • I am applying for an appointment because I have special abilities, knowtedge, and experience. Please list below: I am the CEO and CMO of Miami Beach Communitv Health C~nter. I am not certain of the veracitv of the statement, but a City of Miami Beach staffer told me that the HAC Bylaws requires that one board seat be ~Qrnrnitted le tbe Miami Bea~b CQmrnuai~ t:ieallb Ceatec CEQ I was alsQ lQld tbat as lbe Chair of the HAC , I am required to sit on the HFA Board . Page 2 of6 F \CLERISALLIBOAAO ANO COMMITTIES OA-ABASE\CHECKUST MASTERIBOAAO ANO COMMITTEE APPUCA TION docx Updated. June 2020 296 • Are you a registered active lobbyist with the City of Miami Beach? Yes Dor No IZl • Have you ever been convicted of a felony? Yes Dor No W If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes D or No IXJ If yes, please explain in detail: • Do you currently C1Ne the City of M iami Beach money? Yes Dor No IXl If yes , please explain in detail: • Are you currently serving on any City Board or Committee? Yes IXl or No D If yes , which Board/Committee? Health Advisory Committee and and Health Facilities Authority Board • In what organization(s) in the City of Miami Beach do you currently hold membership? None Name Position Name Positi on • List the address of all properties owned or in which you have an interest within the City of Miami Beach: None • Are you now employed by the City of Miami Beach? Yes Dor No IXJ If so, which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a ~rent D , spouse D , child O brother D or sister 0 who 1s employed by the City of Miami Beach? Yes Dor No W If 0 Yes ," identify person(s) and department(s): _______________________ _ * Note : If applying for the At-Large position of the Historic Preservation Board, p lease answer the below questions · • Have you ever resided in one of the City's Historic Districts for at least one year? Yes O or No 0 If you answered "Yes: please indicate· Address Address Page 3 of6 From: Dates From: Dates FJCLER\SAll\BOAR0 /1110 COMMITTIES 0ATABASECHECKUST W.STERIBOARO /1110 COMMITTEE APPLICATION dOc:x Updated· June 2020 To To 297 NO TE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THA T APPLY TO CITY BOARD/COMMITTEE MEMBERS . THESE LAWS INCLUDE, BUT ARE NOT UIWIT ED T O : o Prohibition from directly or i ndirectly 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 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 88 is for use by any person serving at the county, city, or other local level of government on an appointed or elected Board, Council, Commi ssion, Authority, or Committee. It applies equally to members of advisory and non-advisory bodies who a re presented with a voting conflict of interest u nder Section 112.3143, Florida Statutes App licant's Si gnature Date Name o f Applicant (PLEASE PRINT) Board an d Com m i ttee Application C h eck list : Please ensure you have provided all information before applyi ng or reapplying to any Board and Committee 0 I have answered all questions fully. 0 I have attached additional sheets, if necessary, to provide required informati on. 0 I have attached a current resume, photograph, and a copy of any applicable professional license . 0 I have complet ed and attached the Board & Committee Financial Acknowledgement Statement. 0 I have completed and attached the Diversity Statistics Report. 0 Submit complete application package. Via Email: BC@miamibeachfl.gov Via U .S . Mail or in Person: City of Miami B each Office of the City Clel1< / Board and Committee Section 1700 Convention Center D rive, 111 Floor Miam i Beach, FL 33139 If you have any questions, please contact the Office of the City Clent v ia email: BC@miamibeachfi .gov or t elephone: 305.673.741 1. N ote: Florida Statutes §1 19.071 : 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 d isclosure 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. Page4 of6 F ICLER\SALLISOARO AHO COMMI TTIES OATASASE\CHECIWST MASTERl60ARO AHO COMMITTEE APPUCATION docx Updated· Jl618 2020 298 MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Bea ch, Florido 33139 www .miomibeachR.gov OFFICE OF THE CITY CLERK Email : BC@mjamibeachfl.gov Telephone: 305.673.741 l BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Rabinowitz Mark L Last Name First Name Middle Initial I u nderstand 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 fonns 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, d 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 fonns. pursuant to the Miami-Dade County Code, may subject the person to a fine of no more than$ 0, 60 days in jail , or both. ~,h Signature Date 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 fonn with the Office of the City Clertc However, compliance with the County disclosure requirement does not satisfy the State requireme nt. Page 5 of6 F.ICLER\SALLIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\BOARD ANO COMMITTEE APPLICATION docx Updated: Jooe 2020 299 M IAMI BEACH City of Miami Beach 1700 Convention Center Drive Mio11i Beoch, Florido 33139 www.mjamibeachA.gov OFFICE OF THE CITY Clf RK Email: BC@miamibeachfl.gov Telephone : 305 .673.741 1 Rab inowitz Last Name DIVERSITY ST A TIS TICS REPORT Marie:' L First Name Middle Initial The following information is voluntary and has no bearing on your cons ideration for appointment It is being asked to comply w ith City diversity reporting re quirements. Gender: ~Male □Female □Other D I prefer not to answer. Race/Ethnic Categories : What is your race? 0 African American/Blac k 0 Asian or Pacific Islander !!l Caucasian/White 0 Native American/American Indian 0 Other -Print Race: ------------□ I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? □Yes 1DNo 0 I prefer not to answer. Do you consider yourself Phys ically Disabled? □Yes IUNo 0 I prefer not to answer this question. Page 6 of 6 F .\CLERISALLIBOARD AND COM MITTIES 0A TABASEICHECKUST MASTERIBOARD AND COMMITTEE APPUCA TION doCx Updated June 2020 300 MARK LAWRENCE RABINOW ITZ , M. D., F. A. C. G., A. 8. O. G. 11645 BISCAYN E BOULEVARD, MIAMI, FLORIDA 33181 305/S38-8835 ME DICAL EDUCATION 197S-1979 University of Miami Miller School of Medicine M. 0 . Degree received 6/1979 Florida Medical License issued 7/1/1980 EX PERIENCE 1993-Present Miami Beach Community Health Center, Inc., Miam i Beach, Florida Chief Executive Officer: 1/30/2014-Present Interim Chief Executive Offker: S/9/2012-1/29/2014 Chief Medical Officer: 3/24/2004-Present Co-Medical Director & Director Obstetrics & Gy necology Services : 6/10/2003-3/23/04 Vo lunteer Physician : 1/1/1993-12/31/1994• 1983-2003 Gi libert & Rabinowitz, M . 0 ., P.A., Bay Harbor Isl ands , Florida : Obstetrics & Gynecology, Private Practice 1979-1983 University of Miami Miller School of Medicine & Jackson Health System : Intern & Re si dent 1974-197S University of Miami Biochemistry Department, Research Technician SOC IETY MEMBERSHIP Nat ional Association of Community Health Ce nters Florida Association of Com munity Health Centers North America n Assoc i ati on for the Study of Obesity American So ci ety of Bariatric Physicians Miami Obstetrica l & Gynecological Society American Association of Gynecologic Laparoscopists American Fertility Society American College of Obstetricians & Gynecologists, Fellow 2003-Present 2003-Present 1996-1997 199S -1997 1987-Present 1987-2000 1987-2000 1986-Pre sent 198S-Pre sent 1983-Present 1983-2000 1883 -Present 1983-Present 1979-Present American Board of Obstetrics & Gynecology, Lifetime Diplomat (Recertified: 2000, 2001, 2008) William A. Little Society Florida Obstetrical & Gynecologica l Society• Dade County Medica l Assoc i ation Florida Medica l Association American Medical Association AWARDS. HONORS & APPOINTED POSTI ONS 2016 Florida Association of Community Health Centers, Inc.: Wendell N. Rollason Outstandi ng Leadership Award 2016 Jessie Trice Hero Award Broward Community & Family Healt h Centers, Inc.: Apprecia tion Award Oty of M iami Beach : Health Facility Board Member Oty of Miami Beach : Health Advisory Committee (Cha ir 201S-Present) Health Choice Network, Inc.: Board of Directors Member 2016 2018-Present 2014-Present 2008-Present 2008-2018 2008-2018 2006-Present Prestige Provider Service Network: Credentials Committee & Quality Improvement Committee, Member Prestige Health Choice : Quality Improvement Committee, Member United Health Care : Provider Advisory Committee •oue to dosure of some entit ies, the length of time elapsed, and the Inability to locate records, dates are approximate. MARK LAWRENCE RABINOW ITZ, M. D., F. A. C. G., A. B. 0 . G. Pagell2 301 2005 Miami Beach Community Health Center, Inc.: Mark Rabinowitz Financial Hero Award 2004-2018 Health Choice Network, Inc.: Clinical Committee, Chair- 1994-2000 Board of Directors, Miami Beach Community Health Center, Inc. 1992-1997 St. Francis Hospital/Miami Beach Community Hospital Credentials Committee, Member: 1993-1997• Credentials Committee, Chair: 1992-1993• Department of Obstetrics & Gynecology, Co-Chairman: 1991-1993• 1992-1993 Florida Department of Health, Volunteer 1987-1996 Miami Heart Institute Shared Birth Place, Co-Medical Director & Developer: 1987-1996 Department of Obstetrics & Gynecology, Vice Chairman : 1996-1997 1987-1989 Dade County Medical Association , Public Service Committee 1983-Present Voluntary Faculty/Clinical Instructor PUBLICATIONS University of Miami Miller School of Medicine, Clinical Instructor: 1983-2012 • Florida International University, Voluntary Faculty: 2008-Present• Barry University, Voluntary Faculty: 2010-Present• Nova University, Voluntary Faculty: 2008-Present Marshall JJ , Rabinowitz, ML. Modification of the Properties of Trypsin by Covalent Attachment to Dextran. Arch Biochem Biophys 1976. Marshall JJ, Rabinowitz, ML. Stabilization of Catalese by Covalent Attachment to Dextran . Arch Bi ochem Biophys 1976. Rabinowitz, ML. Throat Swabbing in Epiglottitus {Letter). JAMA 1978. Marshall JJ, Rabinowitz, ML. Preparation and Characterization of a Oextran-Trypsin Conjugate. J Blol Chem 1981. Rabinowitz, ML, Sasson I, Robinson , MJ . Sexually Transmitted Cytomegalovirus Proctitis i n a Woman: A Case Report. Am J of Gasterenterology 1988. Rab i nowitz, ML. Gili bert, JE, Lenes, BE . Avoiding Blood Transfusion : A Report of Two Cases. J Rep Med 1990 •0ue to dosure of some entitles, the length of ti me elapsed, and the inability to locate records, dates are approximate. MARK LAWRENCE RABINOWITZ, M. 0., F. A. C. G., A. B. 0. G. Page2 1 2 302 AC# STA TE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICENSE NO. CONTROL NO. 12/17/2019 ME 36822 6850N ~ i I I ... .. ► i &i ~ ~ . THE IIIEOICA1. DOCTOR g I i I r~ i I NAMED aaow HAS MET All REQUIREMENTS OF THE LAWS ANO RULES OF THE STATE OF FLORIDA. E,cpiration Date: JANUARY 31. 2022 MARK LAWRENCE RABINOWITZ 11645 BISCAYNE BOULEVARD SUITE 207 MIAMI, FL· 33181 Ron OeSantis GOVERNOR DISPLAY IF REQUI RED BY LAW EXPIRATION DATE: JANUARY 31, 2022 Scott A. Rlwees, MO State Surgeon Genera l I I ii .~ I I i~ 1:1 t I ,1 I itj~ i ~i hi ii I ! YOOI llcense number Is ME 36822. P1ease use It In an correapondence with your boaldkouncll. Each lioensee Is ~ re.ponsille for~ the Department in writing of the 6censee's current mailing address and practice location address. If you have not received your renewal notice 90 day9 prior to lhe expiration date shown on this lioeme, please visit www.FLHealthSource.gov and click "Renew A LioanN" to renew onllne. The Medical Quality Assurance Online Services Port.al gives you the ability to manage your license to pe,form address updatea, name changes, request duplicate licenses end much more . It's simple. Log onto yoo1 MQA Online Services account today at http:/fflhealVlsource.gov/ Select the "Account Login• button to access your account For changes to your name, address or to request dupUcate llcenNs, chooee your setectlon from the dropdown 11st under •Manage My License". Your profession will opeo for renewal 90 daya prior lo your expiration dale. VVhen the re,-al cyde ope,,e for your profesl6on, the "Renew My llcense" header will automatically display 011 your llcenle Dashboard. ARE YOU RENEWAL REAOY1 The Depar1meol of HNllh wll now n,view rot' conllnua,g educallon l1l00fds at Che time of 11oe,-renewal. To i.n more . please~ --~YRR IMPQRTANT ANHQUNCEIIENJS GROUNDS FOR DISCIPLINE You llhould be tama. wlln the Groundl for Dildpllne found In Sedlon 458-072{1 ), F1onda s--.. end In .. ~ eel for ht profe8'1on wi wNd'I you are lloenlod. Florida sa... CM 'be ecoNMd "';~ Str.'~ • t ~ i • e ~ t 303 304 • Steven Sonenreich 305 THIS PAGE INTENTIONALLY LEFT BLANK 306 t-/\I.A/V\I BEACH ~ Last Name First Name Middle Initial '331 ~b Home Address State Zip Code .;JoJ--(, c., I · 1 lf _d-~ ....:!}o.{: 31· 2.'1~ C. • (. D "') Home Telephone . Work Telephone Cellular Telephone Email address tn~ .... c~u.~"_+-_S~1-~~"~1_rv'\~~~d~1~r~o.. ....... l ~t~e...c....-()~+-=e'---..,,.-_P.!.....L(_;:e..=-=~::....1.Ld=-e...!."L+!,.__ _________ _ Business Name Occupation y 3 0 0 R. 0 a... C M I .vi) '3-e. 'c.h f ID ✓I AL\.. 33 I 0 Business Address City State Zip Code Professional License (describe) ____ t-\_\_;__Q.,.__ __________________ Expires: __ h_\-=-_S,-"'------ Please attach a copy of currently effective prof essional license. Pursuant to City Code section 2-22 (4)a & b : Members of agencies boards and committees shall be affiliated with the City Th is requiremen t shall be fulfi ll ed in the following ways a An 1nd1v1dua l sha I have been a re s ident of the City for a minimum of six months; or b An individual sha il demonstrata ownersh:p/;nte st for a m inimum of six months in a business established in th e City for a minimum of six months • Resident of M iami Beach for a minimum of s ix (6) months: Yes O or No / • Demonstrates ownership/i ntere st in a busin ess in Miam i Beacifor a minimum of six months Yes [Q'.J or No CJ • Are you a registered voter in M1am1 Beach : Yes O or No ~ • I am now a resident of-North Beach O South Beach O Middle Beach 0 • I am applying for an appointment because I have special abilities , knowledge and experience Please list below: • Are you presently a registered lobbyist w ith the City of Miam i Beach? Yes O or No Please 11 st you r preferences in order of ranking [1) first choice [2) second choice , and (3] third choice Pl eas e note that only three (3) choices will be observed by the Office of the City Clerk. Affordable Housing Advisory Cor1m1ttee Health Advisory Committee Parks and Recreation Fa c,l ties Board oo ....-=-..:.A.c:.rt'-'1'-'n-'-P..::uc:.bl"'ic:...cP_:.:cace=s--=C:..::o..:.rn::..:m.:.:.1tt::..:e:..::e'------......c;:.· :....:He=.:a:c.lt::..:h..:.F..=a:=:ci.:.;.lil::=,e:=s..:..A:..::uc::.tn:..::o.:..:.rity:L..::B::..:oc::.a:..::rd'--------'-'-Personnel Boa:..::rd~------------ Aud 1t Comm nee : Planmn Board · _ Police Crtizens Relat,ons Commrtt"-eec.._ __ ::; Housm Autho _ Production Indus! Council Committee on the Home_le_s_s______ Human Rights Comm ittee : Sister C1t1es Pro ram ,....._C_o_m_m_1tt_ee_fo_r_Q_u_al_1ty~Ed_u_c_a_t1o_n_1_n _M_B ____ -_LG_BT_A_dv_1s_o_ry'---'-C_om_m_1tt_e_e__ _ Su:::sc;.:ta::.:m.:.:a:..::b.:..::11i;L...;;C:..:o:..cm.:.:.m;.:;1.:.:ctte:..:e:.._ _____ ---< Convention Center Adv isory Board Manne & Waterfront Protection Authority -P rransportation Parking & B1cycie-Pedestri an Cultura Arts Counal Design Review Board -M1am1 Beach Commission for Women _ Normandy Shores Local Government Ne, hborhood Im rovement Fac1 l1t ,es Committee -Visitor and Conve nt,on Autho'l -Youth Commission D1sab1llty Access Comm...:..c,ttc=.ee"------------------------1---- * Board members are required to file Form 1 -"Statement of Financial Interest" with the State. * If you seek appointm ent t o a professional s ea t (e .g ., l awye r , archi tect, etc.) o n the B oard of AdjustmenL Design Re v iew Board, Hi storic Preservatio n B oa rd or Planning B oa rd, attach a copy of you r curr ently-effectively license, and furnish t he following information : Type of Professional Lice nse ______________ License Number ______________ _ License Issuance Date _______________ _ License Expirati on Date ___________ _ Page 1 o f 4 F C~ER.SALL aFOR \1 S s:1,vm A'IO CO '.'\1,TTEES BC ;,PPLIC A TION RFVISED ()6·0 20 1 6 doc• 307 00 Note If applying for the Youth Center positions of the Parks and Recreations Facilities Board pl ease 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 (1ndude dates of service) _____________ _ Present partiapation in Youth Center acuvitJes by your children Yes O No 0 If yes please list be l ow the names of your children . their ages and the programs in which they participate Childs name __________________ _ Childs name ------------------~ Age Age Program Program • Have you ever been con victed of a felony? Yes O or No If yes . please explain ·n detail • Do you currently have a v1olation(s) of City of Miami Beach Code? Yes O or N If yes . please explain in detail • Do you currently owe the City of Miami Beach any money? Yes O or No If yes explain rn detail • Are you currently serving on any City Board or Committee? Yes r No O If yes which b • In what organizatron{s) rn the City of ,11am1 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 M1am1 Beach. • Are you now employed by the City of M1am1 Beach? Yes Dor No Which department and title?------------------------------------ • Pursuant to City Code Section 2-25 (bt.J?o you hav0 /2 parent 0. spouse 0. child O brother O or sister O who 1s employed by the Ci ty of Miami Beach? Yes Uor No Gu If ·Yes : identify pers on(s) and department(s). -------------------------------- The following information is voluntary and is neither part of your application nor has any bearing on your considera t i on for appointment. It is being asked to comply with City diversity reporting requirements. Gender: Male LJ Female LJ Race/Ethnic Categories What is your race? 0 African-Amencan/Black 0 Caucasian/White 0 Asian or Paafic Islander 0 Native-Amencan,American Indian Page 2 of 4 f CLlq SALL .aFORr.,s BQAqo A '<D CO'.'','ITTEE'S BC APPLICAT ON qE. SEu Oti'<])I~ doc, 308 D Other-Pnnt Race:---------------------------------- Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box ,f not Spanish. Hispanic Latino/a . □No 0Yes Do you consider yourself Physically Disabled? □No DYes NOTE IF APPOINT ED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO : " Proh1b11ton from di rectly or indirectly lobbyin g City personnel (M1am1 Beach City Code sectio n 2-459) :-Proh1b1t1on from contracting WTth the City (Miami-D ade County Code section 2-11 1) "' Proh1b1t1on from lobbying before the board/committee you have served on for penod of one year after leaving office (M1am1 Beach City Code section 2-26). •') Requirement to disclose certain financial intere sts an d gifts (Miami-Dade Coun t:1 Code section 2-11 .1) o CMS Community Development Advisory Comm i ttee · proh1b illon. during tenure and for one year after leaving office from having any in terest in or receiving any benefit from Community Development Bloc k Grant funds for either yourself or those with whom you have bus iness or immediate fam il y ties (CFR 570 611 ). Sunshine Law -Flonda'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 Flori da Statutes These statutes establish a basic nght of access to most meet.ngs of boards , comm1ss1ons and other governing bodies of state and local governmental agencies or authonlles ., Voting conflict -Form 8B is for use by any person serving at the county , city or other local level of government on an appoin ted or elected board , council comm1ss1on , authority or committee It app li es equa lly 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 W ILL 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." lo -'1...S--/l, Date Name of Appltcant (PLEASE PRINT Name of Deputy Cieri< 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. Page3o1 4 F C !:RSA .. ~FORMS BOA'tC AND COM \1 lTEES BC A0 PUCATICN REVISED :~'•2o'5 ~c-:• 309 MIAM I BEACH City of Miami Beach 1700 Convention Center Drive, M 1om1 Beoch flor do 33 139 www mom beochflc9Q:!' OFFICE OF THE CI TY CLER K C 1tyCler k@m om1beoch9.gov Telephone 305 673 7 ~ l l Fox 305 673 725 4 Acknowledgement of fines /suspension for Board /Comm ittee Members for failure to comply with Miam i- Dade County Financial Disclosure Code Provision Code Section 2-11 .1 (i) (2) Board Member's Name : ______ S-_t+--Q.~L_f e_VJ-+-_S_o_n~e_n~v_e_, c~b ______ _ I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miam i Beach , including those of a purely advisory nature, are requ ired to comply with Miam i-Dade County Financial Disclosure Requirements This means that the members of City Adv isory Boards, whose so le 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 fo ll owi ng forms must be filed with the City Clerk of Miami Beach , 1700 Convent ion Cen t er Drive , M iam i 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 S500 , 60 days in Jail or both Signatu re fJate I Uodated Tuesday. October 04 2016 Page 4 of 4 ~ CLER SALL aFOR,.,s BO.ARO ANO CCl.".11 TTE:.!:S BC APPLICAT,ON REv,SEu '6 ••2 ·~ coc., 310 Mount Sinai \1 E D I ( A L CE\TER Steven D. Sonenreich Steven D. Sonenreich, President and Chief Executive Officer, joined Mount Sinai Medical Center, Miami Beach , Florida , in 1976. After serving as Executiv e Vice President and Ch ief Operating Officer from 1990 to 1996, Mr. Sonenreich became the Chief Executive Officer of Cedars Medical Center in Miami, Florida . In November 2001, Mr. Sonenreich returned to Mount Sinai Medical Center and became its President and Ch ief Executive Officer. Under Mr. Sonenreich's leadership, Mount Sinai has been named as one of America 's Top Hospitals in Geriatric Medicine for five consecutive years by U.S . News and World Report. Mr. Sonenreich spearheaded Mount Sinai's affilia tion w ith Columbia University, New York, New York , creating The Mount Sinai Columbia University Divisions of Cardiology, Cardiac Surgery and Urology. He wa s honored as Cit iz en of th e Year by the Miami Beach Chamber of Commerce in 2012. He serve d as chair of the Florida Hospital Association Board of Trustees in 2013; and has been a member of the board of The Safety Net Hospital Alliance of Florida si nce 2005 . Mr. Sonenreich earned his Bachelor of Arts degree from the State University of New York at Binghamton and a Master of Business Administration and Certification in Healthcare Administration from the University of M iami, Coral Gable s, Florida. HOO Aitc>r, Ro.id M .am, B•ach fl 331.i() P"°"" l( 674 lUI nt TIC om • )un • t 8t-a h • M • S. ., C.. • olog/ 'tl\eflOnd.t•.-. Mount \1N1 Frw•SUndtna lfflf'rlf'R<y Dfop~rtments Mount S1N1 Compr~nSJveCanc•rC~ntf'r • JOO A "" Rooc M.an"UBt-art-fl 1P40 Pt,on, 30"'67 45' m c om 311 312 • Arthur Unger 313 THIS PAGE INTENTIONALLY LEFT BLANK 314 MIAMI BEACH BOARD ANO COMMITTEE APPLICATION FORM _U_n_g_er ________________ A_rt_h_ur _______________ s Last Name First Name Middle Init ial _45_6_5_N_o_rt_h _B_a~y_R_o_a_d ___________ M_ia_m_i B_e_a_c_h _____ F_L _______ 33140 Home Add ress City State Zip Code _3_05_-_9_34_-_0_4_77 _____ ..;;..30.;;_5.;;...-..;;..3_7...;..1-....;;6=2"""0..;;..0 ____ 3_05_-_5_34_-_9_4_75 ____ arthur.unger@eisneramper.com Cellular Work Home E mail Address Eisn e rAmpe r , LL P C PA B usiness N ame: O ccupation : 1001 B rickell Bay D rive Suite 1400 Miami F L 33131 Business Address City State Zip Code P lease l ist you r prefere n ces i n o rder of ra n king [1) fi rst c hoice [2) second c h oice, and [3) third c h oice. Please note that only three (3 ) c hoices will be observed by t he City Clerk's Office. (Regular B oards of City) Choice 1: Health Faciliti es Authori ty B oard Choice 2 : Choice 3: Professional License No Professional Licenses Submitted . Note: If you are seeking appointment to a professional seat (e.g. attorney, a rchitect, etc.), you must attach a copy of your currently effective corresponding professional license. * Note: If applying for the At-Large position of the Historic Preservation Board , please answer the below questions: • Have you ever resid ed i n one of t he C ity's H istoric D ist ricts for at least one year? No No Address in City Historic District s ubmitted . 315 AFFILIATI O N WITH THE CITY OF MIAMI BEA CH Pursuant to City Code section 2-22(4) a , band c : Members of Agencies , Boards , and Committees shall be affilia ted with the city. This requirement shall be fulfilled in the following ways: a . Resident of the City for a minimum of six (6) months: • I am resident of: Middle Bea ch Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "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. Or c . Full -time employee of such a business (for a min imum 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 417th vo te 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 th e Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abili t ies, knowledge and exper ience. Please list below: I am a CPA who handles many healthcare clients and have served on this Board many years and have an enormous amount of institutional Knowledge about the functioning of this board . i think i am uniquely qualified to serve on this board . I love helping my city!!! • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felony : No If yes , please explain in detail : • Do you c urren tl y have a viola tion (s) of Ci ty of Miami Beach codes: No If yes , please explain in detail: • Do you cu rrently owe the City of M iami Beach any money: No If yes , please explain in detail: • Are you currently serving on any City Boards or Committees: No If yes , which board? 316 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Position Mt. Sinai Medical Center B oundation General Boa rd Member • List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property my home -4565 north ba y road my Mom's Apartmen t 5660 Collins Avenue • Are you now employed by the City of Miam i Beach: If so , which department and title? • Pursuant to C ity Code Section 2-25 (b): Do you have a parent, spouse , c hild , brother, or sister who is employed by the City of Miami Bea ch? If "Yes", identify person(s) and department(s): No relative's information submitted . NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE , BU T ARE NOT LIMITED TO: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from co ntracting with the city (Miami-Dade County Code section 2-11 .1 ). No o Prohi bition 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 ce rta i n 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. Toda y , 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 bodie s of state and local governmental agencies or authorities . o Voting conflict -Form BB is for use by any person serving at the co unty, 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 pre sented with a voting conflict of interest under Sec t ion 112.3143 . Florida Statutes . 317 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 o f the C ity of Miam i Beach , includ ing those of a purely advisory nature, are requ ired 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 Beac h , 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 In come T ax Return . Fa ilure to file one of these forms, pursuant to the Mi ami-Dade County Code , may subject the perso n 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 Rnancial Interests (Form 1) with the Miami-Dade Cou nty Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 w ith the County Supervisor of E lections automatically satisfy the County's financial d isclosure requi rement as a Miami Beach City Board/Committee member and need not file an addit ional form w ith the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requ irement. DIVERSITY STATISTICS REPORT The following information is voluntary and has no bearing on your considerati on for appointment. It is being asked to comply with City diversity reporting requirements. Gender: Race/Ethnic Categories What is your race? M ale White Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispan ic/ Latino. No Other Description: No details provid ed Physically Challenged : 318 Board and Comm ittee Application Checkl ist: Please ensure you have provided all information before applyin g or reapplying to any Board and Committee . YES I have answered all questions fully . ::====: YES I have uploaded a current resume , photograph , and a copy of any applicable professional license . YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES I ha ve completed and attached the Diversity Statistics Report. If you ha ve any questions, please contact the Office of the City Clerk v ia email : BC@miamibeac hfl .gov or telephone : 305 .673 . 7 411 Note : Florida Statutes 119.071: Th e role of the Office of the Ci ty C lerk is to receive and maintain fo rms fi led as public reco rds . If your home add ress, telephone numbers , an d/or photograph are exempt from disclosure and you do not wish your home address , telephone numbers, and/or photograph to be made publi c, please: 1) Use your office or other address for your ma iling address; 2) Use you r office or ot her telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Arthur Unger agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 319 SPECIAL TIES FIRPTA Transactions Closely Held Busi n esses Health Care Hospitality CREOENTIAL5/EOUCATION Certified Public Accountant (CPA) Certified Acceptance Agent (CAA) University of Miami: BBA, Accounting AFFILIATIONS American Institute of Certified Public Accountants Florida Institute of Certified Public Accountants Medical Group Management Association Business Network International Success Link Chapte r M iami Beach Chamber of Commerce: Life Trustee; Pillar M ember City of M iami Beach: Audit Comm ittee; Healt hcare Facilities Advisory Board Chairman Miami Jewish Health Sys t ems: Audit Committee Chairman; Seasons Hospice Boa r d Chairman; Executive Board; P.A.C.E .; Quality Rev iew Board Mount Sinai Medical Center Foundation: Execut ive Boa rd Member; Pledge Review Committee Chairman; Pl anned Giving Committee; Legacy Ci rcl e 7isNERAMP ~ Arthur Unger is a M anaging Directo r with over 40 years of experience. He provides individual, partnership and corporate tax services with specialized expertise in Foreign Investment in Real Property Tax Act (F IRPTA) transactions. Artie ha s particular experience in serving cl ie nts in the health care, hospi t ality, restaurant and profess io nal se rvices i ndustries. He also counsels close ly held businesses in a range of area s such as structuring (proposed and exis t ing busine sses ), financing alternatives and credit management, forecasting and finan ci al modeling, profitability analyses , and asset maxim izat ion. De voted t o the betterment of his co mmunity, Artie invests countless hours to civic involvemen t . EisnerAmper LLP l r •r ll~ 320 • Dr. Martin N. Zaiac 321 THIS PAGE INTENTIONALLY LEFT BLANK 322 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME : Zaiac Martin N -----------------------------------------------Last Name First Name Middle Initial HOME ADDRESS : 4308 Alton Road , Suite 750 Apt No. PHONE : 3055884869 Home Home No./Street 3055324478 Work Business Name : Greater Mia mi Skin & laser Center Address: 4308 Alton Rd, Suite 750 Street Miami Beach City FL drmartyz@aol.com Po sition: Med ica l Doctor, Dir ector Miami Beach FL City State Email Address S tate 33140 Zip Code 33140 Zi p Code Pursuant to City Code sec tion 2-22(4) a and b : Members of agenci es, boards, and committees shall be affiliated with the ci ty; this requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a mi nimum of six months; orb) an individual shall demonstrate ownership/i nterest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months No • Demonstrate an ownership/interest in a business i n Miami Beach for a m inimum of six (6) months: No • Are you a reqistered voter in Miami Beach: No • (P lease ci.fci.e one): I am now a resident of: Middle Beach • I am applyinq for an appoint ment because I have special abilities, knowledqe and expe rience. Please list below: I was born and raised in Miami Beach, and leave strong ties. I am not a board certified Medical Doctor known in the community, • Are you presentl y a reg istered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking (1) first choice (2) second choice , and (3) third choice. Please note t hat only t hree (3) cho ices will be observed by the C jty Clerk's Offi c e . (Regular Boards of City) Choice 1: Choice 2: Choice 3: Health Advisory Committee Health F acilities Authori ty Board * 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 ______________ _ Li cense Nu mber License Issuance Date ________________ _ License Expi ration Date Note: If applying for Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1 . Past service on the Youth Center Advisory Board: No Years of Servic e : -------------------- 2 . Present participation in Youth Center activities by your children .;..;Nc::o __ _ 1f yes, please list the names of your children , their ages, and which programs. Li s t below: 323 E rror: Su breport could not be shown. • Have you eve r been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: No • Do you currently owe the City of M1am1 Beach any money: No • Are you currentl y serving on any C ity Boards or Committees: No • What organizations 1n the City of Miami Beach do you currently hold membership in? Error: Subreport could no t be sh own . • I am now employed by the city of Miami Beach : No Which department? If yes, please explain in detail : If yes, please explain in detail : If yes, which boa rd? • List all properties owned or have an interest 1n , which are located within the City of Miami B each: Error: Subreport could not be shown. ll':teottcu~rt co uld not be sh ow n. The follo w i ng information is v oluntary and i s n either part of yo ur application nor has any b earing o n y o ur con s ideration for appointment. It is being asked to comply with f ederal equal opportun ity repo rting require ments. Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Other Other Description : Are you Spanish/Hispanic/ La tino? Mark the "No" box if not Spanish / Hispanic / Latino. Yes Physically Challen!'.jed : N o 324 NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee me mbers. The se laws Include, but are not limited to, the following: G 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 2-1 1 1 ). o Pro hibition from lobbying before board/co mmittee you have served on for penod of one year after leaving office (M iami Beach Code secti on 2-26). '-' Requ irement to disclose certain financial intere sts and gifts (Miami-Dade County Code section 2-11 .1 ). (re : CMB Community Development Advisory Committee): proh1b1tlon , during tenure and for one year after leaving office , from having any interest in or receiving any benefit from Community Development Block Grant funds fo r either yourself, or those with whom you have business or immediate family ties (CFR 570.611 ). Upon r equest, copies of these l aws may be obtained from the City Clerk. "I hereby attest to the accuracy and truthfulness of the app licat ion and have received , rea d and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Martin Zaiac agreed to the following terms on 10/17/2019 2:27:48 PM Received in the City Clerl<'s Office by· N ame of Deputy Clerk Control No . Date 325 Da te: Wo rk Adwess: Date & P la ce o f Birth: Licen se, Flori da: Board Certifications: E ducation & Academic Training: Curriculum Vitae Martin Neal Zaiac, M.D. September, 2019 Greater l\Ii ami Skin and La ser Center 4308 Alton Road, Swte 7 50 ~ami Beach, Flonda 33 14-0 September 11 , 1959 l\Iiami Be ach, F lorida US,\ ME0052008 Board Certifi ed in De rmatology, 1993 Diplomat National Board of ;\Iedical Examiners, 1986 Board Certifi ed ,\mencan Society for :\!ohs Surgery, 1997 Medical College of Wisconsin Sc hool o f :viedmne, l'v Wwau.ke e, Wisconsin M.D. Degree 9/1984 to 5/19 86 U nive rsidad Central de) Canbe Sch ool o f i\ledicine Puerto Rico 8 /1982 to 7 /1984 University of ;\liarru :\Iiami, Florida Post Bachelor P rogram m 131ology 9/198110 5/1982 U nive rsity of ;\..uami i\.uarru, Flonda Ba chelo r of Science Degree Major: Biology .\Iinor: Chemmry 9/1978 to 5/1981 Unive rsity o f Pennsylvarua College College o f .\rts and Sci ence Phil ad elphi a, P.\ 9 /1977 10 5/1978 326 Post Graduate P ositions: 03 /2019 -Present 08/2015-Pre se nt 04 /2015 -Present 02/2012-Present 02/2012-P rescnt 02/20 10-Presenc 02 /20 10 -Present 02 /2010-Present 1/2000 to Present 9 / 1994 to P resent 7 / 1997 10 Presen t 7/199 1 to 7/1995 9 I 1995 to Present 1/199 1 10 Presen t Martin . Za iac. M.D . 2 Pro fe ssor o f D ermatology Florida International Unive r sity He rbert Wertheim College o f ;\Ied.icinc Co-Director Hollywood Dermatology & Cosmetic Surgery Spe ciali sts Cosmetic Fell owship Hollywood, FL Me dical Staff Larlun Hospital i\<!iami, FL Me dic al Staff Miam1 J ewish Health Sys tems 1 Iiam1, FL Chair o f D e rmato logy Florida International University Herbert We rtheim Coll ege o f Medicine Me dica l Staff Memonal H ealth Ca re System Me di c al Staff Jackson H ea Ith System Me di cal Staff Uruverstty o f ;\liami Hospital Chief of Dermatology Mowit Sinai ~led.ical Cen te r ~liami Beach , Fl. 33140 Progn.m Direc to r ;\(ount S1n:11 ;\Iedical Center, Department of Dermatology ;\liami Be ach , FL Clinical In stru cto r (Vo lunteer Fa c ulty) Dermatology and Cutaneous S urgery University of ;\liami Sc hool of ;\[edicine ;\fi ami, FL C linical Ins tructor (Volunteer Faculty) Barry Uni versity Sch ool o f G raduate ~ledical Sciences Pediatric ;\(edicine and Surgery \Iiami, FL Privat e Practice (Firs t paid e mploym e nr) G r eater M1am1 Slun and Laser Cente r Curr icu lum Vitae 327 1/1990 to 12/ 1990 I / 1988 to 12/ 1989 7/1986 to 6/1987 Other Active Associatio n s Pr o fess io nal Organizatio ns: Mart in N. Zaiac . M.D. J ;\fount Sinai ,\{edical Cente r .\liami Beach, FL Chief Resid e nt Department o f Dermatology Mount Sinai Medical Center ,\liami Beach, FL Dermato logy Resid ent Department o f Dermatology ,\fount Sinai ;\ledical Center :Vli arru Beach, FL Interns hip In ternal Medicine Medical College of Wi sconsin and .-\ffiliated Hos pitals .\Wwa ukee, WI Bo ard Membe r !\liarru Beach Health .-\d vi so ry Commmee Allergan, USA Inc. Consultant Dermato logy Cons ulting Nova rti s an d Glaxo Wellcome Pharmaceuticals Jo urn al Skin Appe nd age Disord e rs Editor ial Board , 201 5 De rmato logy Consulting JSDI N,S.A. ► :\m erican .-\cademy of Dermatology ► :\mcrican Medical • \ssociation ► C uban-,\me rican Society of Dermatology ► American Society for La ser :\fedicine an d Surgery ► Colegio Ibero-Latinoamericano de Dermatologia (C IL\D) ► Counctl for N ail Disorders, Board ,\!ember - Sec reta ry /T reasu rer 2002-2004 ► ► ► 2nd Vice Presiden t /2004 -2006 p, Vice President 2006 -2008 President Counctl fo r ·atl D isorders/Past President Fo undation fo r l nternaoonal Educatio n (FIDE) ,\[e m ber o f D irectors. l-lorida Soaery of De rmato logy ,\liami D e rm atologic Society Sec reta ry /Treasurer 1998 -199 9 Dermatological the Board of C urriculum Vitae 328 Invited Presentations /Ora l Platform: Martin N. Za iac , M.D. 4 President 1999-prescnt ► ~Iiami Society fo r Dermatology & Cutaneous Surgery ► Flonda Medical ,\ssociauon ► Dade county i\lec!Jcal .\ssoc1atton ► American Society for Mohs Surgtry ► The Meso . \meocan Academy of Cosmetic Surgery ► The North ,\mcn can ,\ca<lemy of Cosmettc & Restorative Surgery ► E uropean Nail Society ► C:osmettc Dennatolog1c Surgery ► 141h International sc1enttfic congress of esthettcs and cosmetology Speaker Chemical Peeling Lecture Sao Paulo, Brazil September 7-1 Q•h, 20 I 9 ► Healthcare Convenaoo & Exlubitors .-\ssociation (H CE,-\) HCP Pane l Speaker Hi..lton Downtown ~Iiaou, FL .-\ugust 20th , 2019 ► .-\estheacs 2019 Conference Speake r New Dellu, lnc!Ja .\ugust 9 I l'\2019 ► Cool Sculpting Uruversity ParttClpant Reston , \'.\ July 31•1 -,\ug 2nd, 20 19 ► Foamix Phannaccu t1cals FX2016-40 Investigator :\feenng Sofitcl Magruficent :\file Chicago, Illin ois July \91h -2 1", 2019 ► 24th World Congress of Dermatology \Wan 2019 Speaker Mysterious black dots .\-Wan J une 10th -\Sih, 2019 ► Evolus Produce Launch The Ritz-Carlt on Cancun Cancun, Q.R., .\leXJco May 3r<1 .sm, 2019 ► Dermatology to the Stars Curric ul u m Vitae --------------------------------------------·--- 329 Martin . Zaiac, M.D. Cos m etics Speaker How to drop that fat without diet Uruve rsity o f .\liami .\lia mi, Florida .-\pril 15-17, 2019 ► \1 Stmposio lntemac1onal de Dermatologia CLC m Desafios en D e rmatologia Speaker :\Iodulo Medicma lntema, Inmunologia y P1d La s Condes, San tiago, Chile ,\pnl 12-13, 2019 ► XVl !I Riunione : Giomatc 01 Terap1a in Derm ovenereologia Speaker Cosmetic Pearls Catania, February 3-4, 20 18 ► 4th International Summ it on Nail Di sea ses Speaker ai l disorders and syste mic diseases Athens, Greece Ju ne 23 -25 , 2017 ► X In ternational Dermatologic Gal i lei Symposium Speak er ew front ie rs in the injection filler panorama 1" Ga lil ei Sy mposi um Award to Martin N. Za iac, MD Pisa, Ital y June 15 -16, 2017 ► Hair & Nail and Ant i-Aging Speaker Disc uss your patient with the expe rt ln tralesional steroids how and where to inje c t Capri , It aly May 19-20, 20 I 7 ► 21s t .\rnrnal Scientific ;\lee tin g of the Couru;1l for Natl D isorders Presentauon: I low to in1ect ste roids, Q&.\ and Remarks .\larch 2017 ► 75th .-\nnual .-\me ri can .\cademy of Dcrma1ology ,\nnual .\leeung Speaker Hands-on Nail Surgery :\larch 3 "1. 2017 ► 20th .-\nnual .\leering of th~ Council fo r Nail Disorders, Co-C hair lntroducn o n -Whal I 11tw on {'.;<JJ/ P1ona111 Systtmati.-T reatmt11tJ Washmgto n , DC March 3,d, 20 16 ► Hair and N ail and .-\nti-.\gin g. Corso Pra tico 5 Curriculum Vitae 330 Mart in N. Zaiac, M.D. Speaker : Tips for nail surgery & . \es the tic p rocedures to mc rease lip volume. Premio "Aphrodite" 10 th Edition to .\lartin N . Zaiac, MD for hi s efforts to improve the aging of women b y Dermatology Science Capn, Italy. May 6-7, 2016. ► 74 th .-\nnual .\mencan .-\cademy of Dermatology Annual ;\(eeting Speaker H ands-on Natl Surgery Washington, DC ;\(arch 4 -Sth , 2016 ► l la1t & Natl and . \ nu-. \ging Speaker Tips for natl surgery • \es the tic procedures ro mc rease lip volume Capri ;I.lay 6-7, 20 I 6 ► XVII R.iunione:Giornate Di Terapia m Dennovenerco logia "Lessons fr o m anato my: how to opturuze the use of hyaluro nic acid injection fo r skin rejuvcnaoon" Catarua, 30-31 January 2016 ',, 2015 ~Wan Dermatologic ~(eeung Speaker "BTX Pearls" :'\lilano, I mly October 16. 2015 ► I lair & Nail and \n u -. \grng Speaker T ips for natl and hair surgery Botox: how young should we start? Capri, Italy \fay 8-9, 2015 ► 19th .\nnu:tl Sc1enufi c \lccung-Counctl For :--:atl Disorders Speake r :\[,mikcrs \Vh ats t h e future' San Francisco, C. \ March 19th , 2015 ► 73nl .\..\D .\nnual ;\,feeung Speaker Ingrown natls San f'ranc,s co, C. \ March 20-24 , 2015 ► XXl Con grcsso .-\rgen ono De Der matologia Presente r 6 :\Ii expenenc1a en re1uvenecuruento facial La C na: apre n die ndo de los casos climcos Perlase en dermato logia cosmetica .\(endoza, .\rgenona .-\ugust 28-3 1, 20 14 Curr icu lu m Vitae 331 Martin N. Zai ac, M.D. 7 ► ► ► ► ► ► ► X1 Internation al Dermatologic GaWe1 Symposium On Psoriasis, .-\cne & Cosmeac Dermatology Pisa, Italy June 26-27, 2014 Hau & Natl a nd .-\nti -.-\gmg-Cour se Speaker May 9-10, 201 4 .-\mencan ,-\cademy of Dermatology 72nd .-\nnual ~[eetmg Denve r , Co March 21-25, 2014 Corso Practico Programa, Hau and Natl and .-\nu- ,\gmg. Speaker: Ten Surgical Tips and Top u ps to be Tip Top in skin rei uve nation, Capri, Italy. ~fay 10-11 , 20 13. ,-\merican .-\cadem y o f Dermatology Summer ;\,leeting Spe,iker New Developmenr,; ,n Nail Fold C:ap ill aro,cnp y New York, NY J u ly 31 " to ,\ugust .J rh, 2013 71 . \nnual ~lccung Dermatology: Speaker: and :-.lanagement .\men can .-\cademy of .-\typical Wow1d Diagnosis :-.liami Beach, Fl Ma rc h O 1, 2013. 71 .-\nn ual :-.reeting .-\mcncan .\cademy of Dermato logy: Speaker : Electronic Health R ecord (EHR) Physician Demonstration ~ltami Beach, Fl ~larch 1-5, 2013. 17 th ,-\nnual Scientific :-.Iecang Coun cil for Nail Disorders. Speaker: Systerruc Disease. ;\.[iami Beach, 1-1 February 28, 2013. ► .-\merica n Osteopathic CoUcgc of Dermatology. Pracace Based .\lcdicine-Pearls. \~'inter Pa rk , Colorado Janua ry 23-26, 20 13 . ► \'II l n ternaaonal Dermatologtc GaWe1 Symposium on Psori asis and Cosmeac Dermatology, U niversity o f Pisa, and C niversity of ~liarru on Perioral and Lower Face Reiuvenauo n Pisa, Italy . June 15 -16,2012 ► Corso Praaco Programa, Hair and !',;ail and .\ntt - .-\ging. Speake r : Botox, Skin Tigh tening, P iller corso avanzato, C apri, Italy. ;\lay 11 -12, 2012. ► 9 Cong reso Europeo de :--redictna Estetica. X.,'{,.II Congr eso de la Soc1edad Espanola de ;\.lcdicma Estetica. Speaker: Tratarruento de Telagiectasias y Lestones P1grnentadas. .-\pltcac1on de la To:una Botuliruca en e l CucUo. :--ladn d, Spain February 23-25,2012 C urriculum Vitae 332 Martin N. Zaiac, M.D. 8 ► 19 th Congresso C1en t1fico lnternaao na l de Estenca, Speake r on ~liami Peel. Tratamiento Med.tco-Estenco da ll.1p erp1gmentacao. Sao Paulo, Brazil ,-\ugust 4-7, 2011. ► \'I Inte rnational Dermatologic GaWe.1 Sy mposium Psoriasi e Dermatologta Cosmetica, Uruversita d, Pis a, Uruver si ta di .\lia m..t -Speaker on Orucopana Pso riasica: Diagnos1 e Terap1a. Pisa, Italy July 1-2, 2011 ► XX!\' Simpos10 lnternaaonal de De rmato logia, :\ctualizacion en Desordenes Pigmentarios, Patologta U ngueal )' Del Pelo. San nago, Clule. June 10-11, 201 1. ► .-\merican .-\cademy o f Dermatology - Speak e r Chnica l Cases & Role of Biologics in P soria11 c 1'-ia il Dise ase. New Orleans, L-\. February 201 1 ► 1" International Summ..tt fo r ::--:ai l D isease :\thens, G reece. July 20 10 ► Hair & '.',;ail and _-\nti-_ \ging Capn, Italy .. -\prtl, 20 10 ► .-\mencan .\cademy o f Dermatology - Speaker .\!Jam..t Beach, Flonda . .\larch, 2010. ► Cow1cil for :--;ail Disorders, 14th . \nnual .\Ie e ting .\Ciam..t Beac h, Flo rida . .\larch, 2010. ► Soc1edad Centroamencana-Canbe de Dermatologia XVII Congreso .\fanagua, '\iica ragua . :--;ovember 2009. ► Escuela de Dermatologia Hospital Uruv e rs itano Del \'alle "Evaristo Garcia" IX S1mpos.10 de .-\ctualizaci6n e n Terapia Dermatologica Colombia. J une 12-14, 2009. ► .-\OC D .\!i dyear .\.leet.tng and Sc1ent1fic Sem.tnar Steamboat Sheraton Resort & Conference Center. Colorado. January 2 1-24 , 2009 ► III Corso I n ternazionale lI1 Dermocosmerologia- Uruve rsi ta di .\!iam..t, Italia. September 15 & 16, 2008 ► 21 ·• World Congress o f Dermatology, Buenos .-\ires, .-\rgentina, September 301h, 2007 ► Reuruon . \cadem.1ca .\liarru-.\Iexico September 6-8, 2007 .. -\capulco, .\[e:,oco ► )(\'I Jornadas de .-\ctualizacio nes Terapeu acas Dermaro logicas y E ste11ca s, 1:3uenos .-\ires, .\rgc nuna . .\larch 30-3 I , 2007 ► 65th .-\nnual .\le eung Scienufic Program .\meric an Curriculum Vitae 333 Manin N. Zaiac, M.D. 9 :\cade m y of Dermatology, Waslungton DC. rcbruary 2-6, 2007 ► XLII Reunio n .\nnual Sociedad Venezolana de De r matologia y Cirugia Dcrmatol6gica -Ve nezuela November 16-18 2006 ► XXVI Congreso Colomb1ano De Dcrmatologia Ca rtagena Colombia November 2 5, 2006 11 -06 ► Fi rst lntcrnac1onal Course on Cosmeoc Dermaiology -Uruve rsity of Pisa -L:nivers1ty of :\liarru, Pisa, Italy September 9-10, 2006 ► \'T Co n greso _-\vances en Ci rugia Dcrmatologica, Jalisco, :-.Ie x.1co _-\ugust 23 26, 2006 ► XV 1II Congreso Brasile.iro de C =grgia Dermatologica Sao Jose do Rio P rc to, 13 razd 2006. June 3 -7, 2006 ► XV J o rnadas de .\ctualizacio n cs Tc ra pcu ricas D e rmatol6gicas y Esteticas Bue nos ,-\ires, .\ rgen nna .\pril 2 1-22, 2006 ► Practic al Course of Dermato logy, Bologna, Italy, :\larch 25, 2006 ► 64th .-\nnual :'\(eeting .\merican .\cadcmy o f Dermatology, San Francisco, C.\ :\larch 6, 2006 ► x.'\'l CIL\D Congreso lbero-Laonoameacano de Dermatologia, Cartagena, Colombta 'ovem ber 16 -20, 2005 ► Segundo Congreso Naz1onale L:ruficaro di Derm atologia c \'enereo logia, Genoa, Italy June 8, 2005 ► .\.merica n .-\ca d emy o f Dermatology 63m .\nnual ;\Ieeting, ;\iew Orleans, L \ February 18, 2005 ► 13th Congress o f the E u ropea n . \cadem y of De rmatology and \'en creology Venice, Italy ::--.ove m ber 17-2 1, 2004 ► \'ll C urso lnternac1onaJ Teonco-P ra coco Peel.J.ngs, Tecrucas De Rell eno, Re1uvene cuniento Fac ial y Co rpo ral Jalisco, :0-lex.ico .. \ugust I 9 -21, 2004 ► .\.men can .\cademy of Dermatology .\cadem y '04 1':ew York J uly 29, 2004 ► 2004 Flonda Society of Dermatology and De rmatologic Surgery , O rlando, Flonda June 24-27, 2004 Curric ulum Vitae 334 Manin N. Z a iac, M .D. ► XV Congreso lbe n o -Latino-.-\me ricano de Dermatologia, Buenos .\ires, .-\rgentlna October 2 1-23, 2003 ► Xl Congresso Cienufico lnternac10nal de Estetica, R..10 de J anruo, Brasil .-\ugust 7 -10, 2003 ► World Congress m Cosmeoc Surgery of the .\!S. \.. \CS, San Salvador, El Salvado r, C.\. .\lay 1-3 , 2003 ► Sunpos10 In1e rnaz1o nal e E \V,\L-\ 2003 Pisa, Ita ly. ~[ay 21, 2003 ► Jornadas de .-\crualizacio nes Terapeuticas De rmatologicas y F.steocas Buenos .\.ires , :\rgent1na . .\!arch 14 , 15 , 2003 ► .-\mencan. \cademy of Dermatology Forum Director for Febnrnry, 2002 ► Congreso de la Soc1edad .\leXJcana de C:1rugia Dermatologica y O ncologica, .-\.C. Guadala jara, J alisco Mexico l'<ov. 28 Dec. 2, 2001 ► 3er Jornanda lnternac1onal de Es reuca \lontevideo, Uniguay 200 1 ► Primer Congreso I ntc rnac io na l de C liruca Esretica Buenos . \ires, Republica .-\rgenona .\lay 6 -9, 2001 ► Reuruon Inrernaaooal de Terapeuuca Dermatologic a Bue nos .-\ires, Repub!Jca . \rgentina ► So Congreso Cienrifico lote rnac io na_l De 1 :steoca Sao Paulo, B ra zil Septembe r 1-4 , 2000 ► \'I Reunion lntcrnac1o n al <le Terapeuocas Dermatol6gicas l' Estcocas C aracas, \ · cnezucla July 15, 2000 ► lnrernaoonal Society of Dermatology .\filan, Italy -Regional .\le ering July 6, 2000 ► Sede: ,-\.sociac16 n .\led.t ea .-\rgenun a I J o rnada s .-\.rgen tinas de lnestenas mos 1:ac1ales y Corporalc s . \pril 24 and 25, 2000 ► Sociedad Venezolana de Cirugia Plastica y Rccons rnic ti va Caraca ~, \"en ezuda 10 Curr icu lum Vitae 335 Martin N . Zaiac, M .D . 11 :\larch 28, 2000 ► Sociedad Venezolana de Deanatologia Congreso .-\n ua l Cara c as, Ve n e zuela November 11 -14, 1999 ► 4th • \.nnuaI Climca l i\lee ting .-\meocan Society for ;\!OHS Surgery Dermatologic Surgery: .-\ Panorarruc \'1ew Las Vegas, Nevada October 14 -17, 1999 ► V Reunion ln 1ernac1onal De Terapeutica Dcrmatologica ;\lonterrey, .\fcXJc o J uly 22-24, 1999 ► World :'.ledical O rganizati ons I '' I nternanonal Dermatophytosis Conference and Worksh op Sh o rt I Wl s, New Jersey June 11 , 1999 ► 1"' y 2do Taller .\socia cion Colom b1ana de Dermato logia & C1rUgia Dermatologica Buca ramanga, Colombia ~la>· 6-8, 1999 ► L'( Jomadas De acrualizac1011es Terapeuticas Dermatologicas y Esteucas Buenos .-\ires, .-\rgen tina . \pril 16-18, 1999 ► The First World Congress o f th e :--.lcso .\m e rican . \cademy o f Cosmeac Surgery Sa n Salvador, El Sal vador October I 1, 1998 ► !e r C urso Peeling, .\cne, v :\[elasma Guatemala C ity, Guatemala September I I -12, 1998 ► II ;\[eeung Internacio na l de Dc rm atologia Qwnirg1ca Estctica Buenos .\u es, .-\rgenana 14,1 5 y 16 de .\gosro De 1997 ► Centro Dermatologic o Pascua, S.S .. \. Jomada Dermatologica LX .\mversano ;\(elUCO C ity, :--.IelUco 1-3 De :\layo, 1997 ► Rcwuon .\nual De De rmatologos Latino .\mencanos D el Con o Su r 1977 (R .. \.D.L..-\. X\111) Sanaago, C lule "Laser s My Experience " :\lay 17 20, 1997 ► .\me n can .\cademy o f D erma1o logy, Curric ulum Vitae 336 M artin . Z aiac, M .D . 12 .-\nnual Me etmg. San F ran c isco , C .-\ i\larc h 21 -2 6, 1997 ► XX Con grcso Centroameri cano de Dermato logia I \' C ongrcso N ac1o nal de D e rma tologia D o c t or h,inc1sco Jose Gome z U rc uyo, In '.\lemo nan. i\lan agua, l\i 1c aragua, C..-\. Septe m ber 1996 ► .\men can .-\c adem y o f D ermatology _ \nnual i\lcct:1ng. Wash.ingto n , D .C. f-ebruary. 1996 ► IX Congreso Cen troamericano d e D e rmatolo gia. San Salva dor , El Sal vador Se pte mber, 1994 ► .-\mencan .-\cadc m y o f D e rma to logy .-\nnual i\l eeting. W a s h.ing to n , D.C. Fe b rua ry, 1996 ► .-\men c an .\cademy o f D e rmatology .-\nnual i\leetmg N ew O rl e ans, L \ D ecember, 1995 ► .-\me a can .\cademy o f Derma ro logr .-\nnual ;\[ce ting Washingto n, D .C. ► P o s ter E xhibit: "Dmal Subungal Onych omycosis 1s a n .\u tosomal Domin ant D1 st:a st:" Dt:cem bcr , 1994 ► X"\1II Congreso Centroame ricano de Dermatologia. Tequiagal pa, H o nduras Septe mbe r , 1994 ► .-\m cric an . \caclt:m y o f Der matology .-\nnua l '.\leetmg San F ra ncisco, C.-\. December , 1992 ► Segundo Re uru6 n de la Soc1ed ad d e D c rm a tologia d e l La Re p u b li c a D o rrunic a . Sa nto Donungo, D omican Re public Scpte mbt:r 1992 ► :--.:atio n al '.\leetmg o ! .-\me ri can Oste o pathic .-\ssocia uon . N ew O rle ans, I _-\ Novem ber , 19 9 1 ► G re ate r :\liarru Pediatric Socie ty . .\.u ami, FL Decem b e r, 1990 C urricu lum V itae 337 Study Re fe re nces I. Glaxo Pha rmaceutica l, Tinea Pedis, 1990 . ► l'-.liarru Dctmatologtc Society .\lonthly l'-.leeting . i\liarru, FL October, 1990 ► Cuban Medical Convention .\nnual l'-.lecting. ~lia mi, FL ► ">Jew Dimensions tn Dermatology Lasers" Septem ber, 1990 ► . \me rican .-\cademy of Dermatology .-\nnual ;\leen.ng San F rancisco, C.-\ November 1989 ► Sou th ern ;\lcchca l . \ssocrntion . \nnual ;\leering Washing to n , D.C. October, 1989 ► '.\lia mi Dermatologic SoLiety .\[onthly .\leering l'-.liami, FL O ctober, 1989 ► Temple Beth David Seruors Group ;\lia mi, FL 1989 ► Temple Beth El .\liami, FL 1989 ► .-\merican .-\cad cmy of Dermatology .-\nnual ;\leeting Washington, D .C. Decem ber, 1988 ► El Salvador 2002 Shanng wi th the Experrs 2 San Salvado r, El Salvador, C..\ . . -\pril 2002 2. G lax o Pha rma ceuti cal, Ti n ea Corpo ri s/Ti nea Cruri s, 1990-1 990. 3. Bris tol-M ye rs. Impetigo, 1992. 4 . Sa ndo z Pharma q uest, T inea Cru ri s, 1992-1993. 5. Sa nd oz Phannaque st , Ti nea Pedi s (Moccas in -Type), I 992 -I 993 . 6. Sa nd oz Pharmaquest, Tinea Pedis lnt erd igital, 1992-1993 . 7. Sa ndoz Pharmaque st, ormal Skin {Absorption), 1993 . Mart in N. Zaiac, M.D. 13 Curr ic ulum Vitae 338 8. Sandoz. Pharmaquest, Onychomycosis, 1993 . 9. Penederm, Inc., Onychomycosis, 1992 . I 0. Hoffman LaRoche, Tinea Ped is. 1990-1993 . 11. Schering-Plough , Atopic Derma t itis, I 995-1996. 12. Novart is Consumer, Tinea Ped is lnte rdigi tal , 2000. Protocol 11 -PT00-00 I 13. Ferndale Laboratories, Pain Reduction, 2000. Protocol 00-005 14. Galderma. Mel as ma, 2003-2004 15. Pharmanet, Acti nic Kerat osis, 2005 -Pr otoco l 1502-IMIQ 16. 3M, Mollusc um Contagiosum 2004-2005 -Protocol 1494 -IMI Q 17 . DU SA, Act inic Ch ei litis 2005-Present 18. Amgen, Pso riasis Ease by Omnicare Clin ica l Research, Inc. 2004-2005 19 . Ga ldcrma, th e More Trial, Acne, 2005-Present 20 . Genetech , Psoriasis Respon se, 2005-Presen t 21. Am gen, Psoriasis Educate , 2004-2005 22. Protoco l Number : KC706-C08-A Phase 2 Open-Label Uncontrolled Pilot Study of KC706 in Patients with Sta bl e, Active Pem phig us Vulgaris. 23. A Phase II Study Of Oral LBH 589 In Adult Patients Wit h Refractory Cu tan eous T-Cell Lymph oma. 24 . A Phase II Study of Oral LBH589 in Adult Patients with Refractory C utane ous T-Cell Lymphoma and Prior HOA C Inhi bi tor Therapy . 25. A Mult icen ter, Open-labe l Study to Assess the Efficacy and Safety of lnllix imab (REMI CADE®) Therapy in Patients Wi th Plaq ue Pso riasis Who Had an Inadeq uate Response to Etanercep t (EN BREL®) 26. T he Safety and Efficacy of lnll ix imab (Remicade®) for the Treatment o f Hidradeniti s Suppurativa 27 . Protocol CO I 68Z03 : A Mult icenter, Open Registry of Patients with Plaqu e Psoriasis Who Are Ca ndida tes fo r Sy stemic Therapy Inclu din g Bi ologic s (Ce ntocor, Inc.) 28. Phase III : A Phase 3, Multi centcr, Randomized , Do uble-Blind, Place bo-Control led Study Com parin g the Safety and Efficacy of Two Dos ing Reg imen s of AB T-874 to Pla cebo in Subjects wi th Mode rate to Severe Chr onic Plaque Psoriasis 29. Phas e 11IB : Open la bel Study of Adalimumab in Subjects Who Have a Sub opt imal Re s ponse to Systemic Therapy or Phototherap y 30 . The Sa fety and Efficacy of Etane rcept (Enbrel®) fo r th e T reatment of Disco id Lupus Erythematous 14 Curriculum Vitae 339 3 I. U0267-30 I: A Multicenter, Rand omized, Double-Blind, Phase 3 Study of the Safety and Efficacy of Emulsion Formulation Calci potriene Foam, 0 .005%, versus Vehicle Foam in Su bj ects with Plaq ue-type Psor iasis 32 . Stiefel W0027-IO -A Phase 2, Randomized , Doub le-Blind, Placebo-Co ntrolled , Parall e l-Group, Dose- Ran ging Study to In vestigate th e Efficacy and Safety o f 4 Dose Reg ime ns of O ra l Albaco na zole in Subjects with Distal Sub un ga l Onycho mycosi s 33. MediQuest Therapeutics, Inc.-Phase I IB Efficacy and Safety Study of Four Topical Gel Formulations o f An ti-Fu ngal Age nt s, MQX -5 858 , MQX-5859 , MQX-5866 and MQX -5867, Versus Vehicle in the Treatment ofTinea Unguium 2005 -2007 33. .-\mgen-Observational Pat -.\larketing Safety Su rveillance Registry of Enbrel (etanercept) for the T reatment of Psonasis (O BS l·.R \'E-5) 2008-20 18 34. Edge Systems dba the hydrafaaal company-.\ 12 -week, mulucenter, open label study assessing efficacy and safety of H yd rafacial clanfymg treatment fo r acne, Protocoal# 20 180756, .\lay 291h, 2019-Present 35. Sweet Hope Resea rch facility -Foam.Lx, July 201 9-Prescnt Publicatio n s 7.aiac .\IN, G regg P.-\: C utaneous .\(ycobacte rium 1Ginsasii in an .\IDS Patient. Submitted for publication. Beal .\!, Hudson B, Za1ac .\fN· .-\moxicillin-Induced Psyc hosis, .-\mencan Journal of Psyc hi atry, 1986; 14 3 :2 p . 255- 256. He rbst JS, Raffanu S, Pathy .-\, Za1ac .\(1'.: Dysgoruc fermenter-type 2 septicemia with purpura fulnunans: Dermatologtc features of a zoonos1s acquired from household pets. . \rchtves of Dermatology, October 1989; 125: 1380-1382. Zruas N., Zaiac .\[N, .\.lc..""O s J., Rebell G ., Battlstuu F., Gomez-Ur cuyo F .: Tbe Black Dot . .-\ U nique Cluucal s ign seen o nly IJ1 a lmuted number of Derma to logic disease s. Posrer publication . \tla n ta, G .-\., December I 989. Zaia c .\(!\;, Glick BP; The Polyfoam Brush in C hemical P eeling Proced ures. J Dermatol Su rg O n eal; vol 20; pg 553, 1994. Z aias N, Tosti.\., Rebell G, Z aiac .\l>i; .\utosomal Dominant Pattern of Distal Subungal Onychomycos ts Ca u sed by Tnchophyton rubrum. J.-\ .. -\.D., February 1996, volume 34, num 2. Zaiac .\l).i, Glic k BP, Z rua s ~; Chevron Nail. J .. \ .. \.D . .\fay 1998; 38:773 . Zruac ,\l).i, Weiss E, Elgart G; Botuhnum ToXlrl Therapy for Palmar llyperlud ros1s with .\DG ::--:eedle. Dermatol Su rg 2000;26:230 Zaias l'-i, Rebell G, Za1ac .\l).i: G li ck R: O n yc homycosis Trcaccd unul the ~ail Is Replaced by ::--.:or mal Growth or There is Failu re .. \rch Dermato l, \'ol. 136,J uly 2000. Zaiac ~I, Rebell, G:. \ large -sca le North :\me o c an study of fungal isolates fr o m nails: The fre q uen cy o f o n yc h o m ycosis, fungal distribution, and antifungal su sceptib ility patterns. J :\m .\cad Dermatol, \' o l. 43, Number 4 ; pgs 64 1-648 Zaiac, .\!: Probabilities o f Self Diagnosmg l'ungus on the Skin -T in ea Corpon s. Cu ti s . .\lay 2001, \' ol. 67, pgs 3 1-32. Za1ac, .\lN, Daniel , R: Commo n :-.;atl Conditions. Current P ra ctices o f .\(edic me 2000, \'ol. 3 , :s;o. 3, pgs. 1 .7. Za1ac, ,\IN, Weiss, E : .\[ohs .\ltc rograph1c Surgery of the ~ail t..:mt and Squamous Cell Carcinoma. Dermatol Surg \"ol. 27, ;s;o. 3 .\larch 200 1, pgs. 246-251. Manin N. Zaiac, M.D. 15 Curr icu lum Vitae 340 Zaiac, .\IN, Barba .\RNP: D iseases o f the Natl. Ra kel and Bope: Conn's C urrent Therapy 2002. W.B. Saunder s Com pany. Pgs. 794 -7 98. LL Zaulyanov, Z aiac MN : Surgical Pearl: .\ Novel Tech nique For Repai r of Broken Runrung C u taneous Sutures: J am . \cad Dermato l 2006; 55:693-4. Pg. 693-694. Patel R, I lalem :'-1, Z aia c .\IN: The Combined use o f Forced Cold .-\u and Topical .\nes thctic Cream fo r .\nalgesia Dunn g the T r eatment o f Palmar l-l yperhydrosis with Botuhnum T OXIC Injections: J o f Drugs tn Dermato logy, Ocrober 2009; 8: page 948-951 7.a tac .\IN: The Role of B1ological .\gents in the T rearmen r of Nail Pson a s1s .. \men can Jou rnal of D e rmatology, 2010 Suppl. 1 \' olurne 11, p. 27 •28. Htrara SH, Yamanda S, Enok.ih ara .\IY, 01 C hiacduo N, Augusro de .\lme1da F, Enok1hara .\l .\l, .\l.tchalany NS, Zaiac M, Tosti ,-\. Pat te rns o f Natl ;\lat rix and Bed o f Longi tudinal .\[elanonychia by lntraoperative Dermatoscopy: J am .-\c a d Derm atol April 20 1 1. Serg1op Henrique Hiralll, PhD, Sergio Yamada, .\ill, :\lauro YosluakJ Enokihara, PhD, ~ilton D 1 Cluaccluo, :\ill, PhD, Ferna n do .\ugusto de . \lm e1da, PhD, :\Wvia .\[ma S.S. Enokihara, PhD, Nilceo Schwery .\lichalany, .\ill, .\larcin N . Zaiac, ?\,ill, and .\n ton e lla Tosti, ;\ill Patterns of Nail Mau Lx and Bed o f Longi tudinal .\[elanonych1a by lntraope ra tive D e rmatoscop y: Journal of the .-\m e n can .-\c adem y of Dermatology .. \ugust 2011. .\lanya .\l.iteva, :\ill; Debora Cadore de Farias, MD; .\larun N. Za1ac, .\ID; P aolo Romanelly, .\ID; .\ntonella Tosu, .\ID; N ail Clipping Diagnosis of O n ychomamcoma, .-\rdu ves of Dermatology, September 2011. \"ol 147 :--:o. 9 Zaiac, .\-[N an d Clement .\: Treatment of .\ctinic Chewus by Ph o to d yn am1 c T herap y with 5 .-\m1n o levuhru c .\c1d an d Blue Light .\ctivaaon : Journal o f Drugs in Derm atology QDD), November 10, 2011. Publicati o n s Continue d Chen .-\F, C himento S.\l, HC S, Sanc hez ,\I, Zamc .\I, Tosti .-\.: ::--.irul Damage from gel polish m anrcure. J Cosmer Oerma to l. 20 12 .\Car; 11(1):27.9. D01 : 10.11 1/1.14 73 2164 2001.00595 x . .\larun N. Zaiac, .\l.D; an d .\ntoneUa Tos ti, :'-1.D : Commentary on th e New Concept in Reconstructio n afte r Nail Unit Excis io n fo r .\[elano ma In Siru . Oermatologic Surgery, .-\pril 2012. Pg 695. :'-1.ttcva .\!, Frana P.\, Romanelli P, Z a1a c .\1, Toso.\.: O n ychopapilloma presenung as longitudinal mclanonyclua. J .\m .-\cad Dermatol. 2012Jun; 66(6):e242.1 D01: 10.10 16/J.1 aad.2001 0 7.022. '.\[a run N. Zaiac, .\.l.D, Sluno Bay. \gutlera, DO, Lari ss a Zaulya nov-Scanlan, ,\ID , Caroline Caperton, .\.10 , BS, .\-!S PI [, and S tacy C himento, '.\ID: \'irtuaUy Painless Local .\nest hes1a: D tl u ted L d uca111e Proves tu be Supenor to Bu ffered I .idocaine fo r Subcutaneous l n fi h ra 11on. J OO Online, October 20 12. Jddonline.com e39 .\la run N . Za1ac, :\ID;. \ndrea Fedencu Chen , '.\ID ; and C h nstoph er Sp ock, .\ill: La ser Treatment of Psunasis, v1uligu and alopecia areara. De rrnatologic S u rgery S tep by S tep . C h apter 4 6 , Pgs 337. 201 2 . .\Camn N . Za1ac, .\ID; Jordana f lersch thal, .\ID; .\l.ich ael P. :\lcLeod, :\ill; .'.\Janagemenr o f C ngual Wart s. Dermatologic Therapy \'olume 25 Pages 54 5-550. Novembe r /D ecember 20 12 \·1o eUo :'-1, Tos u .\, .\buch ar .\, Z a1a c .\!, K erdel F.\. Us te kJn u m ab fo r the treatme n t o f m1crocys ac ly mphatic m alfo rrn a a o n s Qv mphangioma cu:cum scnption): a systematic review. ln t j Dermatology. 20 13; 52: 358-62 Chacon .-\H, Shiman .\II, Strozie r N, Zrua c :\C\i. Hoozo ntal runn111g ma mess suture m o dified with intermment sunple loops J cu tan .\csthet Surg. 20 13 Jan Martin N . Zaiac , M .D. 16 Curriculu m Vitae ----------. ----------------' 341 D t C hiacchio ND, de Farias D C, Piracci.ni 8?\I, Hirata S H , Richert 8, Z aiac ;\I, Daniel R, F ana P ,-\, .-\nd rc J , Ruben BS , Fleck m an P , Ri ch P , H aneke E, C ha ng P, Chent J D , Sche r R, Tosa ,-\.: C o n sens us o n m elanonych1 a natl p la ce de anoscop y .. \n b ra s D e rma col. 20 13 :'\la r -.-\pr Sav as J.-\, Ledon J, F ra nca K, Chacon .-\, Z a1ac :\I, Noun K Ca rbon dtoXJ de la se r fo r the trea tmen t of nucrocysuc lym p h aoc malformao ons Qymphangiom a CL rcwnscnpoo n ): a systematic review. Dermato l Su rg . 20 13 .-\ug Z a1ac :-..CN , Walke r ,-\.: N ail abno rm a littes associated wi th sys temic pathologies: Cl imes 1.11 D ermatology. Septe m be r 20 13 . 31, Pg. 627 -649 Ru ssell KJ , Lee .\[D, Sa leeby ER, Weiss ET , Zaia c ;\[l\i_ ; Does debu lklng using curettage affect the p rese n ce of fl o a ters?: T h e J ournal of D e rma to logic Surge ry . ;\larch 20 14 . Z aJ as, N ardo & Del Ri o , Eve & H er man, Jamie & N . 7.a1ac, ;\fartin & Flo rez-\Vhi te, Mer cedes & J ungcha roensu kying, P lo ypailin & Escova r, Sandra. (2014). Bo tulinum to XJ.11 and the poste rio r ra rni syndrome : The r elie f o f d e rmato m al sensory maru fe s tauons and other p 31.11 ful con d1t1o ns .. -\1339 .-\8 39. Journal o f the .-\meric an .-\c ademy o f D e rmato logy . \'olume:70 . ;\fay, 20 14 . J u s tin Ru b m , DO' K ha sha T ouleoi, DO, T r acey Favrea u, DO, .\fart.in Za.tac , \.ID, Shi.n o Bay, D O F.-\OCD .; ,\[ohs Surgery in Patients wi th lmmunobull ous Disea se s:S hould P r edru sone be Increased Pno r to Surgery?: "Ibe Journal o f Clm1ca l and .-\esthett c Dermatology . .\larch 2 0 14 . Pg. 4 5. Za.ta c :\[l\i, N o r ton E S, Tos ti .\.; ·11ie "s ub manne hatch" n atl bed biopsy.: Journal o f the .\menc an .-\cademy o f Dermato lo gy, \'ol. 70, Issu e 6, el 27-e l 28.June 20 14 Za1a c :\N, Bloom R, :-..Io rnson BW, Tos u .-\.; The fi gur e 8: a new ha u biopsy cec hruque .: J o urnal o f th e .\rne n ca n .-\c a demy of Dermatology. \·01. 71, Issue 5, e201 :-;ovem ber, 20 14 Weis s , J o n a th an & ::---:. Zatac, :'\larun. (20 15). Bes t W ay t o Remove a S u bung u al Tum o r . De rm aro log1c C li m es. 33 . 10.10 16/j.de t 20 1-U2.010 . Kallt s P ., ;\ln e va :\I., Patel T , Z aia c \.I., T osti .-\., O nyc h o m atncom a wi th Concomitant S u b ungual G lo m us Tumor : Skin ,-\p pendage D is order s . V o l. I , ~o. l , February , 20 15 .\da m T ag li ero B.S.l, Peter D'.\mo re B.S.1, So na ] C h o udhary2 ;\l.D. am! ;\Ja run N eal Zaiacl , :-.1.D.; l'rogre;sively wqr senmg hyp e rsensi tivi ty reaction to local anes thes ia . Dermarologtc Su rgery, \.fa rc h 20 1 5. D S-00 142 -20 I 5 Z :ua c, ;\lartin & Ton gdee, E mil y & Porges , Leeor & T o ul o e 1, Kh as ha & Prod an ovic h, Srd1an . (2015) .. -\nes th euc Bliste r l nducoon to l denafy Biopsy Site Pno r to ;-,[o h s S urg e ry. J ournal o f d rugs m derm a to logy: J DD. 14. -1<1 6 +P. :si. Z a1as , S X E scovar, :\I. \1 Z a1ac.; F mge r and toe.n a tl o n ycho lys1s. J. o f the E uropean .-\cad emy o f D ermato logy and \' enero logy. \.la y, 2015 :-.:. Z a.ta s, S.X . E scovar, ;-,IS Z a tac , E. Del Rio,~ D o u , C Ri com , L. K am, a nd :\I. Flo rez -\~'h.it e; HYPO 1'YC I [IU;\I .-\B>iOR...\L-\LITI E S Congenital .-\be rrant I [yp o n ychium v s .. \c qlllred P terygiwn lnversum U ngUJs vs .. -\c q U1red Reversible Extended Hypo n yc luum : a p roposed class1 fi cau o n b ased o n o ngin, patho logy and outco me; J of the Europea n :\c ad em y o f Der m atology and \'e ne ro logy. \'olume 29, Issue 7 , Pages 14 27 -1 431, July 20 1 5. \' rot sos E , Dosal J , 7..aia c ;\I, .-\le x.is J.; P1ty n as1s rosea like c utaneou s e rup oon as the presenttng srm p tom of H odglun lymphom a. Ca se re po rt and review o f rhe l.t te ran1re. J Dermato logy Sep te m ber 30, 2015. Tos o .-\, Schne ide r S L, Ramuez-Q wzon ;\N , Z aiac :\I, :'\!iteva H ; C:liru cal , dermosco pic , a n d pa tho logic features o f o n yc h o p apdlo m a: ,-\ r eview of 47 cases. J .-\.-\D. Oct o ber 20 15. Ker del F , Zaia c :\I; . \n evo luoo n 1.11 switc htng the ra py fo r psonas1s pa u ents who fail to m ee t trea tme n t g o al s. Dermatologic Therapy. \"ol. 00, Novem ber , 2015. N Za1ac, :\larun & :'\llac ker, Stepharue & Sha h , \'1dlu & Sunmo n s, Bo an . (2016). C luucal Pearl: The Sq ueeze ;\laneuver. C utis. 97 . 202;20 4 . T osu , .\.ntonella & >i. Za.tac, ;\faran & Canazza, .-\gne se & Sanclus-Gomar, F abian & P are1a -Galean o , H cl10 s & .\lts, Ra fae l & Lu cia .. -\le1an dro & Em anuele, Enzo (2016). T o p te al app l.tc aoon o f the W n t/~-cate ntn acnvato r m ethyl M artin N . Z a iac, M.D . 17 C urricu lum V itae 342 varullate 1n creases hair count and hair mass index in women With androgeneac alope □a. Journal of Cosmeac Dennatology. 15. 10 .1111 /iocd.12225. Brian J Simmo ns, Jennifer .\. Baker, Martin Zaiac, Jeong Hee C ho-Vega, ,\nto n eUa Tosti; Subungual Keratoacanthoma 1n a Paaenr With Ye llow Nail Syndrome. Dermatologic Surgery ;'\[ay 6, 2016. Epub. Zaiac, ;\Iartm & Daoud, .\lexander & Lawrence, Katharine & Prado, Giselle & :-.liller, Nancunac & Garces Narvaez, Sofia & Recme, i\foruca. (20 I 6). Enhanc1ng the annsepnc properties of non steril e disposable gloves: .-\ p rospective randomJZed p il ot study o f a novel sterilization technique for dennatologtc surgery. Journal of the .\merican .\cademy ofDennatology. 74. 1262-1264 . l 0.1016/j.Jaad.20 15.12.025. Za1ac, ;'\lartin & Shah, V1d hi & :\Ilac ker, Stcpharue & ~ Bray, Fleta & .\lsaidan, :\Iohammed. (2016). Local anesthesia 1njection technique for aesthcac removal of dermal nevt. Journal of cosmetic dermatology. 15. I 0.11 11 /jocd.12240. ;\lart1n Neal 7.aiac, M.O., Peter D'.\more, 13 .S., .\dam Tagilero, B.S .: Pr ogressively Worserung H ypersensmvity Reacuon to Bup1vacame. Journal of Dermarologtc Surgery, 2016 . . \mber, Kyle & Bloom, Ronu & Yazdani .\byan eh, ;\lohammad-.\li & .\. Falto-.\Jzpurua, Lcyre & Viera, :\lartha & N. 7.aiac, :'.l laran & >loun, Kcyvan & Hu, Shasa . (2016). Patient Factors and The1.r .\ssoc1auon with ~onmelanoma Skin C ancer ;\lorb1ch ty and th e Performance of Self-skin Exams: .\ Cross-Sectional Srudy. The Journal of C linical and .\esthetic Dermatology. 9. 16 -22. J. l',;1chols, .\nna & Bosshardt Hughes, Olivta & Canazza, .\gnese & ~-Zaiac, :'1-lartin. (201 7) .. \n Open-Label Evaluator Blinded Study of the Efficacy and Safety of a New N utnao nal Supplement U1 .\ndrogeneac Alopec1a: .\ Pilot Srudy. J ournal of Clinica l and .\esthenc Dermarology. 10. 52-56. Snyder, .\lyso11 & \. Sducchnt, Rachel & -"· L a1ac .. \larw1. (:!(JI-). :'.l[elasma \ssoc1ared ,Vllh Topical Estrogen C ream . Journal o f C"liiucal ~nd \csthet1c D e rmar o logy . 10 . s--58. :'.lltchael B. Lipp, DO; .\li-x Ro~~n. :\IO; .\lamn '-.. i'.,n:tc. :\ID; D1g11al Pho to mappmg (DP:\[) 111 :\[ohs. Prnrncal Derrrnir ology.Junc 201- :--;ardo Zaias, .\I D, l'loypailin Jungcharoensukymg, :\CD; Sandra Escovar, :,..m,; ;\[arnn Za1ac, '.\ID; Uneven flat feet and closed shoes produce roe natl clirucal changes that mimic aU rypes of o nychomycos1s. J. \. \0, J unc 2017. Ghoneun, Sara & 7.a iac, ;\[aran. (2017). The L.:sc of lntrales1onal Steroids l!l a C ase o f Locahzed Pemplugus Foliaceus. Case Reports m Dermatology. 9. 9 1-97. 10 .1 !59/000477959. Pona, .\dnan & ~-Zaiac, :'-larun. (20 17). The tcnang techruque: .\ novel filler techruyue l!l the danger zones. Journal of the .\mencan .\cademy of Dermatology. I 0.10 16/ J.Ja ad.20 17.09 070. Praveen G Ichculla, ,\ID, :'.llarun I',; Za.1ac, .\10, :--.:ardo Z aias, ;\ID, Francisco.\. Kerdel, :'.\ID, Deruse Guevara, D O ; The effects of botulin um 1oxu1 .\ and glycopyrrolate polytherapy m refractory hey's srndrome. Journal of Dennatological Treatment, December 20 17. Jordan Rosen BS, Kathenne !'sio lan :-.IO, Noah Shaikh BS, Les Rosen :'.\IO, ;\[artin Z aiac .\ID; Coex1sang Basal Cell Carcmoma and Squamous Cell Carcinoma U1 Congerutal 1'-ievus Sebaceous. The Journal of C utaneous medic ine. :'.\lay 2018 \'olume 2 I ss ue 1. Ocampo-Garza J, Bretas J;'\l, :-.latana D, Sobral PJ, Thompson CT, Za1ac :--.1 , Toso.\. Longtruchnal ,\lelanonychia Biopsy: What >iot to Do. J Drugs Denna to!. 2018 ;\lay 1,1 7(5):587 -588. ,\la run ~-Zaiac, \m, Jorge Ocampo-Gana, ,\[D. '.\lodified Tangenual E xcision of the ~atl :'.llatrix. Y'.\I]D J.·\. \O- D -18-00473 .. \ugust, 20 18. ;\lartin 1',; Z aiac, .\ID, Des m oplasac '.\lclan oma .\nsmg after 1,064 nm q-S,vttched :--:d: T.\G Laser of a Susp ected Solar Lenttgo, Case Reporrs in Dcrmatolog1cal ;\lechcine, vol. 20 I 9 .. \rttcle ID 39076 7 1, 3 pages, 2019 .. \prtl. 20 I 9. Martin N. Zaiac. M.D. 18 Curriculu m Vitae 343 ;\fartin N . Zaiac, :\CD, Efficacy and Safety of a Novel Topical .\linocycline Foam for the Treatment of :\[oderate-to- Severe .\cne \'ulgaris: .\ Phase 3 Study, '\Ianuscript, Journal of .\merican .-\cademy of Dermatology OA..\D), \fay, 2019 Book Chapters Zaiac, .\[N: Biology of The Nails, in Harry's Cosmeticology, 8tl• Edition. Chemical Publishing Co., Inc . January 2000. J imenez-.\costa, Zaiac, ,\[N: Dermatology: Just The Facts: Hair and Nails Chapter 22. :,.kGraw-Hill :\fedical 2003 . Pgs. 309-325 . .\fartin N . Zaiac, ;\CD; Jordana Hcrschthal, '.\CD; :\lichael P. :\fcLeod, :\CD; '\!anagement of Li ngual Warts. Dermato logic Therapy Vo lume 25 Pages 545-550. November/December 2012 .\Cartin l\i . Zaiac, :\l.D; .\driana .\buchar, MD; ;\[ercedes Florez, ;\f.D : Complications of Photodynamic Therapy: Management ofComplicat10ns ofCosmeuc Procedures. C hapter 7, Pgs 65-72. 2012 . .\Cartin >I. Zaiac, Chantel .\marillo, and Claudia Leo n; >iail Psoriasis : From.\ to Z. Chapter 2, Pgs 9-13. 2014. Marun Zaiac, '\[.D., Gisele Prado, Sona! Choudhary; >lonsurgical Lip and Eye Rejuvenation Techniques: .\esthetic Proc edures for Increased Lip \'olume: I lyaluroruc .\cid 1:illers in Nonsu rgical Lip and E ye Rejuvenation T echruques. Pages 1 5-23 .. -\ugust 05-20 16. Martin Zaiac, :\LD., Ivan Camacho, .\LD. F.\...-\D, .-\lexander Daoud !3.S.; Nonsurgical Lip and E ye R e juvenation Techniques: Complications .\ssociatcd with Borulinum Toxin .-\drrunistration. Page s 107-115. 2016 .\larun :'J . Z aiac, ;\CD, Lucy C hen, .\ill, G1scllc Prado, BS . :\lela nonychias: Biopsy. C hapter 11 :\fay, 201 7. M art in N . Zaiac, M.D . 19 CUIT icu lum V itae 344 STATE OF FLORIOA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE UCENSENO COHT~OLNO 10/24/2017 The MEOtCAL DOCTOR named below hes met a.t recµremen1s of the flws and Nies of the $late al F~ Exp ra""1 Date JANUARY 31 , 20 20 MARTIN NEAL ZAIAC GREATER MIAMI Sl<,IN ANO LASER 001 Al TON ROAD SUITE 150 MIAMI BEACH. FL 33140 ME 52008 $87689 QUAllftCATION(S); OISPt:HSWCPltACTrTJOt,ll:ll _<_~F-?,.,,,,,,.,~Roci<;,,;S<>Ja~f-A.,.,ill!:,:...,-'~ Celeste ~pH GOVEA.NOR St,rge0n Genera and Secretary 0151'1.AY IF REOutREO BY LAW 345 346 • Nancy Liebman 347 THIS PAGE INTENTIONALLY LEFT BLANK 348 MIAJ\/\I BE.ACH ... AT Home Address 3o£-fe oy-V P CeUular Telephone aus;n4t City state Zip Code 114 No.f\l J eb {;, f!oL•E o11t Home Telephone Email address OmJpa1fl/: Business tf/44s /r//11- Zi(,Code Please list your preferences in order of ranking : (1) first choice , (2) second choice, and (3) third choice. Please note that onl y three (3) choices will be observed by the Office of the City Clerk. Affordable Housing Advisory Health Advisory Committee Normandy Shores Local Government Committee Neighborhood Improvement District Advisorv Council Animal \IVelfare Committee Health Faciliies Authority Board Parks and Recreational Faciities Board Art in Public Places Committee Hisoanic Affairs Committee Personnel Board Audi Commltee Historic Preservation Board * Plannina Board Black Affairs Advisory Committee Housina Authority Police/Citizens Relations Committee Board of Adjustment Human Riahts Committee Production lndustrv Council Budget Advisory Committee LGBTQ Advisory Committee Program for Publ ic Information Committee Committee for Quality Education in Marine & waterfront Protection Senior Affairs Committee Miami Beach Authority Committee on the Homeless Mayor's 41 st Street Committee Sustainability Committee Convention Center Advisory Board Mayor's General Obligation Bond Transportation, Parking, and Bicycle- Oversiaht Committee Pedestrian Facilities Committee Cultural Arts Council Mayor's Panel on Ocean Drive Vasitor and Convention Authority Desian Review Board Miami Beach Commission for \Nomen Youth Commission Disabilitv Access Committee Next Generation Council Note: If you are seeking appointment to a professional seat (e.g . attorney, architect, etc.), you must attach a copy of your curren effective corre ndi rofessional license. Page 1 of6 F :IClER\$AU.\BOARO NE CCMMITTIES DA TA8ASE\CHECKUST MASTER\BOARD Al'«> COMMITTEE APPLICATION.docx Updated: June 2020 349 Sec. 118-131. -Membership. The board of adjustment shall be composed of seven voting members. Two members shall be appointed as citizens at-large and five members shall be appointed from each of the following categories (no more than one per category), namely : Law, architecture, engineering , real estate development, certified public accounting, financial consultation and general business. The members representing the, professions of law, architecture, engineering and public accounting shall be duly licensed by the State of Florida; tt1e member representing general business stiall be of responsible· standing in the community; the member representing the field of financial consultation shall be a certified public accountant, chartered financial analyst, certified financial p lanner, a chartered financial consultant or investment advisor registered with the Securities and Exchange Commission , o r someone recognized as having similar credentials and duly licensed by the State of Florida. Members shall be appointed for a tern, of two years by a five-sevenths vote of the city commission. Members of the board must be either residents of or h ave their principal place of business in the city. (Ord. No . 89-2665, § 16-1 , eff. 10-1-89; Ord. No. 2004-3436, § 1, 3-17-04; Ord. No. 2007-3554, § 1, 4-11-07; Ord. No. 2012-3770, § 4 , 7-18-12) Updated 11 /03/2020 .,, 350 AFAUA 110N WITH THE CITY OF MIAMI BEACH 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 shatt be fulfilled in the following~: a. Resident of the City for a minimum of six months : Yes~ or IJJo • I am a resident or: South Beach D Middle Beach fil North Beach D Or b. Demonstrates an ownershi0 erest (for a minimum of six months) in a business established in the City (for a minimum of six months): Yes O or No "Ownership Interest" shall mean the ownership often 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 liab ility company, or other entity or business association. O r c. Fu.II-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): Yes Dor ClNo Notw;thstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4flth 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 sections 2-22 (4) a and b of the Miami Beach City Code by execufing an affidavit, stipulating that they have met either (or bot!J) ot said affiliation requirements. The original affidavit shall be filed w;tJJ the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abilities , knowledge, and experience. Please list below: ti!,,!112 y I~ ~e,s-~r vq tZ on L.i.n:d U5e.. 1ss. u P..,<; Eel... LA(' aho n -1; fem e ritr 'i S v h. oo / Tear /h e r J2.e s1Gn kJ 1a O'.J 1 0ecr.-d-:i C,ty Cam m1 7?1 oner . Page 2 of6 F:\Cl.ER\SALL\80ARD PHO CCMMITTIES OAT.ABASl:\CHECKUST MASlERIBOAAO AKJ CCMMITTEE APPUCATION.dccx Updated: June 2020 351 • Are you a registered active lobbyist with the City of Miami Beach? Yes O or No~ • Have you ever been convicted of a felony? Yes O or No ~f yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Be~ch Code? Yes □ or N¥if yes , please explain in detail: • Do you currently owe the City of Miami Beach money? Yes O or N~ yes, please explain in detail: on any City Board or Committee? Yes -fo G or No □ If yes , which Board/Committee? d 5 t,o a ~ • In what organization(s) in the City of Miami Beach do you currently hold membership? r:;. l +- t1 I f{ W1 J J)e.s,go Pce 5e v-vat-,o n .8 oa rd V,c c ves , e1 e-n t Name Position fi-1a n1{ T3e @ U n1 r ed focm ~v-Pre~1dc,n 1 Name Position • List the address of all properties owned or in which you have an interest within the City of Miami Beach: S(;,oo Co ff ms Rt e--/ 'l µ l~d Bij !t,Js land A 1-rµoJ;&.pCft)l lh~ He.lcn fjar:1/ 55?)5"eo1l ,ns ftve. · • Are you now employed by the City of Miami Beach? Yes Dor No ~ If so, which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a p.1rent 0 , spouse ~Id ~her D or sister 0 who is employed by the City of Miami Beach? Yes Dor No D If-Yes,· identify person(s) and department(s): _______________________ _ * 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 aJ'~r No □ If you answered "Yes," please indicate: rl: t+~len t:(a,,r Aparfrn -et115 Address J J.i.f cl ! Lo.kc_ fa /)coa sT t?,· From: l3ea J !; I L/o Dates Page 3 of6 F:\Cl.ERISAU.IBCWID ANO CCMMITTIES DA TABASE\CHECKUST MASTERIBOARD Al#:J CCNMITTEE APPUCA TION.docx ~ted: June 2020 To 352 NOTE: IF APPOINTED, YOU WIU 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 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 F lorida 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 authortties. o Voting conflict -Fonn 88 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 . I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED, READ ANO WIU ASIDE BY CHAPTER 2, ARTICLE VU, OF THE MIAMI BEACH CITY CODE, ENTlTLED "STANDARDS OF C UCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS ANO AU OTHER APPLICABLE CO ANO/OR STATE AND STATUlES ACCORDINGLY." jp ~ uebrn a!J Board and Committee Application Checklist: P lease ensure you have provided all infonnation before applying or reapp_)'ing to any Board and Committee g/1 have answered all questions fully. ~ have attached additional sheets, if necessary, to provide required infonnation. ✓,' have attached a current resume , photograph, and a copy of any applicable professional license. D I have co0'1)leted and attached the Board & Committee Financial Acknowledgement Statement. D I have completed and attached the Diversity Statistics Report. D Submit complete application package. Via Email: BC@m1amibeachfl gov Via U .S. Mail or in Person: City of Miami Beach Office of the City Clerk I Board and Corm,ittee Section 1700 Convention Center Drive, 111 Floor Miami Beach, FL 33139 If you have any questions, please contact the Office of the City Clerk via email: BC@m1am1beachfl gov or telephone: 305 .673.7411 . Note: Florida Statutes §119.071: The role of the Office of the City Clerit is to receive and mainta in 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. Page 4 of 6 F:\CLERISALLIBOARDANDCOMMITTIESOATABASE\CHEOOJSTMASlcR\BOARO~COMMITTEEAPPUCATION.docx Updated: June 2020 353 MIAMI BEACH City of Mia mi Beach 1700 Convention Center Drive M iami Beac h, Flo rido 33 139 www.miomibeochfl gov OFFICE OF THE CITY CLERK Ema il: BC@m1amibeachf1 .gov Tele phone: 305.673.7 411 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Last Name F~t Name Middle Initial 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 fonns 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;· ...01' Pro VI de d ~u.,.,/ lf; ~ 0 A.D 2. A ·statement of Financial Interests (Fonn 1)1 ;" or 3 . A Copy of your latest Federal Income Tax Return. Failure to file one of these fonns, pursuant to the Miami-Dade County Code, may subject the person to a fine of no more than $500, ys in j ail , or both. Date I 1 Members of the Pl anning 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 (Fonn 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 Fonn 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 fonn with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. Page 5 of6 F:\CLER\$AU.180ARO ANO CCMMITTIES OATASASE'.CHECKUST MASTER1llOARO NO CCMMITTEE APPUCATION.docx ~:June2020 354 MIAMI BEACH City of Miami Beach 1 700 Convenlton Center Drive Miami Beach F1orida 33139 www m1om1beachA gov OFF ICE OF THE CITY CL ERK Email: BC@m1am1beachfl gov Telephone : 305 .673.741 1 Last Name DIVERSITY STATISTICS REPORT ~~fY Middle Initial 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. Gender: rM:: 00ther 0 I prefer not to answer. Race/Ethnic Categories: What is your race? 0 African American/Bl ack Q ~n or Pacific Islander W'Caucasian/White 0 Native American/American Indian D Other -Print Race: ------------□ I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? Dves fil"'No 0 I prefer not to answer. Do you consider yourself Physically Disabled? efves 0No 0 I prefer not to answer this question. Page 6 of6 F:\CU:RISALLIBOARO ANO CCMMITTIES CATABASE\CHECKUST MASTERl80ARO AIO COMMITTEE APPUCAllON.docx Updated: Jooe 2020 355 NANCY LIEBMAN 16 ISLAND A VENUE MIAMI BEACH, FLORIDA 33139 (305) 538-0082 EDUCATION B.S. Education New Jersey State 1957 EMPLOYMENT Elementary School Teacher Depford Township, New Jersey 1957-59 Dade County Schools, Miami Florida 1959-1961 College Assistance Program Advisor Miami Beach Senior High 1983-87 Executive Director Miami Design Preservation League 1988-92 COMMUNITY EXPERIENCE Miami Beach City Commissioner elected November 2, 1993 Chairperson, Miami Beach Historic Preservation Board 1982-1993 Board of Directors Florida Trust for Historic Preservation 1990-Present Florida Advisor National Trust for Historic Preservation Appointed Oct-0ber, 1993 Chairperson, Governmental Affairs Miami Design Preservation League 1992-1993 Board Member 1979-1988 Member, Greater Miami Chamber of Commerce Hotel Development Task Force 1991 { , 356 Board Member, United Foundation for Aids 1993 Board Member, Area State Theater 1993 Board Member, Miami Beach Development Corporation 1982-1992 Trustee, Dade Heritage Trust 1994-Present President, Biscayne Elementary School PT A 1973-77 Youth Center Advisory Committee Member and Chairperson 1973-78 HONORS Woman of the Year Miami Beach Jaycees 1982-83 Founding C hairman's Award Miami Beach Development Corporation 1986 Dade CoWlty School Board Award For Commendable Contribution to Education 1974 City of Miami Beach Mayors Award 1988 Women Worth Knowing Miami Beach Commission on the Status of Women 1989 Miami Design Preservation League Chairpersons A ward 1993 357 """''' ...... ••O•"" ----·--~~~ -·~ J U •• f.'-"•J • ~••"-J ••t.t.VI!."-• •'-"V ARCIUTECTURAL AWARDIESS AWA1lD N ANCY LIEBMAN Q\JESTION n ~-t Nancy Liebman i.s n ot 1111 arcbitcd. · ~ designer oc developer. She is a sclt-t auglu political ~; a looa time COfflffl~ ':_ dcYOICd adl active moment toward mmnc a bcner quality commamiCy ill wllid1 we can all liw:. She is a ~ wbo raised tllree children in Miami Beach, and• pctSOQ wbo ldcfts bciag part of~ and pvmc>tmc 1111 Clr\Crgin1 aiviloament which speaks of ridl tnditiaQs. cuiaucs and COIIUDWlity soots. Sbc &ec.:ne ~ntcd wills cbc lss.s of bislaric prcse,vab,OI' beca:ase o f her activwn in the schools. libraries and pak systein of Mwni Bach. Years qo. ~ sk was 1be presiderd o f lite clcmcrcary school PTA. an historic JChool in Miami Beach was proposed for demolition. She joined with• amup of puenas to enlist the npport of a f.lcdsJiq pm vauon JIOUP, the Miami Desip l'Nw:.lllioo Lc:aam. Thie PlffldS wae orpnizilta to saw the 9Cbool bccausc its loss would bave cau,cd a disnlpooD to die lffendanrc boa-.daries for all of Miami Sc.:b's dwdral. The joitrt effort bdwc:aa the parea&s w the presa ~ ultimamy sawd the sdloo t -,L. SIie became hwol'ffd firm lbat time~ wi~ Lape and became absorbed with the wvlk of the pnsuvalion movanml lhrougboDt du c.wuby. Sbe is cuncndy • Florida Advisor to lhc NaJioml Tnast fm Ristaric Plaervation, and a boaid mCDlba of the FJorida Trust fcx-Hifloric Plcsa nrioa. This yar she chliD die flocida Trust's A111u1al Meault in Miami Beach. As ,-t of lhe local p1tsa ndoa mo¥aDICDI sbc bdped &o cnlipllCD the wand about tbe wonb of Miami Bach'• 20lh cm-,. tropal deco archiecdurc. She foa&sed on the Art°"° Dislrict u • napba,hood Wbich is rich in ltuma tca1t •~ wilh pr:dcsll'iad qu.alitics . Sbc used her a,mnulllity ladcnbia skills and bowlcdce of die polilics IO cducarc the politia! 1'ody abo\11 the iaupoctaDce C>f PICK1¥D11 Miami Beach's 20dt Century beacbfroet COJD11UUUty . Nanc,, wbo beca:me •Miami Beact City CQ1Nlrissioarr io 1993, 1w tidVOQled for ad successflllly estaMit!Mf · 1. A SfS'OIII msloric prcscrvalion board, wtliich she CMiled for cichl )al'S until her election to the City Commissioa.. 2. A dcsi,n m,iew board for the c ity, ~dl ~,-li6cml .-uddiaes to protcc:t the Na1iom1 1tegiuer Dillrict, • oac ~ mile area of Miami Beach. J . Local lqislalioft ro prOIICd U. NllbOl\ll ~ DiJ!ria from demolition or a1tcn&ioa. nis work took lb&ftcaa yeus 10 c:omplesc. The District was placed on die Naioaal Rqimr ill 1979. It was 1110( until 199211m the local p,otectiom \offrec:oanpleted. 4. The daiption of three new hiJtaric districb to prot«;t otbu bistoriQlly impot1IIOC ams of Miami 8eKh: die Jlaidillc Township Hisfaric District. the 0ceu Bach Historic DislrKt and th& A.hos Del Mar Sincle Family Home Dis1ria. 358 ~ent oy: w~~-~/Hi11iara ~oo 673 5352 09/0 5 /97 6:42 Job 873 Page 3 /4 s The public. impn,...cmir:at pl.am for Ocean Drive, Washinpn A"tllue and Lincoln Road. Lmcoln ~ was saved as• pede• iau mall nilliw thaD opmed to aa10dl0bilclrafrte. 6 A lcadin110k iD sa~ 1blt San To~ {or inclmion iD Miami's pcopo,cdfe,6-m,insAnsCcalCr. 7 . All effort co ICllhwas ~~arts in Miami Beacb's bistoric du1nct. The aru ba11C ldapti'rdy rwsed dac historic buildmp in dac ~CL The Alts were an imponw danalt iD Ck carty ~ ofMiami. Bcacb"s arthiw:ture.. \ 359 r Henrietta Harris Award from Dade Heritage Trust for Leadership in Historic Preservation Issues 1995 Women of Distinction Crohn's and Colitis Foundation of America 1995 NATIONAL TRUST FOR IDSTORIC PRESERVATION CONFERENCES: San Antonio, TX 1984 Baltimore, MD 1985 Seattle, WA 1986 Kansas City, MO 1987 Cincinnati, OH 1988 Philadelphia, PA 1989 Charleston, SC 1990 San Francisco, CA 1991 Miami. FL 1992 St. Louis, MI 1993 Bo&on, MA 1994 Fort Worth, TX 1995 Chicago, IL 1996 OTHER CONFERENCES: Mohonk.NY, Pittsburgh. PA, Raleigh, NC, Winter Park. FL Philadelphia, PA Denver, CO Cultural Tourism 1989 Planning for Preservation Managing Growth in Urban Areas 1990 National Trust Preservation Leadership Training 1991 ISTEA Legislation Planning for Livable Communities 1993 International Downtown Association Conference 1994 International Downtown Association -Conference 1995 SPEAKING ENGAGEMENTS Bo&on,MA Design Students League Harvard University "THE ART DECO DISTRICT" 1990 360 Charleston, SC Panel Participant: National Trust for Historic Preservation: METHODOLOGY TO STUDY THE ECONOMIC BENEFITS OF PRESERVING COMMUNITY CHARACTER-1990 San Francisco, CA Panel Participant: National Trust for Hisotric Preservation FINDINGS AND RECO:MMENDA TIONS : Miami, FL Natchitoches, LA Washington, DC Boston, MA Miami, FL Miami, FL PUBLICATIONS When Past Meets the Future 1991 National Trust for Historic Preservation Panel: "HISTORIC PRESERVATION IN MIAMI BEACH" 1992 National Trust Annual Conference Responsibilities: (Miami Conference 1992) local Miami advisory committee fundraising comrnitte Preservation Action Auction committee Mobile Workshop facilitator National Trust for Historic Preservation POLITICS OF PRESERVATION Preservation Leadership Training Institure Northwestern State University 1996 National Trust Regional Advisory Meeting Panel "SPEAKER POLmcs AND PRESERVATION" 1995 Society for Environmental Graphics "THE ART DECO DISTRICT" 1996 The Coconut Grove Villagers "SOUTH BEACH SUCCESS" 1996 Dade Green Coalition Metro Dade County/University of Miami "URBAN INFILL" 1997 "Three Strikes, You're Out" National Trust Forum Magazine, V o l. 9, Number4 Summer 1995 361 362 • David McKinney 363 THIS PAGE INTENTIONALLY LEFT BLANK 364 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _M_c_K_in_n_e_.y ________________ D--'-a_v--id ________________ ""'"D _____ _ Last Name First Name M iddl e Initial _10-'-2--'-0.;;..._M--e--r---'-id_ia--n----'--A_ve.;;..n_u"""e'""',--'-A...Jp;;..;t_4 __ 1...;;6 _______ --M--'-ia=m-'--'-i "-B..C..ea=c=h-'--------F....;;lo--ri...;;;d_;;,;a _______ 33_1_3_9 ___ _ Home Add ress City State Zip Code _1......_(2_0_2_._)_2_94_-_2_7_5 ____________________ daviddmckinney@yahoo.com Cellular Work Home Email Address Business Name: Occupation: Business Address City State Zip Code Please list your preferences in order of ranking [1] first choice [2] second choice , and [3] third choice. Please not e that o n ly three (3) c hoice s will be observed by the City C le rk's Office. (Regular Boards of City) Choice 1: H istoric Preservation Board Choice 2: Choice 3: 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. * 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 Yes year? 1020 Meridian Avenue , Apt 416 , Miami Bea ch FL 33139 , Since December 2015 365 AF FILIATION WITH THE CITY OF M IAMI BEACH Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies , Boards, and Committees shall be affiliated with the ci ty. This requirement shall be fulfilled in the following ways : a . Resident of the City for a minimum of six (6) months: • I am resident of: South Beach Or b. Demonstrate an ownership interest in a business established in the C ity for a minimum of six (6) months: ~ "Ownership Intere s t" shall mean the ownership of ten percent (10%) or more (in cluding the ownership of 10% or more of the outstanding capital stock) in a business. "Business" sha ll mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association . Or c. Fu ll-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 physi cally located in Miami Beach (for a minimum of six months): ~ Notwithstanding the requirements set forth herein , the qualified full-time employee of a business must be approved by a 417th 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 o f section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit. stipulating that they have met eith er (or both) of said affiliation requirements. Th e original affidavit shall be filled with the Office of the City Clerk prior to being s worn in as a member. • I am applying for an appointment because I have special ab il ities , knowledge and experience . Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? No • Ha ve 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 co des : If yes , please explain in deta il : • Do you cu rrently owe th e City of M iami B each any money : If yes , please explain in deta il : • Are you currently serving on any Ci ty Boards or Committees : If yes , which board? 366 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name MDPL Position Board Member • List the address of all properties owned or in which you have an i nterest within the Ci ty of Miami B each : Property 1020 Meridian Avenue, Apt 416, Miami Beach , FL 33139 • Are you now employed by the City of Miami Beach : If so , which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse , c hild , brother, or sister who is employed by the City of Miami Beach? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 (Mia mi Bea ch 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/com mittee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requirement to disclose certain financia l 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 bod ies 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. 367 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 Fin ancial Disclosure Requirements . One of the following forms must be filled with the City Clerk of Miami Beach , 1700 Convention Center Drive, Miami Bea ch, 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 r ;" 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 Fl orida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnan cial Interests (Form 1) with the M iami-Dade County Supervisor of Elections by 12:00 noon , July 1. Planning Board and Board of Adjustment members who file their Form 1 w ith the County Supervisor of Elections automatically sa tisfy the County's financial discl osure 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 . Gender: Race/Ethnic Categories What is your race? White Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino . No Other Description : No details provided Physically Challenged : 368 Board and Committee Application Checklist : Please ensure you have provided all in formation before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph, and a copy of any applicable professional license. I have comp leted and attached the Board & Committee Financial Acknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you ha ve any questions , please contact the Office of the City Cle rk via email : BC@mia mibeachfl .gov or telephone : 305.673. 7 411 Note: Florida Statutes 119 .071: Th e role of the Office of the City Clerk is to receive and ma in ta in forms filed as public records . If you r home addres s, telephone numbers, and/or photograph are exempt from d isclosure and you do not wish your home address, telephone numbers, and /or photograph to be made public , please : 1) Use your offi ce or other address for your mailing address ; 2) Use your office or o th er teleph one number for your contact number; and 3) Do not attach a photograph. 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 ACCORDINGLT. I Da vid McKinney agreed to the following terms on Re ceived in the City Clerk's Office by : Name of Deputy Clerk Control No . Date 369 Dav id D. McKinney, Ph.D. I 020 Me ridian Ave 416 Miami Beach, FL 33139 202 /294-2754 (Ce ll ) d avi ddmckin ney®yahoo .co m (E-ma il) Arc hitectural Historian a nd Retired Museum Director Educ ation Ph .D. 19 92 M .A. 19 4 A . B . 1979 Architectural Hi story Uoin t degree wi th Art History) Un iver. ity of Virgi nia Charl ottesvi lle. VA 22903 (Di ssert atio n Co mmittee: Rich ard Guy Wil son, Dora Wicbcnso n, C hri stop her Johns, Ra lph Cohen) Architectural Hi tory Uni vc r ·it y of Virginia Charlott esville, VA 22903 Hi s to ry Co ll ege o f Willi am a nd Ma ry Willi a ms burg. VA 231 85 Related Ed uc a ti o nal Ex pe ri ence Reade r, Brit i h Library , 1990. Res id e nt Scholar, Lewis Wa lpole Library, Yal e Un iv e rsity. 1989 (Di ssertatio n Research ) Library Science Progra m. Catholic Uni versi ty , 19 86. Attingham Progra m , 1988 (En g li sh Art, Arc hit ectu re. Hi storic Preservation, and Decorative A rt s) Vic torian Soci e ty e min ar in America, 1984 (Arch itecture, Histori c Preservatio n. and Dec orative Arts) Victorian Society Se min ar in Eng la nd , 19 82 (Arc h ite cture , Hi storic Preservati o n, a nd Decorati ve Arts ) St. Mary 's Coll ege, Uni vers ity of St. Andrews, 19 79-80 (Hi s tory and Di v inity) Fellowships a nd Scho lars hip s Dumas Malo ne Trave lin g Fellowshi p, 19 89-1990. Virg inia Mu seum of Fin e Arts Schol a rs hip. 1988. De wey Lee C urt is Fell owship (Ame ri ca n Decorati ve Arts Trust), 1988. Attingham Trave l Fellowship, 1988. Vi c to r ia n Soc ie ty Sc ho la rs hip , 19 82, 198 4 . 370 David D. McKinney . Ph .D. Governor's cholars hip . 19 8 1-1 983 . Scottish Rite Schol a rs hip , 1977-79. Work Experie nc e U.S. C ustoms and Border Protecti on 1300 Penn sy lva ni a Ave NW, Ma il Stop 1021 Wa hin g ton, DC 20229 Chief Hi stori an June 23, 2009 to March 30. 20 15 Page 2 of 8 Pages Administers C BP History Pro gra m. De ve lop s po lic y a nd procedures for th e Program. Ad v ises on the co ll ection of Heritage Assets. Serves as the age ncy a uthorit y on th e hi tory of U.S. Customs and Border Protection a nd its legacy age ncies. Supervises profess ional s taff co mpri se d o f Historic Pre serva tion Offi cer. Hi stor ian, and C urators . U.S. Departm ent of th e In terior (DOI ) I 849 C Street, W. MS 2266 Wa shin gton, DC 20 24 0 Chi e f. C ultura l Re ou rces Offi ce o f th e Sec re tary Ma rc h 5, 2006 to Jun e 22, 2009 Actin g Chief, Cultural Re sources April 18, 2005 , to March 5. 2006 Admini s ters th e depart ment al mu se um and library. Re prese nt s th e Office of the Secretary on th e DOI Hi stori c Asse ts Partne rship s and Interior Mu se um Property Committ ee. Federal Buildin g Curators Con ortium. See ks , initi ate , nurture , and main tai n productive partn er hips w ithin DOI. w ith oth er federal agencies, and with non-federa l in s t itution s and profess ion a l associa tion s to prov ide mutuall y-be ne fi cia l mu seum services. Engages in conti nuous contact and interaction with DOI burea u and o ffi ce head s, se ni o r exec uti ves and to p o ffi c ial s of oth e r gove rnment agenc ies, pro fe . sio nal associat ions and pri va te sec tor orga ni za tion s. De ve lops and execute th e budge t and fundin g requi rement s as th ey relate to th e impl e me ntat ion of muse um . lib rary, and othe r established and new initiative s. Eva lu ate s prop osa ls, makes recommendation in the selection o f contractors. supervi ses act iviti es and progress. and evaluates effectiveness. Directo r U.S. Department of In ter ior Museum Au gust 20. 2004 to April 17, 2005 371 Dav id D. McKinney. Ph.D. Page 3 o f 8 P ages Acting Direc tor U.S. Department of Int e ri or Museum December 5, 2003 to Augu t 20, 200➔ Develops and imp lements sho rt and lo ng-range plans and st rategies for museum exhibitions and interpretive program . Establishes the goals and objectives of exhibitions and programs. Directs the operations of mu seum collection management serv ices. Supervise , plan s. organizes, and coordinates the work of permanent a nd temporary staff of th e Interior Museum. Cond ucts research on co lle ctions or mu se um policies. Prepares briefing material s for recommending comprehensive strategic to DOI senior sta ff. Develop and administers mu seum budget. Ini tiate s. nurture s. and maintains produc tive partnerships wit hin DOI. with other federal agcncie , and w ith non -fe dera l in st ituti ons and professiona l associations to provide mutually-beneficial mu ·eum serv ices. Curator U.S. Department of Interior Mu seum March 23, 2003 December 5, 2003 Serves as cura tor for th e Office of the Secretary of the Interior. Conduc ts research on co ll ect ions. Coordinates an assessment of the furnis hin g in the Secretary 's perso nal office, develop conservation treatme nt plan, and coordinated the conservation of the I 8th and t 91h cen tury items on display in the Secretary's perso nal office. Develops policies for co ll ect ion s management for the Secre tary 's Office. Virginia Museum of Fin e Arts 2800 Grove A ve nue Ri c hm o nd .VA 2322 1 Direc tor, Office of Sta tewi de Partnerships ovember 1997 to March 2003 Re sponsibl e for the de ign of the tatewide outreach acti vities and their implementation throu g h a network of I 00 arts centers and mu eums , as well as 500 sc hools. Dir ect<; and manage s program operatio n. Represen ts the Museum before loca l and state admi ni st ra ti ve and e lec ted offic ia l . Estab lishes long-range strategies, goa ls, and object ives for the department. Fom,ulates and administers departm ental budget. Coordinates priv a te fu nd-raising wi th the Virgi ni a Mu eum Foundation. Write grant proposal s and admini ster gran t from pri vate foun dat ions and s tate and federa l governments. Es ta bli s hes and mai nt ai ns relationsh ips wi th art s centers, pub lic and private sc hools. and associated professional organi zations across Virgi ni a. Ove rsee all pub li cation s related to th e Office of tatewide Partner hip . Supervise coo rdin ator whose program areas pro vided all the serv ice offered on th e campus of the VM FA to localities th roug hout the s tat e: 372 David D. McK inney, P h.D. Page 4 of 8 Pages • Statew id e Exhi biti ons Progra m: Th is progra m deve lop , fa bri cated, and c ircul a te ex h ibiti ons rela tin g to th e visual a rt , socia l c ie nce . and hum aniti es. Also in cumb e nt in thi s pro gram is th e manag em e nt o f ex hibiti o n sto ra ge , conservati on a nd ca re of the co llec ti on, and preservation ini ti a ti ves re latin g to pa in t ing . work s on pa per. texti les. and thr ee-dime ns iona l work of art . • S tatew id e Pro g ram s: This area o ffe rs a broa d array of progra ms includin g S peakers on th e Art s . performin g arts. and Art i ·t Wo rks hops. • Tec hni ca l Ass i ta nce: Th i program ran ge fro m co nsu lt ation to ind ivid ua l orga ni za ti ons to a comp etiti ve grant pro gram a nd strn ctu re d wo rks hops. The techni cal as i ta nce progra m cove rs a ll as pects o f m u. eum o perations fro m faci liti es. coll ec ti ons manage me nt , conse rv ati on. and a rchi ves to int erpreta tio n, v i itor se rv ice s, and mark e tin g. • St atew id e Edu ca ti onal Outreach : Thi s pro gra m o ffe rs c lassroo m instrn cti on. in - erv ice tr ai nin g prog ram s, and tec hni ca l ass ista nce to 500 sc hools across Virg ini a. Thi s progra m prov ides o n-s ite progra ms to a ppro xim a te ly 36 sc hoo l di stri c ts a nnu a ll y. • Statew id e Edu ca ti onal Re our ces: Th is progra m prov id es ed ucatio nal medi a and reso urces th at cover wo rld c ulture. Mate rial s are d eve lo ped by the O ffice o f State wid e Pa rtn ership s or o bta in ed through co mmerc ia l sour ces. • Edu cat iona l Tec hn ology: Thi s progra m area admin is ters th e mu se um's websi te, a ud io tours fo r ex hibiti o ns, a mul t i-medi a laboratory, a nd th e c rea ti on of o n lin e exhibit io ns. Hum a n Reso ur ce Resea rch Orga ni zatio n 66 Ca na l Cent er Pla za Al exan dria, VA 2231 4 Se ni or ins tru c ti ona l Des igne r Full -tim e: Oc to be r 1995 to ovem bcr 1997 Deve lops and des ig ns e du ca ti on, tra inin g. and eva lu ati o n sys te ms. Works with edu ca tors. s ta keho ld e rs, a nd representati ves fr om re lated professio na l organ izatio ns to de te tm in e lea rnin g objectives, tra ini ng forn1at , an d approp ri a te delivery systems. Sup erv ises s ubj ec t matt e r expert s in th e writin g of mater ials. Deve lo ps grant s and co ntracts propo sal s, and admini stered g rant s and co ntract s aw ar ds. Ve ry S pec ia l Art /Edu ca t io na l Se rvices Wa shington , DC Direc tor of Prog ra m Develo pm e nt. 1992-1995 Ma nage r o f Progra m Deve lopm e nt , 199 1 Full -time: Oc to be r 199 1 to October 1995 Direc ts research, des ign. a nd dev elopm e nt of prog rams a nd se rv ices; ident i fi cd sources o f fundin g ; deve lops gra nt proposa ls; and provi ded techni ca l ass i ta nce in nat io nal imp le me nt ation of programs. Deve lop and ad m ini s ters budgets for 373 David D. McKi nney. Ph.D. Page 5 of 8 Pages programs. Rep resen ts th e organ ization at regio na l a nd na t iona l co n fe rences. Supe rvi ses staff, hi g h-l eve l co ns ult an ts, a nd up e rvi sed cons ul tan ts. Deve lo ps int ern al servi ces and progra ms to bu ild th e ca pac ity of state a ffili ates, in c ludin g a s pec ia l projec t grant program. fu nd -ra ising work shops a nd publi ca tions. and progra m evaluati on gui de I ine .. Uni ve rs it y o f Vir gin ia Li brary Cha rl otte vill e, V A 22903 Re earchc r/Refere nce Staff Part-ti me: A ugu t 1990 -Septembe r 199 1, Augu st 1987 -August 1989 Full-tim e: Au gust 198 4 -Au g us t 1987 Res pons ib ili t ies in c lud e long-t ern1 and short-te rm research projec ts fo r Un ive rsity depa rtm ents and facu lt y. Prov id es c lassroo m instruc ti on a t the grad uate and advanced und ergra d uate levels on bi bli ograp hic resou rce in th e humani t ies, fi ne arts . and socia l sci e nces. Co ndu c ts onlin e lit era tur e earc hin g fo r c lients. Pro v id es coll ec tio n deve lo pm ent in th e areas o f A meri can hi story and art for th e Re fere nce co ll ecti on. Serves o n library system-wid e co mmillee (Personne l a nd S tudent Employees). Profe siona l d evelo pm e nt in cl udes two three -m on th ro tati ons : • Specia l Co ll ec ti ons: T ra in ing in the fun ct ions o f th e ma nu sc rip ts, ra re books, and uni ve rs ity archi ves, includin g ca re and preservat ion of wo rk s o n pa per. Ind epe nd ent project fo r th i tra in ing progra m was th e p rod uctio n of an ex hi b iti o n u ing manu erip ts. pri nt , an d rare boo k from th e Sadl e ir-B lac k Coll ection of Goth ic ovels ti tled th e Imprin ts of Gloom th and a co m pa nion pub lication. • Gove rnm ent Doc um ent s: Spec ia li zed trai ning in th e fu nc ti o ns of a regio na l depos ito ry fo r state. fede ra l, a nd int ern ati ona l governm ent docume nts. In de pen dent projec t fo r th is tra in ing progra m was a g uide to art s and hum a niti es re ources in gove rn me nt docume nt s. As h Lawn/I I ig hl and -I lome of Pr es id e nt Ja me Mo nr oe Cha rl ott esvi ll e, V A 2290 I Archivist/ A sistant Curator Admini sters th e archi ves o f a hi to ri c-ho use mu eum. Deve lops long-term pre ervati o n prog ra m fo r the fa nn and buildin gs. Es ta bli s he co ll ec ti ons pl an for the mai n ho use . Develops gra nt p ro posa ls fo r local, state, fe deral, a nd pri va te e nti ties. Con s ultin g Work Am eri ca n Alli a nce of Mu se um s Wa hin gto n, DC Surveyo r M usc um Assessme nt Progra m Dates: :mo o to c urrent 374 Dav id D. McKfoncy , Ph.D. Page 6 of 8 Pages Reviews current museum operation by evaluating sel f-study re po rt s and cond ucting s ite v is its. Pro vid es gui dan ce to th e mu seum in identi fyi ng a nd address in g defic its. Areas of conce nt ra ti o ns: archives , coll ect ions, conservat io n, programm ing. visi tor acce. s , educational programs , and hL toric structures. Eval uato r Mu se um Accreditati o n Pro gram Dates : 2000 to current A scsses operati ons and admini s tration of mu se um to detennine if they meet accreditation stand ards. Make rec omm end a ti ons for accredit ati on to AAM s taff. Provides detailed reports, includin g g uidance to bring mu se um s into compliance wi th acc reditati on standa rd s. Selected Bibliography Feature Writer. Frontlin e Magazine. (2009 102015) .. A Symbol ofa ew Age : Th e Ari and Architecture of the Main Interior Building;· P eople Land and Wate r 2009 . Contribut o r. Abs olutis m a11d th e Scie ntific Revo/11tio11 1600 -1720 : A n Inte rdisciplinary Biog raphical Dic tio11a1y. We tpo11 , CT: Greenwood. 2003 . Cont ri buto r. Dictionary of H ano1 ·e rian England. Detroi t, MI : Garland, 1997 . .. The Upward Surge : Electricity and th e De ve lopme nt o f th e Skyscrape r," Electric Pe rsp ectives . (May 1994) 24-33 . Contributor. International Dic tiona,y of Arc hitects a11d Architecture. Chi cago: St. Jam e . 1993 . Contribut in g Author. Virg inia Drawings : Th e Making of Virginia Arc hitecture. Richmond , VA : Virginia Mu e um of Fine Arts, 1992. "Th e Cast le of My A ncestors: Horace Wa lp o le and S trawberry Hi 11 , ·• British Jour11al for Eig hteenth-Ce ntury Studies. ( 1990) 13: 199-214. 'The Pl ace of th e Sku ll : Rud o lf Steiner an d th e Fir t Goet hean um ." Athano r ( 1990) 9:55-65. Th e Imprints of Gloo mth. Charlortesvi lie, VA : Universi ty of Virgi ni a Library. 1988 . .. Benjamin Tompkin s an d the Third Prince William Co untry Court ho use.'' No rth e rn Virginia He ritage ( 1986) 8: I 5-I 9ff. 375 David D. McKinney. Ph .D. Pa ge 7 of 8 Pages Select ed Pape rs and Presentations: '·Psyc hed e lic Patriot ism? Peter Max s park s debate on an appropriate na tional image at America's internation a l bo rders," Sympos ium in honor of Ri chard Gu y Wil so n. School o f Architecture, ni vcrsity of Virginia, ovcmbcr 15 , 20 19. Cha ir. Man y Di sc iplin es; One Community: A Forum for Hi s tory Museum , Art M use um s, Science Mu se um s, and Publ ic Libraries. Virginia As soc iati on of Mu se um s. March 2002 . Art Re so urce that Teach Acro ss the Curriculum. Virginia Asso ciation o f Independent School s. ovember 200 I . T he World in Proportion : Arc hitectura l Prirn.:iples. Mathematics, and Geometry . Vi rginia Art Education As sociation Annual Meeting. o vember 200 I . Where We s t Meets Eas t: Frank Lloyd Wri ght ·s Debt to Japanese Art. Longwood Univer ity. Cent e r for th e Vi s ual Art , Fa ll Lectu re Series, October 2000. Mu se um s and the Standards of Learnin g: Creati ve Way s to Reach Student s and Teachers. Work ho p co-sponsored by the Virginia Mu se um of Fine Arts, Sci e nce Mu seum of Virginia. and Virgini a Department of Education. March 2000. Sharing Res ources and Pro gram s: Muse um s and Public Lib raries. South. ide Vi rgin ia Publi c Librarians Retreat. Ma y 1999. Strange Bedfellows or th e Perfe ct Pa rtn e rs hip : En g ineering Co ll a bora ti on bet\ve en Art , Sci e nce, and Hi story Mu eum s. Virginia Association of Museum s Annu al Conferenc e. Ma rch 1999. The Mo st Appropriate Style : John Rus e ll Po pe, the Co mmi ss ion on Fine Arts , and th e Chri sti an Church De bate th e Merit o f Class ici s m for the ationa l Church of an 'American ' Denomin ation . ational Building Mu se um . March 1997 . Embe lli shed Perspectiv es: Ho race Wa lp ole , Strawberry Hill , and the Painter's View of Hi story. Faculty Seminar on Eighteenth-Century Studies. Co lumbia Uni ve rs it y. December 19 94 . Spirituality in Architectural Form : Rud o lf Steiner and the Des ig n of the Fir t Goetheanum. Conference o n Rel igion and Arc hit ectu re. Miami Uni vers ity of Ohio. January 1992. Retreat int o the Pas t. The Gothic Transformation of Stra\ berry Hill. Spring Lecrure Series on the History of Art. Brown Uni ve rs ity. Februa ry 1991. 376 Da v id D. '1cKinney. Ph.D. Page 8 of 8 Pa ges Horace Wa lpole. Historio graphy, and Strawberry Hill. Internati onal ympo ium on the Gothic Revi val. St. Mary·. College, Twickenham , Eng land. Dec ember I 990. Be ho ld the Burlington Heir: Horace Walpo le and the Reviva l of Medieval Taste in Eighteenth-Century England. Studies in Medievali sm: The Fourth Genera l Conference , U.S . Military Academ y. October 1989. Teaching Experience Lecturer. Art Hi story De partment. Vi rginia Commonwealth University, :woo -2002. Lecturer. His toric Preservation. Goucher Co llege, 1994 -I 996. In structor. Archi tectura l History . Uni vers ity of Virg in ia. 1989 . Board Positions Member. Bo ard of Directors. Mi ami Design Preserva tion League Member. Council of the Virginia Association of Mu seum s. 1997 to 2005 . Com mitt ee J\ssignment s: Professiona l Developme nt , Diversity, Leader hip, and om ina t in g. Member. Curricu lum Advi sory Committee for Govemor·s School for the Gifted and Talented . Virginia State Board of Education . 200 I to 2003 . Memb e r Local Arrangements Committee. Soci ety of Arc hitectural Hi storian s ational Meeting , Richm ond. 2002. 2000-2002 . Steeri ng Committee: Standards of Lea rning Revision and Deve lo pm ent. Virginia State Board of Educat ion. 2000 to 2002. Member. Adv isory Board . Hi stori c Pr ese rvation Pro gra m . Gouc he r Co ll ege. I 994 1997. Member. Board of Directors. Metro Teen A ID S. Chair, Services Comm itte e. 1994-1998 . 377 378 • Sandra Scidmore 379 THIS PAGE INTENTIONALLY LEFT BLANK 380 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM =S=ci=d.;_;_m.:...::oc.:...re=----------------_S_a_nd_r_a ______________ =L _____ _ Last Name First Name M iddle Initial _1_00_L_in_c_o_ln_R_o_a_d~,_A-p_t._4_2_3 _________ M_ia_m_i B_e_a_c_h _____ F_L _______ 33139 Home Address City State Zip Code _78_6_5_6_6_0_42_2 ______ 78-'--6"'-'5'"""6--'-6-'--04_2_2 ____ 30_5_5_3_8_46_4_1 ____ sscidmore@hotmail.com Cellular Work Home Ema il Address N/A -Contract Worker Architecture and H istory Tour Guide (Contractor) Business Name: Occupation: N/A Miami Beach F lorida 33139 Business Address City State Zip Code P lease list your p r eferences in order of ranking [1] first choice [2] second c hoice, and [3] third choice. Please note that onl three 3 choices will b obs rved b the Cit Clerk's Office . (Regular Boards of City) Choice 1: Historic Preservation Board Choice 2 : Design Review Board Choice 3 : Planning Board License Number Professional License Real Estate (Voluntarily Inactive) SL3076278 Issuance Date 2/18/2004 Expire Date 9/30/2021 Note: If you are seeking appointment to a professional seat (e .g . attorney, arc h itect, etc .), you must attach a c opy of your currently effective corresponding professional license. * Note: If applying for the At-Large position of the Hi storic Preservation Bo ard , please answer the below questions: • Have you ever resided in one of the City's Historic Distri cts for at least one year? Yes If you answered "Yes", please indicate: 100 Lincoln Road , Apt. 423, Miami Beach , FL 33139 Add re ss From: 7/4/1998 To: 11 /12/2020 Dates 381 AFFILIAT ION WITH T HE Cl Y OF MIAMI BEA H Pursuant to C ity 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: a. Resident of the City for a minimum of six (6) months : • I am resident of: South Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months : ~ "Ownership Interest" shall mean the ownership of ten percent (1 0 %) or more (including the ownership of 10% or more of the outstanding capital stock) in a business. "Business " shall mean any sole proprietorship, sponsorship, corp oration. limited liability company, or other entity o r business association. Or c. Full-time employee of such a business (for a m ini mum of six months); and I am based in an office or other location of the bus iness that is physi cally lo cated i n Miami Beach (fo r a minimum of six months): ~ Notwith standing the requirements set forth herein , the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission . NOTE: Members of Agencies, Boards, and Commi ttee s shall be required to demonstrate compliance with the Cit1 affiliation requ irements of section 2-22 (4) a and b of th e Miami Bea ch City Code by executing an affidavit, stipulating that they have met either (or both) of said affiliation requirements . Th e original affidavit shall be filled with the Office of th e City Clerk prior to being sworn in as a member. • I am applying for an appointment because I ha ve special abilities , knowledge and experience . Please list below: If appointed, I would s upport the architectural integrity , design excellence and sou nd future development of Miami Beach , using my knowledge of: • Miami Bea ch architecture and history, from 22 years' experience as a tour guide • Arc hitecture and design, from art history studies • Preservatio n iss • Are you presently a reg istered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a fe lony: No If yes , please explain in detai l: • Do you c urrentl y ha ve 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: If yes , please explain i n detai l : • Are you currently servin g on any Ci ty Boards or Committees : If yes , whi ch board? 382 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Position Miami Design Preservation League Miami Beach United • List the address of all properties owned or in which you have an interest within the City of Miami B each : Property N /A • Are you now employed by the City of Miami Beach : • Pursuant to City Code Section 2-25 (b): If so , which department and title? Do you have a parent, spouse , child, brother, or sister who is employed by the City of Miami Beach? If "Yes", identify pe rson(s) and department(s): No relative's information submitted . 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 Sunsh ine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic ri ght of access to most meetings of Boards . Commissions, and other governin g bodies of state and local governmental agencies or authorities . o Voting conflict -Fo rm 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 equa lity to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes . 383 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 Ju ly 1. of each year all members of Boards and Committees of the City of Miami Be ach , including those of a purely advisory nature , are requ ired to comply with Miami-Dade County Financial Disclos ure Requ irements . One of the following forms must be filled with the City Clerk of Miami Beach , 1700 Convention Center Drive, Miami Bea ch , 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 lat est Federal Income Tax Return . Fail ure to file one of these forms , pursuant to the Miami-D ade Co unty Code, may subject the person to a fine of no more t han $500 , 60 days in jail , or both . 1 Members of the Planning Board and Board of Adjustment will be notified dire ctly by the State of Florida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnan cial Interests (Form 1) with the M iami -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 Co unty Supervisor of Elections automatically sa t isfy the County's finan c ial disc losure requ irement as a Miami Beach City Board /Committee member and need not file an additional fo rm with the Office of the City Clerk. However, com pl ia nce with the County disclosure requirement does not satisfy the State requirement. DIVERS! STATISTICS REPORT The following information is voluntary and has no bearing on you r conside ration for appointment. It is being asked to com ply with City diversity reporting requirements. Gender: Race/Ethni c Categories What is your race? Female White Are you Spanish/His pani c/ Latino? Mark the "No" box if not Spanish / Hispan ic / Lat ino . No Othe r Descriptio n : No det ai ls provided Physi cally Challenged : No 384 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph , and a copy of any applicable professional l icense . I have completed and attached the Board & Committee Financia l A cknowledgment Statement. YES I have completed a nd attached the Diversity Statistics Rep ort. If you have any quest ions, please contact the Office of the City Clerk via email : BC@miamibeac hfl .gov or te lephone : 305 .673 . 7 411 Note: Florida Statutes 119.071: Th e role of the Office of t he Ci ty Clerk is to receive a nd ma intain form s filed as public records . If your home address, telep hone 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 p hotograph . 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 ACCORDINGL T . I Sandra Scidmore agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 385 OBJECTIVE : CURRICULUM VITAE November 2020 SANDRA L. SCIDMORE 100 Lincoln Road , Apt. 423 Miami Beach , Florida 33139-2023 T elephone: 786-566-0422 (Cellular) 305-538-4641 (Home) E -mai l: sscidmore@hotmail.com Application for board membership to the City of Miami Beach: to support the architectural integrity, design excellence and sound future development of Miami Beach, using my knowledge of: • Miami Beach architecture and history, from 22 years ' experience as a tour guide • Architecture and design , from art history studies • Preservation issues , from membership in M iami area preservation organizations • Miami Beach residential properties , from past experience as a realtor • Board hearing app lications, from past experience as a land use and zoning legal assistant PROFESSONIAL EXPERIENCE : Work in the hospitality, real estate and legal fields since 1998. Was a software consultant in New York and Jamaica prior t o arrival in Miami Beach . TOUR GUIDE : Mia mi Desi gn Preserv ati on Leagu e (1998 -Present): Provide public and private walking tours of the Miami Beach Art Deco Distri ct. Served as a presenter for MDPL Tour Guide Academy and developed tours of Espanola Way for MDPL's "Great Streets of the Art Deco District" program and "Sheroes: Remarkable Women of M iami" for Art Deco Weekend 2020. The Villa Casa Casuarina (2003 -Present): Provide tours and presentations for private events. The Villagers Hou se and Garden Tours (2012 -Presen t) Serve as a guide for open house and garden fundrais ing tours for The Villagers preservation organiza tion. Mi ami Culina ry Tou rs (2019 -2020 ) Gave culinary tours involving food tastings as well as presentations on the history and architecture of South Beach. Vizcaya Museum and Garde n (2007 -2012): Gave public house and garden tours and private special events tours. Tour of Italia n Villas and Gardens (2010 -2011 ) Initiated and participated in a ten-day tour of Tuscan villas and gardens for a small group of arts and antiques professionals. Art Basel Tour (2007): Provided a tou r of Ritz-Carlton South Beach artworks, for Art Basel Miami Beach attendees. 386 SANDRA L. SCIDMORE Page 2 of 2 OTHER TOURS (Including work for private companies, 2006 -Present): • Miami Beach Tour Walk ing and bus tours • Miami City Tour • Wynwood/Design District Miami, Miam i Beach , Coconut Grove and Coral Gables Walk ing and bus tours • Little Havana • Ev erglades • North Beach MIMO REALTOR: Walk ing and bus tours Swamp walk fundraisers, airboat rides and bus tours Walk ing tours Coldwell Banker Residential Real Estate, M iami Beach , FL (2004-2017) Showed residential properties in Miami Beach . Prepared contracts for sale and lease, and communicated with mortgage and title insurance compan ies, attorneys , condominium associations and realtors to coordinate closings. Assisted senior realtors to set up listings and property databases . LEGAL ASSISTANT/JUNIOR PARALEGAL : Legal Search Solutions, Solomon Search Group, Robert Half, Brickell Personnel Consultants, Miami , FL (1998-2007 , 2014-2019) Worked in the areas of corp o ra te law, real estate , and civ il defense litigation . Drafted and filed legal documents, prepared hearing/trial/d iscovery notebooks , real es tate closing documents and correspondence , communicated with clients and external agencies , ma intained calendar and did general office work . Prepared for/attended depositions in Chile and Spain and typed deposition summaries. Pathman Lewis , LLP (2007-2014) Worked in the areas of land use and zoning , property tax reduction/appeal , real estate and civil defense litigation . Researched and prepared board hearing applications to City of Miami Beach , City of Miami and Miami-Dade County. Prepared property tax appeal appl ications to Miami-Dade, Broward , Palm Beach and Monroe Counties. Drafted and filed legal documents , prepared hearing/trial/discovery notebooks , real estate closing documents and correspondence , communicated with clients and external agencies, maintained calendar and did general office work . EDUCATION : BA in Fine Arts , Art History, Syracuse University , Syracuse , NY M.S .E . in Computer and Information Science , University of Pennsylvania , Philadelphia, PA MEMBERSHIPS: HistoryMiami Miami Beach United Miami Design Preservation League (Secretary , Board of Directors) Historic Preservation Associat ion of Coral Gables The Villagers Vizcaya Museum and Gardens FOREIGN LANGUAGES: Beginning knowledge of French , Spanish , Portuguese and Italian. 387 388 • Laura Weinstein-Berman 389 THIS PAGE INTENTIONALLY LEFT BLANK 390 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Weinstein-Berman Last Name HOME ADDRESS: 6103 Aqua Ave Apt 602 Apt No. Home No./Street PHONE: 3056068948 3056068948 Home Work Business Name : The Va abond Grou Address : 7272 NE 6th C t Ste 10 Street Laura Fi rst Name Miami Beach City FL A Middle Initial State laura@ lwassocin c.com Position: Arc hitect M iami City FL Email Address State 33141 Zip Code 33138 Zi p Code Pursuant to City Code section 2-22(4) a and b : Members of agencies, boards, and committees shall be affilia ted w ith the city: this requirement shall be fulfilled in the followi ng ways : a) an individual shall have been a resident of the city for a minimum of six months; orb) an in dividual shall demonstrate ownership/i nterest for a min imum of six months in a business es tabl ished in the city . • Resident of Miami Beach for a minimum of six (6) months Yes • Demonstrate an ownership/interest in a business i n Miami Beach for a m inimum of six (6) months: No • Are you a req iste red voter in Miami Beach : Yes •(Please~ one): I am now a resident of : Middle Beach • I am applyinq fo r an appointment because I have speci al abilities, knowledqe and experience. Please list below: I am a registered architect with a Master's in Histori c Preservation from Columbia University. Currently I work as a Managing Dir • Are you prese ntly a reg istered lobbyist with the Ci ty of Miami Beach? No Please li st your preferences in order of ranking [1) first choice [2) second c hoice , and (3) thi rd choice . Please note tha t only three (31 choic es will be observed by the City Clerk's Office. (Regu lar Board s of City) Choice 1: Choice 2 : Choice 3: Historic Preservation Board Art in Public Places Committee Cultural Arts Council * Board members are required to file Form 1 -"Statement of Financial Interest" with the State. If yo u s eek appointment to a professional seat (e.g., lawye r, architect , etc.) on the Board of Adjustment, Design R ev ie w Boa rd , Hi storic Preservation Board or Plan ning Board, atta ch a copy of your currently-effective ly licen se, and furn ish th e following information: Type of Prof essional License ______________ _ Li ce n se Number License Iss uance Date _________________ _ License Expir ation Date Note: If applying fo r Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1 . Pa st service on the Youth Center Advisory Board : No Yea rs of Service: -------------------- 2. Present participa tion in Youth Center activities by your c hildren '"N'""o __ _ if yes , please list the names of your ch ildren, their ages, and which programs. List below: 391 • Have you ever been convicted of a fe lony: No If yes, please explain in detail : • Do you curre ntly have a violation(s) o f City of Miami Beach codes: No If yes, please exp la in in deta il : • Do you c urrently owe the City of Mia m i Be ach any money: No If yes. please expl ain in detail : • Are you currently serving on any City Bo ards or Committe es: No If yes, which board ? • What organizations in the City of Miami Beach do you currently hol d membership 1n? • I am now employed by the city of Miami Beach · No Which department? • Lis t all properties owned or have an interest in, which are located within the City of Miami Beach: Gender: none The following information is voluntary and is neither part of your applicati on nor has any bearing on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. R ace /Ethnic Categones What is your race? Mark one or more races to indicat e what you consider yourself to be. none Other Description: Are you Spanish/Hispan id La tino? Mark the "No" box if not Spanish / H ispanic/ Latino. No Physically Challenged: No NOTE: If appointed, you will be requi red to follow certain laws which apply to city board/committee members. These laws Include, but are not limited to, the following: v Proh1b1t1on from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Proh1b1t1on from contracting with the city (M1am1-Dade County Code section 2-1 1. 1 ). o Proh 1bit1on from lobbying before board/committee you have served on for period o f one y ear after le aving office (Miami Beach Code section 2-26). ~ Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11 .1 ). (re: CMB Community Development Advisory Committee): proh1b1t1on , dunng tenure and for one year after leaving office . from having any in terest 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 570.6 11 ). 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 have received, read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members ." I Laura Weinstein-Berman agreed to the following terms on 1/12/201911 :07 :22 AM Received in the City Clerk's Office by· Name of De puty Clerk Control No . Date 392 Contact laura@lwassoc1nc.com www.linkedin.com/in/laweinstein Certifications NCARB LEED Green Associate Sustainable Cities -SDG Academy AIA Honors-Awards Faculty Award for Outstanding Thesis Habitat on the Hill Youth Scholarship Publications The Vagabond Effect Brougham Cottage Sea Level Rise and Historic Resources in Miami Beach : Mapping Elevation Intersections and Historic District Choropleths The Progression of Historic Preservation in Miami Beach and the Challenges of Sea Level Rise Heritage . Tourism . and Urbanization The Landscape and Development of Lal1be la, Ethiopia laura weinstein-berman AIA Managing Director at Vagabond Group Consulting Experience Vagabond Group Consulting Managing Dire ctor July 20 17 -Present Based in the MiMo/Biscayne Boulevard H istoric District , Vagabond Group Consultancy, LLC is a private consultancy focused on enhancing communities through historic preservation , adaptive reuse of historic resources , place- making , and innovative private and public partnerships . Led by Avra Jain, an in-house team of archi te cts and project managers have developed a successful balance between art and commerce to engage in projects which range from affordable housing to boutique restorations . As Ma naging Director of th e Historic Divis ion , my respon si bili ties include aspects from pre- design and financial analyses of potential projects and partnerships, t hrough architectural schematic a nd design development, and c lient representation through project management and cons truction administration . LW Assoc., Inc. Founder June 2011 -Present Ba sed in Miami Beach, LW Associates Inc. is a multidisciplinary design stud io focusing on architecture, historic preservation consulting, and art direction . We produce effective , beautiful and strateg ic designs for our client list com posed of Fortun e 500 companies, boutique brands , and non-for-profit organizations. New York City Landmarks Preservation Commission Graduate Fellowship , Res earch and Special Proje cts September 2016 -May 2017 (9 months) Education Columbia University in the City of New York Page 1 of 2 393 Master's degree , Historic Preservation , coursework in Real Estate Development University of Miami Bachelor's degree , Architecture Pag e 2 o f 2 394 395 THIS PAGE INTENTIONALLY LEFT BLANK 396 • Kirk Paskal 397 THIS PAGE INTENTIONALLY LEFT BLANK 398 MIAMI BEACH ~s~I ~~ ----"-..;;_;_"'----------------- Last Name First Name BOARD AND COMMITTEE APPLICATION FORM Middle Initial ~7~9 ~15;;....._;;C~r~es~p~i~B~o~u~le~v~a_r~d ___________ M_ia~m_i_B~e~ac~h ______ F_L _______ 33141 Home Address C ity State Zip Code 305-469-2413 305-469-2413 305-469-2413 KPaskal@gmail.com ~.;;...._....;;._:_~~'------------------------ Cellular Work Home Ema il Address Miami Dade Coll ege Grant Director Business Name : Occupation : 300 NE 2nd Avenue Miami Florida 33132 Business Address City State Zip Code Please list your preferences in order of ranking [1] fi rst choice [2] second choice, and [3] third choice. Please note that onl three 3 choices will be observed b the Ci Clerk 's Office. (Regular Boards of City) Choice 1: H istoric Preservation Board Choice 2 : Planning Board Choice 3: Design Review Board No Professiona l Licenses Submitted . Professional License 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 li ce nse. * Note : If applying for the At-Large position of the Histori c 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 If you an swered "Yes", please indicate : 7915 Crespi Boulevard , Miami Beach , FL 33141 Address F rom : 5 /16/2018 To: 11/22/2020 Dates 399 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , band c : Members of Agencies , Boards , and Committees shall be affiliated with the city. Th is requirement shall be fulfilled in the following ways : a . Resident of the City for a minimum of six (6) months : • I am resident of: North Beach Or b . Demonstrate an ownership interest in a business establ is hed in the C ity for a min i mum of six (6) months : Yes "Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more of the outstanding capital stoc k) in a business. "Business" shall mean any sole proprie torship , sponsorship , corporation. limited liab ility company, or other entity or business association. Or c . Full-time employee of such a business (for a minimum of six months); and I am based in an office or oth er location of the business that is phys ically located in Mia mi Beach (for a minimum of six months): No Notwithstanding the requirements se t forth herein, the qualified full-time employee of a business must be approved by a 417th vote o f the Ma yor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements o f section 2-22 (4) a and b of the Miami Bea ch City Code by executing an affidavit, stipulating that th ey have met either (o r both) of said affiliation requirements . The original affidavit shall be filled with th e Office of th e City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience . Please list below: Miami Beach United . Di re ctor North Beach Master Plan Steering Committee, Committee Member North Shore Hi storic District Neighborhood Association , Co-founder and president North Beach Neighbors Alliance , Co-founder and member of the NBNA Steering Committee Miam i Foundation : Sea Level Rise • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felony: If yes , please explain in deta il : • Do you c urrently have a violation(s) of City of Miami Beach codes : If yes. please exp la in in detail : • Do you currently owe the City of M iami Beach any money: If yes , please expla in in detai l: • Are you currently serving on any City Boards or Committees: Yes If yes , which boa rd ? Historic Preservation Boa rd (Applying for reappointm ent -Dade Heritage Tru s t Appointee) 400 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Position Miami Beach United Board Member North Beach Neighbors Alliance Steering Committee Member • List the address of all properties owned or in wh ich you have an interest within the City of Miam i Bea ch : Property 7915 Crespi Boulevard , Miami Beach , FL 33141 • Are you now employed by the City of Miami Beach : If so , which department and title? • 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 Bea ch? If "Yes", identify person(s) and department(s): No relative's info rmati on submitted . NOTE : IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CE RTAIN LAWS THAT APPLY TO C ITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE , BUT ARE NOT LIMITED TO: o Prohibition from directly or indirectly lo bbying city personnel (Miami Beach City Code section 2-459 ). o Prohibition from co ntracting 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 Sunsh ine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunsh ine 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 confli ct -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 . 401 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension fo r Board/Comm ittee Members for failu re to comply with Miami-Dade County Financial Disclosure Code Section 2-11.1 (i)(2) I understand that no late r than July 1. of each ye ar 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 Dri ve , 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 . Failu re to file one of these forms, pursuant to t he Miami-Da de 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 Adju stment will be notified directly by the State of Florida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnan cial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12 :00 noon , July 1. Plann ing Board and Board of Adjustment members who file their Form 1 with the Coun ty Supervisor of El ections automatically satisfy the Coun ty's fina ncial d isclosure requirement as a M iami 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 requi rement does not satisfy the State requirement. DIVERSITY STATISTICS REPORT T he fo ll owing information is voluntary and has no bearing on your consideration for appoin tment. It is being asked t o comply with City diversity repo rt ing req uirem en t s. Gender: Ra ce/Ethnic Categories What is your race? White A re you Span ish/Hispanic/ La ti no? Mark the "No" box if not Spa nish / Hispanic / Latino . No Other Description : No details provided Ph ysically C ha ll enged : 402 Board and Committee Application Checklist: Please ensu re you have provided all information before applying or reapplying to any Board and Committee. YES I ha ve answered all questions fully . YES YES I have uploaded a current resume, photograph , and a copy of any applicable professional li ce nse . I ha ve completed and attached the Board & Committee Finan cial Acknowledgment Statement. YES I have completed and attached the Diversity Statistics Report. If you have any questions , plea se contact the Office of the City Clerk via email : BC@miamibeachfl.gov or telephone : 305.673 . 7 411 Note: Flor ida Statutes 119 .071 : The role of the Office of the City Clerk is to re ceive and maintain forms filed as public records . If your home address, telephone numbers , and/or photograph are exempt from disclosure and you do not wis h 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 . 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 ACCORDINGLT. I Kirk Paskal agreed to the following terms on 11 /22/2020 1 :36 :04 PM Re ceived in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 403 Ex erience Kirk Paskal 7915 Crespi Boulevard M iami Bea ch, FL 33 141 Phone : 305 -469 -24 13 Emai l : KPa skal@gmai l.com North Beach Master Plan Steering Committee, M iami Beach , FL January 2016 -September 2016 Appointed by the Mayor to serve on the Steering Committee for the North Beach Master Plan . During my time on the Committee, I was recommended by my fellow members to serve as the North Beach representat ive on the M1am1 Beach Historic Preservation Board. Miami Beach United, Miami Bea ch, FL January 2014 -Present Serve on the non-profit MBU Board of Drrectors. I also served on the MBU Nominating Committee and Charred both the MBU Marketing Committee and MBU North Beach Committee. North Shore Historic District Neighborhood Association, Miami Beach, FL March 2013 -Present Co-founder and President The NSHDNA's m ission is to protect and enrich the historic quality of our residential neighborh ood s, promote appropriate commercial development in the commercial areas, ensure responsible stewardship o f our parks and natural resources, address quality of life i ssues for residents and visitors and promote a strong sense of community. North Beach Neighbors Alliance, Miami Beach, FL July 2015 -Prese nt Co founder and member of the NBNA Steering Committee The No rth Beach Neighbors Alliance (NBNA) is d edicated to building community and advocating on behalf of local residents through creative neighborhood outreach and educat ion . We are committed to responsible development, transparent governance, and colla borative action that celeb rates the neighborhood's vibrant character and preserves our architectural h eritage Miam i Foundation: Sea level Rise Focus Group, M iami, FL June 2016 Served as a community representat ive on the Miami Foundation's focus group addressing how best t o inform and mob1lrze geographically vulnerable communities in making Miami resilient to sea level rrse. Miami-Dade County Arts: Festivals Grant Revie w Panel, M iam i, FL Served on the Review Panel for M1am1-Dade County 'Festrva ls' Grant Program Employment History Winter Music Conference, Inc., Fort Lauderdale, FL Director of Operation s & Development January 1998 -Prese nt 2008,2009,2010,2012 Foc1htote and supervise all aspects of operotIons for one of M,omi Beach 's prem,er week -long c,tyw,de events wh,ch serves as che prem,er annual platform for the advancement of rhe mus,c industry with over 50,000 music enthusiasts and professionals from 70+ countnes ,n orrendonce and featuring over 500 1010/ events presented at more than 130 venues and over 2,100 port,cipotmg artists. 7915 Cre spi Boule vard, Miami Beach, FL Owner/Operator O ctober 2000 -Present Focthtote all business operot,ons for a four-un,t waterfront res,denI,ol oparlmen t building wh,ch I lov,ngly restored over several years The property w as conslructed ,n 1948 and designed by noted orch,1ect Carlos B. Schoepp/ ,n the Posrwor Streomhne orch,tecrurol style It is a contributmg slruClure of lhe North Shore Historic D1s1rict l1s led on t he Not,onol Reg1s1er of H1sIoric Places . For more than a decode, I hove been on active advocore on quohry of hfe ,ssues and a steadfast proponent for the positive advancement of our commun,ty through managed growth, preservation and optImIzotIon of the unique historic allure 1hot defines the rever ed character of our neighborhood. Miami Gay & Les b ian Fil m Festiv al, Inc., M ia mi Beach, FL Managing Di rector October 2006 -Octo ber 2007 Collaborated wi th Program Dtrector and Boord of 0,rectors ,n develop,ng and coord,not,ng all aspects of operations and promot,ons for onnuol 10-doy film fest1vol and 501(c)3 orgon1101ion which produced the largest annu al gay and lesbian cultu ral event m rh e Southeastern U.S. The Le ft Bank Organization / Blondie Music, Inc., New York, NY Artist Manager May 1996 to January 1998 Responsible for coordmotion of all aspects of ortisr involvement for the reun ion of ,nternocionol platinum selling recording artists, Blondie. Overland Productions, Inc./ Radioactive Records, J.V., New York, NY Artist Manager/ Produ ct Manager January 1991 to May 1996 Coord,noted and superv,st'd all ospeCls of ort,st engagements, producl development, recordmg, monufoctur,ng, d1stribu1ion and promotion for internorionol recording artist cl1en1s Ramones, Deborah Horry, Big Audio Dynom11e, Talking Heads, Tom Tom Club and Thompson Twins Education Furman Universi ty, Greenville, SC B A , Boyles Arts Scholarshi p. Sw imming Scholarsh,p New York University, New York, NY Tosch School of t he Arts. Visual and Dramatic Wrot,ng 404 KIRK PASKAL 7915 Crespi Boulevard Miami Beach, FL 33141 Phone: 305-469-2413 Email: KPaskal@gmail.com EMPLOYMENT HISTORY Miami Dade College Miami, FL The Humanities Edge. The Andrew W . Mellow Foundation Grant Director October 2020 -Present Overview: Facilitate all operational leadership for the implementation and development of the Humanities Edge program as supported by the Andrew W. Mellon Foundation. The Humanities Edge is an academic and career development program for MDC-to-FIU transfer students majoring In the humanities. Th is pathway partnership between Miami Dade College and Florida International University creates a rich academic experience to help students maintain an Interest In the humanities while supporting their transition to university. • Work in collaboration with the Co-Director at Florida International University (FIU) to lead. coordinate and imp lement t he Making Diversi ty M eaningful in lhe Humanities program. • The Humanities Edge program strengthens faculty and staff collaborations between the institu t ions and positively impacts humanities students in completing their degrees at Miami Dade College and transferring to FIU. 7915 Crespi Boulevard Miami Beach, FL Owner. Operator and Property Manager October 2000 -Present Overview: Facilitate all busine ss operations. maintenance , administration. improvements. licenses and compliance for a four -unit waterfront res idential apartment building located within M iami Beach's North Beach neighborhood. • Property. construc ted in 19 48 by architect Carlos B. Schoepp! 1n the Postwar Streamline architectural style. • Building is a contributing structure of the North Shore Historic District as listed on the National Reg ister of Historic Places and w1th 1n M1am1 Beach 's North Shore Local His toric District. Miami Dade College Miami, FL Mission North Star, The Annie E. Case y Foundation: EOYF Grant Pr ogram Coordin ator November 2019 -October 2020 Overview: Facilitated all operations and project development initiatives under the leadership of Miami Dade College District Vice Provost of Student Affairs and Director of Student Services Operations for the implementation of the Mission North Star program as supported by the Annie E. Casey Foundation. Through a consortium of multi - stakeholder community-based partnerships with MDC serving as the "hub" organization. the program sought to authentically engage young adult parents to learn about their needs and aspirations and to engage in a process of mapping the system of services and pathways for young adult parents' economic opportunities while addressing their needs to parent their children successfully. Through this work the consortium identified service. system and policy opportunities for strengthening economic opportunity pathways for young adult parents across Miami-Dade County. • Collaborated with community partners and program leadership to develop and implement plans to engage young adult parents and incorporate their stated interests. aspirations. needs and challenges in the program design. Organized and led monthly Executive Council meetings to report on progress and ensure a timely flow o f information and collaborat ive implementation. 405 • Coordinated with community partn ers a n d leadership team to recruit and support young parent Community Ambassadors. Organize and facili tate leadershi p train ing sessions, meetings, coils and convenings with 26 young adult parents who participate on the You ng Parent A dvisory Committee to activate a nd amplify young parent voices across t he community. Established open channels o f communicat ion and develop o constructiv e collaborative process between the partners, leadership team, intermediaries, external evaluators and ambassadors to jointly advance the program's mission. • Developed assessment and evaluat ion instruments and protocols in conjunc ti on w ith external evaluators. community partners and foundation intermediaries to identify gaps in services (including gaps in doto shoring and coordination) a s w ell os opportuni ties to increase organizational capacity and efficiencies. and c reate o r refine policie s and practices that supp ort social and e conomic mobility for young adult parents and their families. • Fa cili tated oil financial operations. bookkeeping . accounting reconciliation and reporting to the foundation in alignment with procedural guidelines and project budget. Establi sh and administer subgront partnerships with collaborating orga nizations. • Compiled and documented progress and findings. Compiled reports and developed progress updates in consu lt ation with stakeholders to !rock program performance measures. • Organized and facilitated oil young parent engagement activities presented in coordination w ith communi ty partners and ambassadors ot locations across Miami-Dode County. • Outreached and developed new collaborative partnerships and strengthened existing rela tionships with te n multi-stakeholder community organizations serving young adult parents and their children across Miami-Dode County. • Managed projec t t imeli nes and deliverables. Served as the project spokespe rson for mont hly cross-site consultations. coaching c alls and cross-site convenings. reporting on th e project and collaborating with other sit e s on methods. progress and outcomes. • Compiled a nd o rganized assessment findings. survey reports and inventory of services. Su p ported and facilitated the work of the partners in conjunction with program leadership . interme d iones, consultants. external evaluators and ambassadors to synthesize data. assess th e needs of the target popula tion. identify gaps in se rvices a nd croft intervention strategies !hot to be imple mented to fill those gaps. Miami Dade College Miami, FL No tional Scie nce Fo u ndatio n, STEM -M io Grant Pr ogra m Coordinat or Moy 2018 -Novem ber 2019 Overview: Facilitated all operations, activities, programming and initiatives in collaboration with grant P.I. and Co- P.l.s for the implementation and development of the STEM-Mia program, a National Science Foundation funded project focused on increasing retention, degree completion and transfer success for academically talented, low- income students in STEM fields at Miami Dade College Eduardo J. Padron Campus. • Fa cilitated all programming, organizat ion, logistics, promotion and administration for project activities and initiatives including STEM inar Serie s, worksho ps. field trips. presentations and networking events. Developed strategic allia nces and slrengthened relations with STEM industry leaders, researchers and faculty participants, community organizations. as well as administrato rs and advisors at learning institutions regionally and across the st ole to advance the program 's mission. Re cruited STEM industry le aders t o participate as featured presenters and guest speakers. • Organized monthly b oard meetings. supplementary follow-up consultations and progress updates with faculty leadership . faculty mentors and program administrators. Maintained open lines of communication to foste r o positive . p roductive and collaborative spiri t of cooperation . Advocated on behalf of faculty leadersh ip, mentors. scholars and oil program participants to ensure challenges were timely resolved and opportunities for imp ro vement were mutually addressed. • Implemented and directed oil recruiting and outreach in itiatives. Developed marketing strategies. c a mpaigns. content c reation. design and marketing assets in coordina tion with Media Services and Public Relations staff and the Program Leadership to promote all aspects of the p rogram. • Consulted regularly with scholars. Faculty Mentors , facul ty leadership and administration to ensu re o timely flow of information and collaborative implementation of interv e ntions and supports to promote student retention and success. Collaborated with Project P.I. to recruit. coordinate and support Faculty Mentors . • Collaborated w ith Educational Researc her to develop surv eys, forms, applications and evaluations through the estab lishment of our STEM-Mio Quollrics portal, thereby improving accessibility to forms and information while streamlining administrative workload for faculty partners and scholars. As o direct resu lt of these effo rts, in combination with our marketing and outreach initiatives. we were able to dramatically broaden our reach a nd increase the number of eligible applicants by over 500% from project year 1 to year 2 . 406 • Coordinated all planning. logistics and adminis tra tion for faculty and sch olar participation in STEM conferences and field trips. Collaborated w ith Program P.1. and faculty leaders to develop and submit proposals outlining program initiatives. progress. results and insights for regional. state and notional conferences. • Ensured adherence to project budget. grant narratives. timelines and fu nding requ irement s. • Compiled project documentation. assessments, statistics and updates for external project evaluator and Notional Science Foundation reports. Winter Music Conference, Inc . Miami Beach, FL Di rector o f O p e ra tions & Developmen t Janu ary 1998 -Oc tober 2016 Overview: Guided the growth and program development for the largest global dance music industry conference wh ich served as the premier p latform for the adv ancement of the industry and attracted over 2,000 participating artists, 3,500 music industry professionals and 100,000+ attendees from 209 countries and terr itories across the world for a concentrated schedule of more than 400 performance events. seminars. e x hibits and workshops presented annually at 200+ venues in Miami and Miami Beach. • Directed and facilita ted all aspects of business operotions. promotions. marketing. fundroising and program developme nt. • Led all fundraising iniliolives. Strengthened relations with corporate sponsors. grant funding agencies and advertisers . Maintained a positive trajectory in combined grant funding. sponsorship and advertising revenues each year for the entirety of my tenure. Worke d c losely with gra n t partners and sponsors to ensure compliance with funding requirements and objectives. • Negotiated contractual terms and drafted proposals and agreements with artists. venues. hotels. event partners. vendors. consultants and media partners. • Initiat ed. developed and impl emented a ll aspects of marketing and promotion strategies including copywnting, editing. art d irection . internet and d irect moil marketing. advertising and promotion campaigns. • Cultivated a worldwide network of media partnerships comprising over 3.000 journalists from magazines. newspapers. television. radio . internet and international wire services generating over 350 news articles published in more than 1 SO publications a c ross 30+ countries and yielding over 500 million unique viewer impressions and generating more than 13 billion total media impressions each year through our marketing and publici ty campaigns. These e fforts in combinat ion with our p rogramming stra tegies, contributed to establishing Winter Music Conference as the highest ranking citywide event for weekly overage hotel room rotes and the highest weekly overage occupancy for the 52-week cycle on Miami Beach across my tenure based on OCC- AD R reports as provided by the G reater Miami Convention and Visi to rs Bu reau. • Formula t ed media plans. coordinated press conferences. wrote and serviced press releases. established media placements worldwide and direc ted a ll aspects content c reation for advertising, email compoigns. over 1 400 live web pages and the annual printing of industry and consumer event guides. • Facilitated all aspects of office operations -hiring. management and supervisi on of a ll office staff including event c oordinators. marketing d irectors. production stott. website designers and programmers. graphic artists and program facilitators . • Es tablished on ongoing student internship p rogram in collaboration wi th local colleges and universi ties . • Directed and supervised program development initiatives for industry panels. workshops. trodeshow and events . Produce d and d irected the International Dance M u sic Awards. the premier annual awards show for the dance music industry including programming. scrip t ing. staging, talent p rocurement, budgeting and logistical coordination. Miami Gay & Lesbian film festival. Inc. Miami Beach , FL M a nagin g Director October 2006 -Octo ber 2007 Overview: Developed and coordinated all aspects of operations and business development for an annual 10-doy film festival and 501 ©3 organization which produced the largest annual LGBTQ cultural event in the Southeastern USA and one of the three most prominent LGBTQ film festivals In the notion featuring over 100 film presentations and special events attracting more than 15,000 ticket buyers and 120 filmmaker and industry guests from around the world . • Developed annual budgets in coordination w ith Boord Treasurer to build financial strength and stability. and oversaw all financial management and administration. Facilitated all aspects of fundraising , negotiations and expenditures to adhere to budget projections. • Led and directed all fundroising initiatives. Strengthened relationships with public ond foundation grant partners. surpassed revenue projections and expanded programming and reach. Substonl1olly increased corporate sponsorship cash support over budgetary revenue projec tions. Im p lemented membership drives and fundroising campaigns. Solic ited and nego lioted advertising soles . Managed and supervised all aspects of 407 ticket soles and memberships. Coordinated with all Federal. State, Local and Foundation grant partners and sponsors to ensure compliance with all funding requirements and objectives. • Contrac ted and coordinated with vendors. consultants and suppliers including production personnel, designers, printers. hotels. web development, moiling services. publicists. e vent p lanners. venues. distributors. etc. Re sponsi ble for h1nng. directing, supervising. mentoring and evalua ting staff. • Coordinated production and d istribution of all festival printed matter and web site content including press releases. advertising, brochures. as well as co-writing and edi ting the festival's 114-poge program book:. • Served as board liaison. informing and supporting the board and working closely with the board Choir. Served as principal spokesperson for the organization. Worked with board and staff to develop and advance the organ iza ti on's strategic plans. • Nurtured strong relationships with public agencies. memb e rs and other community all ies to develop programming and advance the organization's mission. Overland Productions, Inc./ Blondie Music, Inc. New York . NY Artis t Manager January 1991 -January 1998 Overview: Coordinated and supervised all aspects of artist engagements, day to day business operations and development, recording, manufacturing , d istribution , touring and promotion for international recording artist clients Ramones, Deborah Harry, Blondie , Big Audio Dynamite, Talking Heads, Tom Tom Club, Jerry Harrison, Sam Sever, Deee-Lite, Babble, Thompson Twins and Downtown Science. • Conducted d o ily consultations with artist clients and served as liaison between artists and international and d omestic record company deportme nts. independent contractors a nd vendors. • Negotiated. budge ted and facilitated day to day client tasks. public relations. events and tours in conjunction with accountants. attorneys and agents. • Coordinated a nd su pervised all aspects of artist related product developm e nt. recording. manufacturing. distribution and promotion. • Planned. budgeted and coordinated all touring. recording, p roduction. publicity. promotion and logistics management to achieve client o bjectives. Selected, budgeted and negotiated with producers. engineers, mixers. studios, art and video directors and photographers. • Negotiated deals. contracts and fees for recording. performances. personal appearances. special projects. publishing and licensin g agreements and sponsor endorsements including Ak:oi Electronics (Japan). Converse. Nike. Budweiser and McKenzie River Brewi ng among many o t hers . PUBLIC SERVICE , LEADERSHIP & ADVOCACY Miami Beach Historic Preservation Board Miami Beach, FL Board Member November 2016 -Present Serve as Dode Hentoge Trust appointee on the whose purpose is to organize the practices procedures ord business for the conduct of hearings, for processing proposals for designation of historic districts and sites and for the processing of opplicot1ons for certificates o f oppropnoteness. Miami Beach United Miami Beach , FL Director January 2014 -Present Nominated to serve on the Boord of DirectOfs for M1om1 Beach United (MBU). MBU 1s o non-profit Ofgonizotion estobhshed to provide Miami Beach Residents o c ohesive voice for city-wide issues which impact quality of hfe . MBU 1s dedicated to 1mprov1ng the quality o f life for M iami Beach res idents. managed and measured growth of our cit y, and e thical leadership o f government - for o vibrant c ity rooted 1n h istory, its people. resources and neighborhoods, with focus on the future . North Beach Steering Committee Miami Beach , FL Committee Member January 2016 -November 2017 Served two terms as o community advocate and spokesperson 1n the development and 1mplementotion of the North Beach Moster Pion which was developed 1n coordination with Dover Kohl and Partners and adopted by unanimous vote of the Miami Bea c h Commission on O c tober 19. 2016. On Moy 5, 20 I 7 the pion received a Charter Awo1d from the Congress for the New Urbanism and was recognized as "o multifac eted approach to the North Beach neighborhood's needs for historic oreservotion pedestnon-onented design. p reservation of workforce housing, and answers to rising seo levels". North Beach Neighbors Alliance, Miami Beach , FL 408 Co-founder and Steering Committee Member July 2015 -Present NBNA 1s o dedicated to building community and advocating on behalf o f loco ! residents through c reot,v e neighborhood outreach and education. NBNA is comm itte d lo responsible development. lronsporenl g o vernance. and collabo rative action that celebrates the neighborhood's v ibrant character and diversity and preserves our architectural heritage. Florida Academic Advising Association (FLACADA) Boca Roton , FL Pre senter, 2019 FLACADA Annual Conference May 2019 Invited lo co-present o concurrent session entitled lnsp1nng A cl,ons from Asp,rot,ons Insights on Adv1s,ng Srra teg,es from the NSF STEM -M ,o Program ot Florido Allont1c University 1n Boca Roton. FL os port o f t he 20 19 Flondo Academic Advising Associot1on's Annual Conference. Miami Foundation: Sea Level Rise Focus Group Miami, FL Community Advoc ate June 2016 Invited lo serve a s community advocate and spokesperson on resiliency focus g roup addressing vulnerable communities and sea le vel rise Miami-Dade County Arts : Festivals Grant Review Panel Miami. FL Panelis t 2008, 2009, 20 I 0, 2012 Appointed lo serve four annual terms on the review panel for the Festivals and Spec ial Events !FEST) grants program for Miami- Dode County. The Festivals and Special Events Gran ts Program 1s designed to support major annual festivals and special events. Th e program provides significant funding to o rganization s which hove on established reputation tor excellence and credibility, ore capable o f attracting visitors on regional. notional a nd/or inlemol1onol levels and hove a signific a nt and positive impact on the perception o f Miami-Dode Coun ty as a dynamic cultura l communi ty . EDUC A TION Furman University Greenville, SC B.A .. Art MOJOr Boyles Art Scholarsh ip . Sw1mm1ng Scholarship New York University New York , NY Ti sch School of the Arts Visual and Dromot1c Writing 409 410 • Alan Fishman 411 THIS PAGE INTENTIONALLY LEFT BLANK 412 MIAM I BEACH BOARD AND COMMITTEE APPLICATION FORM _F--'is_h_m--'a_n _______________ ;_A=la"""n-'-----------------_B _____ _ Last Name First Name Middle Initial ;_4 ~64~0.;;....;..P--'o~s~t ~A~v~e ______________ M_ia_m_i_B_e _ac_h ______ F_lo_r_id_a ______ 33 140 H ome A ddress City State Zip Code _________ .._(3_0_5.._) _53_2_-2_8_1_0 __ .._(3_0_5...._) _5_32_-_2_8_1 O ____ ab_f_e_sq....,@......__a_ol_.c_o_m ________ _ Cellular n/a Business Name: n/a Business Addr ess Work H ome Email Address n/a Occupation: n /a n/a n/a City State Zip Cod e Please list you r p refe rences in order of ranking (1] first choice [2] second choice, and (3] t hird choice . Please not e that only three (3) choices will be observed by the City Clerk's Office. (Regula r B oard s of City) Choice 1: H uman Ri g hts Committee Choice 2: Transportation , Parking and B icycle-Pedestr ian Facilit ies Committee Choice 3 : Professional License No Professional Li censes Submitted . Note: If you a r e seeking appointment to a professional seat (e .g . attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. * Note: If applying for the At-Large position of the Historic Preservation Board , please answer the below questions: • Have you ever resided i n one of the City's Histor ic D ist ricts for at least one year ? ~ No Address in City Historic District submitted . 413 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to C ity Code section 2-22(4) a , band c : Members of Agencies , Boards , and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways : a . Resident of the City for a minimum of six (6) months: • I am resident of: N/A Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6 ) months : Yes "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 liab i lity company, or other entity or business association. Or 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 No twithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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 th e Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience . Pl ease list below: Attorney • Are you presently a reg i stered lobbyist wi th the City of Miami Beach? 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 Bea ch codes : If yes , please expla in in detail: • Do you currently owe the City of Miami Beach any money : If yes , please explain in detai l: • Are you currently serv ing on any City Boa rds o r Committees : If yes , whi ch board? Human Rights Committee -Chair 414 • 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 4640 Post Ave • Are you now employed by the City of Miami Beach: If so, which department and title? • Pu rsuant to Ci ty Code Secti on 2-25 (b): Do you have a parent, spouse , chil d , brother, or sister who is employed by the City of Miami Beach? If "Yes", identify person (s) and department(s): No relative's information submitted . 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 cont ra cti ng 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 l ocal 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 vo ting conflict of interest under Section 112.3143 . Florida Statutes . 415 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Ack nowledgement of fines/suspension for Board /Committee Members fo r fa ilure to c omply with Miami-Dade County Financial Disclosure Code Section 2-11 .1 (i)(2) I understand that no later than July 1 . of e ach y ear 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 m u st be fill ed with the City Clerk of Miami Beach , 1700 Convention Center Drive , Miami Beach , Florida, no later than 12:00 noon of J uly 1 , of each yea r : 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 M ia mi-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 Rnancial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon, July 1 . Plannin g Board and Board of Adjustment members who file the i r 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 add itional form with the Office of the City Clerk. However, compliance with the County disclos ure requirement does not satisfy the State requ irement. D IVERSITY STATISTICS R EPORT The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City d iversity reporting requirements . Gender: Race/Ethnic Categories What is your race? White Are you Spani sh/Hispani c/ Latino? Mark the "No" box if not Spanish / H ispanic / Lati no. No Other Description : No details provided Physically Challenged : 416 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph , and a copy of any applicable professional license . I have completed and attached the Board & Comm ittee Financial Acknowledgment Statement. YES 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. 7 411 Note : Florida Statutes 119.071 : T he role of the Office of th e City Cl erk is to receive and maintain forms fi led as public records. If your home address , telephone numbers , and/o r photograph are exempt from d isclosure and you do not wish your home address, telephone numbers, and/or photograph to be made public , please : 1) Use you r office or other address for your mailing address ; 2) Use you r office or other telephone number for your contact number; and 3) Do not attach a ph otograph . 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 ACCORDINGLT. I Alan Fishman ag reed to the following terms on 11 /3/2020 3:48 :32 P M Received in the City C lerk's Office by: Name of Deputy Clerk Control No . Date 417 PROFESSIONAL AFFILIATIONS: EXPERIENCE: PUBLICATION: EDUCATION: HONORS ANO ACTIVITIES: Alan B. Fishman, Esquire 96 0 Arthur Godfrey Road Suite 102 Miami Beach, Ronda 33 14 o 1305) 532-281 0 The Florida Bar, 1987. Certified Public Accountant (Florida), 1 987. Solo Practitioner, Law Office d Alan 8. Fishman, Miami Beach, Florida. May 1989 -Present. Practice In real estate, bankruptcy and corporate law. Therrel Baisden & Meyer Weiss, Miami Beach, Florida. Oct.0ber 1987 -May 1989, Attorney. Research and writing opinions and memoranda Involving banking and real estate law. Tax research in partnership, corporate, foreign, estate planning and federal and state tax controversies. Research and writing pleadings and memoranda for cMI litigation proceedings . Michael J. Moorhead, Professor of Law, University of Florida, Gainesville, Florida. September 1985 -May 1987, Research Assistant. Researched labor law, administrative law and civil rights law to assist in the preparation of articles for publication. Extensive use of WESTLAW computer research and legislative materials. Co-author, Florida CM! Pract1c:e Damages Chapter Six, (CLE Second Edition, 1989 Supplement). Jurls Doctorate, University of Florida College of Law, May 1987. Bachelor of Science In Business Administration in Professional Accounting and Finance, The American University, May 1984. University of Florida Colfege of Law Merit Loan (1984 -1987). The American University Merit Scholarship (1981 -1984). Charles Glover Scholarship ( 1983 ). Sidney Ludwig Foundation Scholarship ( 1980 -1983). Outstanding Student Service Award. Kogod College of Bu.uless Adrrunlstration. The American University ( 1984 ). Chairman, Commencement Committee (1983 -1984). 418 MEMBERSHIPS: Senator. Kogod College of Business Administration Student Representative to Faculty Senate ( 1983 -1984 ). Student Representative, Senate Finance Committee ( 1983 -1984 ). Student Representative, Board of Trustees Finance Committee (1983 -1984). Assistant Academic Advisor, entering freshmen (1983). Student Confederation Judge, Criminal and Conduct Code Tribunal (1980 -1981 ). Dade County Bar Association: Director. Young Lawyers Section (1988 -1991). Treasurer, Young Lawyers Section (1991-1993). American Bar Association. Phi Delta Phi LegaJ Fraternity. 2 419 12/3/2020 Member Profile -Alan Bruce Fishman -The Florida Bar MEMBER PROFILE Alan Bruce Fishman Bar Number: 699251 Mail Address: 4045 Sheridan Ave# 398 Miami Bea c h , FL 33140-3665 Office: 305-532-2810 Cell: 305-532-2810 Email: abfesq@aol.com Personal Bar URL: Member in Good Standing Eligible to Practice Law in Florida https://www. florid a ba r.o rg/myba r prof i I e/699251 vCard: County: Miami-Dade Circuit: 11 Admitted: 10/06/1987 10-Year Discipline History: None Law School: https://www.floridabar.org/directones/find-mbr/profile/?num=699251 112 420 12/3/202 0 Member Profile -Alan Bruce Fishman -The Florida Bar Un iver sity of Florida, Fredric G. Levin College of Law, 1987 Firm Size: The Find a Lay.iyer directory 1s provided as a public service The Flonda Bar maintains hm1ted basic nformat1on about lawyers licensed to practice in the state leg. name. address year of birth. gender, law schools attended adm1ss1or year) However The Florida Bar allows 1nd1v1dual attorneys the opportunity to add p e rsonal and profession al information t o the directory The lawyer 1s solely responsible for rev1ew1ng and u p dating an y add1t1onal 1nfor mat1on 1n the dir ectory The lawyers added ,nformation 1s not reviewed by The Bar to, accuracy and The Bar makes no warranty of any kind, express or implied The Fl orida Bar. its Board of Governors. employees. and agents are not responsible for the accuracy of that add1t1onal 1nformatton Publication of la""'Yers· contact 1nformat1on in t his listing does not mea n the laYJYE?rS have agreed to receive unsolicited commurncat1ons in a ny form Unauthorized use of this data may resu lt in c1v1I or cnm,nal penal ties The Find a Lawyer directory 1s not a la~r referral service hltps ://www.Ooridabar.org/directories/find-mbr/profile/?num=699251 2/2 421 422 • Jesse Fleet 423 THIS PAGE INTENTIONALLY LEFT BLANK 424 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMM ITTEE APPLICATION FORM NAME: Fleet Jesse Last Name First Name Middle Initial HOME ADDRESS: 855 Euclid Ave Miami Beach FL 33139 -------------------------------------------Apt No. Home No./Street City State Zip Code PHONE: 3057468999 Home Work djbombjack@hotmail.com Email Address Business Name : RSJF LLC Posit ion: Auto Consultant ~~=~----------- Address : 2475 NW 38th Street Miami Florida Street City State 33142 Zip Code Pursuant to City Code section 2-22(4) a and b : Members of agencies , boards , and committees shall be affiliated with the c ity ; 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; orb) an individual shall demonstrate ownership/i nterest for a minimum of six months in a business established in the city. • Resident of Miami Bea ch for a minimum of six (6) months Yes • D emonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes • Are you a req istered voter in Miami Beach : No • (Please cin.!.e. one): I am now a resident of: South Beach • I am applyinq for an appointment because I have special abilities, knowledqe and experience. Please list below: 2 years on CMB Human Rights Committee -I'd like to stay on for another 2 years. • Are you presenUy a registered lobbyist with the City of Miami Beach? 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 City Clerk's Office. (Regular Board s of City) Choice 1 : Choice 2: Choice 3: Human Rights Committee Art in Publ ic Pl aces Committee Affordable Housing Advisory Committee • Board members are requ ired 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 Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board : No Years of Service: -------------------- 2 . Present participation in Youth Center activities by your children _N_o __ _ if yes, please list the names of your children, their ages, and which programs. List below: 425 • Have you ever been convicted of a felo ny: No If yes, please explain in detail : • Do you cu rrently have a violation(s) of City of Miami Beach codes: No If yes, please explain i n detail: • Do you cu rrently owe the City of Miam i Beach any money: No If yes . please explain in detail : • Ar e you c urrently serving on any C ity Boards or Committees: Yes Human Rights Committee If yes, which board? • What organizations 1n the City of M iami Beach do you currently hold membership in? Name Chamber Of Commerce • I am now employed by the city of M iami Beach : No Title Member Which department? • List all properties owned or have an interest in , which are located within the City of Miami Beach: Gender: Male 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 federal equal opportunity reporting requirements. Race/Ethnic Categories What is your race? Mark one or mo re races to indicate what you consider you rself to be. White Other Description: Are you Spanish/Hispanic/ La ti no? M ark the "No" box if not Spanish / Hi span ic/ Latino. No Physically Challen~ed: No NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: ~ Proh1b1bon from direcUy or indirectly lobbying city personnel (Miami B each City Code secti on 2-459). c Proh1b11lon from contracting with the city (Miami-Dade County Code section 2 -1 1.1 ). o Prohibition from lobbying before board/committee you have served on for pe riod of one year after leaving office (Miami Beach Code section 2-26). -Requirement to disdose certa in financial interests an d gifts (Miami-Dade County Code section 2-11 1 ). (re: CMB Community Developmen t Advisory Committee). prohib1bon, dunng tenure and for one year after leaving office . from having any interest 1n or re ceiving any benefit from Community Development Block Grant funds for either yourself, or those with wh om y ou have business or immediate fami ly ties (CFR 570.611 ). Upon request. copies of these laws may be obtained from the City Clerk. "I hereby attest t o the accuracy and truthfulness of the applicat ion and have received , read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Jesse Fleet agreed to the following terms on 12/4/2018 10:53:37 AM Received in the Ci ty Clerk's Office by: Name of Deputy Clerk Control No . Date 426 I do not have a current resume. I have not needed one in over 8 years. Regards , Jesse Fleet 427 428 • Jessica Londono 429 THIS PAGE INTENTIONALLY LEFT BLANK 430 MIAM I BEACH Londono Last Name 1100 venetian way Home Address 3052990486 Cellular Telephone Work Telephone Jess ica First Name miami beach City Home Telephone BOARD AND COMMITTEE APPLJCA TION fl State Middle In itia l 33139 Zip Code jbatty7 4@gmail.com Email address The Advantaged Yacht charters and Sa les Yacht Broker Busines s Name Occupation 1800 Purdy av e ms3 miami beach 33139 fl Business Addres s City State Zip Code Please list your preferences in order of ranking: (1] first choice , [2] second choice , and [3 ] third choice . Please note that only three (3) chojces will be obseryed by the Office of the City Clerk Affordable Housing Advisory Comm ittee Animal Welfare Committee Art in Pub li c Places Committee Aud it Committee Black Affa irs Advisory Committee Board of Adjustment Budget Adv isory Committee Committee for Quality Education in Miami Beach Comm ittee on the Homeless Convention Center Advisory Board Cu ltural Arts Council Des ign Review Board Disability Access Committe e 1. 2 . 3 . ---'-'H=uman Rights_Q_ommittee Type of Professional License Health A dvisory Committee Norm andy Shores Local Government Neighborhood Improvement District Advisory Council Health Facilities Authority Board Parks and Recreational Facilitie s Board Hispanic Affa irs Committee Personnel Board H istoric Preservation Board * Planning Bo ard Housing Authority Police/Citizens Re latio ns Committee Human Rights Committee Production Industry Council LGBTQ Advisory Committee Program for Public Information Committee Marin e & Waterfront Protection Senior Affa irs Committee Authority Mayor's 41 st Street Committee Sustainability Committee Mayor's General Obligation Bond Transportation , Parking , and Bicycle- Oversight Committee Pedestrian Facil ities Committee Mayor's Panel on Ocean Drive Visitor and Convention Authority Miami Beach Commission for Women Youth Comm ission Next Generation Council P rofess ional Li cense License Number State of Issuance License Issuance Date License Expiration Date Note: If you are seeking appointment to a professional seat (e .g . attorney , arch itect, etc.), you must attach a copy of your current! effective corres ond in rofessional li cense . Page 1 of 6 F \CLERISALLIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION docx Upd ated : June 2020 431 AfEILIAJION WIJH THE CIJX Of MIAMI BEACH 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 requ irement shall be fulfilled in the following ways : a. Resident of the City for a minimum of s ix months: Yes ~ or D No • I am a resident of: South Beach ~ Middle Beach O North Beach 0 Or b. Demonstrates an ownership interest (for a minimum of six months) in a business established in the C ity (for a m inimum of six months): Yes 0 or O No "Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more of the outstanding ca pital stock) in a business. "Business" shall mean any sole proprietorship, sponsorship, corporation , limited liability company, or other entity or business association . Or c. Full-time employee of such a business (for a min imum of s ix 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): Yes ~ or D No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business mus t be approved by a 417th vo te of the Mayor a nd City Commission. NOTE: Members of Agencies , Boards, and Committees shall be required to demon strate compliance with the City affiliation requirements of sections 2-22 (4) a and b of the Miam i Beach City Code by executing an affidavit, stipulating that they have met eithe r (or both) of said affiliation requirements. The original affidavit shall be filed with the Office o f the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abili ties , knowledge , and experience. Please list below: Current Member for the last two years Page 2 of 6 F \CLERISALLIBOARO AND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION docx Updated : June 2020 432 • Are you a reg istered active lobbyist w ith the City of Miami Beach? Yes O or No [;z} • Have you ever been convicted of a felony? Yes D or No GZJ If yes , please explain in detail : • Do you currently have a violation (s) of City of Miami Beach Code? Yes O or No l;z. If yes , please explain in deta il : • Do you currently owe the C ity of Miami Beach money? Yes O or No ~ If yes, please explain in detai l : • Are you currently serving on any C ity Board or Committee? Yes~ or No O If yes, wh ich Board/Committee? Human Rights • In what organ ization(s) in the City of Miami Beach do you currently hold membership? Name Pos ition Name Position • List the address of all properties owned or in which you have an interest within the City of Miami Beach: • Are you now employed by the C ity of Miami Beach? Yes O or No ~ If so, which department and t itle? • Pursuant to City Code Section 2-25 (b): Do you have a parent 0 , spouse 0, child O brother O or sister 0 who i s employed by the City of Miami Beach? Yes D or No ~ If "Yes ," identify person(s) and department(s): __________________________ _ • 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 Hi storic Districts for at least one yea r? Yes O or No 0 If you answered "Yes ," please indicate : From: Address Dates From: Address Dates Page 3 of 6 F ICLERISALLIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION docx Updated : June 2020 To To 433 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 leavi ng 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 Sunsh ine Law -Florida 's Government-i n-the-Sunshine Law was enacted in 1967. Today, the Sun shine Law regard ing 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 governi ng bodies of state and local governmental agencies or authorities . o Voting conflict -Form 88 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 bod ies who are presented w ith a vot ing confl ict of interest under Section 112.3143 , Florida Statutes . 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/O~~i= LAWS AND STATUTES ACCORDINGLY ." _ === => 11 /6/20 C ~ Jessica Londono Applicant's Signature Date Name of Applicant (PLEASE PRINT) Board and Committee Appl ication Checklist: Please ensure you have provided all information befo re applying or reapply ing to any Board and Committee ~ I have answered all questions fully . D I have attached additional sheets, if necessary , to provide requ ired in formation . D I have attached a current resume , photograph, and a copy of any applicable professional license . ~ I have completed and attached the Board & Committee Financial Acknowledgement Statement. IZl I have completed and attached the Diversity Statistics Report. D Submit complete application package . Via Email : BC@miamibeachfl.gov Via U .S . Mail or in Person : City of Miami Beach Office of the City Clerk / Board and Comm ittee Section 1700 Convention Center Drive , 151 Floor Miami Beach , FL 33139 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 publ ic records. If your home address, telephone numbers, and /or photograph are e xempt from disclosure and you do not w ish your home add re ss , 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. Page 4 of 6 F·\CLER\$ALLIBOARD AND CO MMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICAT ION docx Updated: June 2020 434 MIAMI BEACH City of M iami Beach l 700 Conventi on Center Drive M i ami Beach , Flor ido 33139 www miamibeachA gov OFFICE OF THE CITY C LERK Email : BC@miamibeachfl.gov Telephone: 305 .673.7 41 1 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Londono Jessica Last Name First Name Middle Initial 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 M iami-Dade County F inancial Disclosure Requirements. ~ of the followi ng 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;" 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;~ jail, or both . C -1115120 Signature Date 1 Members of the Planning Board and Board of Adjustment will be notified d irectly by the State of Florida, pursuant to F .S . §112.3145(1 )(a}, to file a Statement of Financial Interests (Form 1) with the M iami-Dade County Supervisor of Elections by 12:00 noon , July 1. Plann ing Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the Cou nty's financial disclosure requirement as a M iami Beach C ity Board/Committee member and need not file an additio nal form w ith the Office of the City C lerk. However, compliance with the County disclosure requ irement does not satisfy the State requirement. Pag e 5 of 6 F ICLERISA LLIBOARD AND COMMITTIES DATABASEICHECKLIS T MASTERIBOARD AND COMM ITTEE APPLICATION.docx Updated June 2020 435 MIAMI BEACH City of Miami Beach I 700 Co nvention Center Dri ve Mia mi Bea ch , Fl o r ido 33139 www.miami b eac hfl .g ov O FFI CE O F THE CITY CLER K Email : BC @miami beachfl .gov Telephone: 305 .673.7 411 Londono Last Name DIVERSITY STATISTICS REPORT Jessica First Name Middle Initia l The following information is vol untary and has no bearing on your con s ideration for appoi ntment. It is being asked to comply with City diversity reporting requirements . Gender: DMale 0Female O ather 0 I prefer not to answer. Race/Ethnic Categories : What is your race? 0 African American/Black 0 Asian or Pacific Islander l;z) Caucasian/White 0 Native American/American Indian 0 Other -Print Race: __________ _ 0 I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? 0 Yes 0No 0 I prefer not to answer. Do you consider yourself Physically Disabled? D ves 6ZJNo 0 I prefer not to answer this question . Page 6 of 6 F ICLER\$ALLIBOARO AND COMMITTIES DATABASEICHECK UST MASTERIBOARO AND COMMITTEE APPU CATION.docx Updated : June 2020 436 PB.OFILE J ess ica Londono I 800 Purdy a ve YIS 3 Mi ami Beach FL 33139 3052 99 01-86 jcssica@thcadvantagcd.com Yl iami Beach res ident fo r over 16 years, local business owner, community activist and an all around profession a l and yo ung addition to H uman Righ ts Committee. E\PElllE\CE HUillan Rights Committee 2018-Present Attended and contributed ro .\l1am 1 Beach I Iuman Rights Comm ittee appointed by .\lickey Steinberg. Sisl<'r C iLiC's \liami lkach boa rd rnl'mlJC'r 2009-20 18 [ have bcen on thc <;1stcr C:i ncs board whcn ,\1ayor i\larti Bower wa~ in office. I abo ~at on the board during .\layor Philip Levine\ tenurc. I have the mo~t expe ncnce and per~onal contact, related rn Consulate~ and other Si~ter C itic, related anions. [ have suppl ied a yac ht ch arter for every delegation and have been involved m all ~ocial media ta,b. T he \chan tagc-d hchl-2006-Prc-sc-nl VP and Co founder of o n e of the largest yacht charter companies in Yli a mi Beach and South Fl orid a \ss islanl lo Torn Dal) l\c-lalcd G ro up 20()/j.2006 Facili tated day to day items on Mr. D aly's work agenda along with p e r sonal ass istant tasks such as his home a nd p e rso nal requests EDl CI\T I O \ :'-l onhEa t H igh Ft Lauderdale H S D iploma S Kl LLS L icen e d FL Yacht Broke r Li censed :'-lota ry 437 438 • Michael Sherman 439 THIS PAGE INTENTIONALLY LEFT BLANK 440 lD MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME : Sherman Last Name HOME ADDRESS : 1573 Pennsylvania Ave, 1N Apt No. Home No./Street PHONE : 3052405822 Home 3054210400 Work Michael First Name Miami Beach City Business Name: :....:A.,_p p"'lc:ce ____________ _ Position: Apple Address : Apple Apple Middle In itial FL State powe rfulcalm @gmail.com Email Address Apple -------------------------------------Street City State 33139 Zip Code Apple Zip Code Pursuant to City Code section 2-22(4) a and 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 m inimum of si x months; orb) an individual shall demonstrate ownership/interest for a mini mum of s ix months in a business established in the city . • Resident of Miami Beach for a minimum of six (6) months No • Demonstrate an ownership/interest i n a business in Miami Beach for a minimum of six (6) months: No • Are you a req istered voter in Miami Beach: No •(Please~ one): I am now a resident of: • I am applyinq for an appaintment because I have special abilities , knowledqe and experience. Please l ist below: • Are you presently a registered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking [1) first choice [2 ] second choice , and (3) third choice . Please note that only t hree (3) ch oices will be observe d by the City Clerk's Office . (Regular Boards of City) Choice 1: Choice 2 : Choice 3 : Human Rights Committee LGBTQ Advisory Committee Police /Citizens Relat ions Committee • Board members are requ ire d to fi le Fonn 1 -"Statement of Financial Interest" w ith the State. If you seek appointm ent to a professional seat (e.g., lawyer, arc hitect, etc.) on th e Boa rd of Adjustment, Desi gn Revi ew Board , Histor ic Preservation Board or Planning Board , attach a copy of your curre ntly-effective ly license, and furnis h the following Information : Type of Professional License ______________ _ License Number License Issuance Date _________________ _ License Expiration Date Note: If applying for Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board : No '""-"---Years of Service: _______________ _ 2. P resent participation in Youth Center activities by your children _N_o __ _ if yes, please list the names of your children, their ages, and which programs. List below: 441 • Have you ever been convicted of a felony: No 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 cu rrently 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: No If yes , which board? • What organiza tions in the City of Miami Beach do you currently hold membership in? • I am now employed by the c ity of M iami Beach: No Which department? • List a ll propertie s owned or have an interest in, which are located within the City of Miami Beach: Gender: Male The following information is voluntary and is neither part of your applicati on nor has any bearing on your consideration for appointment. II is being asked to compl y with federal equal opportunity reporting requirements. Race/Ethnic Categories What is your race ? Mark one or more ra ces to indicate what you consider yourself to be . White Other Descriptio n: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hi spanic / La tin o. No Physically ChallenQed : No NOTE: If appoi nted, y ou will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: o Proh 1b1bon from directly or indirectly lobbying aty personnel (Miami Beach City Code section 2-459). o Prohibition from contracting with the city (Miami-Dade County Code section 2-1 1.1 ). 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). " Requirement to disclose certain fin ancial interests and gifts (Miami-Dade County Code section 2-11 .1 ). (re: CMB Community Development Advisory Committee): proh1b1t1on. dunng tenure and for one year after leaving office . from having any interest in or receiving any bene fit from Commun ity Development Block Grant funds for eilher yourself. or those with whom you have business or immediate family ties (CFR 570.611 ). Upon request. copies o f these laws may be obtained from the City Clerk. "I h er eby attest to the accuracy and truthfulness of the application and have received, read and w ill abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees an d Agency Members ." I Michael Sherman agreed to the following te rms on 1/31 /2019 2 :31 :32 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control N o . Date 442 M ic hae l J. S he rma n (30 5)240-582 2 powerf ulca l m@'g ma il.com 15 73 Pennsylvani a Ave., 1 N U nited S t a tes M ia mi Beac h Florida 33139 Education S ummary: Degree High School Hawa ii Preparatory Academy Degree Co lorad o State University -CSU Assoc iate's Degree Miami Dade Col lege -MDC Empl oy me nt Summ ary: Em plo ye r (Current 8 years of service) Apple In c. Lead er hip Empl oyer (Ame ri ca n Airlines) Pi edmont Airlines J ob Title Operations Man age r Em pl oye r Maste rpiece Product ions J ob Title VP. Customer Deve lopment and Relation Emp loyer Hilt on Hote ls Job Title Direc tor o f Corporate and Intern ati o na l Sales Emp loyer Omni Hotels and Resorts Job Title a ti o nal Sa les Manager/ Director of Deve lo pment Empl oyer Hya tt Hotels and Re sort s Job Titl e Sales Manager 443 Secondary Language Spanis h : Proficiency: lntennediate 444 445 THIS PAGE INTENTIONALLY LEFT BLANK 446 • Dale Stine 447 THIS PAGE INTENTIONALLY LEFT BLANK 448 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Stine Dale ..;:;..;.;.;c...;..:;.... ______________ _ Last Name F irst Name Middle Initial _1_57_3_P_e_n_ns~y~lv_a_n_ia_A_v_e_._#_1N ________ M_ia_m_i B_e_a_c_h _____ F_lo_ri_d_a _____ 33139 Home Address City State Zip Code .::..30.::..5::....--'--76.::..1.;_-...::.3.:::.25.::..3::...._ _____________ 30_5_-_76_1_-_32_5_3 ___ dale@dalestine .com Cellular Work Home Email Address Heart Prints Inc. President/Photographer Bu siness Name: Occupation: 1573 P e nnsylvania Ave. # 1 N Miami Beach Florida 33139 Business Address City State Zip Code 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: Human Rights Committee Choice 2 : Art in Public Places Committee Choice 3: Animal Welfare Committee Professional License No Profe ssional Li censes Submitted . Note: If you are seeki ng appointment to a professional seat (e .g . attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. * 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 ? No No Address in City Histori c Distri ct submitted . 449 A FFI LI ATION WITH THE C ITY OF MIAMI B EAC H Pursuant to C ity Code section 2 -22 (4) a , b and c : Members of Agen cies. Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways : a. Res ident of the City for a minimum of six (6) months : • I am resident of: South Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: fu "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" s hall mean any sole proprietorship, sponsorship, corporation . limited liability company, or other entity or business associa tion. Or 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): N.Q Notwithstanding the requirements set forth herein , the qualified full-time employee of a business must be approved by a 417th vote of th e 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 (o r 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. • I am applying for an appointment because I have special abilit ies , knowledge and experience . Please li st below: Photographer -working in a variety of areas with individuals , corporations, organizations and events in M iami Beach and beyond Musician -Direc tor of musi c ministry at Unity on the Bay in M iami and a member of the Special ad hoc committee we have created to address "healing racism." • Are you presently a reg is tered lobbyist with the City of M iami Beach? No • Have you ever been convicted of a felony: No If yes , please explain in detail : • Do you currently have a violation(s) of City of Miami Beach codes : No If yes , please explain i n detai l: • Do you cu rrently owe the City of M ia mi Beach any money: No If yes , please explain i n d etai l: • Are you currently serving on any City Boards or Committees : Yes If yes , whi ch board? Human Rights Committee 450 • 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 with in the City of Miami Beac h: No Owned Property Information submitted. • Are you now employed by the City of Miami Beach : No If so , which department and title? • Pursua nt to City Code Sectio n 2-25 (b ): Do you have a parent, spouse, child , brother, or sister who i s employed by the City of Miami Beach ? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 lobbyi ng before board /committee you have served on for period of one year after leaving office (Miam i Beach Code section 2-26) o Requirement to disc lose 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 basi c right of access to most meetings of Boards , Commissions , and other govern ing bodies of state and lo c al governmental agencies or authorities . o Voti ng conflict -Form 88 is for use by any person s erving at the county , city, or other l ocal level of government on an appointed or elected Board , Council, Commission , Authority, or Committee . It applies equal ity to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143 . Florida Statutes . 451 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines /suspens ion for Board/Committee Me mbers for failure to comply w ith M iam i-Dade County Financial Disclosure Code Sect ion 2-1 1.1 (i)(2) I understand that no later than July 1. of ea c h year all members of Boards and Committees of the C ity of Miami Beach , including those of a purely advi sory nature , are requ ired to comply with M iami-Dade County Financial Disclosure Requirements . One of the following forms must be fill ed with the City Clerk of Miami Beach , 1700 Convention Center Dri ve, Miami Beach , Florida , no later than 12:00 noon of July 1, of each year: 1. A "Source of In come 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 Plan ning Board and Board of Adjustment wil l be notified directly by the State of Florida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnancia l 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 the ir Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requ irement as a Miami Beach City Board/Co mmittee member and need not file an additional form w ith the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requ irement. DIVERSITY STATI STICS REPO RT The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City d iversity reporting requirements. Gender: Race /Ethnic Categories What is your race ? White Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / L ati no. No Other Description : No detai ls provided Physi cally Challenged : No 452 Boa rd and Committee Appl ication Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . ~====! YES I have uploaded a current resume, photograph, and a copy of any applicable professional license . YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES I have completed and attached the Divers ity Statist ics Report. If you have any questions, please contact the Office of the C ity Clerk via emai l: BC@miamibeachfl.gov or telephone : 305 .673 . 7 411 Note : Florida Statutes 119.071 : The role of the Office of the City Clerk is to receive and main tain forms filed as public reco rd s . If you r hom e add ress, telephone num bers, and/or phot ogra ph are exem pt fro m disclosure and you do not wis h your ho me address , t elephone numbers, and/or photog raph to be made pub l ic, 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 . 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 ACCORDINGLT. I Dale Stine agreed to the following terms on 11 /3/2020 4 :08:44 PM Rece ived in the City Clerk's Office by : Name of Deputy C lerk Control No . Da te 453 Dale Stine is a self-taught shutterbug, who quickly established himself as one of those most sought-after photographers in Miami since moving to Florida in 2001. His photographs and images have been featured on innumerable magazine covers, feature spreads, CD / record covers and websites . Internationally-acclaimed DJ's/ producers and drag personas, as well as various politicos, businesspeople and entertainers are among his favorite clients. He has been an official photographer for the South Beach Wine and Food Festival , Aqua Girl , The National LGBTQ Task Force, Pridelines, Palace Bar, Twist Bar, Hot Spots and many more. Dale's work has appeared in countless exhibitions , including a good number of his own solo shows, the first of which was "The Diva Collection: Illusion Series" with images of over forty drag and trans performers. He has also shown his work during Art Basel as well as during other high-profile events. With a background in music and entertaining, Dale brings his love of the stage and singing to everything he does. A North Carolina native who moved to New York City after being accepted into the world-famous Juilliard School , he received his Master's Degree in opera from that institution. He lived in New York for over 20 years in total and during that time worked in a wide variety of genres, among them, classical music, mus ical theater, modeling & commercials. In addition to his photography work, Dale is cun-ently the Director of Music Ministry at Unity on the Bay. He performs regularly in the Miami area and continues to travel as a guest artist. As a Miami Beach resident, Dale served as a member of the mayor's LGBTQ Advisory Committee for eight years and now sits on the city's Human Rights ColIDnittee. Tonight, Dale is beyond thrilled to be a judge for Miami's Ultimate Drag Competition. 454 455 THIS PAGE INTENTIONALLY LEFT BLANK 456 • Jonathan Welsh 457 THIS PAGE INTENTIONALLY LEFT BLANK 458 " :~1J ~ ' '; l". l dSt N.e11"e ~ .._) -M,c11lt-> l'lll :ii _!' \!_ t;.__---'-t--,-.-"-J_1_t:_• ___,_; ,.,)~---' .L: '_,,__c_, _r"' __ . __ i ... :'-1-✓_c._,_,_r ___ ...:;:_--=_1... ___ -...)__,_-,;5_,_s_7;__ __ _ 1 C t1 Stole I Z,p Code le. ~oJ __ I;.' uc H1,rne Acdress "t 171 ·~,-, ) i } ) , . ' r +· '"ILi..) -._;_ ', ,r , r > ~ / r.:: --1-d I ' ' li, I p . J ,. e-,_ C , e ' ' '.: ~. Home 1 e ephone Woo Telephone Cellular Telephone EMa,t address C l I ,! f ")O ~ r ( ( """' I j:>\)iJ •;,"'<,_:'1._ Bus ness Name OCCLpatlon -~ ~ r ( ' '_,( c t ,, \' I)• q, .;,-./ Bus,ness Address Coty · State Z ,p Code P-ofess,orat License (descr b e) _________________________ E ,p,res Plea se attach a cop y of cur rently effecltve professional license. Pursuant to City Code section 2-22{4)a & b : Members of agencies. boards and committees shall be aff1ilatcd wit, the C ity This requ irement sh all be ful filled n the fol lowing ways · a. An i ndividual shall have been a residen t of the City for a m inimum of si x months; or b An ind ividual shall demonstrate ownersh1p/1nte rest for a minimum of six months in a bus ness esta blished In th e City fo r a minimum of six months • Resident of M1a"Tii Beach for a minimum of six (6) months. Yes ~or No 0 • Dem onstrates owner ship/i nteres t in a business ~iam1 Beach for a m in mum of six mon ths Yes U r No (2g • Are you a regis tered voter rn M iami Bea ch . Yes ~or No 0 • I am now a reside'lt of North B each O South Beach "ID Middle Beach Ll • I am applytng for an appointment because I have specrcil abilities. knowledge and expencnce Please list below: ~,.,.,,.,,1 .,~,I L,,C1 ~1r-11~ P~. '! '(oni,. • Are you pres ently a regi stered lobb yis t w th the Crty of Miamr Bea ch? Yes O or No 0 Please lrst yo ur preferences 1n order of ranKrng [1] firs t choice (21 second cnoice, and [3] tt-rd cl·o1ce. Please note that 0 o1x three (3) choices wiH be obseryed by the Office of the Citx Clerk Affordable Hous,"9 Adv sory Committee H eah.., A.dv,so,y Comrnonee ---' Pa !i<s a"ld Reoeat10n Faol bes Board 00 --~ _Art :nPubNc PlacesCoMmlttee Heat.n Fa e.Illes Autronzv Board Personoe Boa<d Aud,ICOll1'Tilt1ee H.soan,c Affairs Comm ttee P,af1ntnaOoard• * I I - - ,. 3oard o l Ad1u-nt • * H1sloroc Pre:;e ,vat,on Board * _I Police C,1 ~tns Relaltons Com,~_;,_\ __ BudgPt Adv so~ Ccn'VTltnee -H0JS 1,gAulhofihl Production l"ldJSW Couf1o Cor-,m,tteeon tilt! Homeless Human Rl(J h!s C0"1'T11tee / I ) Sisle•Cn esProoram ~.omm1ttee forOLa~ty Eaucatoon ,n MB LGBT Advisor; Comm,t:ee -,•:::i, Susta111ao-;,;.;; Co"'lm tte_e ___ --Con11en110n C1>nlrr Advisory Boatd M ar,ne & Waterf•on t Proted,on Authonr Tra rsportat,on Pan<,ng & 8 cydn Pooe,nar, Fac,illles Comm,ree C .JtturalArtsCounc I Miam, Beaeh Comniss•on tor Women Vis tor and Conveni,on Aulh0< hi Desgn RevoeNBoard * Nomiandy Shores Local Government YO<Jth Comm15s1on Ne,chbothood impn,.,,e'Tlenl o ,sab1L:y Access Comrri ttt ee Ad Hoc Anti-BuUying Taslc F0tce ·- • mm re re u ired fllo F rm 1-"S f Fin n lal Inter "w Board e bars a q to o tatement o a c est Ith the State. ff you scok appointment to a professi onal seat (e .g ., lawyer, architect, etc.) on the Board of Adj ustmen t , Design Revi ew *B oard, H istori c Preservation Board or Planning Board, attach a copy of your c urrently-effectivel y license, and furnish the following inform ation : Type of Pro fe ssional Llcensc ______________ Llcense - -N-umber -1 L icense Issuance Date ________________ Llcen se Expiration D ate ~ L ________ _ Poge 1 or 4 C IIJ1en'(, ERCueR\Oes,top BC APPLICAnON dOc, 459 00 Note If applying for thl' Youth Center pos t,ons of the Pc1ri\<; ard R ecre;it,ons Fac:l1t1P,s Boa'd please nd,cate your affhat,on w,t., the Scott 1'a~o "" Yo..1 th Ce,iter and1or the Nortt-Shore Pari<s Youth Cen te r ____________________ _ ---------------------------------------,----------- Ple<1SP de'>Crbo your past scMco with the C1tIs Youth Cenh:rs ( ncude oates of ser.,,co) __ ....__.__.,_A~--------- Pr;;sent pdrto<:1pat on,,. Youth Center actMUes by yoi..r ch,.dren Ye:; ~ ~o 0 If yes p l ease list below the rames o' your children, the1r ages and the programs 1n which they part,c,pate Ch,ld s name C h ,ld s name Age ___ Program Age ___ Program • 1-<a ,e you e,er been c.o-iv,cted of .i fe lony? Yes o r No If yes :, ease el'p a,r '" deta • Do you currently ha ve a v,o a bon(s) o f City of Miam· Beach Code? Yes O or N If yes. please explain in deta· • Do you currently owe the C ty of M,ar-i Beach any money? Yes O or No~ If y es. expla n ,n detail. • Are yo<J currently serving on ai,y City Board or Comm.nee? Yes O or No ~ye~ wh,c-i board/co~:ee? • In w,iat organ,z au9n(s) n the City o' MM3m , Beach do you current y ho:d m er-ibersh 1p? 1\,/ I A NaMe P os,tior • List all properties o"""ed or }::;t/r;; yo<J ha•;e an interest w,thin t he City of M am Beach • Are yoi.. row employed by the C t1 o f "-'tam, Beach? Yes O or No~ Which department a nd t11Je? ___ _ • Pursuant t o City Cod e Section Z-2 5 (b ): Qc yo1., ~ a pa'ent rrrployed b, I.he C ty of M .im B1u1ch? Yes U or No -/;J If Yes· ,del"!:~ per50n(s) a'ld oepMmo,ii(s) 0 spouse::_, ch•ld J brO''le r O or s,,,:er O w,o s The following Information is v oluntary and Is neith e r part of your application nor has any bearing on your consider ation for appoi ntment It l s b Ing asked lo comply w i th C ity d iver sit y reporting requi rements. Gender: M a'e Female RaceJEthn lc Categories What is your race ? Q Afncan-A mencan/BJack 1 1:;j Caucas1an/VVh1te ::J As,on or P ac,fic Islander :J Nat1ve-Ar,,erican/Amencan Indian C 'l.,s e11ICLEROueR,Ou,1opl 8 C APPLICATION doe> Pag,i 'J of 4 460 ...J Other -Pr,nt Race --------------------------------- Do you consider yourself to b e Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish. H,spa mc. Larmola it} No DYes Do you consider yourself Physi cally Disabled? NOTE IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/C OMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO: Prohtb1t10n from directly o r indirectly lobbying City personnel (M1am1 B each Crty Code sect10n 2-459). Proh1b.t1on from contracting with the City (M1am1-Dade County Code section 2-1 1 1) Proh1b11Jo n from lobby•ng before the board/committee you have served on for penod o f one year a':er leavmg office (~1am1 Beact, City Code section 2 -26) Requirement to disclose certain financial interests a nd gifts (Miami-Dade County Code sect on 2-11 1) CMB Community Development Advisory Committee· proh1b•ll on, dunng tenure and for one year after leaving o ffice. 'rorr hav ng any interest In or receIv ,ng any beneftt flom Corr,mun1ty Development BloCK Grant funds for ether yourself, o r those wn r whorr you riave business o r mmedIate tam,ly ties (CF R 570 61 1) Surshme Law .. F londa's Gov ernment-m-the-Sunshme Law was enacted in 1967 T oday :he Sunshine Law regarding oper government can be found -n Chapter 286 of the Fonda Statu tes These s tatutes estabhs'I a bas c nght o f access to rrost meetings of boards, oommIss1ons anc other governing bodies of state and ocal governmental age'1cies or eutro nt1es Vot,ng c onfl ct -Form 88 1s for use by ary person serving at ttie oouniy c ty o r other local leve of g o verrmen t on ar, a ppo1 r-ted or e,ected board. council, oommis!>•on. duthonty or corr'Tl1 ttee It applies equally to rrembers of ad111sory a ,d ,on-advisory bod es w tio are presen ted with a votmg oonf ct of in terest under Sectl()n 112 3143, F:o nd a S tatU1 es Upon request, copies of these laws may be o btaine d 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 C ITY OFF ICERS. EMPLOYEES AND AGENCY MEMBERS ANO ALL OTHER APPLICABLE COUNTY ANO/OR STATE LAWS AND STATUTES AC CORDINGLY." • ./ I / ..---<;_, r I ~ ,x.J..L'-: /1...,_g,fr l ____ -'"'!,..,_ ......... v'-'-/~ . .,'-'1"'-'-1 ....,_ 1 __ __,....,_ ......... ...,,"', ~c ...... 1..,,1-:..:""'"':..:,,...-----'.,.,,._,,~.,._.J ;,,:1 ... : '-' "--------- Ap~canrs Signature Date "lame ol Appiicant (PLEA E PRINT 1 Receive<' in the Office o f the c,ty Cle r~ Oy ___________________________ _ Name of Depu:y C e •~ Control No Date ATTACH A CURRENT RESUME, PHOTOGRAPH ANO A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. Page 3 of 4 ~ 11.,,e.-.'C LERUuoq,Q u ,too•,BC APPLICATIO N doe< 461 City of Miami Beach 1 J( Con"~~toon Ce nt er Dr .·e, M 1r:'I , P.Poch , Florido l1 I !9, ·,'W,v ,r, n n,b~.-t,f, .J. • .,:,rnc E OF TH E CITY n~R!.. C tyCle rU~m om .beo,1 q go·. 'rlep'"crt-305 673 .,..c l fu, JCS 673 7254 A ck nowledgement of fines /suspensi on for Board/Committee Members for fai l ure to comply w i th Miami- Dade County Financial Disclosure Code Pr ovision 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 M1am1 Beach. including those of a purely advisory nature. are requ ired to comply with Miami-Dade County Financial Di sclosure Requiremen ts . This means that the members of C,ty Advisory Boards. whose sole or primary responsibility is to recommend legis lation or give advice to the City Commission must file . even though they may have been recently appointed . Qn.Lof the fo llowing fo rms must be fjled with the City Clerk of M1am1 Beach, 1700 Convention Center Dnve Miami Beach, Flonda. no la ter than 12 :00 noon of July 1 , of each year. 1 . A ·source o f Income Statement" 2 . A Statement of Financial Interests (Form 1 )" 3 A Copy of your latest Federa l In co me Tax Return Fa ilure to file one of these forms , pursuant to the Miami-Dade County Code , may subJect the person to a fi ne of no more than $500, 60 days in jail or both 1S1gnatu~e v Pdaled Thursday uecember 22 2016 C Use•,.CLEROu,RDe«lop BC APPLICA7 0 N coc, Page 4 of 4 462 Profile Jonatha n We lsh 744 Jefferson Avenue -Unit It 4 I Miami Beach, FL. 33139 I 954 . 793 . 58 17 I jwelshmiam1@gma1I com htt p.//www. ltn ked in. com/pu b/jonathan -we lsh/7 /485 /490 , Experienced in program planning, proJect development and budgeting 1n both the private secto r and in nonprofits , Prof1c1ent in planning and implementing advocacy, development, public relations and marketing campaigns ► Skilled 1n vo lunteer engagement an d management and ha ve engaged 600+ volunteers 1n both advocacy activities awa r eness in1tiat1ves on a yearly basis ► Adept at managing membership drives with a r etentio n rate of 1,200 members ► Skilled at overseeing specia l events including AIDS WALK Miami and White Party Week "' resulting in raising more than $SOOK , Excellent communicator and have been hired to speak to approximately 1,000 patients, doctors, re sea rchers and Association Execu tives on a yea rl y basis , Experienced in proposal development and solic1tat1on resu lting 1n raising more than $1 m1ll1on per annum Positions/ Aecom plishments Care Resource Miami, FL Ca re Resource is a Federally Qualified Health Center (FQHC) that provides compre hen sive health and support services to address the full health care needs South Florida's ped ia tric, adolescent and adu lt populations. Marketing and Development Manager, 2/2014 -present , Develop and mainta in internal/ext ernal agency marketing budget and media plans ensuring agency's advertising and marketing is properly conduct ed ~ Ident ify, cultivate and maintain beneficial relationships with agency spon sors and donors 1n addition to overseeing the planning, implementation and execution of all agency special events , Manage the production of public relations materials, press releases associated with the agency activ1t1es including website and social media content and acting as agency's spokesperson in absence of CEO . ► Participate in the budget plan nin g and gran t proposals involving m arketing content to ensure adequate resources are estimated 463 Alpha-1 As sociation Miami, FL The Alpha -1 Association , a not-for-profit membership organ1zat1on that 1dent1f1es ind1v1duals affected by Alpha-1 and improves the quality of their lives through support, education and advocacy. Advocacy/Communications Manager, 2/2010 -2 /2014 , Built a grassroot s advocacy program that trained, mobilized and engaged 500+ volunteers in advocacy ac tivities at the state and Federal level ;... Actively managed an online community of more than 2,000 members and managed national Alpha -1 public relations and awareness programs that generated feature placements in local media , Served as Editor and Chief of a quarterly 16-page printed Newsletter reaching more than 10,000 households , Assis t ed in th e planning and implementa t ion of an annual 3-day national education conference for more than 550 attendees , Regularly engaged in public s_peaking on behalf of the organization as requested and assisted i n th e development of annual industry funding proposa ls that result 1n raising more than $1 mill io n per annum and generated quarte rly and annual dashboard reports to monitor and track advocacy and communications activities Kaplan Higher Educati on/Washi ngton Post Company Fort Lauderda le, FL Kaplan Higher Education Corporation 1s a wholly -owned subsidiary of the Washington Post Company. They ha ve a t est prep division in addition to a postsecondary education division . Operations Coordinator, 6/2008 -9/2009 ,.. Coordina ted internal operational activities including managing vendors, developing and maintaining internal web portals and opening of new office buildings , Developed internal corporate-wide campaigns, events and activities including the ECOLYMPICS and EARTH HOUR , Wrote internal policy and procedure guidelines, new employee handbooks and an Environmental Annual Report working in conJunct1on with staff in all departments United States Peace Corps Pretoria, South Africa The Peace Corps 1s a Federal volunteer program that provides both technical assistance and international cultural understanding. Community Development 8/2005 -10/2007 ', Planned and implemented 15+ community programs su ch as Gardening/Nutrition He al th/Wellness, and HIV/AIDS to address the severe needs of the local community , Mentored staff and strengthened links between government and other volunteer programs , Identified potential sources o f funding and prepared and submitted grant proposals J.-Wrote monthly newsletters, curriculums an d press releases 464 Actors' Playhouse Public Theatre Coral Gables, FL The Actors ' Pla y house provides a work environment for theatre professionals and encourages the creation and production of new theatre works . Advertising In tern, 1/2005 -6/2005 ► Developed numerous press releases , calendar listings, advertising placements, press kits and over saw t r ade advertising contr acts ;... Compiled media lis ts and conducted compet1t1ve research ', Assi sted with the planning and 1mplement1ng of special events Florida Sheriffs Youth Ranches Ingli s, FL The Florida Sheriffs You t h Ranc h es Is a not-for-profit res1den t 1al child and family services organization that offers camping services an d community ba se d clinical and family facilities. Site Director, Program Leader, 1999-2005 , Pl anned and implemen t ed summer programs throughout the state of Florida for more than 4,000 at-risks youth s t o prov ide li f e skills training , Worked in collaboration with neighborhoods resources including parents, churches and other organizations in order to build trust between them and law enforcement , Managed scheduling, inventory, payroll and staff development EDUCATION UNIVERSITY OF MIAMI -Cora l Gables , FL -June 2005 Bachelors in Communications and Arts and Sciences Double MaJor· Political Science and Public Relations. Special cl asses : Graphic Design , Media & Advertising Research, Public Relations Campaigns and Public Polley SKILLS Prof1c1e nt in Microsoft Excel, PowerPoint, Word, Adobe In -Design, Photoshop, SharePoint, Publisher, Const ant Contact, Results Plus, Contribute, Joomla PROFESSIONAL AFFILIATIONS Miracle Mile Toastmast ers Clu b -Former President, National Institutes of Health/Commun1cat1ons Affinity Gr oup -Fo r mer Member, Alpha -1 Association -Public Policy Working Group -Former Member, America n Plasma Users Coa l it ion {A-PLUS) -Former Member, Flo rida Society o f Associa t ion Executives (FSA E) -Member, speaker, contributing author COMMUNITY AFFILIATIONS Boca Raton Wine and Food Festival -Production Ca ptain (2010 , 2011, 2012), Bass Museum -Member, Environmental Coalition of M1am1 & the Beaches (ECOMB) -Member, Icoconutgrove.com -Con tributing Writer, ORGULLO Hispanic Gay Pride Celebration -voluntee r and sponso r, TRANSART -volunteer and sponsor, SAVE -Young Guardian 465 466 • Jefferson E. Brackin 467 THIS PAGE INTENTIONALLY LEFT BLANK 468 lD MIAMI BEACH CITY OF MIAMI BEACH BOARD ANO COMMITTEE APPLICATION FORM NAME: Brackin Last Name HOME ADDRESS : 1561 We st Ave nu e Apt No. Home No./Street PHONE: 3057937662 Home 3057937662 Work Business N ame: Biscayne Associat es Address: 4770 Biscayn e Blvd Street Jefferson First Name Fl o rida E Middle Initial Mia mi B each City State jeffersonbracki n@ g mail .com Position: Manager Miam i City Florid a E mail Address State 33 139 Zip Code 33 143 Zip Code Pursuant to City Code secti on 2-22(4 ) a and b : Members of agencies, boards, and committees shall be affiliated with the city: this r equirem ent shall be fulfilled in the followi ng ways : a) an individual shall have been a resident of the city for a m inimum of six months: orb) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the c ity. • Resident of Miami Beach for a minimum of six (6) months Yes • Demonstrate an ownership/i nterest in a business in Miami Beach fo r a m inimum of six (6) months: No • Are you a reQ istered voter in Mi ami Beach: No •(Please ~ one): I am now a resident of : South Beach • I am applyinq for an appointment because I have special abilities, knowledqe and experience . Please list below: Re al Esta te • Are you presently a reg istered lobbyist with the City of Miami Beach? No Pl ease list your prefere nces in order of ranking [1] first choice [2 ] second choice, and [3] third choice. Pl ea se 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: Next Generation Council Convention Center Ad visory Board Susta inability Committee * Board m e mbe rs are requ ired to file Form 1 -"Stateme nt of Finan ci al Inte rest" w ith the State . If you seek appoi ntment t o a profes sion al seat (e .g ., la wy er, a rchitect, etc .) on the Board of Adj ustment, Design Revie w Boa rd, Historic Pre servat ion Board or Pl a nning Bo ard , attach a copy of yo ur currently-effectively license , and furnish th e following information : Type of Profess io nal Li cense ______________ _ Li cense Number Licen se Iss uance Date _________________ _ Lice n se Expiration Date Note: If applyi ng for Youth Advisory B oard . please indicate yo ur affiliation with the Scott Rakow Youth Center : 1. Past service on the Youth Center Advisory Board: No ;..;..:. __ _ Years of Service: _______________ _ 2. P resent participation in Youth Cent er activities by your children ""N;..;;o __ _ if yes, pl ease list the names of your childr en, th eir ages. and which progr ams. List below: 469 • Have you ever been convicted of a felony: No If yes, please explain in detail : • Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please expla in in detai l : • Do you currently owe the City of M iami Beach any money: No If yes. please explain in detail: • Are you c urren tl y serving on any City B oards or Committees: No If yes, which board ? • What organizations in the City of Miami Beach do you cu rrently hold membership 1n? • I am now employed by the city of Miami B each: No Whic h department? • List all properties owned or have an interest 1n, which are located within the City of Miami Beach: Gender: Male The follo w ing information Is voluntary and is neither part of your application nor has any bearing on your consideration for appointme nt. It is being asked to comply with federal equal opportunity reporting requirements . Race/Ethnic Categories What is your race? Mark one o r more races to 1nd1cate what you consider yourself to be. White Other Description : Are you Spanish/Hispanic/ Latino? Mark the "No" box if no t Spanish / Hispanic / La tino. No Physically Challenqed : No NOTE. If appointed, you will b e required to follow c e rtain laws which apply to city board/committee membe rs. These laws include, but are not li m ited to, the followi ng : ~ Proh1b1t1on from directly or indirectly lobbying city personnel (M1 am 1 Beach City Code section 2-459). c Proh1bit1on from contracting with the city (M1am 1-Dade County Code section 2-1 1.1 ). o Proh ibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami Beach Cod e section 2-26). Requirement to disclose certain financial interests and gifts (M1am1-Dade County Code section 2-11 .1 ). (re . CMB Community Development Advisory Committee) proh1b1t 1on . dunng 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 ). Upon re quest, copies of these laws may be obtained fro m the City Clerk. "I hereby attest to the accuracy and truthfulness of the applicat ion and have received, re ad and will abide by Chapter 2, Artic le VII -of the City Code "Standards of Conduct for City Officers, Employees and Agenc y Members." I Jefferson Brackin agreed to the following terms on 11 16/2018 10:09 :54 PM Received in the City Clerk's Office by Name of Deputy Clerk Control No . Date 470 Jefferson E. Brackin 1561 West A ve nue Miami Beach , FL 33 139 I C: (305) 793-7662 I jeffersonbrackin@ g ma il.com Profe ss ional Summary Build ing a career in the rea l estate. hospitality a nd tourism in dustry struct ured around finance , c ustomer service and entn:pren e urship . Ex perience Manage r 09/2016 -Present Biscayne Associa t l'S Miami , FL Providi ng a broad range of rea l estate related advisory ser vice s 111cludin g investment sa les . acqu is itio ns and asset management. Associate 08/2015 -09/2016 HC:VI ·Kw Properties Miami, FL De ve lope d expertise in hos pitality and real estate in ves tm ents w ith focu s o n re posi ti on in g of multi fa mil y acqu is itions both lo cally and nationall y. House keepin g S upervisor 08/20 I 4 -08/2015 Shelborne Wyndham Gra nd Miami, FL Establi s hed house keepi ng depa rtment prco pening and directed fi r t y ear in operati o n a fter S90 million renovation . 1anagement Training Inte rn s hip 11 /2013 -06/2014 Four Seasons Ho te ls and Reso rts Miami, FL Rece ived managem ent train mg in a v ariety of F&B outlet . Wo rk ed closel y with sen io r management in learning fun cti o na l ad mini s trative skill s. Assis ta nt Director Torch I .L C 0 1/2011-05/2012 C h a rl eston, SC C reated an d managed a unique a nd exci ted customer experi ence in a hi gh traffic, to uri st d estin at io n a rea of C h a rl e ton. Sou th Caro lin a . R esearch Technician 01 /2008 -05/2 009 Ba ptist Hea lth South Florida Miami, FL Resea rc h Technician -To tal Cancer Care Program . Moffitt C a ncer Center. Education Florida Int ernational Univers ity Holl o School of Real Estate Master in Sc ien ce in International Re a l Esta te. MS/RE Candidate Florida International Univers ity Chaplin School of Ho pitality and Tourism Mana gement Ma ster o f Science: Ho s pita lit y and Touri s m Mana ge ment Chair uf Huspi1<1/i1_1 • S1ude n1 Leaders hip Co1111 cil Coll eg e of Cha rle ston 20 12 Bache lo r 's Degree: Spanis h 471 472 • Carmen Browne 473 THIS PAGE INTENTIONALLY LEFT BLANK 474 MIAM I BEACH BOARD AND COMMITTEE APPLICATION FORM Browne Carmen M ------------------------------------ Last Name First Name M iddle Initial _5_7_5 _N_o_rt_h_S-'-ho"'""r"""e_D_riv_e ___________ M_ia_m_i _B_e_a _ch ______ F_L _______ """3-'-3 _14_1 ____ _ Home Address City State Z ip Code 305-793-4445 carmenmbrowne@g ma ii. com --------- Cellular N/A Business Name: Business Address Work Home City Email Address R etired Occupation: State Zip Code Please list you r preferen ces in order o f ranking [1] first choice [2] second choice, and [3] third choice. Please note th at on ly t hree (3) ch oices will be observe d by t he City Cl e rk's O ffic e. (Regular Boards of City) Choice 1: Normandy Shores Local Government Neig hborhood Improvement Choice 2 : Choice 3 : 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. * 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 Distri cts for at least one year? No No Address in City Historic Di strict submitted . 475 AFFILIATION WITH THE r.lTY OF MIAMI BEACH 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: a. Resident of the City for a minimum of six (6) months: • I am resident of: North Beach Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months : No nownership 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. Or c. Full -time employee of such a busi ness (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 (fo r 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 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the C ity 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. Th e original affidavit shall be filled with th e Office of the City Clerk prior to being s worn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience. Please list below: I have lived and worked in this community since November 2003 . I also serve on the board of our HOA (the Normandy Shores Homeowners Association) and I am familiar with the issues concerning our neighborhood which is a special taxing district. • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you eve r been convicted of a felony : No If yes , please exp lain in detail : • Do you currently have a violation(s) of City of Miami Bea ch codes: No If yes , p lease explain in detail : • Do you currently owe the City of Miami Beach any money : No If yes , p lease explain in detail: • Are you currently serving on any City Board s or Committees: Yes If yes , which board? Normandy Shores Local Government Neighborhood Improvement Board 476 • In what organization(s) in the City of M iami Beach do you currently hold membership in? Name Position Normandy Shores HOA Board member • List the address of all properties owned o r in w hich you have an interest within the City of Miami Bea ch : Property 575 North Shore Drive, Miami Bea ch , FL 33 141 • Are you now em ployed by the City of Miami Beach : If so, which department and ti tle? • Pu rsuant 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 Bea ch? If "Yes", identify person (s) and department(s): No relative's information submitted . 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 ha ve served on for period of one year after leavin g office (Mia m i Beach Code section 2-26) o Requirement to disclose certa in financial interests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunshine Law was ena cted 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 authorit ies . 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 , o r Committee. It applies equality to members of advisory and non -advisory bod ies who are presented wi th a votin g conflict of interest under Section 112.3143. Florida Statutes. 477 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines /suspension for Board/Committee Members for fa i lure to comply wit h Miami -Dade County Financial Disclosure Code Section 2-11 .1 (i)(2) I understand that no later than J uly 1. of eac h 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 Disclosu re Requirements . One of the following forms must be filled with the City Clerk of Miami Beach , 1700 Convention Center Drive, Miami Beach , F lorida , 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 late st Federal Income Ta x Return . Fai lure to file one of these fo r ms , pursuan t to the Miami-Dade County Code, may subj ect the person to a fine of no more than $500 , 60 days in jail , or both . 1 Members of the Planning Boa rd and Board of Adju stment will be notifi ed directly by the State of Florida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnan cia l Interests (F-orm 1) with the M iami-Dade County Supervisor of Elections by 12:00 noon , Ju ly 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, compl iance with the County disclosure requirement does not satisfy the State requ i rement. DIVERSITY STATISTICS REPORT Th e following information is voluntary and has no bearing on you r consideration for appointment. It is being asked to comply with City diversity reporting requirements . Gender: Race/Ethnic Categories What is your race? Female White Are you Span ish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino . llil Other Description : No details provided Physically Challenged : 478 Boa rd and Committee Appl ication Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph, and a copy of any appli cable professional license . I have completed and attached the Board & Committee Financial A cknowledgment Statement. YES 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 . I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED, READ AND W ILL ABIDE BY CHAPTER 2 , ARTICLE VII , OF THE MIAMI BEACH C ITY CODE , ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS , EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLT. I Carmen Browne agreed to the following term s on 11 /4 /2020 2:57 :06 PM Rece ive d in the City Clerk's Offi ce by : Name of Deputy Clerk Control No. Date 479 Education: Carmen M. Browne 575 N. Shore Drive Miami Beach , FL 33141 305-793-4445 1975 Graduated summa cum laude with a Bachelor's of Social Work from Temple University, Philadel phi a, PA 19 83 Graduated wi th a Juri s Doctor degree fr o m th e Uni ve rs ity o f Denve r Coll ege o f Law , Denve r, CO Past Work Ex p e ri e nce: 1975 -1977: Socia l worker with Hahneman n Hos pita l in Philade lph ia. PA 1978 -19 80: Fos ter ca re wo rk er wi th the Fair fax Departme nt of Socia l Services in Fai rfax, VA 1983 -1995: Attorney. Pract iced law in Den ver, CO 1995 -2003: Assistant ma na ger for Strategic Asset Management. LLC in De nv er, CO C urre nt Occupation: 20 12 to present : One of two managing me mbers of o Be Venture s LLC , a Flori da limited liabi li ty company in Miami Beach , FL 480 481 THIS PAGE INTENTIONALLY LEFT BLANK 482 • Susanne Demmerle 483 THIS PAGE INTENTIONALLY LEFT BLANK 484 ... A'V\I BEACH Last Name First Name Cellular Telephone Work Telephone Home Telephone A: C.U /.J (,, "' C 6--t<-Ll( Business Name Occupation ~St Business Address City 6 A~O Ar.jr )'l"o'l TTFf APPL A TION Middle Initial 5314 \ State Zip Code <)cl . °' w. \,\,A cr-<c:. e ~-1 ~ Email address ?l,'-'-1 )OC ,a,._, State Zip Code 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 w i ll be observed by the Office of the Ci ty Clerk. Affordable Housing Advisory Health Advisory Committee Normandy Shores Local Government Committee Neighborhood Improvement D1stnct Advisorv Counal Animal Welfare Committee Health Facilities Authonty Board Parks and Recreational Facilities Board Art in Public Places Committee Hisoanic Affairs Committee Personnel Board Audit Committee Historic Preservation Board • Plannina Board Black Affairs Advisorv Committee Housmo Authority Pol ice/Citizens Relations Committee Board of Adjustment Human Riohts Committee Production lndustrv Council Budget Advisory Committee LG BTO Advisory Committee Program for Public Information Committee Committee for Quality Education in Marine & Waterfront Protection Senior Affairs Committee MIam1 Beach Authontv Committee on the Homeless Mavor's 41 st Street Committee Sustainabihtv Committee - Convent ion Center Advisory Board Mayor's General Obhgat,on Bond Transportation . Parking, and Bicycle- Overs1aht Committee Pedestrian Facilities Committee Cultural Arts Counal Mavor's Panel on Ocean Drive Visitor and Convention Authority Desion Review Board Miami Beach Commission for Women Youth Commission Disabilitv Access Committee Ne){t Generation Council 1 . Nh'1tl{;,1.,tdy Bic((S A~c. ... ( Go~I IA,WLl.t fh~J.».Jl, •. •tf 0tvfvO<, ~sl-nc.f Mv (:oc, .... c... l 2. ft:0 ( ~ Adv, S6••"1 (~Id, 44·◄, II& j :;; 3. ~s-!a ,),o.~, l. h, C: ,~, w., We< Professional license Type of Professional License License Number State of Issuance License Issuance Date License E){piration Date N ote: If you are seeking appointment to a professional seat (e .g . attorney, architect , etc.). you must attach a copy of your current! effective corres ond1n rofessional license. Page 1 of 6 F ,CLER\$ALUlOARO MD COMMITTIES DATABASE,CHECl<LJST MASTER,SOARD ANO COMMITTEE APPLICATION docx Updated June 2020 485 AFFILIATION WITH THE CITY OF MIAMI BEACH 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 : a. Residen t of the City for a minimum of six months: Yes 0 or D No • I am a resident of: South Beach O Middle Beach 0 North Beach 0 Or b . Demonstrates an ownershie.J!!terest (for a minimum of six months ) in a business established in the City (for a minimum of six months): Yes D or U::l No "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 o1her entity or business association. Or 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 M1am1 Beach (for a minimum of six months ): Yes Dor B No Notwithstanding the requirements set forth herein. the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission . NO TE. Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requ,rements of sections 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 filed with the Office of the City Clerk pnor to being swom in as a member. • I am applying for an appointment because I have special abilities , knowledge , and experience. Please list below : .~ a .. ,, VV' CL• ,t.e-, l <-v<!( Y'( c;.,-. ~ .,,,, f-~ I "' )v:, r ......_,P• c<-:J a c.q s ~c( C, M ,._. u "1 •~ ~i; ~o .... '-l .) n UA ...e (Ad C( ~ cf Q ~ 9 LPo .., "' tMJ \,<A be -r "--2 kl'&-l~ cf.au ~ ldb IC. :le i..1 kd, y ""' I ~!d t.~ pi-£.. Ul. -h.'l e.e.H:::2 , C2~ ( eo ..... ?::t ...... ,7:3 ~a,~ V ~ ~Q ~ C t! ct , ~- Page 2 of 6 F -CLER·.$AJ.L SOARD AND C OMMtTTtES OATABASE'CHECKL1S T MASTER'BOARO AAO CO~MtTTEE APPUCATION ooc, Updatoo June 2020 486 • Are you a registered active lobbyi st with the City of Miami Beach? Yes D or No □ • Ha ve you ever been convicted of a felony? Yes Dor No GZl If yes, please explain in deta il : • Do you cu rrently have a violation (s) of City of M1am1 Beach Code? Yes D or No oa If yes , please explain in detail. • Do you curren tly owe the City of Miami Beach money? Yes D or No ~ If yes. p lease explain in detail : • Are you currently serving on any City Board or Committee? Yes (0 or No D If yes , which Boa rd/Committee? .,,de u~o ., V'-' ... -~.t ~ b~t--r1 -.,e ,J B,i 11«.f d v ~Jt (i..'.P • In what organizat1on (s) 1n the City of Miami Beach do you currently hold membership? Name Position Name Position • List the address o f all properties owned or in which you have an interest within the City of M1am1 Beach • Are you now employed by the City of M1am1 Beach? Yes O or No ~ If so , which department and title? • Pursuant to C ity Code Section 2-25 (b): Do you have a parent 0 , spouse 0 , chil d O brother O or sister 0 who is employed by the City of Miami Beach? Yes D or No 0 If "Yes ," identify person(s ) and department(s): _________________________ _ • 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 O or No 0 If you answered "Yes ," please indicate : From : Address Dates From : Address Dates Page 3 of 6 F .C.ER$ALL,80AR:> M::> CO~'MITTIES DATABASE .CHECKLIST MASTERBOARO MO COMMITTEE APPLICATION docx Updated J une 2020 To To 487 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 : :, Prohibition from direcUy or indirectly lobbying City personnel. (M1am1 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 (M1am 1-Dade County Code section 2 -11 .1) 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 Statu tes. These statutes establish a basic right of access to most meetings of Boards, Commissions , and other governing bodies of state and local gove rn m ental agencies or authorit ies. o Voting conflict -Form 88 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 appl ies equally to members of advisory and non-advisory bodies who a r e presented with a voting conflict of interest under Section 112.3143, Florida Statutes. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; ANO 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 ANO/OR STATE LAWS AND STATUTES ACCORDINGLY." Appl icant's S ignature Date Name of App li cant (PLEASE PR INT) Board and Committee Appll cation Checkll st: Please ensure you have provided all information before applying or reapplying to any Board and Committee [9" I have answered all questions fully . D I have attached additional sheets, if necessary, to provide required information . D I have attached a current resume, photograph , and a copy of any applicable professional license . B I have completed and attached the Board & Committee Financial Acknowledgement Statement. B' I have completed and attached the D1vers1ty Stahst,cs Report D Submit complete application package. Via Email : BC@m1am1beachfl .gov Via U .S. Mail or in Person. City of Miami Beach Office of the City Cler k / Board and Committee Section 1700 Convention Center Drive , 111 Floor Miami Beach, FL 33139 If you have any question s , please contact the Office of the C ity Clerk via email: BC@m1amibeach f1 .gov or telephone. 305.673 .7411 . Note: Florida Statutes §1 19.07 1 : 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. Page 4 of 6 F ICLER\$ALLl80ARD AND COMMITTIES DATABASEICHECKLIST MASTERl80A RD ANO COMMITTEE APPLI CATION docX Updated June 2020 488 BEACH City of Miami Beach 1700 Convention Center Drive M1am1 Beach , Florida 33139 www miom ,beachA goy OFFICE OF THE CITY CLERK Em01I BC@m1amibeachO gov Telephone · 305 673 7 4 1 1 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board /Comm ittee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11 .1(i) (2) Last Name Fi rst Name Middle Initial I understand that no later than Jul y 1, of each year all members of Boards and Committees of the City of Miami Bea ch , includ ing tho s e of a purely advisory nature , are required to comply with M1am1-Dade County F1nanc1 al D isclosure Requirements . On e of the follow ing forms must be filed with the City Clerk of Miam i Beach , 1700 Convention Center Dri ve , M1am1 Beach, Flonda, no later than 12:00 noon of July 1, of e ach year: 1 . A "Source o f Income Statement ;" or 2. A "Statement of Financial Interests (Form 1 )': or 3. A Copy of your latest Federa l Income Tax Return. Fa i lure 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 jai l, or both . ~2, 2.e,-2 V Signature Date 1 Members of the Planning Board and Board of Adjustment w ill be notified directly by the State of Florida , pursuant to F.S . §112.3145(1 )(a), to file a Statement of F1nanc1al 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. Page 5 of 6 F \CLER SALLIBOARO AND COMM TTIES OATABASE\CHECKLIST MASTER\BOARO ANO COMMITTEE APPLICATION docx Updated June 2020 489 MIAM~-[EMii.l SOURCE OF INCOME STATEMENT Section 2-11 1 Ii) or the County Ethics Code requ,res that certain employees and public olhc1als hie a financial disclosure Statement on a yearly basis by July 1st or every year Disclosure for Tax Year Ending I last Name First Name Middle Name/Initial 2019 Demmerle Susanne Mailing Address -Street Number, Street Name, or P.O. Box 1155 N Shore Drive City, State, Zip Miami Beach , FL 33141 If your home address Is your mailing address and your home address Is exempt from public reco rds pursuant to Fla Stat §119 07. read mstrucllons on the following page and check here. 0 Filing as an Employee (cfleck one) I D County D Publ ic Hea lth Trust Depa rtment Position or Trtle I D Municip al: (Munlcipallty) Employee ID Number I j Wor1< address L I Work telepho ne Employmen t began on/ended on j I Filing as a Board Member (check one) D Cou nty '2) Mu nici pal: Miami Beach (Municipality ) r Board where serving -- Normandy Shores Local Government Ne ighborhood Improvement Board Alternate address (if home address is exempt) Wor1< telephone 803-629-3466 Term began on/ended on 20 19 / still in position List below e\ery source or income you rece,ved. along Wtth the address and the pnnc1paJ actmty ol each source Include your pubhc salary Place the sou rces ol income in descending order. Wtth the largest source first Examples of S011rces of income include compensat10n for services income from business. ga,ns from property dealings interest rents. dividends. pensions IRA d1stnbut10ns and sooal secunty payments Also, include any source of income received by anot!Jtr person for your benefit However the ,ncome or your spouse or any business partner need not be disclosed If continued on a separate sheet, check here.U Name of Source of Income I Address Description of th e Pnncipal Business Activity ~ Radiant Acupuncture LLC 1155 N Shore Drive , Acupuncture and Oriental Miami Beach , FL 33141 Medicine --->------I I I hereby swear {or affirm) that the mformabon above Is a true and correct statement. RECEIVED BY EUCT IONS DEPARTMENT: ~&& 4/2!1/2.0lO Date signed OFFICE USE ONLY Accepted Y tl Def,oency __ _ t. ,P •J 1f ------------ Hardcopy Electronic Copy _ __ Processed Date tntials ______ Scanned Date I11111aI• ' 1 ~ I I I I 490 A /\I BEACH City of Miami Beach 1700 Convention Center Drive M1om1 Beach , Florid o 33139 www m1am1beochA.gov OFFICE OF THE CITY CLERK Email : BC@m1am1beachfl.gov Te lephone. 305.673.74 11 Last Name DIVERSITY STATISTICS REPORT Middle Initial The following information 1s voluntary and has no beanng on your consideration for appointment. It is being asked to comply with City diversity reporting requirements . Gender: DMale ~Female 0 Other 0 I prefer not to answer Race/Ethn ic Categories : What is your race? 0 African American/Black 0 Asian or Pacific Islander 0 Caucasian/White 0 Native American/American Indian D Other -Print Ra ce . ------------w I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a ? □Yes □No lil I prefer not to answer. Do you consider yourself Physically Disabled? Dves fDNo D I prefer not to answer th is question. Page 6 of 6 F •CLER SALL ·BOARD MO COM"11TTIES 0A TABASE ,CHECKLIST MASTER BOARD MO COMMITTEE APPLICA TIO,-. c1oCX Updated Jvne 2020 491 Susanne Demmerle , PhD 1155 North Shore Drive • Miami Beach , Florida 33141 • USA • +1 803 629 3466 (Cell) • sd .acupunct.omw@gmail.com Academic Degrees and Licenses • Dipl. OM (NCCAOM), 2018 • A .P . Licensed Acupuncturist, 2018 (FL License# AP 3947 ) • M .Ac . Licensed Acupuncturist, 2014 (MD License# U02155) • Licensed Massage Therapist, 2009 (MD License# M04665) • License of Veterinary Practice (Approbation), Bavaria, Gem,any, 1987 • Doctor Thesis in Veterinary Medicine, Munich , Gem,any, 1989 • Bachelors of Veterinary Medicine, Faculty of Veterinary Medicine, University of Alexandria - Alexandria , Eg y pt , 1986 Professional Experience Practicing Acupuncture and Chinese Medicine in Miami Beach, Fl Maryland University of Integrative Health, Laurel, Maryland, USA Doctorate Degree in Acupuncture and Oriental Medicine (DOAM) Volunteer at the Department of Veterans Affairs Medical Center, Washington, DC Volunteer and Assistant to Michelle Gilles (Facial Acupuncture and Rej uvenation) Maryland University of Integrative Health, Laurel, Maryland, USA Master of Acupuncture and Chinese Herbal Medicine Nenuphar Therapeutic Massage & Wellness, LLC -Columbia, South Carolina , USA 2009 2018 • today 2015 • 2017 2017 2015 · 2017 2011 -2015 Founder & Business owner: providing service in Medical Massage Therapy, Deep T issue Massage , Neuromuscular Massage, Swedish Massage, Trigger Point Re lease , Chair Massage , Cranio-Sa cral Therapy, and Reiki. Midlands Technical College -Columbia, South Carolina, USA Completed Clinical Massage Therapy Progra m . 2008 -2009 College of Veterinary Medicine, Michigan State University -East Lansing , Michigan , USA 2005 Research in Molecular Biology: Preparation of RNA extraction , c-DNA Synthesis , gel electrophoresis, and mRNA isolat ion . Laboratory of Xenobiotics of "lnstitut National de la Recherche Agronomique" -Toulouse, France 2003 · 2004 Study of in vitro hepatic biotransformation of surfactants at the subcellular level. The project was sponsored by the "Environmental Risk Assessment and Management". 492 Laboratory of Cellular Biology, Department of Molecular Structural Biology, Centre d 'Etudes Nucleaires de Grenoble -Grenoble, France 1993 Post-doctoral research on the effect of polycyclic aromatic hydrocarbons, i.e. Benzo(a)pyrene , on the endocytosis of the social amoeba , 'Dictyostelium discoideum'. Virginia Institute of Marine Science , The College of William & Mary -Gloucester Point, Virginia, USA 1990 -1992 Post-doctoral studies on the effects of environmental pollutants such as polycyclic aromatic hydrocarbons on the immune system of aquatic animals with the help of immuno-toxicological techniques and long-term cell cultures. Institute of Zoology and Hydrobiology, Faculty of Veterinary Medicine, Ludwig-Maximilian University -Munich, Germany 1986 -1989 Thesis and post-gradual studies on morphological , bacteriological and immunological level on the pathogenesis of Glomerulonephritis in Ra inbow trout with Bacterial kidney disease. Intensive training in histopathology, light and electron microscopy, and immunopathological methods. Practiced the isolation and identification of viruses of cold-blooded vertebrates using gel-electrophoresis and immuno-fluorescence techniques. German Veterinary Medical Authorities -Bavaria, Germany License of Veterinary Medicine Practice (Approbation) Faculty of Veterinary Medicine, University of Alexandria -Alexandria, Egypt Bachelor Degree in Veterinary Medicine. Personal Data Nationality: US citizen Family Status: married, three children Hobbies : Badminton, swimming, reading , Languages: German. Mother tongue. Fluently in English, French and Arabic. 1987 1981 -1986 493 Meetings Presentations and Publ ished Abst racts 1. S . Sarni and R.J . Huggett : The Use of Surface Receptors of Oyster Hemocytes as an Indicator of Pollution of the Aquatic Environment. Atlantic Estuarine Research Society (AERS), Virginia Institute of Marine Science, Gloucester Point, Virginia , May 1990, USA. 2. S. Sarni and R.J . Huggett : Cytometric Characterization of the American Oyster, Crassostrea V irg in ica, as a Parameter for Hea lth Status. Eastern Fish Health Workshop, Charlottetown, Prince Eduard Island , June 1990, Canada . 3. S . Sarni and R.J . Huggett : Influence of PAH-Exposure on the Expression of Concanavalin A Receptors and Phagocytic Activities of the American Oyster, Crassostrea Virginica , Hemocytes. Eastern Reg ional Symposium on Mechanisms of lmmunotoxicology, Williamsburg , Virginia . October 1990, USA. 4 . S . Sarni and R.J . Huggett : The Use of Cytometric Characterization of the American Oyster, 'Crassostrea Virginica ·, Hemocytes as an Indicator for environmental Pollution . Society of Environmental Toxicology and Chemistry (SETAC), Arl in gton , Virginia , November 1990, USA. 5. S . Sarni , M . Faisal and R.J . Huggett : Long Term Cultures of Oyster, 'Crassostrea Virginica ', Cells: Culture Requirements and Stimulation by Mitogens. The Chesapeake Research Consortium , Baltimore, Maryland, December 1990, USA. 6. S . Sarni, M . Faisal and R.J. Huggett : The Effects of PAH -Exposure on the Ph enotypic, Cytometric and Functional Characterization of the American Oyster Hemocytes. Sixth International Symposium on Response of Marine Organisms to Pollution . Wo ods Hole , Massachusetts, April 1991 , USA. 7 . S . Sarni , M. Faisal and R.J . Huggett : Alterations of Hemocytes Characteristics in the American Oyster, 'Crassostrea Virginica ', from PAH-Contarninated Environment. Eastern Regiona l Symposium on the Mechanisms of lmmunotoxicology. Virginia Beach , Virginia, October 1991 , USA. 8 . S . Sarni , M. Faisal and R.J . Huggett : Macromolecular Synthesis of the American Oyster, 'Crassostrea Virginica ', Cells: Effect of Mitogens and Toxic Chemicals. Society of Environmental Toxicology and Chemistry (SET AC), Seattle, Washington , November 1991 , USA. 9. S . Sarni , B.J . Rutan and M. Faisal : In Vitro Continuous Cultures of Liver Cells from Spot (Leiostomus Xanthurus , Pisces: Sciaenidae). PAMAQ-5 , Montpellier, April 1992, France. 10.S . Sarni , B.J . Rutan and M. Faisal : A Cell Line from the Splenocyte of Spot (Leiostomus Xanthurus): Characterization and Immune Functions. Federation of American Society for En vironmental B iology (FASEB). Anaheim , California , April 1992, USA. 11 .M . Faisal , S. Sarni, B.J . Rutan D.E. Holmes and S .F . Hoegerman : Development of Hepatocytes from Atlantic Menhaden (Brevoortia Tyrannus ). World Congress on Cell and Tissue Cultures, Arl ington, Virginia, June 1992, USA. 12.M . Fa isal and S . Demmerle-Sami : Suppression of Cytotoxic Activity of Mummichog (Fundulus Heteroclitus) Leukocytes by Benzo(a)pyrene . European Association of Fish Pathologist (EAFP), September 1993, Brest , France . 494 Published Articles 1. S . Sarni , M . Shpigel and M . Faisal : Comparison between the Host Defense Mechanisms of Thermal Stress on Concanavalin A-binding Sites Expression on Hemocyte Surface. J. Appl. Zool. 78 : 69-87, 1991 . 2. S. Sarni , M . Faisal and I.A. Ahmed : In Vitro Cu ltures of Oysters Crassostrea Virginica Cells: Stimulation by Mitogens. In : New Prospectives in the Chesapeake System . A Research and Management Partnership. Proceedings of a Conference . Chesapeake Research Consort ium . Salomons. MD, (eds. J .A . M ihursky and A . Chaney ), pp . 403-407 , 1991 . 3. S . Sarni , Th . Fischer-Scher!, R. Hoffmann and C . Pfeil-Putzien : Immune Complex-mediated Glomerulonephritis Associated with Bacterial Kidney Disease in the Rainbow Trout (Oncorhyncus mykiss). Veterinary Pathology. 29: 169-175 , 1992. 4 . S. Sarni , M . Faisal and R.J . Huggett : Alteration in the Cytometric Characteristics of Hemocytes from the American Oyster, Crassostrea Virgin ica , Exposed to a Polycycl ic Aromatic Hydrocarbon (PAH) Contaminated Env ironment. Marine Biology. 113: 247-252, 1992. 5. M. Fa isal , S. Sarni , B .J. Rutan , D.E. Holmes and S.F. Hoegerman : Development of a Cell Line of Hepatocytes from Atlantic Menhaden (Brevoortia T yrannus). In-vitro World Cong ress on Cell and Tissue Culture , Arlington, Virginia. 28A (3), 1992. 6 . M. Faisal , S . Sarni and B .J . Rutan : Fish Cell Lines of Leucocyte origin : Maintenance and Characterization. In : Tec hniques in Fish lmmunology-2 , J.S. Stolen , T.C. Fletcher, D.A. Anderson , S .L. Kaattari and A.F . Rowley, eds., SOS Publications, Fair Haven, NJ , pp . 35-59, 1992. 7. M. Fa isal, S.F. Hoegerman. B .J. Rutan and S. Sarni : Chromosomal Analysis of Fish Leucocytes . In : Techniques in Fish lmmunology-2, J.S. Stolen, T.C . Fletcher , D.A. Anderson . S.L. Kaattari and A.F. Rowley, eds., SOS Publications, Fair Haven , NJ , pp. 185-196, 1992. 8 . S. Sarni , M . Faisa l and R.J . Huggett : Effect of Laboratory Exposure to Polycyclic Aromatic Hydrocarbon Contaminated Sediments on the Hemocytes of the American Oyster. Crassostrea Virginica. Marine Environmental Researc h. 35: 131-135, 1993. 9. M . Fa isal and S. Demmerle-Sami : Polycyclic Aromatic Hydrocarbons Modulate the Molecular Synthesis in Hemocytes of the Eastern Oyster (C rassostrea Virginica). J.S . Stolen, T .C . Fletcher eds ., SOS Publi ca tions , Fair Haven, NJ . 20 : 235-246, 1994. 10. M . Faisal , B .J . Rutan and S. Demmerle-Sami : Development of Continuous Liver Cell Cultures from the Marine Teleost, Spot (Leiostomus Xanthurus , Pisces: Sciaenidae ). Aquaculture . 132: 59-72 , 1995 . 11 . S.D . Dyer, M.J. Bernhard , C . Cowan-Ellsberry, E . Perdu-Durand , S . Demmerle, J .-P . Cravedi : In vitro biotransformation of surfactants in fish . Part1 : Linear alkylbenzene sulfonate (C12-Las) and alcohol ethoxylate (C13EO8). Chemosphere . 72 :850-862, 2008 . 495 496 • Diane Klein 497 THIS PAGE INTENTIONALLY LEFT BLANK 498 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Kle in Diane ------------------ Last Name First Name Midd le Initial 765 South Shore Dr Miami Bea ch Fl 33 141 -----------------------------------Home Address City State Zip Code ____________________ 3_05_-_9_0_5_-2_2_4_1 _____ kd_i_a_n_e .... @ .... n_o_v_a_.e_d_u ________ _ Cellular Work Home Email Address Nova Southeastern University Adm instrator Business Name: O ccupati on : 3301 College Ave Davie FL 33 141 Business Address City State Zip Code Please list your preferences in order of ranking (1) first choice (2) second choice , and (3) th ird choice. Please note that onl three 3 choices will be observed b the Cit Clerk's Office. (Regula r Boards of City) Choice 1 : Normandy Shores Local Government Neighborhood Improvement Choice 2 : Next Generation Council Choice 3 : M ia mi Beach Commission For Women Professional License No Professional Licenses Subm itted . Note: If you are see king appointment to a professional seat (e.g . attorney , architect, etc.), you must attach a copy of your currently effective corresponding profe ssional li cense. * Note: If applying for the At-Large position o f the Historic Preservation Board , p lease answer the below questions : • Have you ever resided in one of the City's Historic Di stricts for at least one year? No No Address in City Historic District submitted . 499 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c: Members of Agencies, Boards , and Committees shall be affi liated with the city. Th is requirement shall be fulfilled in the following ways : a. Resident of the City for a minimum of six (6) months : • I am resident of: North Beach Or fu b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: MQ "Ownership Interest" shall mean the ownership often percent (10%) or more (including the ownership of 10% or more of the outstanding capital stock) in a bus iness . "Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. Or 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 loca ted in Miami Beach (for a minimum of six months): MQ Notwithstanding the requ irements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission . NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate co mpliance wi th 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. • I am applying for an appointment because I have special abi lities , knowledge and experience . Please list below: Been on the Normandy Shores Hom e Association for 4 years and a beach res ide nt my whole life . • Are you presently a registered lobbyist with the City of Miami Beach? No • Ha ve 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 : If yes , please explain in detail : • Do you currently owe the City of Mia mi Bea ch any money: If yes , please explain i n detail : • Are you currently serving on any City Boards or Committees : If ye s , which board? 500 • 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 765 South Shore • Are you now employed by the City of Miami Beach : If so , wh ich department and title? • 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 Mia mi Beach? If "Yes", identify person(s) and department(s): No relative's information submitted. 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 Bea ch 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 (M iami-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 governi ng 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. 501 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 J uly 1. of each year all members of Boards and Committees of the City of Miami Beach , including those of a purely advisory nature , are requ ired to comply with Mi ami-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 B each , Florida , no later than 12:00 noon of July 1, of each year: 1. A "Source of Income Statement;" or 2 . A "Statem ent of Financial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federal Income Tax Return . Fa il ure to file one of these forms , pursuant to the Miami-Dade County Code , may subject the person t o a fine of no more than $500 , 60 days in jail, or both . 1 Members of the Pl anning Board and Board of Adjustment will be notified directly by the State of Fl orida , pursuant to F.S . §112 .3145(1)(a), t o file a Statement of Rnan cial Interests (Form 1) with the M iami-Dade County Supervisor of Electi ons by 12:00 noon , July 1. P lanning Board and Board of Adjustment members who file the ir Form 1 with the County Supervi sor of Elections automatically sa t isfy the County's financial disclosure requ irement as a M iami Beac h City Board/Committee member and need not file an additional form with the Office of the City Clerk . However, compliance with the County disclosure requireme nt does not satisfy the State requ irement. DIVERSITY STATISTICS REPORT The foll owing information is voluntary and has no beari ng on your consideration for appointment. It is be ing asked to comp ly w ith City diversity reporting requiremen ts . Gender: Ra ce/Ethni c Categories What is your race? Fem ale White Are you Spanish /Hispanic/ Latino? Mark the "No" box if not Spanish / Hispa ni c/ Lati no. No Other Desc rip tion : Physically Challenged : No detail s provided No 502 Board and Committee Application Checklist : Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully. :=::::==:::! YES I have uploaded a current resume , photograph, and a copy of any applicable professional license. YES I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES 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 . 7 411 Note: Florida Statutes 119.071 : The role of the Office of the City Clerk is to receive a nd maintain forms filed as public rec ords . If your home address, telephone numbers , and/or ph otograph are exempt from disclosure an d 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 you r mailing address; 2) Use you r office or other telephone number for your contact number; and 3) Do not attach a phot og ra ph . 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 ACCORDINGLT. I Diane Klein agreed to the following te r ms on 11 /4 /2020 9 :28 :35 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 503 Diane Klein ~ s-~ SMJ"I 1>11\~, Ml-' e.-. ft nu1 I (lOS) 90&-l2AJ I 1tJrna~1wO 1WD E DUCl\1101" MIISIU'S .J Sdmtt lo Co llttl.t St11dnu Affail'J CaOO!n!J.'8llion In Collfila H.~ t>on Nova Soo~rn UIIM!rRI}', Foin Lulrrtbl,, FL Bacbclw ot SCi6'« i-i Piydioloa, M.:tjcr: Ps :,d>olo NOV11 Soo~nl t.Jni1,trs.iy, ~on i..oderrl~!.,. Fl Jun~ l OOU Jwor?006 A.1sod,m Dl.ffl:tor of~ ~elop,iaMt IIUrdt 2014-PnRnt Nova s~~ lJnrvwn;ary; Fan Lwdi,~. fL • C)vene.e all d&ly ~wbilltle,J for Em.,toyu R~lklM 1N111 "''hlch C0111il$1.S of 11\'l'T 250 pMJittSlll()6, .0 employer rclatro 11"Jiflltl1S ~ )"fflr hdlc!.1ng l'\o'O cnijor Ciree1 Nll"S "-'1Cl CJYi,f 70 !!lli(lluym 11\d 50() stU.dN!t il.lJd m l !MI p:micip.WS • Buth ~labomh.ipt. wilh 0\ 1500 lo cal/nail trmulanal org11ni:z..wons ~udi ts, OHL. Cln1lf. Officr Oq!Cl. Cnt.ttpn~ aoo City F\Jmlrure to recru,i '."S U midmts • Mmn~ ~ponmohip prcgtaW! collecling over S'20 000.00 in dcn.dions ~ 'f"-~r • O n \"CII .md ;us,,:1 over 20 einploye ~ progr,uns ch:idmg nt'fWClrkb,~ l"\'tmts, S.ill! v1ilts. ca_p: ~ions, lnfo1'11<1ooll >l!SSlons. .id ~el dlsaJ.$100~ • Crt..n-m.J •~~t in oveottU\g C.uee, O\!velopuu:~ bu~ Qf avn-S76..000 00 • Collect mil provt~ .ii r-.!rd! and Em-pk,yu lulat?O(l5 d;lt.l (QI' rqx,rtng • ~y rrw,ag." 2 full-<lu.1e .utf members .md9 ~1$ w-arttm • M,ma1,~ .ii d1Lly o~tx11::s of IW\J Gateet' Ceaten stdJli ovtr t SOO "'1ldt-ats mu! 4.lumw. • rusisi.tt Dlrec{c,r ol E.rmplO')'fl' llel atiom IU!d h1krnllbi9S No va Soucbedsl.em Vohw-:iry , F'o n I~. Fl Jl•ly 2tQ8.Mard, 20L4 • Dt!velqied ~reJ1eosl\'l' .. d re,tr,1lmd 111~1]1 prof!rdll'I fur llllverstry uodl'rgraJlJ.lte .in:! gmduair su,deoo • en~ird and ~ c..rtt, oi,,,-•dopllli'.l'.'!1 spaucnlup prow,im IQ lli1Ul dow.oncu (rum d ~ery of ClflAl!lolll(JIIS • Collaborate widl Ac;idn11c A.dvuor.s SJ:Jd Faailr co cre1ll! SITT!ilmlloo:l 1roislu p proet,u fer Slllldeni:s to e~m .ic;2drrmc mdll for .niemshi~"!I bll~lt Emp\c,)'ff Ccmcraa, 1,.v.ilualiau dad 111111'..-mhtp Ouccome gulliNl~ for '\SU lolenislllp Progf~ • \llsk ellljlloylllenc ~nd lllt,.,m<Jup i.11r lao,uoas to met"! th employers ¥Id vmfy won eovlron[:)('fll'S or sro~ • Organltt cl \'ilJ'1et}' or lotmi~up ori-<.anpu• rmuilins, e'\'tru:S • Cnatt Stula:JU lnte!USh!p \oo'Olksh~ 504 Graduate AslkisllUll tor UOM.U,!Jlg AtJgu,it 2007 -~y 21168 NOV11 SO<llhrasl r m Univ" ·1,. Fort Lauderdale. fl.. • ~ 17\l'f 000 madv\'rtumg-far ~Office of Reskt(,oo aJ L1f-, .n! 1-l=ng • ~ the Offi<'\" o( R=drlldal We !lad llousla8 off~ booil II prog;m, • M&~gl!d 11w d;n;ih•n .md w,,l:mll' for ltr~ ~s h -prognm • Mel "'1th w ,~. f.>l"\l!ry aid mff ID hNp di,m with dldr oll-anpos bousllUI ~~ • ,...'ar ked with loGJI l'ffllill orJ;1 mta1lons 10 pl'O\'ldt ofl-ampus hOQiln{l liftVICl'5 .irnd m;,autn'$ • Asstsred the Dtncwr of Hourina ro<>Nrd1mg au-4'0d ofl-campw bousiog O'tOds • He!J,ed publlsh the armu Off-c.n(ll~ I lt.'U'WIJ! G\1lde md ~ promouoo.J Items • COordJIWUd Off-Campm ffo\llt Fain, Prujeai wid E\'fflts Gr.duatr ~ {o r t9dmc and ComntLrnlty Rdadcu1s Aug. 2"6 -i,g, ?007 ND\'a 5o(lllea5:em IJllive:~. Fon Lalldmµl ~. FL • CJuttd ctn NSU Hm Oi5coo:nt c.rtl wuh <l\''l'f' 17 vmdtr.1 for •l KS U srudfflts • A ssistrd wnb plattrblg. marketing.~ crrg;mwnR l~r11r sc.tk-canpas t-venm • Waricrd wl1h Ul\dergradl.late aiDd gr.iduilte oipniud0!1$ ID 2WR wnlr fomflns and pL!lwi1-g C evter fc,r C.,.111.l11\lt:y ~ .. k ffl!ltm St!pt. 2007 -~ 1007 Muuw•Oldt' Colle8e: MlalDI, ~L • l'.adlit,,t«l l>Yt'r 1brtt ervtc. l cMTlill8 ~od commmuy 11M>l'l'l"llltt1.I JM1)grl1m • Azislrd will, aunmunily owed program to luah ,dw,ol <11Xlenl3 111 thl, IUfruUOO!ng area • Prcmded re5tWdl rot ocw ~ts for !ill'l'Vke ~ • Cn.u.n:I ,..,., ,.., .. wirg toe Commoolry IPY\'otvi-r.>f"ll Progr;,nu Off~ of Oriuuatioo and Commu w-~eel Ja11. 2.eoa-.April 2008 F'lori,d;i lnirm a11nGill Unh·enuy, MJa111I, ~1.. • F'a:,bt~tttl 31rd purlltlpati'd In u-atntng new .nrl Tffl!m lrl11 PttT-Aitvhion • ProvlW'd vn:r l ~ for the Orleooooo and Commlllff Sffv1ct Ofti«- • Plalllll'd mJ Ofll"'1ii.td = orirnUllion • Qew>d "ll'W pol <lfS ~ J!l'O<'fdu~ fat ~ Ad\-154r5 Mfftlben . s --•.::.::;:Flar:.~:..._iti_A_C_E ________________________ _ • SOA Cf. ACE 505 Diane Klein 765 South Shore Drive, Mia mi Beach FL 33141 (305) 905-2241 k lei ndiane938@ gma il.com Se plembc r 2 9 , 201 7 R e: Campus Directo r of Advisement and C areer Serv ices D ear Hiring Direclor. A~e r review ing C a mpus Director of Adv i e m e nt and C aree r S e rv ices p o iti o n a t Miami Da de Coll ege and I am very interes te d is ve ry e xciting o ppo rtunity . From m y know ledge o f Mia mi Dade C oll ege i s the largest colle ge in the Unit ed States and a ward s more A ssoc ia te Degrees to Hi s panics and African American s. As yo u c an see from m y resume, m y recent ex perien ce as th e A ssoci a te Direct o r o f Career D eve lo pment has a ll owed me to d evelo p the s kill s and abiliti es for thi position. In read in g th e j o b des cripti o n , I hav e hi g hli g ht ed some qua lificati o ns that w ill b e ne fit y our d e pa rtme nt , fo r example : o Develo pe d over 1500 a cti v e re la tions w ith e mployers to rec ruit s tude nt s a nd a lumn i o O vers ee two o ffi ce tha t s ee ove r 1200 students a year o Work with fa c ulty a nd adminis tra tor partners to s hare job a nd inte rn s hip information w ith s tudent o O vers aw countl e s prog rams and dev el o pme nt new a nd c rea te way s t o recruit stude nts throug h c a s e compe titi o n W ith m y e xpe ri e nce in work in g for the Ca reer D evelopme nt at SU I feel th a t I can de fini te ly be a bene fit to your depa rtme nt at Miami D ad e C olleg e. If you have an y questi o ns o r concerns, pl ease fee l fre e to contact m e a t (305) 905 -2241 . I look forward to hearing from y ou in th e n ear future a nd sch eduling some time to meet a t a nd the possible disc ussio n o f a future with your g re at coll ege . Thank Yo u , Diane Kl e in 506 Diane Klein 765 outh Shore Drive, Miami Beach FL 33141 (305) 905-2241 klcindianc938@ gmail.com EDUCATIO Masters of Science in College Student Affairs Concentration in Con fli c t Reso luti on ova Southeastern University , Fort Lauderdal e. FL Bachelor of Science in Psychology Major: Psyc ho logy ova Southeastern University, Fort Lauderdale , FL PROFESS IONAL EXPERIE~CE June 2008 June 2006 Associate Director of Career Development March 2014-Prese nt Nova So uth eastern Uni ve rs ity; Fort Lauderdal e, FL • Manage a ll daily operation of two Caree r Ce nter whi ch sees over 1500 stude nts a nd alumni a year • Oversee a ll dai ly responsibilities for Employer Re lation s team whi ch co nsis ts of over 250 pa rtn e rs hips. 40 empl oyer re lated pro gra ms per yea r including two major Ca reer Fairs with ove r 70 employe rs a nd 500 stud e nt and a lumn i parti c ip ant s • Managed o r ass is ting in over 20 employer related progra ms s uch as; networking even ts. ca e competition , informat ion sessions, si te v is it · an d pane l disc uss ions, etc. • Bu ilt relationships wit h ove r 15 00 local/natio nal /international organ iza tions such as; DHL. Ci tri x, Office Depot, Enterprise a nd City Furn iture to rec ru it SU student • Direc tly manage 2 full-tim e s taff member ; Assis tant Direc tor of Empl oyer Relation s Int e rn s hip s and Administrative Coordinator I an d 9 stud en t worke rs • Create and a sist in overseeing Ca reer Developmen t budget of over $76,000.00 • Co llect and ma na ge pon so r hip program with ove r $20 ,000.00 in donation s a year • Co-C ha ired Interns hip Workin g Group with fac ult y rep resenta ti on from our 6 undergraduate serv ing coll eges th at developed new process for undergradu ate s tudents in obta inin g an internship for academic credit • A sist in the supervi s ion of 7 Graduate as i tants in the are as of Ca reer Advisement, Em plo yer Rel ation s and First Year Ex pe ri ence • Co ll ec t and provide a ll research Em pl oye r Relat io ns data for reportin g Assistant Director of Employer Re lations and Internships Jul y 2008-March 2014 ova Sou t heastern Uni ve rsity; Fo rt Lauderdale, FL • Deve lo ped comprehe nsive and centra lized int e rn ship program for uni ver ity undergraduate and brradu ate s tudents • Created and mana ge Career Deve lopments sponsors hip program a nd gain donation s fr o m a va ri ety of organ iza tion s • Co llaborate with Academic Advisors and Facu lty to cre ate stre a m lin e int ernshi p process for students to gai n academi c cred it to intern s hip s • Estab li s hed gu id e lines for NSU Inte rn ship Prog ram from : Em pl oyer Contract , Eva lu a ti o ns a nd Internsh ip Stude nt Expe ri ence Outcomes • Vi it emp loymen t a nd intern hip site location to meet with employe r and chec k out wo rk e nviro nm ents fo r student s • O rganize a va rie ty o f in te rn ship on campu s rec ruit ing eve nt s s uch as ; in fonnat ion sessions, mee t and greets a nd networking events 507 • Create work s hop s ba ed on differe nt internship topics s uc h as ; "Intern hip IO I", ''How do I gain an in ternship", •·int e rnati o na l Int ernships Search" Graduate Assistant for Hous ing A ug u s t 2007 -May 2008 • • • • • • • • ova Southea stern Uni ve rs ity: Fort Laude rd a le. FL Oversaw and operate the off-camp us program for th e Office of Residentia l Life and Housing Managed the database and websi te for the off-campus hou s in g program in conju nc tion with Off-Campus Housing IO I Meet with students. facul ty and s taff to help them with th eir off-ca mpu s housing nee d s Work and me ets with local rent al communities/renta l co mpanies to provide information abo ut off-campus hous in g serv ices and re so urces Assist the Direc tor o f Hou in g with research project abo ut on and off-ca mpus hou ing tre nd Help publi s h th e annual Off-Campus Hou sing Guide and all promotiona l items dea lin g with ova Southea tern Uni ve rsity o ff-campus housing program Market and collect ove r $32 ,000 in ad ve rtising income fo r th e Office of Resid entia l Life and Hous in g Coordinat e three Off-Campu s Ho us in g Fairs , the Ann ua l Bl ock Pai nt ing Part y, Wo rld AIDS Da y, a nd Wa ll of Hate Projec t. Graduate Assista nt for S tudent and Community Relations Aug. 2006 -A ug . 2007 ova Sou theastern Universi ty; Fort Lauderdal e, FL • A s isted with pl a nnin g, marketing , and o rganizing large sca le ca mpus eve nt s such as Welco me Week. Homecoming, Ho ll ywoo d Squares and Life IO I on campus • Creat ed an S U I 0% Di scount Card with over 17 ve nd ors fo r all SU student s • Worked with und e rgradu a te and graduate organ iza tions lo assist th e m with plannin g th en: progra ms a nd deve lo pin g ways to get funding Practicum Experie nc e Cente r for Community In volvement Sept. 2007 -Dec. 2007 Mi a mi -Dade Co ll ege; Miami , FL • Fac ilitated over thre e erv ice lea rning and community invo lve me nt program s at Miami -Dade Communit y Co ll ege • A sis ted with community outreach program to hi g h sc hoo l studen t in the surroundin g area of Mi a mi Dade Coun ty • Pro vided re search for new ervice gran t for Miami-Dad e Co mmunity Co ll ege • Helped w ith the c re at io n of new mark et ing for Community Involvement Programs Office of Orientation and C ommuter Se rvices Jan. 2008-A pril 2008 Florida Int e rnational Uni versity: Mi a mi. FL • Faci litated a nd part ici pa ted in trai nin g with new and re turn in g Peer Advisors • Pro vid ed vita l resea rch fo r the Orientation an d Commuter Servi ce Office • Worked on planning and orga ni z in g th e summer ori entation • He lp ed wi th creation of new po licies and pro ce dures for Peer Advisors 1embe rs hips • SOACE • ACE 508 509 THIS PAGE INTENTIONALLY LEFT BLANK 510 • Gail Harris 511 THIS PAGE INTENTIONALLY LEFT BLANK 512 MIAM I BEACH BOARD AND COMMITTEE APPLICATION FORM Harris Gail .;....;..:;;.;..;..;.c:...._ ______________ _ L ------------------Last Name First Name Mid d I e Initial 9 Is land Avenue #2211 Miami Beach ..;;.._;...:c=.;..;..::....:....;.;....:::..:...c:;..::....;.;,.;::..:=....c....;_ ________ _ Florida ---------33139 -------- Home Address City St ate Z ip Code _1 ""'"(7...;;;8..;;;.6L..) =21_;_0:;_-4..;..8=--1-'-4'-----_________ 1 _3_0_5_8_6_4_-7-'-6..;_64 ___ gai lkayharris@gmail.com Cellular Work Home Email Address Gail L. Harris LCSW Psychotherapist Business Name: Occupation : 975 Arthur Godfrey Road Miami Beach F lori da 33140 Business Address City State Zip Code Please list your preferences in order of ranking (1] first choice [2] second choice , and (3] third c hoice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Personne l Board Choice 2: Art in Public Pla c e s Committee Choice 3: Committee for Quality Education in Miami Bea ch Professional License No Professional Li censes Submitted . Note: If you are seeking appointment to a professional seat (e .g . attorney, arch itect, e tc .), you must attach a copy of you r currently effective corresponding professional license. * Note: If applying for the At-Large position o f the Historic Preservation Board , please answer the below questions: • Have you ever resided in one of the City's Hi storic Districts for at least one year? No No Address in City Historic District submitted . 513 AFFILIATION WITH T HE CITY OF MIAMI BEACH Pursuant to C ity 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 fu lfilled in the following ways: a. Resident of the City for a minimum of six (6) months: • I am resident of: South Beach Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: fu "Ownership Interest" shall mean the ownership often 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. Or 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 ): NQ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abilities, knowledge and experience . Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? 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 : If yes , please explain in detail : • Do you currently owe the City of Miami Beach any money : If yes , please explain in detail : • Are you currently serving on any City Boards o r Committees : fu If yes , which board? Personnel Board 514 • In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Temple Beth Shalom Temple Beth Shalom Position Member Member • List the address of all properties owned or in which you have an interest within the City of Miami Beach : No Owned Property Information submitted . • Are you now employed by the City of Miami Beach : If so , which department and title ? • 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 Bea ch? If "Yes", identify person(s) and department(s): No relative's information submitted . 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 lobbyi ng before board/committee you have served on for period of one year after leaving office (Miam i 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 bod ies of state and lo ca l 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. 515 BOARD & COMMITTEE FINANCIA L ACKNOWLEDGEMENT STATEMENT Acknowledgement of fine s/suspension for Board/Committee Members for failure to comply w ith Miami -Dade County Fi nanc ial Disclosure Code Section 2-11 .1 (1)(2) I understand that no later than Ju ly 1. of e ach yea r all members of Boards and Committees of the City of Miami Bea ch , including those of a purely advisory nature , are required t o comply w ith Miami-Dade County Finan cial Disclosure Requirements. One of the following forms must be f ill ed w ith 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 )' ;" or 3 . A Copy of your latest Federal Income Tax Return . Fa il ure 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 Rnancial Interests (Form 1) with the M ia m i-Dade County Supervisor of Elections by 12:00 noon , Ju ly 1. Pl anning Board and Board of Adjustment members who file the ir Form 1 with the County Supervisor of Elections automatically satisfy the Cou nty's financial disclosure requirement as a Miami B each 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 R EPORT -------------~,-~ 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 . Gender: Ra ce/Ethnic Categories What is your race? Female White Are you Span ish/Hi spanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No Other Description : No details provided Physically Challenged : 516 Boa rd a nd Comm ittee Application Checklist: Please ensure you have provided all information before applyi ng or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES 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. 7 411 Note: Florida Statutes 119.071 : The role of the Office of the City Clerk is to rece ive and mainta in 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 you r office or other telephone number for your contact number ; and 3) Do not attach a photograph . 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 ACCORDINGLT . I Gail Harris agreed to the following terms on Re c eived in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 517 Facilitator: Holocaust Survivor Group for those having attended the March of the Living .... 1990 -present (.MOL Holocaust survivors) Fabulous Fifties Group ... ongoing for twenty one years to present Women survivors of Sexual Abuse ..... - Facilitator for The Listener's Program for Miami-Dade County- Schools: North Dade area .... 2006-Present Workshops: Celebrating Aging: A Four week program designed for women 60+ February, 2014 -present Women's transitions -at Barry Univ. Group work with Holocaust Survivors at Barry Univ. and Univ. of Miami Stress Management: Women's health Forum: Mt. Sinai Hospital International Meeting of Association for Death and Dying in Washington, DC ... Speaker on: Resiliancy in Holocaust Survivors .... From couplehood to parenthood ..... 07-present Parent workshops: Step Parenting ... at various schools and temples Effective communication skills ... to parents; students, couples From invisibility to Visibility; A Guide for women 60 and beyond ... Jan. 24, 2017 at Greater Miami Jewish Federation Private practice: 1993-(to Present) Individual, Couples and Group Therapy: 975 Arthur Godfrey Rd. Ste. 303 Miami Beach, Florida 33140 Awards: Women Worth Knowing Award for City of Miami Beach presented by Commission on Status of Women -2008 Book : Co-author as of January-2017-: Journey From Invisibility to Visibility -A Guide for Women 60 and Beyond by: Gail K. Harris, Marilyn C. Lesser, PhD, Cindy T. Soloway, www.womensguidetoaging.com 518 Resume Gail L. Harris 9 Island Avenue #2211 Miami Beach, Florida 33139 Cell: 7862104814 Univ. of Miami 1961-8.Ed. ; 1966 M.Ed. Barry University 1987 MSW, 1991-LCSW Work Experience: Teacher: Elem. Educ. 1961-66 '79-81 Jewish Family Service: 1984-1991 Private practice : Psychotherapy 1991-present : Individual, Couples and Group Therapy with Adu lts .... self esteem; loss and bereavement; marital therapy, ; divorce and family issues; aging; women issues; sexual abuse and victims of domestic violence; Holocaust survivors; life transitions Adjunct professor -Barry University-one semester on Women's studies Community activities: Some examples Jewish Family Service Bd. 1984-86 Central Agency of Jewish Ed uc. Bd ... 1980-2012 (30+)yrs Greater Miami Jewish Fe deration-Women's Dept .... Now women's philanthropy Chaired: Developme nt; education, Shalom Ba yit, Founding member of Gesher Program; Miami Beach area Board, Chaired Commission on Status of Women on Miami Beach 2005-2007 Board member: Hebrew Acad emy 20011 -2 015 March of Li ving Participan t: 1990,1 99 4 ,98,2006,.2010 Chaire d Lay committee for March of Living 1998+ City of Miami Beach: Committee for Homeless (2010-2/2017} Women Survivors of Sexual Abuse .... over 18 years Personnel Committee on City of Miami Beach ( 3/2017)-12/31/20 Groups -on a:oing: 519 STATE Of' Fl.ORIDA ~ 0£PARTMENT Of' HEAL TH DMS,QN Of' UEDICAl QUALITY~ 1-l --o-::~V20-T""E-11_--+I--UC£H-,rw_s_2:-:---tl-'CON=,,~'-'~"Ol="o~~1 , The LICENSED CLINICAL IOCIAL WORKER nam..:t b9kMi t1a11,,,.1 al teQl.ltr~ of lhelews1ndNesofthea&.1teof~ f><plrlllon Dato MA,RCH )1, 2021 G AIL LOUISE HARRIS LICENSEE SIGNATURE I \ 520 521 THIS PAGE INTENTIONALLY LEFT BLANK 522 • Raquel Pacheco 523 THIS PAGE INTENTIONALLY LEFT BLANK 524 MIAM I BEACH BOARD AND COMMITTEE APPLICATION FORM _P_a_ch_e_c_o ________________ R_a.....,q_u_e_l _______________ '--A'------- Last N ame Fi rst N ame Middle Initial _7_3_2 _L~e_n~o_x _A_v~e~n~u~e ____________ M_ia_m_i _B_e_a_ch ______ F_lo_r_id_a ______ 33139 Home Address City State Z i p Code ____________________ 3_0_54_5_0_5_3_5_7 ____ rpacheco@rdptranslation .com Cellular B usiness Na me: 732 Le nox A v enue Business Address Work Home Email Address Business Owner Occupation: M iami Beach Florida 33139 City Stat e Zip Code P lease list you r p re fe rences 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: Person nel Board Choice 2 : Land U se and Sustainability Committee Choice 3 : Sustainability Comm ittee Professional License No Professional Licenses Submitted . Note: If you are seeking appointment to a professional seat (e.g . attorney, a rchitect , etc.), you must attach a copy of your currently effective correspondin g professional license. * Note: If a pplying for th e At-Large position of the Historic Preserva tion Board , please answer th e below q uestio ns : • Have you ever resided i n o ne of the City's H istoric D ist ricts for at least o n e year ? No No Address in City Historic District submitted . 525 AFFILIATIO N WITH THE CITY OF MIAM I BEACH Pursuant t o 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 : a. Resident of the City for a minimum of six (6) months : • I am resident of: South Beach Or No b . Demonstrate an ownership interest in a business establ ished in the City for a min imum of six (6) months : N,o nownership Interest" shall mean the ownership often percent (10%) or more (including the ownership of 10% or more of the outstanding capital stock) in a business. nBusiness" shall mean any sole proprietorship, sponsorship, corporation . limited liability company, or other entity or business association. Or 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 tha t is physically located in Miami Beach (for a minimum of six months): No Not withstanding the requireme nts set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abilities , knowledge and experience . Please list be low: I have served on the Personnel Board for almost 2 years, we have made good progress together and I know I can continue to contribute in a positive way . • Are you presently a reg istered lobbyist with the City of Miami Beach? 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: NQ If yes , please expla in in detail : • Do you curren tl y owe the City of Miami Beach any money: No If yes , please explain in detail : • Are you currently serving on any Ci ty Boards or Committees : fu If yes , which board? Personnel Boa rd 526 • In what organization(s) in the City of M iami Beach do you currently hold membership in? Name Pos it ion M iami Beach United V P of Marketing • List the address of all properties owned or in which you ha ve an interest within the City of Miami Beach : No Owned Property Information submitted . • Are you now employed by the City of Miami Beach : If so , which department and title? • Pu r sua nt to C ity Code Section 2-25 (b ): Do you have a parent, spouse , child , brother, or si ster who is employed by the City of Miami B each? If "Yes", identify person (s) and department(s): No relative's information submitted . NOTE: IF APPOINTED, YOU WI LL BE REQU IRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEM BERS. THESE LAWS I NCLUDE, BUT ARE NOT LIMIT ED TO: o Prohibition from direc tly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Proh ibition from contracting with the city (M iami-Dade County Code section 2-1 1.1 ). o Proh ibition fr om lobbyi ng before board /committee you have served on for period of one year after leaving office (Miami Bea ch Code section 2-26) o Requirement to disclose certain financial interests and gifts (M ia mi-Dade County Code section 2-1 1.1 ). o Sunshine Law-Florida's Government-in-the-Sunshine Law was enacted in 1967. Toda y , the Sunshine Law reg arding open government can be found in Chapter 286 of the Florida Statutes. These s ta tutes 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, ci ty , or other local level of government on an appointed or elected Board , Council, Commission , Authority , or Commi ttee . It applies equality to members of advisory and non -a d visory bodies who are presented with a voti ng conflict of interest under Section 112.3143. Florida Statutes. 527 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Comm ittee 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 eac h year all members of Boards and Committees of the City of Miami Bea ch , includi ng 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 B each , Florida , no later than 12:00 noon of July 1, of each year: 1. A "Source of In come Statement;" or 2 . A "Statement of Financi al 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 Fl orida , pursuant to F.S . §112 .3145(1)(a), to file a Statement of Rnancial 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. Howeve r , compliance with the County disclosure requirement does not satisfy the State requirement. DIVERSITY STATISTICS REPORT Th e following information is voluntary and has no bearing on yo ur consideration for appoin tment. It is being asked to comply with City diversity reporting requirements . Gender: Race/Ethnic Categories What is your race? Female White Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic/ Latino . No Other Description : No details provided Physically Challenged : 528 Board and Committee Application Checklist: Please ensure you have provided all information before app lying or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES 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. YES 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 Stat utes 119 .071 : The role of the Office of the City Clerk is to rece ive and maintain forms filed as public records. If your ho me add ress, telephone numbers, and/or photograph are exempt from disclosure and you do not wis h your home address , te lephone numbers, and /or photograph to be made public, please: 1) Use you r office or other address for your mailing address; 2 ) Use you r office or other telephone number for you r contact number; and 3 ) Do not attach a photograph . 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 ST ATE LAWS AND STATUTES ACCORDINGL T . I Raquel P acheco agreed to the following terms on 10/20/2020 10:29:12 AM Rece ived in the City Clerk's Office by : Name of Deputy Clerk Control No. Date 529 Raquel A. Pacheco BIOGRAPHICAL SKETCH Born on November 2, 1974, in Luanda, Angola, to parents of Portugue se desce nt, Raquel A. Pacheco spent the first ten years of her life living in the countries of Portugal, Spain and Morocco. At the age of ten, she moved to Connecticut where she attended the University of Connecticut and graduated with a Bachelor's Degree in Urban Studies. In 1993 Raquel joined the CT Army National Guard and in 1995 became the first woman to be recognized as "Soldier of the Year" in the history of the State's Army National Guard . Her mil itary accomplishments are repre se nted by variou s di stinguished awards inc luding: the Department of the Army "The Army Achievement Medal" (January 3, 1995), Department of the Army and the A ir Force National Guard Bureau "Command Se rgeant Major's Award (January 29, 1995), Department of the Army First United States Army Command Sergeant Major's Award (March 11, 1995), Department of the Army "The Army Commendation M edal" (October 19, 1995), D e p artment of th e Army "Certificate of Achievement" (December 5 , 1998), among others. At the age of 22, while se rving in the CT National Guard and attending the University of Connec ticut on a full -time ba sis, Raquel opened RDP Agenc y LLC, a full-service language translation and interpretation agency, in Hartford, CT. In 1999, Raquel began her career in Public Relations and event Planning when she join e d force s w ith a loca l Public Re l a tion s firm and excelled i n both the Public Relati on s and language translation arena s. Today RDP Agency has two locations; Hartford, CT and Miami , Florida. RDP Agen c y LLC se rves clients ranging from small bu s inesses to Fortune 500 companies i ncluding: AARP , Merrill Corporation, Cendant Corporation, The Metropolitan D is tri c t Commission, Middlesex Community College, Pars on's Transportation, Bay State Environmental, Gerber Scientific and the State of CT 's Department of Social Services, the CT Departme nt of Children & Families, Social Security Admini stration and many more. 530 Raq u el has a b r oad public relations and event planni n g background and has worked on several distinguished projects . H er career in event p lanning b egan in 1999 when she p l aye d an instrumenta l rol e i n the planning of the first Africa Business Trade Conference in Hartford, CT. Over the years she has managed and executed t h e public relation, sponsorship, and event p l anning aspects of various key events including: the Congressional Trade Aid Mission to Senegal, Mali, Ghana, Nigeria a nd Cote D' lvoire {September 2003); U .S. Department of Housing & Urban Development {HUD) Media Campaign to increase homeownership among African Americans and Latinos {2003); the Cendant Corporati on's 1st Annual Executive Summit on Diversity, Parsippany, N .J. {September 2003); the White House Welfare to Work Event, Washington, D.C. (June 4, 2002); the J.C. Watts, Jr . Congressional Tribute to the Negro leagues of Baseball, at the library of Congress, Washington, D.C (September 18, 2002); Fleet Bank "Cheers for Reading", statewide-Connecticut {2001-2003); The Metropolitan District Commission CSO Abatement Project {2002-2003); the Connecticut Development Authority URBANK Workshops, statewide- Connecticut {2000-2002); the Minority Supplier Diversity Council's Annual Summit, Miami, Florida {2001); The Metropolitan District Commission 75th Anniversary Events (October 2003-2005), and many others. In 200 0, Raquel edited a-first-of-its-kin d in novative job tra i ning l ife skills manual for t h e Connecticut Departm ent of Transportation (Conn DOT) e n titled "S.K.I.L.L.S." (Seeking Knowledge and Insight to Live Life Successfully). This training program was designed to assist the underemployed to gain access to job training and life enhan cement skills and to lead productive l ives in the workforce . In January of 2001 Raquel worked with the White House to produce the "Martin Luther King Celebration" for President Bu sh and Coretta Scott-King. H ailed as one of the most significant Martin Luther King events ever celebr ated by a U .S. Pr esident, t h i s celebration was broadcast e d i n over 130 cou ntr ies b y t h e U.S. State De p a r tment. I n May of 2002, Raquel serv ed as a co -t ra i ner for t h e United States Department of State teaching p rofess i o n a l a n d Communication s Skills trai n ing workshops at the Regional Progr am Offices o f Ame r ica n Em b assies in Austria, Poland , and Germany. Raq u el taught Communications training to over 100 Foreign Se r vice N ationals and America n Se r vice O fficers from Europe, Eastern Europe, A frica, t h e Middle East, t h e fo r mer Soviet Republ ics and Russia . Raquel also served as editor of the course materials approved by the State Department for u se at these worksh ops. Th rough o u t her caree r , Ra q uel w o rked w ith vari ous w e l l reco gnized and accomp l ished individ u als inclu ding: baseba ll l egends W i llie M a y s, a n d Buck O' N ei l, actor Bl air Un d erw ood , th e late Attorney Joh nie Coch r an, performer MC H ammer, former Congressm an J .C. Wat ts, Jr., Congress m an D an n y Davis, Congressman Charles Rangel , Senator Barbara Miku lsk i, Senator 2 531 Richard Santorum, Mamie "Peanut" Johnson, LFCA Executive Director Zoe Baird, CBS News Reporter Mika Brzezkinski, Congressman Christopher Shays, former CT Governor M. Jodi Rell, and many other state and local key-centers-of-influence. Raquel worked extensively on securing sponsorships for her clients and successfully secured significant contributions from a long list of corporate industry leaders, some of which include: American Airlines, Microsoft, Inc., Fleet Bank, Greyhound Bus Lines, Inc ., Coca -Cola, HBO, Nestle, Rawlings, Office Depot, Office Max, Partners with Youth Sports Foundation, Inc., Tri - Rose Foundation, Inc., Lamar billboard advertising, and many more. Raquel's unique personal and professional experiences contribute to her deep insight into cultural trends and a deep understanding of international and regional political affairs. For three years she managed a successful media campaign for the CT Department of Transportation aimed at increasing seat belt and child passenger safety usage among African American , Latino and Caribbean populations . She also worked as the main consultant for DEMOCRACYWorks, on the "Reflecting CT-Reflejando a CT!" initiative aimed at increasing the representation of women and minorities on State and Local Boards and Commissions. Throughout her career, Raquel also served in the capacity of editor and speech writer for various political and community leaders as well as some national personalities including; former CT Governors John G. Rowland and Governor Jodi M. Rell, former Congressman J .C. Watts, Jr., and many local law enforcement officials. In 2011, Raquel and her firm, RDP Agency LLC, were featured in the subscriber issues of Forbes Magazine in NY and CT in an article highlighting "Conne cticut Women in Busine ss" (i ss ue date: August 22, 2011). That year RDP Agency was also awarded "Top 2011 Business" by DiversityBusiness.com . Raquel wa s a member of the Commonwealth Institute of South Florida and served as the President of Harmony Villa Condominium Association until April of 2017 . In 2019 she was a candidate for Miami Beach Commissioner and currently she is the Vice Chair of the Personnel Board for the City of Miami Beach, a board member and VP of Marketing for Miami Beach United and the owner and manager of RDP Agency LLC. 3 532 • Ricardo Barboza 533 THIS PAGE INTENTIONALLY LEFT BLANK 534 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Barboza Ricardo J ---------------------------------- Last Name First Name Middle Initial _16~8~8'--W~e~s~t _A~v~en~u~e'--P_e _nt_h_o_us_e_4 _______ M_ia_m_iB_e_a_c_h _____ F_L _______ 33139 Home Address Ci ty State Z ip Code 305 968 4660 Cellular Lennar Homes Business Name: 730 nw 107 ave third floor Business Address Work --------rjbarboza@gmail.com Home Em a i I Address International New Home Consultant Occupation : MIAMI FL 33172 City State Zip Code Please list your preferences in order of ranking (1) first choice [2) second choice , and [3) third choice . Please note that onl three 3 choices will be observed b the Cit Clerk's Office. (Regular Board s of City) Choice 1: Personnel Board Choice 2 : Affordable Housing Advisory Committee Choice 3 : Committee on the Homeless Professional License License Numbe r Sales A ssocia te Real Estate SL3259440 Issuance Da te 6/1 1/2012 Expire Date 3 /3 1/2022 Note: If you are seeking appointment to a professi onal seat (e .g . attorney, architect, etc .), you must attach a copy of your currently effective corresponding professional license . * 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 Hi storic Districts for at least one year? Yes No Address in City Historic District submitted . 535 AFFILIATION WITH THE C ITY OF M IA M I BEACH 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 i n the following ways : a. Resident of the City for a minimum of six (6) months: • I am resident of: South Beach Or b . Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: fu "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. Or 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): NQ Notwithstanding the requ irements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of th e Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements o f section 2-22 (4) a and b of the Miami Bea ch 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. • I am applying for an appointment because I have special abil ities , knowledge and experience . Please list be low: 1) Community Leader : I founded Snack Patrol ; a Miami Beach based non profit helping the homeless with the views of addressing this problem in our city . 2) Commitment : I have the passion to go beyond the line that would improve the standards of Miami Beach . 3) Management Skills : Along my career • Are you presently a registered lobbyist with the City of M iami Bea ch? ~ • Have you ever been convicted of a fe lony : If yes , please explain in detail : • Do you currently have a violation(s) of City of Miami Beach codes : If yes. please explain in detai l: • Do you currently owe the City of Miami Beach any money: If yes , please explain in detail: • Are you currently serving on any City Board s or Committees : If yes , whi ch board? 536 • In what organization(s) in the City of M iami Beach do you currently hold membership in? No Organization Informatio n Submitted . • List the address of all properties owned or in which you have an interest within the City of Miami Beach : Property 1688 West Avenue, Penthou se 4 , Miami Beach . FL 33139 • Are you now employed by the City of Miami Beach : If so , which department and ti tle ? • 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 M iami Beach? If "Yes", identify person (s) and department(s): No relative's information submi tted . 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 c ity personnel (Miami Beach City Code section 2-459). o Prohibition from contrac ting with the city (Miami-Dade County Code section 2-11 .1 ). N.Q o Prohibition from lobbying before board /com mittee you have served on for period of one year after leaving office (Miam i Beach Code section 2-26 ) o Requirement to disclose certa i n financial intere sts and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunsh ine 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 basi c 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 , Coun cil , Commission , Authority, or Committee. It applies equality to members of advisory and non-advisory bod ies who are presented with a voting conflict of interest under Sec tion 112.3 143. Florida Statutes . 537 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of f i nes/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. o f each ye ar all members of Boards and Committees of the City of Miam i Beach , including those of a purely advisory nature , are required to comply with Miami-Dade County Financial Disclosure Requirements. One of the fo ll owing forms must be filled with the City C l erk of Miami B each , 1700 Convention Center Drive , Miami B each , Florida , no later than 12 :00 noon of July 1 , of each year: 1. A "Source of Income Statement;" or 2 . A "Sta tement of Financial Interests (Fo rm 1 )1 ;" or 3 . A Copy of you r 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 Pl an ning Board and Board of Adjustme nt wi ll be notified directly by the State of Florida , pursuant to F.S. §112 .3145(1)(a), to file a Statement of Fi nancial Interests (F-orm 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon , July 1. Planni ng Board and Board of Adjustment members who file the ir Form 1 w ith the Cou nty Supervisor of Elections automatically sa tisfy the County's financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form w ith 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 you r consideration for appointment. It is being asked to comply with City diversity repo rting requirements . Gender: Race/Ethnic Categories What is your race? Male Other Are you Spanish/H ispanic/ Latino? Mark t he "No" box if not Spanish / H ispanic / Latino . ~ Othe r Description: No details provided Ph ysically Challenged : 538 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . ::===::::! YES I have uploaded a current resume , photograph , and a copy of any applicable professional license . YES I have comp leted and attached the Board & Committee Financial Acknowledgment Statement. YES 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. 7 411 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. 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 ACCORDINGLT. I Ricardo Barboza agreed to the following terms on 10/14/2020 7:34:45 AM Rece ived in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 539 SUMMARY Ricardo Barboza 1688 West Avenue, Penthouse 4 M iami Beach, FL 33139 (M) 305-968-4660 ~barboza @gmail .com A seasoned , experienced sales oriented individual w ith over fifteen years collective experience in domestic and international Sales focus ing in New Construction Homes; forecast ing , budgeting , marketing campaigns and re lated bus inesses ; Supervision , motivation and coa ching of employees. High networking knowledge (ov er 2,500 Linkedin Real Estate connect io ns ). trade shows (Domesti c and International) and identifi cation of potential new businesses sources. Excellent computer skills . Tri-lingual. Extremely detail oriented and identification of employees who are effe ctive to the company Vs . employees not-effective to the company. PROFESSIONAL EXPERIENCE Lennar Corporation, South East Florida Division International New Home Consultant June 2016 -Present Lennar Headquarters. Miam i FL • Performing public p resentations regarding all Lennar communities in Miami Dade/Broward/Palm Beach , negotiating and signing new agreements with international buyers and investors around the world . As a result, International s ales increased a 12.80 % from 2015 to 20 16 . • Strateg izing new promotio n te chniq u es with the Marketing Department to grow in different markets through partnering with Internationa l Brokers in order to distribute Lenna r Homes in their territories. • Attendi ng and planning all International Homes events/expos i n order to generate sales and reinforce the Lennar brand overseas. • Assisting in planning , proje cting and forecasting revenues for Q1 , Q2 , Q3 and Q4 for the International Department considering economic, political and social trends around the world . Lennar Corporation , South East Florida Div ision New Home Con sul tant Jun 20 11 -June 2016 D ifferent communities M iami Dade & Broward , FL • Handling floor sales directly with buyers or through Realtors in different communities within the Miami Dade and B roward counties . Up to this date, closed out 12 different communities in the South Flo rida region with high margin conversion of visitor to buyer. Follow up with v isitors . • Prese nt at io n of the Lennar products (S ingle Family/ Condos/ Townhomes) at trade shows in the US and Lat in America . Local p re sentation at Broker's offi ces. • Act as a lia ison between different departments such as Lending , Marketing , Collections, Construction and Closing (t itle company) as well as w ith the options-upgrades providers. • Responsible for competition reports and commun ity sales reports. Communication with other Lennar offices nationwide . • Preparation of sale agreements , revisions , color selections and a ll the paperwork involved in the purchasing pr ocess. Knowledge of cancellation procedures , rules and regulations . • Maintenance of model homes: Supervision of clean ing , deodorizers, impeccability. Magnificent Me dia President I Business Owner Jan 2010-May 2011 Mia mi Beach , FL • Directed , managed and developed the only local d igit al ad sales network in Miami Beac h. • Acted as a permanent con sultant for Oceans TV, a pay -TV provid er fo r maritime entertainment s ervices (Ro ya l C aribbean Cru ise Line s) covering Progra m Sales and ne w deals w ith satellite a ccessib le TV channels c ont. 540 cont. MTV Networks International Miami Beach, FL Affiliate Sales and Operations Director (Caribbean and Latin America) Jan 2006 -Jul 2009 • Renewed expired contracts at the best possible rate to ensure maximum profit margins ; Grew revenues from 2006 to 2007 by 11 %; from 2007 to 2008 by 15% • Implemented new sales strategies (Other than conventional MSO : Digital media , cruise ships); supervised & approved all Marketing initiatives : Barters , promotions, premieres, off-shelves , special eve nts and trade shows . • Managed , forecasted , supervised and maintained a mu lti-million Dollar budget annually. • Effectively pitched MTV Networks' channels (MTV, Vh1 , Nick) for potential clien ts (presentation and closure o f contracts) resulting in approximately in 100 new clients . • Highly experienced in wine and dine and all PR initiat iv es. Affiliate Sales Manager (Caribbean and Latin America) Jun 2001 -Dec 2005 • De veloped solutions to manage devaluation crisis in underdeveloped markets . (i .e . Financial rel ieves and payment plans) • Met with and visited clients regu larly to maintain good rela tionships and ensure clients ' needs are met • Supervised and managed sales team of 6 employees; provided mentoring and business expertise within the Cable TV industry • Worked closely with finance department to ensure prompt payment from cli ents and provide top customer service Sales P lanner, Affiliate Sales (Caribbean) Oct 1999 -May 2001 • Worked directly with the Advertising & Marketing Departments to provide promotions for large and medium size clients in the regions allowing exposure of our brands and building relationships with the viewe rs • Worked directly with the account manager to secure new clients to help and maintain small accounts in the region ; assisted with trade shows and conventions . • Prepared and compiled subscriber d istribution reports for company prospecting and analysis Discovery Channel Latin Americ a/ Iberia Coordinator-Affiliate Sales 1996 -1999 • Managed the technical uplink and activation/deactivation of satellite signals • Renewed contracts for small clients after re ceiving approval from Regional Manager Miami, FL • Provided management and assistance with database in Miami and in the regions (Argentina/Mexico/ Brazil) EDUCATION University of Westminster, BA International Bus iness -London NW1, England , 1992 Oxford University , English for Foreign Students, Oxford , England 1987 Coleg io Juan XXIII , Hig h School Diploma in Science LANGUAGES Fluent in Engl ish, Spanish and Italian. Bu sin ess Portuguese . ACHIEVEMENTS/ AWARDS Leader 1st Qlr. 100% Goals achieved / LENNAR 2014 Highest a verage sales pe r week I LENNAR 2014 Leader 3rd Qtr . 100% Goal achieved / LENNAR 2015 100% Sales satisfaction 3rd Qtr./ LENNAR 2015 Little Red Hen Award / LENNAR 2015 541 542 •Jamie B. Laufer 543 THIS PAGE INTENTIONALLY LEFT BLANK 544 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Laufer Jamie B ------------------------------------ Last Name First Na me M idd le Init ia l _72~5"--W~S~0~S~tr~e~e~t ____________ M_ia_m_i B_e_a_c_h _____ F_L _______ 33140 Home Add ress C ity State Z ip Code _3_0_5-_2_0_6_-0_0_4_4 _______________________ jam ie laufer@gmail.com Ce llular Work Home Email Address American Youth Footba ll Executive D irector-Non Profit Organizati on Business Name: Occupation : Busi ness Address C ity State Z i p Code P lease li st your preferences in order of ranki ng [1 ] first choice [2] se cond choice, and [3] th ird c hoice . Please note that only three (3) choices will be observed by the City Clerk's Office. (Regu la r Boards of C ity) Choice 1: Personnel Board Choice 2 : Choice 3: Professional License No Professional Licen ses Submitted . Note: If you a re seeking appointment to a profess iona l seat (e .g. attorney, arc h itect , etc.), you must atta ch a copy of your c urrently effective correspondi ng professional license . * Note: If applying for the At-Large posit ion of the Historic Preservation Board , please answer the below questions : • Have you ever resided i n one of the City's Historic Districts for at least one yea r? N.Q No Address in City Historic District subm itted . 545 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c : Members of Agen cies, Boards , and Committees shall be affiliated with the city . This requirement shall be fu lfilled in the following ways : a . Res id ent of the City for a minimum of six (6) months: • I am resident of: Middle Beach Or b. Demonstrate an ownership in terest in a business established in the City for a minimum of six (6) months: No "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, co rporation, limited liability co mpany, or oth er entity or business association. Or 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 physica lly located in Miami Beach (for a minimum of six months): ~ Notwithstanding th e requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NO TE: Memb ers of Agencies, Boards, and Co mmittees 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. • I am app lyi ng for an appointment because I have special abilities, knowledge and experience. Please li st below: I have been a resident of Miami Beach since 2001 and care about t he city, those th at live in it , and those that help to make it one of the best! • Are you presently a registered lobbyist w ith the City of Miam i Beach? No • Have you ever bee n convicted of a felony : If yes, please expla in in detail : • Do you currently have a violation(s) of City of M iami Bea ch codes: If yes , please explain in detail: • Do you currently owe the City of Miami Beach any money: If yes , please explain in detail : • Are you curren tly serving on any C ity Boards or Committees : If yes , wh ich board ? 546 • In what organ ization(s) in the City of Miami Beach do you currently hold membership i n? No Organ izat ion Information Submitted . • List the address of all properties owned or in wh ich you have an interest within the City of Miami Beach : No Owned Property Information submitted . • Are you now empl oyed by the C ity of Miam i Beach : N.Q If so, wh ich department and title? • Pu rs uant to City Co de Secti on 2-25 (b): Do you have a parent, spouse , ch ild , brother, or sister who is employed by the C ity of Miami Beach? If "Yes", identify person(s) and department(s): No relative's information submitte d . NOTE: IF APPO INTED , YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS T HAT APPLY TO CITY BOARD/COMMITTEE MEMBERS . THESE LAWS INCLUDE , BUT ARE NOT LIMITED TO: o Prohi bit io n from d i rectly or indirectly lobbying city personne l (Miam i 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 Requ irement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in-t he-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 governi ng bodies of state and loca l governmental agencies or authorit ies . o Voti ng conflict -Form 8B is for use by any person serving at the county , city, or other local level of government on an appointed or e lected Board , Council , Comm ission , Authority , or Comm ittee . It appl ies equa li ty to members of advisory and non-advisory bod ies who are presented w ith a voting conflict of interest under Section 112.3143. Florida Statutes . 547 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 Comm ittees of the City of Miami Beach , including those of a purely advisory nature, are requ ired to comply w ith M iami-Dade County Fi nancial Disclosure Requirements . One of the fo ll owing fo rms must be filled w ith the City Clerk of M iam i Beach , 1700 Convention Center Drive, Miami Beach , Florida , no later than 12 :00 noon of July 1, of each year: 1. A "Sourc e of In co me Statement;" or 2 . A "Statement of Fi nancia l 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 Plann ing Board and Board of Adj ustment w ill be notifi ed d ire c tly by the State of Florida, pu rsuant to F.S . §112 .3145(1)(a), to file a Statement of Financial Interests (Form 1) w ith the Miami-Dade County Supervisor of Elections by 12:00 noon , Ju ly 1. Planning Board and Board of Adj ustment members who file the ir Fo rm 1 w ith the County Supervisor of Ele ctions automatica lly satisfy the County's finan ci a l di scl osu re requ irement as a M iami Bea ch City Board/Comm ittee member and need not file an add itional form w ith the Office of the C ity C lerk. However, compli ance w ith the County d isclosure requ irement does not satisfy the State requ irement. DIVERSITY STATISTICS REPORT The foll owing information is voluntary and has no bearing on your consideratio n for appointment. It is being as ked to comp ly w ith City d iversi ty reporti ng requ i rements . Gender: Race/Ethnic Categories What is your race? Female White Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / H ispan ic / Latino . No Other Descript ion : No deta il s provided Physica ll y Challenged : 548 Board and Comm ittee Applicat ion Checklist : Please ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . :=:::==:::: YES I have uploaded a current resume , photograph , and a copy of any appli cable professiona l license. YES I have completed and attached the Board & Committee Financial A cknowledgment Statement. YES 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@m iam ibeachfl.gov or telephone : 305.673. 7 411 Note: Florida Statutes 119.071 : The role of the Office of t he C ity 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 ad dress; 2) Use your office or other t elephone number for your contact number; and 3) Do not attach a phot ograph . 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 ACCORDINGLl'. I Jamie Laufer agreed to the follow ing terms on 12/7/2020 1 :01 :49 PM Rece ived in the C ity Clerk's Office by: Name of Deputy Clerk Control No . Date 549 JAMIE LAUFER I PROFESSIONAL SUMMARY Forward-thinking Senior Executive with proven record of accompli shment in both non profit sector as well as manufacturing during 20+-year career. Driven and ambiti ous change manager dedicated to continuous business improvement focused on enhancing revenue ( manufacturing) and streamlining business operations (non profit) WORK HISTORY American Youth Football -Executive Director M iam i, Florida • 0 l /2007 -Current • Coordin ated and implement ed effective training for over twelve regional d ivi sions to improve organizational processes. • Worked closely w ith organizational leadership, in c lu d in g board of d irectors, to strateg ically affect d irection of operations. • Completed accurate mat erial and labor estimates for jobs w ith $200K + budgets. • Focused teams on developing innovative and cuttin g-edge approaches at a ll levels w ith effective resource a ll ocation and strategic p lannin g. • Increased new capacity and technology bases to brin g more sponsors and su pport services to membership. • A li gned department vision, goals and objectives with company strategy to achieve consistently high resu lts. • Negotiated new annual contracts and service agreements with vendors to achieve prime E: Jamielaufer@gmail.com P: (305) 206-0044 A : Miami Beach, FL 33140 www.americanyouthfoottball.com SKILLS • Policy and Procedure Adherence • Performance Feedback • Team Leadership • Confli ct Reso lution • Program Leadership • T earn Bondin g • Member Databases • Media relations • Fundraisin g • Staff Management • Case Management • Bus iness adminis tration • Strategic Plannin g • Project Management • Marketin g • Social media • Busin ess Development • Operations management • Consu lting • Vendor relations • Bu dgeting • Bus in ess plannin g • Negotiation EDUCATION Lynn University Boca Raton, FL 550 pricing. • Establ ished new partnership team to support NFL- National Football League. Puppet Workshop -Product Development Executive M iami, FL • 02/2000 -10/2006 • Oversaw development of more than 200 new products each year. • Interac ted with customers and clients to identify bus iness needs and requirements. Cus tomers including Target, The Walt Disney Company, Gap, Sears , JC Penny. • Improved success of program by making proactive adjustments to operations. • De li vered training for staff development, change management and materials, process and technical controls . 551 552 • Kareem Brantley 553 THIS PAGE INTENTIONALLY LEFT BLANK 554 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMM ITTEE APPLICATION FORM NAME: Brantley Last Name HOME ADDRESS : 11 Island Avenue #1008 Apt No . PHONE: 305-206-7018 H ome Home No./Street 954-347-467 5 Work Kareem First Name Miami Beach City T Middle In itial FL State kareem @ bravi sgroup.com Email Address Business Name: ~B~ra_v~l s~G~r~o~u~p ___________ Pos ition : Real Estate Development Addre ss: 6007 NW 7th Avenue Miami FL Street C ity State 33139 Zip Code 33127 Zip Code Pursuant to City Code secti on 2-22(4) a and b : Members of agencies, boards , and committees shall be affiliated with the city; this requirement shall be fulfilled i n the following ways: a) an individual s hall have been a resident of the city for a minimum of six months ; or b) a n individual shall demonstrate ownership/interest for a minimum of six m onths in a business established in the city . • Resident of Miami Beach for a minimum of six (6) months Yes • D emonstrate a n ownership/i nterest in a business in M iami Beach for a minimum of six (6) months: Ye s • Are you a registe red voter in Miami Beach: Yes •(Pl ease~ one): I am now a resident of : South Be ach • I am applying for an appointment because I have special abilities, kn owledge and experience. Please list below: I have experi ence as an electrical engineer performing r es idential and commercial electric distributi on vault design for Next Era • Are you presently a reg istered lobbyi st w ith the City of Miami Beach? No Plea se list your preferences in order of ranking (1) first choice [2] second choice . and [3] third choice . Please note t hat only three (3) c hoices will be observed bv t he City Clerk's Office. (Regula r Board s of City) Choice 1: Planning Board Choice 2 : Choice 3: * Board members are required to file Form 1 -"Stateme nt of Financ ial Inte rest" with the State. If you seek appointme nt to a professiona l seat (e .g ., lawyer, architect , et c.) on the Boa rd of Adjustm ent, Design Review Board, Historic Preservation Board or Planning Board , attach a copy o f your currently-e ffective ly license, and furni sh the following information : Type of Professional Li cense ______________ _ Li cense Numbe r License Issuance Date _________________ _ License Expiration Date Note: If applying fo r Youth Advisory Board , please indicate your affiliation with the Scott Ra kow Youth Center: 1. P ast service on the Youth Center Advisory Board : No Years of Service: ---- 2. P resent participation i n Youth Center activi ties by your children ""'N.a..o __ ages, and which programs. List below: ---------------- if yes. please list th e names of your childre n , their 555 • Have you ever been convicted of a fe lony: No If yes, please explain in detail : • Do you currently have a violation(s) of City of M iami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of M ia mi Beach any money: No If yes. please explain in detail: • Are you currently serving on any City Boards or Committees: No If yes, which board? • What organizations in the City of Miami Beach do you cu rrently hold membership ,n? • I am now employed by the city of Miami Beach: No Which department? • List all properties owned or have an interest in, which are located within the City of Miami Beach : Gender: Male The following Information is voluntary and i s neither part of your application nor has any beari ng on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. Ra ce/Ethnic Categories What is your race ? Mark one or more races to indicate what you consider yourself to be . African-American/Black Other Description: Are you Spanish/Hi spanic/ Latino? Mark the "No" box if not Spanish / Hi spanic/ La tin o. No Physically Challen~ed : No NOTE: If appointed, you will be r equi red to follow certain laws which apply to city board/committee members. These laws include, but are not limit ed t o , the following: o Proh1bit1on from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Proh1bit1on from contracting with the city (Miami-Dade County Code section 2-1 1 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 ). (re: CMB Community Development Advisory Committee)· prohibition. dunng 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 fami ly ties (CFR 570.611 ). 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 have rece ived , read and will abide by Chapter 2, Article VII -of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Kareem Brantley agreed to the following terms on 12/18/2018 7 :50 :15 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 556 KAREEM T. BRANTLEY , CFA 11 Island Avenue #1008, Miami Beach , FL 33139 (954) 347-4675 kareemb@bellsouth.net Finance and business strategy leader with experience in operations and strategic capital allocation for small to medium sized businesses. Highly motivated w ith strong fundamental and quantitative ski ll to generate results/solutions. CFA charterholder. Completed MSF in addition to BSEE . Expertise includes: Cross Functional Team Leadersh i p Profitability & Segment Analysis Strategy Creation & Design PROFE SS IONAL EXPERIENCE Project Implementation Ability Organizational Change Agent Technical Comprehension Lib e rty Square Redevelopment, Miami, FL (Current Development) Partner/Project Manager Forecasting & Modeli ng Financial Reporting Effective Negotiator • Manage all aspects of development for Liberty City Rising, a $400MM public private partnership revitalization initiative to develop new public housing, affordable housing and workforce housing con sisting of over 1,455 new apartment units and 60 homeownership units. • Supervise subcon tractors during demolition and development. • Created contractual reporting to the Miami-Dade Board of County Commi ssio ners. • Lead coordination of all members of design team, including civil, MEP, Structural and architecture. • Work w i th underwriters and finance sources for project funding. • Proof legal documents from legal team. • Lead pre-development activity with AHJ such as DERM, WASD, PHCD, Ci ty of Miami Bui l ding Department an d BCC. • Obtain affordable housing impact fee deferral. • Propose disposition plan and secure property disposition from HUD . • Mange budgets, job cost reporting and project scheduling. • Work through all phases of zoning and entitlement. Bravi s Investment Group, LLC, Miami, FL Managing Member 2005 -present • Developer of low rise residential multifamily apartment projects in M i ami Dade County using public priva te partnership opportunities provided by local and State governmental entities; Establishment and implementation of mandatory developer requirements such as Section 3 requirements, Davis Bacon performance bonding. • Negotiated with sta kehold ers, City/County officials and community activist t o support development o f wholly owned and JV community partners to align all interes ts in favor of project creation. • Created and developed RFP response to affordable housing requests from local governmental entities resulting in project award and ensuing development. • Created and developed a PPM for raise of $3MM in private ca pital for acqu isi tion and development of multifamily housi ng projects. • Developer of spec single family residential homes in Miami Dade Cou nty using CTP financing. • Collaborated with bank len d er s and private alternative financing so urces to obtain project financing, including project narrative, source and use, waterfall projections and cr edit enhancement strategies. • Management of field construction budgets and subcontractor line items to reduce project cost variability/over ages, including change orders and scope of work changes. • Supervised rea l estate development projects, with heavy emphasis on distressed property prospects offering high yield and increa se d market valu e post r edevelopment. • Reviewed, eva luated and modified plans and prospective d esign work to achieve desired improvements. • Conducted stress test analysis for valuation ch anges due to variability in income assumptions or significant change in assumed asset valuation; resulted in increa sed defensive preparation for various changes in assumptions. • Created cash flow analysis models using excel to extract reasonable acquisition price rela t ive to expected disposition price. These models were further use d to create scenario analysis that considered operational profit versus projected investor r eturn in co ns i dera t ion of capital costs and construction speed . • Advised cli ents on impact of costs of capital , due diligence, investment strat egy per property an d d isposition; experienced in complete asset cycle turnover . • Own and manage several multifam ily units within South Florida . Miami Wheelz, Inc, Dania Beach , FL (Con sultant) 20D6-present 557 • Successfully oversaw the start-up and development of this retail/wholesale company from $0 to $1.SM. • Free cash flow increased significantly per quarter, while maintaining no debt. • Devel oped on-going future business plans and obtained credit lines for inventory financing . • Changed operations model to just in time order flow to avoid inventory bui ld, heavy cash usage and improve on hand cash metrics for external credit enhancement . FINRA Expert W itness Consultant 2013-present • Advised and elaborated on FINRA rules and regulation s in customer claims against brokerages; specializing in industry practices, compliance and typical supervisory policies and procedures. Assisted in valuation of award claim for cla imant based on statement of claim . Money Con ce pts Capital Corp & Bravis Advis o r s, LLC , Hollywood, FL Equity Analyst/lAR , 2004 -2009 Broker Dealer/Investment Advisor • Created research and fundamental analysis decision process of companies, sectors and countries, including bottom up (micro) and top down analysis (macro) of specific companies and countries to discover investment opportunities. • Analyzed ind ividual company reported data to derive metrics such as standard deviation, Sharpe, BV , cash flow cycles to determine interest coverage ratios to determine appropriate candida tes for equ ity and credit investment. • Bu ilt internal relative valuation methods using dividend discount models and free cash flow models to identify intrinsic values for co mparison to p r icing of individual equity securities and fixed income securities to be included in client portfolios. • Utilize and evaluate economic and statistical data as part of the investment decision-making process involving equity secu rities, credit secu r ities, private investments and other investment products to create short-term tactical as se t allocations. • Independently worked w ith client assets as t ea m leader and had full d iscretion of client assets for investment and allocation decisions. • Provide structured financial plans and policy statements for both individuals and businesses ba sed on stated goals, objectives and current financial status. • Performed and created financial planning seminars for corp orate, state and coun ty government employees, focusing on 457 plan s, Florida Retirement System, 403(b) and 401k plan type transfers to increase AUM. RS Davis Financial Group, Pem broke Pines , FL Director of Mortgage Operations, 2004-2006 Licensed Mortgage Corresp ondent Lender • Focus on large to medium residential mortgage transact ions, utilizi ng both standard and non-traditional tools to underwrite mortgage loan s. • Develop ed mortgage loan co mmitment process to ana lyze borrower credibility before underwriting, incorporating DTI , FICO and employment measures for lending lines of credit. The process allowed for increased loan conversion from start of underwriting and increased AAA -b orrower volume . • Developed projection models to forecast interest income to monitor cash flow assumptions to real time results. Models allowed for quick identification of variab ility in pre-transaction assumpt ions. • Developed full strategic plan for asset management of post l oan commitments for owner and non -owner occupied single family and multifamily residences in South Florida. • Created private lending sce nario analysis models based on appraisal data to stress test portfolio va luation changes against changes in cost of ca p ital, acquisition t ime and future bus iness growth. • Negotiated both debt settlements and property surrender agreements alongside attorney; r esulted in fewer BATNA scenario outcomes, curtailing large losses, an d best outcomes for company/investors. NextEra Energy, formerly known as FPL Group, M i ami, FL Custom er Project Manager, 2000-2004 • Focus on external customer project coordination, internal project management and continuous customer external and internal stakeholder synchroniz at ion for seam less t ime driven project completion . • Supervise and managed union construction re source s to provide construction of all aerial and underground distribution facility installations to provide electric se rvice to new and exis ting customer projects. • De sign overhead and underground distribution networks using power distribution standard s using AutoCAD . Process included plan reading, kWd load demand calculation, voltage interpretat ion and se quential installation planning; installations on 23kV , 13kV and 4kV networks. • Responsible for design and overs ight of key distribution in st allations including la rg e vault configu rations, duct bank and manhole systems, throw over feeder desi gn and overhead distribution systems; projects range from multi-uni t re si dentia l condominiums to large commercial developments. 558 Miami Dade College, Miami, FL Adjunct Faculty Instructor, 2006-Present Teach and i nstruct physical courses in Personal Finance, Inst i tutional Finance and Finan cial Institutions within School of Business. Constructed supplementary excel spread sheets based on Simon Benn i nga financial modeling as supplement to college required text books to enhance student retention and understanding. EDUCATION • Florid a Internation al Un iversi ty, Miami, FL MSF, Finance • University of Florida, Gainesville, FL BS, Electrical Eng i neering PROFESSIONAL LICENSES , CIVIC & OTHER Licensed Realtor (Sales Associate), Florida Life, Health & Va riable Annuity Broker, NASD Series 7 (S tock Broker), Ser ie s 66 (IAR). CFA Institute Miami Chapter (formerly known as Association for Inve st ment Management and Research), Ad j unct Fa cu lty Member to Miami Dade College. COMMUNITY CONTRIBUTIONS Florida Blue Key ; Historic Overtown Public Health Initiative (Florida Department of Agriculture); Cha ir , Kappa Lead er ship Institute (Kappa Alpha Psi Fraternity); Miami Foundation Fe llow (Class VIII); Board, World Literacy Crusade of Florida, Inc; Named to The Miami Herald and Legacy Magazine's "Top 40 Under 40 Black Business Leaders of 2015". 559 KAREEM T. BRANTLEY, CFA 11 Island Avenue #1008, Miami Beach, FL 33139 (954) 347-4675 kareemb@bellsouth.net Kareem T. Brantley is a 4th generation Floridian, born and raised in Miami Dade County. After graduating with an electrical engineering degree from the University of Florida in 1999, Mr. Brantley relocated to Miami after a brief stint as a software programmer. After working at FPL as a power distribution utility vault designer for developments such as 1800 N Bayshore Dr (1800 Club) and 350 Ocean Dr, Key Bi scayne (Sonesta Beach Re so rt). In 2002 Mr. Brantley began to transition i nto re al estate development and money management. Subsequently, Mr. Brantley began working for a regional broker dealer and a local real estate brokerage firm. In 2002, Mr. Brantley graduated from FIU with a graduate degree in finance . In 2004 Mr. Bran tley completely transitioned out of core engineering into finance and real estate development. Kareem obtained a CFA Charter from the Chartered Financial Analysts Institute in 2011 (formerly the Ass ociation of Investment Management and Research). In 2004, Mr. Brantley began building single family homes throughout South Florida, us ing buyer financi ng or construction to permanent loan financing through SunTrust Bank, i n developed neighborhoods, also known as infill, such as 13105 NW 22 Avenue and 10831 NW 21 CT . Subsequently he added redevelopment of multifamily properties in the City of M iami and greater Miami Dad e County such as 1202 NW 61 ST or 1910 NW 72 ST; and managing property for others. Through development he forged relation ships with local and out of state vendors and contractors to scal e development and reduce per unit material costs, while managing labor rates . In 2009, Mr. Brantley began to form a group to acquire, renovate and operate smalle r multi-fa mily properties in Miami Dade County and manage buildings for others. Mr. Bra nt ley focused on dist ressed and under-performing properties in need of better management that coul d be acquired quickly for cash. These early experiences helped him bu il d competencies that have added to a skill set of project implementation, financial forecasting and modeling, site plan layout and de sign, and negotiation. As Mr. Brantley's reputation grew, owners of under-performing properties began to solicit his services. The portfolio of mul t ifa mi ly properties grew to 59 units over multiple sites in Miami Dade County. The portfolio was stabilized in 2011 and later placed for strategic cash flow with cheap debt financing. In 2015, Mr. Brantley unwound his direct investment i n his sma ller multi -family portfolio to pursue m ixed use commercial development and deal driven real estate acquisiti on . In December of 2015 he purchased over an acre of land in the City of Miami to develop 65 units of apartment rentals enveloped by both retail and commercial office space. In 2015, Mr.Brantley was approached by a principal at Related Urban Development Group's (RUDG), a division of Related Group, to co-develop Liberty Square, an existing 753-unit M i ami-Dade public housing apartm ent complex in the Liberty City neighborhood of Miami, Florida, into a new 818-unit complex called Unity Village. Mr. Brantley's past experience w as sought to contribute to the development of the multifamily and single family aspects of the project. The project includes a museum operated by HistoryMiami, a renovated community cen ter and a community health center operated by the Jessi e Trice Community Health Foundation. Academica, the nation's largest for-profit charter school company, would run a K-2 charter school and a K-8 charter school on si te. The project will begin in late 2016 once awarded by Miami Dade County. RUDG is one of two finalist for the project to be awarded in 2016 . In addition to his business interests, Kareem has served on the boards of local community based organizations and volunteered time to assist applicants for county and city based contracts. As he continues to develop both h is professional and personal relationships in South Florida, he aims for opportunities that allow him to serve h is community where he can contribute to strategies or actions that promote desired outcomes . PROFESSIONAL LICE NSES, CIVIC & OTHER Licensed Realtor (Sales Associa t e), Florida Life, Health & Variable Annuity Broker, NASO Series 7 (Stock Broker), Se ries 66 (IAR}, CFA Institute Miami Chapter (formerly known as Association for Investment Management and Research), Adj unct Fa culty Member to Miami Dade College . COMMUNITY CONTRIBUTIONS Fl orida Blue Key ; Historic Overtown Public Health Initiative (Florida Department of Agriculture); Chair, Kappa Leadership Inst itute (Kappa Alpha Psi Fr aternity); Miami Foundation Fellow (Class VIII); Board , World Literacy Crusade of Flori da , In c.; Citizens' Advisory Committee for the Jackson Miracle-Building Bond Program; Named to The Miami Herald and Legacy Magazine's "Top 40 Under 40 Black Business Leaders of 2015". 560 561 THIS PAGE INTENTIONALLY LEFT BLANK 562 • Tanya Bhatt 563 THIS PAGE INTENTIONALLY LEFT BLANK 564 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _B_h_at_t _________________ T_a_ny,._a _________________ K _____ _ Last Name First Name Mid dle Initial _8_3_0 _R_a_.y_m_o_n_d_S_t. _____________ M_ia'--m_i _B_e_ac.;..h ______ F_L _______ .;;.33..;...;..14.;..1.;..._ ___ _ Home Address City State Zip Code _1-_6_1_7 _-8_4_0_-4_9_0_5 ____________________ tanya@launchbrand.net Cellular Work Home Email Address Frye Fi na ncial Center D irector of B randing Business Name: Occupation : 20900 West D ixie H ighway A ventura F L 33180 B usiness Add ress City S tate Z ip Code Please list your preferences in orde r of ranki ng [1] first choice [2] second choice , and [3] t hird choice. Please note t hat only three (3) choices will be observed by the City Clerk 's Office . (Regular Boards of C ity) Choice 1: Planning Board Choice 2: Choice 3: Professional License No Profess io nal Licenses Submitted . Note: If you are seeki ng appointment to a professional seat (e.g . attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. * Note: If applying for the At-Large position of the H istoric Preservation Board, please answer the below questions: • Have you ever resided in one of the City's H istoric D ist r icts for at least one year? Yes No Address in City Historic District submitted . 565 A FFILIATION WITH T HE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a, b and c : Members of A gencies, Boards , and Committees shall be affili ated with t he city . Th is require men t sh a ll be fulfilled in th e following ways: a . Resident of the City for a m in imum of six (6) months: • I am res ident of: N/A Or b . Demonstrate an ownership interest i n a business established in the City for a mi ni mum of s ix (6) months : No "Ownership Interest" shall mean the ownership of ten percent (10 %) or more (including the ownership of 10% or more of the outstanding c apital stock) in a bus iness . "Business" shall mea n any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. O r c . Fu ll-t ime employee of such a busi ness (fo r a m inim um of six mon t hs); and I am b ased in an office or other location of th e bus iness that i s physi cal ly located in M iam i Beach (for a mi nimum of six mon ths}: ~ Notwithstanding the requ irements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commiss ion. NO TE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requireme nts of section 2-22 (4) a an d b of the Miami Beach City Code by executing an affidavit, stipulating that they have met either (or both) of said affiliation re quirements. Th e original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appoi ntment because I have spe c ial abilities, know ledge and experience . Please li st be low: • Miami Beach homeowner since 2003; advocate for community and chara cter of place sin ce 2015 • Ad voca t es a measured approach to projects , with all sides coming together to share needs , desires , and conce rns • Precedents can be set for good or for ill ; it is imperative to cons ider how they m ight pl • Are you presently a registered lobbyist w ith the C ity of Miam i Beach? No • Have you ever been co nvicte d of a f elony: If yes , please explain in det a il: • Do you currently have a violation(s) of C ity of Miam i Beach cod es : If yes, pl ease explain in detail : • Do you currently owe the City of Miami Beach any money: ~ If yes, pl ease expla in in detail: • Are you currently serving on any Ci ty Boards o r Comm ittees : If y es, which board? 566 • In what organization(s) in the City of Miami Beach do you curren tly hold membership in? Name Miami Design Preservation League M iami Beach Un ited Position Director Presi dent • List the address of all properties owned or in wh ich you have an i nterest w ith in the City of Miami Beach : Property 830 Raymond St. Miami Beach FL 33141 • Are you now employed by the C ity of M iam i Beach : If so , which department and t itl e? • 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? If "Yes", identify person(s) and department(s): No relative's information subm itted . 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 Prohibi tion from d irectly or i ndirectly lobby ing c ity personnel (Miami Bea ch C ity Code section 2-459). o Proh ibition from contracting with the city (Miami-Dade County Code section 2-11 .1 ). o Proh ibit ion from lobbying before board/comm ittee you have served on for period of one year after leaving office (M iami Beach Code section 2-26) o Requi rem ent to disclose certain financial interests and g ifts (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 bod ies of state and local governmental agencies or authorities . o Voti ng conflict -Form 8B is for use by any person serving at the county, ci ty , or other local level of government on an appointed or elected Board , Council, Commission , Authority, or Comm ittee . 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. 567 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 la ter t han July 1 . of each year all members of Boards and Committees of the City of Miami Beach , including t hose of a purely advisory nature , are required to comply with Miam i-Dade County F inancia l Disclosure Requ irements . One of the fol lowing forms must be filled with the C ity Clerk of M iam i Beach , 1700 Conventi on Cent er D ri ve , Miami Beac h , Florida, no later than 12:00 noon of July 1, of each year: 1. A "Sourc e of Income Statement;" or 2 . A "Statement of Fi na nci a l Interests (Form 1 )1 ;" or 3 . A C opy of you r lat est Fe deral In come Tax Return . Fa il ure to fil e one of these forms, pursuant to the M iami-D ad e County Code, may subject the person to a fine of no more than $500, 60 days i n j a il , or both . 1 Members of the P lanning Boa rd and Board of A djustment w ill be not ified d irectly by the State of Florida , pursuant to F.S. §11 2.31 45(1)(a}, to file a State me nt of Rnan ci al Interests (Fo rm 1) w it h t he M ia mi-Dade Co unty Supe rv isor of E lections by 12:00 noon , Ju ly 1. Planning Board and Board of Ad j ustment members who fil e the ir Form 1 w ith th e County Supervisor of Elect io ns au tomatica lly satisfy the County's fin ancial d isclosure re q uirement as a M ia mi Beach Ci ty Boa rd /Comm ittee member a nd need not file an add ition al form wi th th e Office of t he Cit y Cle rk . However, compliance w ith the County disclosure require ment does not satisfy t he State requirement. DIVERSITY STATISTICS REPORT The fo ll owing information is voluntary and has no bearing on yo ur consideration for appo intment. It is being asked to comply w ith C ity dive rsity reporting requ i rements . Gender: Race/Ethnic C ategorie s What is your race? Fe ma le Are you Spani sh/Hispan ic/ Lati no? Mark the "N o" box if not Spanish / H ispanic/ Lati no . No Other Desc r iption : No deta ils provided Ph y s ic a lly Ch a lle ng e d : No 568 Board and Committee Appl ication Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee . Y ES I have answered all questions fully . ::===:::! Y ES I have uploaded a current resume , photograph , and a copy of any applicable professional license . YES I have completed and attached the Board & Comm ittee Financial Acknowledgment Statement. YES 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. 7 411 Note: Florida Statutes 119.071 : The role of the Office of the C ity Clerk is to receive and ma inta in forms filed as public records. If your home address, telephone numbers , and/or photograph are exempt from disclosure and you do not w ish 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 . 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 OFFI CERS, EMPLOYEES AND AG E NCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STA T E LAWS AND STATUTES ACCORDINGLT. I Tanya Bhatt agreed to the following terms on Received i n the C ity Clerk's Office by: Name of Deputy Clerk Control No. Date 569 Tanya K. Bhatt Statement for Application to City of Miami Beach Planning Board Executiv e Summary : • Miami Beach resident and homeowner since 2003 (in Bayshore then in North Beach since 2016) Appointed to the Executive Committee of Miami Design Preservation League in 2016 , board member since 2018 Invited onto board of Miami Beach United in 2016 by Commissioner Samuelian ; served as president since December 2017 (stepping down from that role in January 2021 and would recuse myself from any discussions pertaining to issues coming before Planning Board) Advocates a measured approach to projects , with all sides coming together to share needs, desires, and concerns Precedents can be set for good or for ill ; it is imperative to consider how they might play ou t in different settings , different parts of the city, different projects as unintended consequences can be devastating Finding a path forward to create thoughtful , measured growth that looks holistically at the impacts on the affected neighborhood and the city will be c ritical to our coll ective success I am applying for the Historic Preservation seat on the Planning Board for the term comm encing in 2021 . Deeply involved in Miami Beach advocacy since 2015, I have been a homeowner in Miami Bea ch since 2003 (first in Bayshore , now in North Beach since 2016) and have seen many changes in the city during those years. I ad vocate a measured approach to projects, with all sides coming together to share needs , desires , and concerns ; I believe that it is in that overlapp ing portion of the Venn diagram where the best solutions lie. Too often people on one side of an issue or another castigate each other without really listening to each other, thereby missing an opportunity to create something greater than that from which they started . The Ocean Terrace project was one such example -the community resisted the original project, so the developers went back to the drawing board . They incorporated community input, brought new experti se to bear, and came out with a revised proposal which the majority of the community could embrace, and one which created new development while preserving the character of place that was so critical to the community. We live in a truly unique city -small but with global attention paid to us for better and for worse ; historic architecture coexisting beautifully with stunning new design ; remarkable natural beauty imperiled by climate change issues. Finding a path forward to create thoughtful , measured growth that looks holistically at the impacts on the neighborhood and the city will be critical to our collective success. People come to Miami Beach precisely fo r this mix of unique chara cteristics; plowing them under without finding ways to protect, incorporate, and elevate what makes this place special is a recipe for disaster. Appointed by the City to the Executive Committee of the Miami Design Preservation League in 2016 , and a Director of the Board si nce 2018, I brought my branding and business sense to bear on the goals and pra ctices of the organization. Preservation is not the blind protection of anything old ; it is the identification of the value of contributing structures in a community's character of place ; education about that heritage, and the elevation of that heritage to create something truly special. The juxtaposition of architecture from every decade since the turn of the 20th century coexisting in a living , active display sets us apart. Teaching new generations to value that, and to embrace it as new projects get brought forward, is critical. Without our architectural heritage we are just another sun ny strip of sand . Invited to join the Board of Miami Beach United by then-MBU president, now Commissioner Mark Samuelian gave me insight into broader issues affecting our city. My philosophy of the intersection of the Venn diagram holds here , too ... as does the philosophy of the "tip of the spear" -precedents can be set for good or for ill. So as decisions are being weighed, it is imperative to consider how they might play out in different settings, different parts of the c ity, different projects . Unintended co nsequences can be devastating. Yet we do not live in a city cas t in amber. Needs, times, opportunities change. The challenge, and the fun , is finding ways to evolve thoughtfully, in a holistic way, which can elevate the City as a whole, rather than ta ckle issues and projects with a myopic view. The challenges before us , from managing our natural resources , t o recreating our image, are significant. Nowhere is this going to be more important than in No rth Beach, where I reside , as new Town Center projects are already planned , and the CRA gets underway. Balancing the needs of preserving c hara cter of place with the opportunities for upgrading the community , and planning for its future , will be c ritical. North Beach is the last section of Miami Beach that has so much opportunity, and progress needs to come in a sustainable way that is embraced by the community. 570 As the 2025 Comprehensive Plan states , the role of the Planning Board is critical in "ensuring that character and location of land uses maximize the potential for economic benefit and the enjoyment of natural and man-made resources by citizens while minimizing the threat to health , safety and welfare ;" more so now than ever before. It would be an honor to take on this serious responsibility to work for the greater good of our beloved city. NB: I have served as president of MBU for the past three years but will be stepping down from that role in January, and like other MBU directors who serve on key City boards, I will recuse myself from any discussion/votes pertaining to issues coming before the Planning Board so as to avoid any possible conflicts. 571 TANYA K. BHATT 83 0 Raymond Street · Miam i Beac h • FL • 3 3141 617 · 840 · 4905 ranya@launl hbr and. net For detailed work history and samples. please vis it linkedm com/m/1anyakbha11 I PU BLIC POLICY LEADERSHIP Miami Beach United • Miami Beach . FL Pres ident -December 2017 -present VP, Market ing & Communicat ions -Ap ril 2016 -January 2020 · Lead 501(c)4 all-volunteer organization advocating for res idents' rights and quality of life issues in the city of Miam i Beach since 2012 . • Generated aid membership growth YTD •243%; ma ili ng li st growth ·175% since 2017 . · Creates & hosts reeular forums on relevant municipal top ics; regularly quoted in M1om1 Herold for balanced views on issues affening Miam i Beach quali ty of life po li cy. • Rebuilt webs ite, created monthly po li cy positi ons newsletter. created social media presence. started Members Mixers and community outreach programs. M1am1 Design Preservation League • Miam i Beach, FL Board Member -April 2016 -present · Advise on branding, outreach. marketing and general overal l business guidance. · Moder ate and parucmate in panels as appropria te. The Underline • Miam i, FL Committee Member/Marketing 2014 -2016 · Shaped cohesive story for website. social media, and video building public, private & polit ical support for 10-mile park. sa~e Miami Beach Neighborhoods · Miami Beach. FL July 2015 -June 2016 · Grass -roots volunteer organization to drive ballot initiative seeking to proten non -des ignated pre -1942 single family homes from demo liti on. · Created and managed soc ial media prese nce; still in use . Friends of lndreni · Redding, CA Board of DirenorsfVP Marketing 2014 -2017 • Rebuilt webs ite and revamped all commun irnions ; created so cial med ia awareness · Ra ised largest ever sing le-eve nt tota l a~er Nepa l earthquake. more than doubling $25,000 target goal. · Experienced strateg ic. creat ive marketing . branding priva te secto r and not-for-profit profess ional. · Adept at multitasking. problem so lvi ng. team leade rsh ip. mentor ing, conse nsus -bu ilding. · Wide reader, persuasive writer, engag ing content creator to bu ild knowledge, ra ise awareness, empower commun ity. · Pass ion for community-bui lding . place-making, big-idea generation with enthus iastic, de tail -or iented executional fa ll ow-thro ugh. • Excell ent written and spoken communica ti on and present ati ons . I ENTERPRISE EXP ERIENCE Frye Financial Center • Aventura , FL Di rector of Branding -2016 -present · Complete reimag ining and overhau l of heavil y regu lated webs ites for financia l serv ices and legal pranices, including one originally bu ilt in and unchanged since 2005. · Strea mli ned. synerg ized and upgraded all branding, internal and ext ern al communications, and events across a variety of platforms and business needs for three-bus iness-un it practice. · Ongoing creation and management of all marketing efforts . client commu ni cat ions, internal procedures for financ ial adv isory that is among top 1 % of those affi li ated with LPL Financ ial. Top Secret Nutrition LLC • Miramar , FL Director of Marketing -2014 -2015 · Created cohesive produn and brand str ategy for startu p nu tr itional supp lements company. · Bu ilt community of influencers and deve loped na tiona l exper ient ial event program/staff. TEAM Enterprises • Fort Lauderdale, FL Direnor of Branding -2010 -2012 · Responsib le for all brand direction and content marketing (webs ite, newsletter, SO[ia l med ia, blog] and corpo rate commun icati ons aniv ities for expe rie nti al marketing fir m supporting major brands. including entire Bacardi and Mil lerCoors po rtfolios. · Created and managed TE A M's public pos itioning ( The New York Times , trade journals). · Led projen reams writing proposals and pitching new business, including lead ing team respons ible for one of three vo lumes of s500M US Gove rn ment RFP CONVERSE, INC. · No rt h Read ing, MA Director of Global Ma rketing -199 4 -2000 · More than doubled children's business to s70 million in revenue by rolling out several innovative produm in global markets. includ ing highly suuessful line of Touch -EFX shoes · Negotiated and closed deals 10 deve lop products and implement long-term alli ances based on Lucasnlm's Star Wars brand and OddzOn's Koosh brand. NW Ayer, FCBKatz, Grey Advertis i ng, Houston Effle r • New Yo rk. NY and Bos ton. MA Ass istant Account Executive to Account Executive -1988 -1994 · Kids and fam ily market ing fo r Bu rger Kin g and Kool -Aid; recognized ki ds' expert. · Launched MA anti-smoking campaign now known as "T ruth" campaig n nationally SKILLS • Portuguese · French · Spanish Strategic Plann ing, Brand Managemenl Sponsorship/Partner Marketing, Publi c Speak ing, Persuasive Wri ting , Advocacy, Proj ect Managemenl Publ ic Re lations, Event Managemenl Content Creation. Dig ita l Marketing, App le iWo rk/M icros* Su ite . Wordp ress. Social Med ia (Facebook, Twitter. Pinterest. Linkedln. You Tube]. HootSuite. Dog Rescue. Endurance Sports. live Music Fan EDUCATION : Brown Un iversity • Prov idence, RI· B.A., Ame rican Civil izat ion 572 573 THIS PAGE INTENTIONALLY LEFT BLANK 574 • Alex J. Fernandez 575 THIS PAGE INTENTIONALLY LEFT BLANK 576 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Fernandez Alex J ---------------------------------- Last Name First Name Middle In itial .;..3=20'"'"0a......aC..;..h ..... a ___ se.c...;...A;..;.v .... e _. ____________ M __ ia __ m__..;..i B __ e.a..a .... c __ h;....._ ____ F--"lo_ri""'"da ___________ 33_1_4_0 ___ _ Home Address City State Z ip Code _78_6_---9""'"99_-_5""'"66-"-2 _____________ ~(7_8_6-) _99_9_-_56_6_2 ___ fernandezalexj@gmail.com Cellular Work Home Email Address Miami -Dade County Sen ior Commun ication & Leg islative A ide Business Name : Occupation: 111 N .W. 1st St. Suite 200 Miami F lorida 33 128 Business Address City State Z ip Code Please list your preferences in order of rank ing [1] first choice [2] second cho ice, and [3 ] th i rd cho ice. Plea se note t ha t o nly three (3) choices will be observed by the C ity C lerk's Office . (Regu lar Boards of City) Choice 1: Planning Board Choice 2 : Choice 3 : 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. * Note: If applying for the At-Large pos it ion of the Historic Preservation Board , please answer the be low questions: • Have you ever resi ded in one of the City's Historic D ist rict s for at least one ye ar? fu No Address in City Historic District submitted . 577 AFFILIATION WITH THE C ITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c : Members of Agencies, Boards , and Committees sha ll be affiliated with the city. This requirement shall be fulfilled in the following ways: a. Resident of the City for a minimum of six (6) months: • I am resident of: N/A Or Yes b . Demonstrate an ownership interest in a business established in the City for a min imum of six (6) months: Yes "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. Or c. Fu ll -tim e 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 Bea ch (for a minimum of six months): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: Despite the challenges we face , our city finds itself at the c us p of great opportunity and potential. By seeking this appointment, I offer to bring to th is body my professional demeanor, calm characte r, and many years of proven experience in public service -specifically in the leg isla t ive analysis • Are you presently a registered lobbyist with the City of Miami Beach? No • Have you ever been convicted of a felony: If yes, please explain i n deta il: • Do you currently have a violation(s) of C ity of M iam i Beach codes: NQ If yes , please expla in in detail : • Do you currently owe the City of Miami Beach any money : ~ If yes , please expla in in detail : • Are you currently serving on any City B oards or Committees : If yes , which boa rd ? Police Cit izens Relations Committee 578 • In what organization(s) in the City of Miami Beach do you currently hold membership in? No Organization Inform ation Submitted . • List the address of all properties owned or in whi ch you have an interest with in the City of Miami Beach : Property First Mortgage Equities , Inc. Dakota Park South , In c . Bay Po int East Pine T ree Gardens, Inc. Hamadeh Properties, In c . • Are you now employed by the C ity of Miami Bea ch : • Pursuant to City Code Section 2-25 (b): If so , which department and t itle? Do you have a parent , spouse , ch i ld , brother, or si ster who is emp loyed by the C ity of M iami Beach? If "Yes", identify person(s) and department(s): No relative's inform ation submi tted . 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 Proh ibit ion from d ire ctly or indirectly lobbyi ng city personnel (M iami Beach C ity Code section 2-459 ). o Proh ibition from contract ing with the city (Miami -Dade County Code section 2 -11 .1 ). o Prohibit ion from lobbying before board/committee you have served on for period of one y ear after leavi ng offi ce (M iam i Beach Code section 2-26) o Requ i rement to d is cl ose certain financial interests and g ifts (Miami-Dade County C ode section 2-11 .1 ). o Sunshine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regard ing open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a bas ic right of access t o mo st meetings of Boards , Comm issions, and other g overn ing bod ies of state and loca l governmental agenci es or authorities . o Voting conflict -Form 88 is for use by any person serving at the county , c ity, or other local level of government on an appointed or elected Board , Council , Commission , Authority , or Committee. It app li es equal ity to me m bers of advisory and non-advisory bod ies who are presented w ith a votin g confl ict of i nterest under Section 112 .314 3. Florida Statutes. 579 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-Dade County Financ ial Disclosure Code Section 2-11 .1 (i)(2) I understand that no later than July 1. of each year all members of Boards and Comm ittees of the City of Miami Beach , includ ing those of a purely advisory nature, are requ i red to comp ly with M iami-Dade County Financia l Disclosure Requirements . ~ of the following forms must be filled with the City C le rk of Miami Beach , 1700 Convention Center D rive , M iami Bea ch, F lorida, no later than 12:00 noon of July 1 , of each year: 1. A "Source of Income Statement;" or 2 . A "Statement of F in ancial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federal Income T ax Return . Fa il ure to fi le one of these forms , pursuan t to the M iami-Dade County Code , may subj ect the person to a fine of no more than $500 , 60 days in j ail, or both . 1 Members of the Pla nning Board and Board of Adjustment w ill be notified d irectly by the State of Florida, pursuant to F.S. §112 .3145(1)(a), to file a Statement of Rnancial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment membe rs who file their Form 1 with the County Supervisor of Elections automatically sati sfy the County's financial disclosure requirement as a Mia mi Beach City Board/Committee member and need not file an add it io nal form w ith the Office of the City Clerk . However, compliance with the County di sclosure requ i rement 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 w ith C ity d iversity reporting requirements. Gender: Race/Ethn ic Categories What is your race? White Are you Spanish /Hispanic/ Latino? Mark the "No" box if not Span ish / Hispanic / Latino. m Other Description : No deta ils provide d P hysically Challenged: 580 Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES I have answered all questions fully. YES YES I have uploaded a current resume , photograph , and a copy of any applicable professional li cense. I have completed and attached the Board & Committee Financi al Acknowledgment Statement. YES 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. 7 411 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 te lephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Alex Fernandez agreed to the fol lowing terms on 12/28/2020 12:44:47 PM Received in the City Clerk's Office by : Name of Deputy Clerk Control No . Date 581 Current Experience : 2006 -Present 2014 -Present 2019 -Present Past Experience: 2014-2018 2013 -2014 2011-2013 2007-2011 2004-2007 2004-2005 Alex J. Fernandez 3200 Chase Avenue Miami Beac h, Florida 33140 786-999 -5662 Miami Beach Resident & Property-Owner Senior Communications & Legislative Aide M iami-Dade Board of County Commissioners Pertinent legislative experience includes review and analysis of: Zoning Ordinances & Amendments Zoning Applications & Appeals Comprehensive Development Master Plan Amendments Historic Designation Applications & Ad Valorem Tax Exemptions Applications Resiliency, Sea Level Rise, and Bi scayne Bay Legislation Transit Oriented Development Proposals Class I DERM Applications Conveyances, Alienations, & Publi c Private Partnership Proposals Chair, Police Citizens Relations Committee City of Miami Beach Member, Hispanic Affairs Committee City of Miami Beach Member, Ad Hoc Charter Review and Re v is ion Board City of Miami Beach Aide, Office of the Mayor & Commissi on City of Miami Beach Self Employed New Star Media Soluti ons , Inc. Media & Protocol Affairs Coordinator Miami-Dade Board of County Commissioners Member, Affordable Housing Adv isory Board Miami-Dade County 582 583 Granado, Rafael Fr om: Sent: To: Cc: Subje ct: Attachments: Alex Fernandez <fernandezale xj@g mail.com > Wednesda y, December 23 , 20 20 9:26 PM Granado, Rafael Aguila , Raul ; Paz, Rafael Planning Board Appli cation Ale x J. Fernandez Resume.pdf I THIS MESSAGE COMES FROM AN EXTERNAL EMAIL USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS I December 23 , 2020 City of Miami Beach 1700 Conventi on Center Drive Miami Beach, Florida 33139 Dear Honorable Mayor and Members of the City Commission : By means of this letter I wish to express my interest to serve on the General Business seat of the Miami Beach Planning Board . I have attached my resume for your rev iew and consideration . Despite the challenges we face, our city finds itself at the cusp of great opportunity and potential. By seeking appointment to the Planning Board , I offer to bring to this body my professional demeanor, calm character, and many years of proven experience i n public service -specifically in the l egislative analysis of l and -use, comprehensive development master plan, and zoning applications. It is my hope to be a consensus builder and to find common ground to achieve decisions that increase our workforce housing stock, preserve the character of our neighborhoods, advance our resiliency initiatives, protect our public assets, and enhan ce the safety of our community. Nearly 15 years ago , I met my husband, Robert, in Miami Beach and since then this city has been a part of our story. Along the way, I met gr eat leaders such as our for mer mayo r, Matti Bower, who entrusted me with the opportunity to serve in the Office of the Mayor & Commission giving me a front row view of the complexities of Miami Beach 's land -use and planning issues. Eventually, I elevated my civic involvement as a member of the M iami Beach Charter Rev iew Task Force , the Hispani c Affairs Comm ittee, and most recently, the Police Citi ze ns Relations Committee. In each of these positions I have proudly raised my voice in ad vocacy for residents' quality of life, enhanced public safety, the expansion of workforce housing, and the protection of public lands. I am hopeful that in reviewing my professional and civic experience for this quasi-judicial appointment, you will note my ability to work with residents, city officials, and applicants alike with an open mind, ease of accessibility, and without prejudice. I thank you in advance for your consideration of my application. Please do not hesitate to contact me at 786- 999 -5662 should you have any questions regarding my qualifications. I will appreciate the opportunit y to meet with you individually. Sincerely, Alex J. Fernandez 584 • Oscar Llorente 585 THIS PAGE INTENTIONALLY LEFT BLANK 586 , t' 0sc4tl Last Name First Name" Middle Initial Home Address C ity State Z ip Code Cellular Telephone Work Telephone Home Telephon e Email address M-'--'-o....__u-"",-.n:"-'-_-6=-•-'-A--'-N--'-'~~-~--=-'-c_A-_L_.c~=-=-----"---rc;-(2 J:3 n (X;J"DP. 1--.i &1do I<.~ 1)evc bpYA ~ 1 Business Name Occupation QoM Y'(j (.)N l"f'{ ~<.EL~O N.S t.-{6 00 A l-""TJ)N P.."D . µ I A; M I ~ ~cl-\ F L .;3;, l L\--0 Bus iness Ad dress City State Zip Code Please list your preferences in order of rankin g : (1) fi rst choice , (2) second choice, and (3) third cho ice. Please note t hat only three (3} choices w ill be observed by the Office of the Ci ty Clerk. Affordable Housing Advisory Health Advisory Committee Committee Animal Welfare Committee Health Facilities Authority Board A rt in Public Places Committee Hi sp anic Affairs Committee Audit Committee Hi storic Preservation Board * Black Affairs Advisorv Committee Housinq Authority Board of Ad1us tment Human Riqhts Committee Budget Ad v isory Committee LGBTQ Advisory Committee Committee for Quality Educ ati on in Marine & Wa terfront Protection Mia mi Bea ch Authority Committee on the Homeless Mayor's 41 st Street Committee Convention Center Advisory Board Mayor's General Obligation Bond Oversiqht Committee Cu ltural Arts Council M avor's Panel on Ocean Drive Desiqn Rev iew Board Miami Beach Commission for Women Di sability Access Committee Next Generation Council 1."'Sci...i\C>g.. ~I~~ ~M •f4ec:.... 2. LG. blQ Anv,:,cX2.':! ~o l'-'\M ,-\+e. ~ \ 3. \,\. c;::: A ..... ~ A j) \)l~y. Co M M ~ C.... ' Professional Li cense Normandy Shores Local Government Neigh borhood Improvement District Advisorv Council P arks and Rec reational Facilities Board Perspnnel Board Pl annin q Board Police/Citizens Relations Committee Production Industry Council Program for P ublic Information Com.mittee Senior Affairs Committee Sustainability Committee Transport ation , Parking , and Bicy cle- Pedestrian Facilities Committee Visit or and Convention Authoritv Youth Commission Typ,e of Professional Licens e t:i:o r,J ~ License Number Stat e of Issuance License Issuance Date License Expiration Da te - No te : If you are seeking ap point ment to a pro fessional sea t (e.g . attorney , architect , etc.}, you must attach a copy o f your current! effective corr es ond in rofessiona l license Page 1 o f 6 F ICLERISALLIBOARO AND C OMMI TTIES DATABASEICf-'ECKUS-MASTERIBOARO AND COMMITTEE APPLICATION dooc Updated June 2020 587 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code s e cti on 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: a. Resident of the City for a minimum of six months: Yes O or ~No • I am a resident of: South Beach O M iddle Beach O North B each 0 Or b . Demonstrates an ownershi_ej_Q~erest (for a minimum of six months) in a business establi shed in the City (for a minimum of six months): Yes O or.I;?:IN o ·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 compa ny, or other entity or business association. Or c. Full -time employee of such a business (for a m inimum of six months); and I am based in an office or other location of the business that is physically located 1n Miami Beach (for a minimum of six months): Y es ~ or O No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation reqwrements of sections 2-22 (4) a and b o f the Miami Beac h City Code by executing an affldawt, stipulating that they have met either (or both) of said afflliation requirements. The original afflda vit shall be filed with the Office of the City Clerk prior to being swam in as a member. • I am applying for an appointment because I have special abilities , knowledge , and experience . Pl ease list below: :z:~~~t;~ t1,4~U:...-(.(.2~-tt." ~ ~ t.t.~ .. ~ fn ~~. ~~-, IJ)a:J,, -,;.J .JL Ak tan~ l)[J. (;__,_,~-l. a-•= ~ ~ ~ -,Al ta.~ &:»thLI~, Page 2 of 6 F·ICLERISALL\BOARD AND COMMITTIES OATABASEICHECKLIST MASTER\BOARD AND COMM ITTEE APPLICI\TION docx Updated June 2020 588 • Are you a registered active lobbyist with the City of Miami Beach? Yes O or No 6g • Have you ever been convicted of a felony? Yes O or No '6?l If yes, please explain in detail · • Do you currently have a violation (s) of C ity of Miami Beach Code? Yes O or No 81 If yes , please explain in detail • Do you current ly owe the City of Miami Beach money? Yes O or No 15'1 If yes, plea se explain in detail: • Are you currently serving on any City Board or Committee? Yes ~ or No O If yes, wh ich Board/Committee? Sv:')...\1a a.::, AtP-&1 es Cov.M,++-e..e, • In what organization(s) in the C ity of Miami Beach do you currently hold membership? Posit ion Pos1t1on • List the address of 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 O or No ~ If so , which department and tit le? • Pursuant to City C o d e Se ction 2 -25 (b): Do you have a parent 0 , spouse 0. ch ild O brother O or sister 0 who 1s employed by the City of Miami Beach? Yes D or No ~ If "Yes ," 1denl1fy person(s) and department(s): __________________________ _ * Note: If applying for the At-La rge position of th e 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 O or No 0 nswered "Yes," please indica te : Address Page 3 of 6 From Dates From: Dales F ICLERISALL\BOARO AND COI.IMITTIES DATABASEICHECKLIST MASTER\BOARO ANO CQl,'MITTEE APPLICATION doc.c Updated June 2020 To To 589 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 Proh i bition from directly or indirectly lobbying City personnel. (Mi ami Beach C ity Code Section 2-459) o Prohi bition from contracting with the C ity (Miami-Dade County Code Section 2-11 .1) o Prohi bition from lobbying before the Board/Committee you have se rved on for period o f one year after leaving office . (Miami Beach City Cod e S ection 2-26) o Requ irement to disc lose certain financia l interests and gifts . (Miami-Dade County Code sect ion 2-11.1) o Sunshine Law -F lorida's Government-in-the-Sunshine Law was enacted in 1967 Today , t he Sunsh ine Law rega rd ing 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 othe r governing bodies of state and local governmental agencies o r authorities . o Voling conflict -Form BB is for use by any person serving at the county, city , or other local level of government on an appointed or e lected Board . Council, Comm ission , Authority . or Committee. It applies equ ally to members of advisory and non-advisory bodies who are presented with a vot ing conflict of inte rest under Section 11 2 .31 4 3 , Florida Statutes. I HEREB READ AN OF URACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED, TER 2 ARTICLE VII , OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS I ERS , MPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE C AND SA O DINGL Y ." 0 Name of Applic ant (PLEASE PRINT) Board and Committee Application Checklist: Pl ease ensure you h ave provided a ll information before applying o r rea pply in g to any Board and Committee ~ I h ave answered all questions fully . ~ I have atta ched additional sheets, if necessary , to provide requ ired information. ,gj' I hav e attached a current re sume, photograph , and a copy of any applicable professional license . id.--I have completed and attached t h e Board & Committee Financial Acknowledgement St atement. rJf I have completed and attached the Diversity Statistics Report. 1:ft Subm it complete application package Via Email : BC @m1 amibeachfl .g ov Via U.S . Mail o r in Person: City of Mi ami Bea ch Office of the City Clerk / Board and Committee Section 1700 Convention Cent er Drive, 1 ll Floor Miami Beach , FL 33139 If you have any questions, please contact the Office of the City Clerk via email: BC@m1a m 1beachfl .gov or telephone 305 .67 3 . 7 41 1. Note : Fl orida Statute s §119.071 : The role of the Office of the City Clerk is to rece iv e and maintain forms filed as public records . If your home address. teleph one numbers , and/o r photograph are exempt from disclosure and you do not wish your home address. telephone numbers, an d/or photograph to be made public, please: 1) Use your office or other address for your mailing address ; 2) U se your office or other t elephone nu mber for your contact n umber; and 3) Do not attach a photograph. Page 4 of 6 FICLERISALL\BOARD AND COMMITTIES DATABASEICHECKLI ST MASTERIBOARD AND COMMITTEE AP PLICATION docx Updated· June 2020 590 City of Miami Beach 1700 Convention C enter Drive M iami Beach, Florido 33139 www miomibe oc~ OFFICE OF THE CITY CLERK Email: BC@m1amibeach fl gov Telephone: 305.673.74 11 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for fai lure to comply with Mi ami - Dade County Financial Disclosure Code Provision Code Section 2 -11 .1 (i) (2) C>.sc.~#..... L ast Name First Name Middle Initial I understand that no later than July 1, of each year all members of Boards and Committees of the City of M iami Beach , including those of a purely advisory nature , are required to comply with Miami-Dade Coun ty Financial Disclosure Requiremen ts . 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 yea r: 1. A ·source of I ncome Statement;" or 2 . A "Statement of Financial Interests (Form 1) 1;" or 3 A Cop y of your latest Federal Income Tax Return . nt to the Miami -Dade County Code , may subject the person to a fine Date 1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Flori da , pursuant to F .S . §112 .3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Da de County Supervisor of Elect ions 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 Coun ty's financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additiona l form with the Office of the City Clerk. However, compliance w ith the County disclosure requi remen t does not satisfy the State requiremen t. Page 5 of 6 F ICLER\$Alll8OARO AND COMMITTIES DA TABASEICHECl<L ST MASTERISOARO AND C~MITTEE APPUCA TION c1ocx Updated June 2020 591 City of Miami Be ach 1700 Conven tion Center Drive M iami Beach, Flo rido 33139 www.miomibeochA .gov OFF ICE OF THE CI TY CLE RK Ema il : BC@mia mi beachfl.gov Teleph one: 305.6 73.7 41 1 Last Name DIVERSITY STATISTICS REPORT First Nam e Midd le Initial The fo llowing information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements . Gender: CifMale □Female □Othe r 0 I prefer not to answer. Rac e/Ethnic Categories : What is your race? 0 African American/Black 0 Asian or Pacific Islander t8i.caucasi an/White D Native A merican/American Indian 0 Other -Print Race: ------------□ I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? 3Yes □No 0 I prefer not to answer . Do you consider yourself Physically Disabled? □Yes □No ~ I prefer not to answer this question . Page 6 of 6 F \ClERISALLIBOARO AAO COMMITTIES OATABASE\CHECKUST MASTERl80ARD AND COMMITTEE APPLICATION docx Updated June 2020 592 OSCAR LLORENTE 177 6 Polk Street Apt. 1013. Hollywood. FL 33080 • (954) 296 -3951 • conceptoscar@yohoo.com PROF ILE SK ILLS & EXPERTISE Dynamic business professional in the medical health field with experience in community relations. network/business development, networking. special events management. marketing and brand awareness. Innovative and resourceful with a keen sense of judgment and motivation. Strong in customer service with on exceptional ability to communicate in both English and Spanish. Technically proficient. creative visionary. well organized with an eye for detail. Excellent Management Capability Practiced Public Speaker & Interpersonal Communication Exceptional Customer Service Social Media. Word. Excel. Outlook. KRONOS. Solesforce, Constant Contact Profound Time Management. Organization & Prioritization Adaptable to Fast-Paced & Evolving Work Environment Strong Problem-Solving Abili ty Coupled With Creativity & Resourcefulness Experienced In Developing Custom Curricula Highly Responsible & Dependable EXPERIENCE DIRECTOR , NETWORK DEVELOPMENT. COMMUNITY RELATIONS AND OUTREACH Mount Sinai Medical Center. Miami Beach Feb. 99 to Present Managed an average of 40 monthly outreach events; health related lectures. health screenings and healt h expo programs . Increased community awareness through networking and establishing strong community relations. Providing strong leadership, management and mentorship to staff members. Established personalized concierge program. Developed professional relationships with physicians. business leaders. community representatives. nursing home administrators. police and fire rescue . Participated in local senior affairs agencies and advocacy groups Pro duced marketing resource collateral materials and promotional i ems. Oversaw Mount Sinai's Community Activities Reflec ting Employee Service-employee volunteers. Directed monthly employees volunteer ac tivities such as Form Shores. Senior holiday food drive, bock to school supply give-a-ways, feeding the homeless and community parades. Established data marketing surveys. photographs. reports and presentations. International liaison linking physicians. insurance companies and patients. Arranged medical procedures and physician appointmen ts for interna tional and VIP patients. Nego tiated contracts with area hotels. local transportation and air/land ambulance. Developed and conducted customer service training programs for employees. Prepared, analyzed and reported on surveys and marketing e fforts. Worked in conjunction. trusted by and reported to Senior V.P. and CFO. Prepared and maintained reports on outreach e fforts . employee expenses . budgets and preserved con fi dential records. 593 HONORS & AWARDS EDUCATION VOLUNTEER & COMMUNITY INSURANCE CLA IMS SPECIALIST Jan. 1992 t o Feb. 1999 Bocen & Kaplan, P.A./First Recovery Inc., Ft. La u d e rdale Managed over 600 accounts in the billing and collection process. Provided cus tomer serv ice and collection actions for hospitals and physicians. Analyzed various activities and in teractions with insurance companies to determine most appropriate recovery action. Upheld knowledge of various res ources and programs in resolving account and initia ted health insurance cla ims appeals. Recognized Top Claims Recovery Specialist SHERATON KEY BISCAYNE Manager, Front desk and reservations RAMADA GALT OCEAN MILE Fronl desk a nd reservation representative HYATT REGENCY CORAL GABLES PBX, re servations representative, fr ont desk, lo bby and Gold Passpo rt Concierge BENNETTON M IAMI Manager. Omni and Dolphin Moll Con tributions l o Elder Healthcare Issues Awarded Outs tanding Pro posals for Better Customer Service In iti atives and Training Recognized For Implementa tion of Cost Saving Measures Designated Employee Activities Coordina tor Mayor's Award for Community Involvement -Hollandale Beach Police 12-week Nutrit ional Educa ti onal Program Recognized by Miami-Dode Mayor Jimenez for outstanding community service Recognized by Miami Beach Mayor Gelber for ou t standing community service South West Sen ior High School. M iami, FL Miami Dode Communi ty College, Miami, FL TKE Tau Kappa Epsilo n Fralernity Saddlebock College, Mission Viejo, CA Vice Chairman Art and Culture Cen te r. Hollywood Vice President North Miam i Beach Chamber o f Commerce Boord of Dire c tor North Miami Chamber of Comm erce Chairman Grant Reviewer Hallandale Beach Com munity Partnersh ip President Hallandale Beach Chamber o f Commerce Board of Dire ctor Aventura/Sunny Isles Beach Chamber o f Commerce Boord of Director and Program Choir Miami-Do de Coalition on Aging Chairman Hallandale Beach Mayor's Green Leadership Committ ee LANGUAGES Fluent in Spanish. speak and writing INTERES TS Traveling, Visual and Theatrical Arts . Yoga. C y cling , Volunteering, Social Networking 594 , I:,-:-•.,;--~ ,,,,,_., , , ,_, :--~ ·. , ·, "·-:--:--~ •,:-.,~ ; • --4-........... ', .. ... --..... ·.• •• ,t_'., • ...... . . -,.., .... -, ..... _ ... ,(.-,. •' -•',,•"' ~ ~ ... -. · .. ' ..... ,~ ... · , . ~' --' .. ' , .. . ,,.-,••· .. ~·· ... , .. .. ,,,_,,,,.. . . .,., ...... , --__ .... , ,, .. ,. , -• • • ... ~ ·,~ ♦ ••••• ' ••• • I ' '• -• • • • • ; -....... "' ♦ •••• •' •• ♦ ~ T e ,.. ' a •1 ♦ t \ • •♦ , , ••••• ! • ,, " • ! --·. • .. ',, .•. ·z• ~~. • ••t'.!•••!!• ,' 411 , , • • • .. • • ••• ... - - ; ~-..... ; ~. ''• , ~ ~.. . . . . .. , ~ ; ' ... , ••••••• \II , ,,-,. • ,. ~ • • • • l , • ~ "·•···-·~, ...... .. . .. ' .... ,,, ... ,, if ♦• ,. , •• • • '-I ' ---· ..... , • , , • • • •• ,•I'., •. , ,, ---.. -. . •-. , -• • ,. • I -. . . .. ' • • •• . . . . . . ' . . . .. ,, . -.. ·. -• ... , .. : ; . ' -. . .r a ~ -, .... . ' . 595 THIS PAGE INTENTIONALLY LEFT BLANK 596 • Enilda Thomas 597 THIS PAGE INTENTIONALLY LEFT BLANK 598 M IAM I BE ACH ---r-:to tY1 ,r-:; Last Name 3Roo ~ Asf. Home Address BOARD AND COMMITTEE APPLICATION First Name Middle Initi al Zip Code Please list your preferences in order of ranking : [1) first choice, [2} second choice, and [3) third choice. Please note that only three (31 choices will be observed by the Office of the City Clerk. Affordable Housing Advisory Committee Animal Welfare Committee Art in Public Places Committee Aud it Committee Black Affairs Advisory Committee Board of Adjustment Budget Advisory Committee Committee for Quality Education in Miami Beach Committee on the Homeless Convention Center Advisory Board Cultural Arts Council Desian Review Board Disability Access Committee 1. 2. 3 . Type of Professional License Health Advisory Committee Normandy Shores Local Government Neighborhood Improvement District Advisorv Council Health Facilities Authority Board Parks and Recreationa l Facili ties Board Hispanic Affairs Committee Personnel Board Historic Preservation Board • Plann inQ Board HousinQ Authority Police/Cit izens Relations Committee Human RiQhts Committee Production Industry Council LGBTQ Advisory Committee Program for Public Information Committee Marine & Waterfront Protection Senior Affairs Committee ([) Authority Mayor's 41 st Street Committee Sustainability Committee Mayor's General Obligation Bond Transportation, Parking , and Bicycle- Oversiaht Committee Pedestrian Facilities Committee Mavor's Panel on Ocean Drive Visitor and Conventi on Authority M iami Beach Commission for Women Youth Commission Next Generation Council Professional License License Number State of Issuance License Issuance Date License Expiration Date Note: If you are seeking appointment to a professional seat (e .g attorney, architect, etc.), you must attach a copy of your current! effective corres ondin rofessional license. Page 1 of 6 F ICLERISALLISOARD AND COMMITTIES DA TABASE\CHEC K LIST MASTERl8OARD A ND COMMITTEE APP LICATION docx U pdated · June 20 20 599 AFFILIATION WITH THE CITY OF M IAMI BEACH Pursuant to City Code section 2-22(4) a, b , and c : Members of Agencies, Boards, and Committees shall be affiliated with the City. Th is requirement shall be fulfilled in the following ways: a . Resident of the City for a minimum of six months: Yes lXf or D No • I am a resident of South Beach D Middle Beach~ North Beach D Or b . Demonstrates an ownersh i~erest (fo r a minimum of six months) in a business estab lished in the City (for a min imum of s ix months). Yes Dor ~No ·ownership lnteresr 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, limi ted liability company, or other entity or business association. Or c . Full-time employee of such a busin ess (for a minimum of six months), and I am based in an offic ~other locat ion of the business that is physically located in Miam i Beach (for a minimum of six months)· Yes O or ~No Notwithstanding the requirements set forth herei n, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. N OTE: Members of Agencies, Boards, and Committees shall be required to demons trate compliance with the City affiliation requirements of sections 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 origmal affidavit shall be filed with the Office of the C ity Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abi li ties , knowledge , and experience Please list below: Page 2 of 6 F ICLERISALLI BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\BOARD AND COMMITTEE APPLICATION clocx Upd ated June 2020 600 • Are you a registered active lobbyist w ith the C ity of Miami Beach? Yes D or No~ • Have you ever been convicted of a felony? Yes O or No~ If yes , p lease explain in detail: • Do you currently have a violation(s) of City of M iami Beach Code? Yes Dor N~ If yes, please expl ain in detail : • Do you current ly owe the City of Miami Beach money? Yes O or No~ If yes , please explain in detail : • Are you currently serving on any City Board or Committee? Yes or No D If yes , which Board/Committee? • In what organization(s ) in the City of Miami Beach do you currently hold membership? Na me Position Name Position • List the address of a ll 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 O or No~ If so, which department and title ? • Pursuant to C ity Code Section 2-25 (b): Do you have a ~t Cl, spouse 0 , child O brother O or sister 0 who is employed by the City of Miami Beach? Yes Dor N~ If "Yes ," i dentify person(s) and department(s): __________________________ _ • Note: If applying for the At-Large position of the His toric Preservation Board, please answer the be~':" questions • Have you ever resided in one of the City's Historic Districts for at least one year? Yes O or No~ If you answered "Yes,· please indicate : Address Address Page 3 of 6 From: Dates From : Dates F I CLERISALL\BOARD AND COMMITTIES DATABA SE\CHECKLI ST MASTER\BOARD AND COM MITTEE APPLICATION docx Updated. June 2020 To To 601 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 Prohibit ion 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) 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 financi al interests and gifts. (Miami-Dade County Code section 2-11 .1) o Sunshine Law -Florida's Government-in -t he-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 , Commissi ons , and other governing bod ies of state and local governmental agencies or authorities . Voting conflict -Form SB is for use by any pe rson serving at the county, city, or other local level of government on an appointed or elected Board , Council, Commi ss ion , Authority, or Committee. It applies equal ly to members of advisory and non-advisory bodies who are presented with a voti ng conflict of in terest under Section 112.3143, Florida Statutes. 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 ." ~ . ~ IJ ; cr)fl-r , ---;-: wirt!:, Name of App licant (PLEASE PRINT) Board and Committee App li cation Checklist: Please ensure you have provided all information before app lying or reapplying to any Board and Committee ~ I have answered all questions ful ly. 0 I have attached addition al sheets, if necessary , to provide required information. ~ I have attached a current resume, photograph, and a copy of any applicable professional license . ~ I have completed and attached the Board & Committee Financial Acknowledgement Statement. ~ I have completed and attached the Diversity Statistics Report. ~ Subm it complete application package. Via Email: BC@miamibeachO.gov Vi a U.S . Mail or in Person: City of Miami Beach Office of the C ity Clerk / Board and Committee Section 1700 Convention Center Drive, 111 Floor Miami Beach, FL 33139 If you have any questions , p lease contact the Office of the C ity Clerk via email: BC@miamibeachfl.gov or te lephone· 305.673.7411 . Note: Florida Statutes §119.071 : The role of the Office of the City Clerk is to receive and mai ntain forms filed as pub li c records . If your home address , telephone numbers, and/or ph otograph are exempt from disclosure and you do not w ish your home address , telephone numbers, and/or photograph to be made public , please: 1) Use your office or other address for your maili ng address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph. Page 4 of 6 F ICLERISALL\BOARD AND COMMITTIES DATABASE\C HECKU ST MASTER\BOARO AND COMMITTEE APPLICATION doc,, Updated June 2020 602 MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach , Florido 33139 www mjom ibeachfl g o v OFF ICE OF THE Cl1Y CLERK Emai l : BC@m iamibeachfl .gov Telephone : 305 .673.741 1 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Last Name First Name Middle Initial I understand that no later than July 1, of each year all members of Boards and Committees of the City of M iam i 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 filed with the City Clerk of Miami Beach , 1700 Convention Center Drive, Miami Beach , F lori da, no later than 12:00 noon of July 1, of each year: 1. A "Source of Incom e Statement;· or 2. A "St atement of Financial Int erests (F orm 1)1;" or 3. A Copy of your latest Federal Income Tax Ret urn. Failure to file one of these forms, pursuant to the Miami-Dade C ounty Code, may subject the person to a fine o no more than $500, 60 days i n jai l, or both. ~ S ignature Date ' 7 1 Members of t he Pl anning Board and Board of Adjustment w ill be notified directly by the State of Florida, pursuant to F .S. §112.3145(1 )(a), to fi le a Statement of Fi nan ci al Interests (Form 1) with the M iami-Dade Cou nty Supervisor of El ections by 12:00 noon , July 1. Pla nning Board and Boa rd of Adj ustment members who fi le their Form 1 w ith the County Supervisor of Electi ons automaticall y satisfy the County's financia l d isclosure requirement as a Miami Beach City Board/Comm ittee member and need not file an add it ional form w ith the Office of the C ity Clerk. However, compliance w ith the County disclosure requ irement does not satisfy the State requirement. Pa ge 5 of 6 F ICLERISALL\80ARO AN O COMMITTIES DATABASE\CHECKLIST MASTERIBOARD ANO COMMITTEE APPLICATION docx Upd ated: June 2020 603 M IAMI BEACH City of Miami Beach 1700 Conventi on Center Drive M i am i Beach , Florido 331 39 www.m iomibeochA .gov O FF ICE OF THE CI TY CLERK Email : BC@mia m ibeachfl.gov Telephone : 305 .673.741 1 Last Name DIVERSITY STATISTICS REPORT First Name Middle Initi al The following inform ation is voluntary and has no bearing on your cons ideratio n for appointment. It is being asked to comply with City d ive rsi ty reporting requirements. Gender: □Mal e 15a.Female D Other D I prefer not to answer. Race/Ethnic Categories : Y'i!)at is your race? 6J African American/Black D Asian or Pacific Islander D Caucasian/White 0 Native American/American Ind ian 0 Other -Print Race: D I prefer not to answe_r __ ----------- Do you consider yourself to be Spanish , Hispanic, ore ~~~s D I prefer not to answer. Do you consider yourself Physically Disabled? @,Yes No D I prefer not to answer this question. Pag e 6 o f 6 F ICLERISA LLI B OARO AND C OMMITTIES DATABASEICHECKLIST MASTERIBOARD A NO COMMITTEE APPLICATION docx Updated : June 2020 604 Enlda F. Thomas Employment 03/08 -Present 09/06 -03/08 01/02 -12/03 1995 -2001 1995 1963 -1994 Edu cation 1970 -1974 Othe r Courses / Workshops 12/2002 -06/2003 07/2002 Volunteer Experience 2002-2003 Languages 3800 Collins Ave apt 1106 M ,a m, Beach -FL · 33140 EHDOC-Council Towers Apartments Adm inistrative Ass istant II El ite Learning Center Office Administrator Carol's Educare Ch i ld Care Center Bookkeeper/ Adm i nistrative Ass is tant TIEP -Thomas lnt'I Education Programs Partner ANELO Admin istrative Consultante IBM Bras il Ltda . Human Resources Ana lyst Executive Secretary to the Pres ident Phone (305) 934-7433 E-mall en1ldat@gma11 com Miami Beach , Fl Miami Beach, FL Queens , NY Rio de Jane iro, Brazil Rio de Jane i ro, Brazi l Rio de Janeiro, Brazil Sr. Adm. Secretary to the Director of Finance Rio d e Jane iro, Brazil College of International Relat ion of Guanabara Rio de Janeiro, Brazil Degree : Completion of the Course of l nt'I Relations Attended se vera l courses from the New York , NY NYC Department of Publ ic Hea lth York College Queens, NY Introduction to Bookkeeping New York Congregationa l Nurs i ng Center Brooklyn, NY Member of "CAN" Caregiver Adv isory Network Engl ish (read, write, speak) Portuguese (native) Span is h (read, speak) 605 606 • Gaby Baglietto 607 THIS PAGE INTENTIONALLY LEFT BLANK 608 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _B_a_gl_ie_tt_o _______________ G_a_b..._y _____________________ _ Last Na me Firs t Name Middle Initi al _86_3_8_H_a_rd_in~g..__A_ve_n_u_e_,_,_A_._p_t_3_1 _3 _______ M"'"'ia'""m_i_B_e~a'-'c_h _____ F_;;lo-'ri..;;;.da.;;,;..._ _____ ..;..33.;;_1.;_4'""'1 ___ _ Home Address City State Z ip Co de _78_6_-_28_5_-_8_89_1 _____________________ gabydebag@gmai l.com Cellula r Work Home Ema il Address none Bus iness Name : n/a Business Address n/a City retired Occupation : n/a State n/a Zip Code Plea se list you r preference s in order of ranking [1] first choice [2 ] second choice , and [3] third choice . Please note hat onl three 3 choices will be observed b the Cit Clerk's Office . (Regular Board s of City) Choice 1: Senior Affa irs Committee Choice 2 : Choice 3 : License Number Professional License Gab y Baglietto B-24 3-280-52-70 7-0 Issuance Date 3/14/2018 Expire Date 6/7/20 26 Note: If you are seeking appointment to a professional seat (e .g . attorney, architect, etc.), you must attach a co py of your cu rrently effective corresponding professional license. * Note: If applying for the At-La rge pos ition of the Hi stori c Preservation Board , please answer the below questions: • Ha v e yo u ever resided in one of the City's Hi storic Distri ct s for at least one year? Ye s If you a nswered "Yes", please indicate : n/a From : To : Address Dates 609 AFFILIATION WITH THE CITY OF MIAMI BEACH 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: a . Resident of the City for a minimum of six (6) months: • I am resident of: North Beach Or b. Demonstrate an ownership interest in a business estab lished in the City for a mi nimum of six (6) months: No "Ownership Interes t" shall mean the o wnership 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. Or c . Full-time employee of such a business (for a min imum of six months); and I am based in an office or othe r location of the business t hat is p hysically loca ted 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 417th 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. • I am applying fo r an appointment because I have special abilities, knowledge and experience . Please list below: • Are you presently a reg istered lobbyist with the City of Miami Bea c h? No • Have you ever been convicted of a fe lony: If yes , please explain in detail : • Do you currently have a violation(s) of City of Miami Beach codes : If yes , please explain in detail: • Do you cu rrently owe the City of Miami Beach any money: If yes, please explain in detail : • Are you currently serving on any Ci ty Boa rds or Com m ittees : If yes , which board? 610 • 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 o r in which you have an interest within the City of Miami Bea ch : Property n/a • Are you now employed by the City of Miam i Bea ch : n/a • Pursuant to C ity Code Section 2-25 (b ): If so, wh ic h department and title ? Do you have a parent, spouse, child , brother, or sister who is employed by the City of Mia mi Beach? If "Yes", identify person (s) and department(s): No relative's information submitted . 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 lob bying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracting w ith 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 (Mia mi Beach Code section 2-26 ) o Requirement to disclose ce rtain 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 Chapte r 286 of the Florida Sta tutes. These statutes establish a basic right of access to most meetings of Boards , Commissions , and other governing bod ies of state and local governmental agencies or authorities. o Voting co nfli ct -Form 8B is for use by any person servi ng at the county, city , or other local level of government on an appointed or ele cted 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 . 611 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 l ater than July 1. of e ach y ear all members of Boards and Committees of the City of Miami Beach , including those of a purely adv isory nature , are required to comply w ith Miami-Dade County Financial Disclosure Requirements. One of the following forms must be filled w ith 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;" o r 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 Pl an ning Board and Board of Adjustment wi ll be notified directly by the State of Florida , pursuant to F.S. §112 .3145(1)(a), to file a Statement of Rnancial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12 :00 noon, July 1. Planning Bo ard and Board of Adjustment m embers who file their Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requ irement as a Miami Beach City Board/Committee member and need not file an additional form w ith the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. DIVERSITY STATISTI S REPORT The following inform at ion is voluntary and has no bearing on your co nsideration for appointment. It is being asked to comply with City diversity reporting requirements . Gender: Race/Ethn ic Ca tegories What is your race? Female White Are you Spanish/Hispani c/ Lat ino? Mark the "No" box if not Spanish / Hispan ic / Latino. ~ Othe r Description : No details provided Physically Challenged : 612 Board and Committee Application Checklist : Please ensure you have provided all information before app lyi ng or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES I have uploaded a cu rrent resume, photograph, and a co py of any applicable professional license. I have comp leted and attached the Board & Comm ittee Finan cial A c knowledgment Statement. YES I have completed and attached the Diversi ty Statistics Report. If you have any questions , please contact the Offi ce of the City Clerk via email : BC@miamibeachfl .gov or telephone : 305.673 . 7 411 Note: Florida Statutes 119 .071: The role of the Office of the C ity Clerk is to receive and main tain forms filed as public records . If your home address , telephone numbers , and/or photograph are exempt from d isclosure 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 you r office or other telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Gaby Baglietto agreed to the following terms on 11 /12/2020 12 :35 :24 PM Rece ived in the City Clerk's Office by : Name of Deputy Clerk Control No . Date 613 614 • Larissa Caijao 615 THIS PAGE INTENTIONALLY LEFT BLANK 616 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM ..;;.C...;;_a.._jia;;_o;;.__ ______________ ...;..M'-'-a""'ri=a ________________ L _____ _ Last Name First Name M iddle Initial 15201 SW 46th Street Miramar Florida 33027 ---------------------------------- Home Address City State Z ip Code .._(9...;;54___._) _49"'-6"""-..;;..62;c;..8;;_3;..._ ___ ..__(3_0_5.._) 8_6_7_-0_0_5_1 __________ lcajiao@unidadmb.org Cellular Work Home Ema il Address UNI DAD of Miami Beach In c. Meals Program Coordinator Business Name: Occupation: 7251 Collins Ave. Miami Beach Florida 33141 Business Address City State Zip Code Please l ist your p refe rences in order of ranking [1] first choice [2] second choice, and [3 ] th ird choice. Please note that onl three 3 choices will be observed b the Ci Clerk's Office. (Regular Boards of City) Choice 1: Senior Affairs Committee Choice 2: Choice 3 : No Professional Licenses Submitted. Professional License 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. * 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 H istoric Districts for at least one year? Yes No Address in City Historic District submitted . 617 AFFILIATION WITH THE CITY OF MIAMI BEACH 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 : a. Re sident of th e City for a minimum of six (6) months: • I am resid ent of: N/A Or b. Demon strate an ownership interest in a business estab lished in the City for a minimum of six (6 ) months : ~ "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 o th er entity or business association. Or 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): Yes Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate co mpliance 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. Th e original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have specia l abilities, knowledge and experience . Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? No • Ha ve yo u ever been convicted of a felony : If yes , please explain in detail : • Do you cu rrently have a violation(s) of City of Miami Beach codes : If yes , please explain in detail: • Do you currently owe the City of Miami Beach any money: If yes , please explain in detai l: • Are you currently serving on any City Bo ards or Committees : If yes , wh ich board? 618 • In what organization(s) in the City of Miami Beach do you currently hold membership in? No Organ ization Information Submitted. • List the address of all properties owned or in wh ich you have an interest within the C ity of Miami Beach : No Owned Property Information submitted. • Are you now employed by the City of Miami Beach : If so, which department and title? • Pursuant to City Code Sect ion 2 -25 (b): Do you have a parent, spouse , child , brother, or s ister who is employed by the City of M iami Beach ? If "Yes", identify person (s) and department(s): No relative's information submitted. 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 contractin g with t he city (Miami-Dad e Co unty Code section 2-11 .1 ). o Prohibition from lobbying before board/committee you have served on for pe riod 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 Sunshi ne Law regarding open government can be found in Chapter 286 of the Florida Statutes . These statutes establish a basi c right of access to most meetings of Boards, Commissions, and other governing bodies of state and loc al 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 . 619 BOARD & COMMITTEE FINANCIA L 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 . o f each year all members of Boards and Committees of t he City of Miami Beach , includ ing those of a purely advisory nature , are required to comply with Miami-Dade County Finan cial Disclos ure Requirements. One of the foll ow in g form s must be fi lle d w ith the C ity Cle rk of Mi a mi Beach , 1700 Co nventi on Center Drive , M iami Beach, Flor ida , no l ater than 12:00 noon of July 1 , o f e ach ye ar: 1. A "Sourc e of Income Statement;" or 2. A "Statement of Financial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federal Income T ax Return . Fa ilure to file one of these forms , purs uant to the Miami-Dade Co unty Code , may subje ct th e person to a fine of no more than $500 , 60 days in jail, or both . 1 Members of the Planning Board and Board of A djustment will be notified directly by the State of Florida, pursuant t o F.S . §112 .3145 (1)(a), to file a Statement of Rnancial Interests (Form 1) wi t h t he Miami-Dade County Supervisor of El ections by 12:00 noon, July 1. P lanning Board and Board of Adjustme nt mem bers who file their Form 1 w ith the County Supervi s or of Elections automati cally sa t isfy the County's finan cial disclosure requ irement as a Miami Bea ch City Board/Committee member and need not file an add it ional form with the Office of the City Cle r k . Howev er, compl iance w ith the County d iscl osure requirement does not satisfy the State requ i rement. DIVERSITY STATISTIC S REPORT T he following information is volun t ary a nd has no bearing on your considerati on for appointment. It is being asked to com ply with City diversity reporting req u irements. Gender: Race/Ethnic Categories What is your race? Female White Are you Spanish/Hispanic/ Latino? Mark t he "No" box if n ot Spanish / Hispanic / Latino . Yes Other Description : No deta ils pro vided Physic ally Challenged : 620 Board and Committee Appl ication Checklist: Please ensure you have provided all information before applying or reapp lying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES 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. 7 411 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 add ress fo r your mai ling address ; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . I HEREBY ATTEST TO THE ACCURACY AND TRUTHFU L NESS OF THE APPLICATION ; AND I HAVE RECEIVED , READ AND WILL ABIDE BY CHAPTER 2 , ARTICLE VII , OF THE MIAMI BEACH C ITY CODE , ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYE ES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLT. I Mar ia Cajiao agreed to the following ter ms on 11/20/2020 3 :57 :51 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 621 Maria Larissa Cajiao 15201 SW 46th Street, Miram a r Fl. 33027 I 954-496-6283 I Larissacajiao@yahoo.com Professio na l Program Director with a s trong co mmitme nt to serve youth a nd adults. Ov e r ni ne (9) yea rs of ex pe ri ence in t he custome r service , program developme nt a nd social development indus tries for nonprofit organizatio ns. Ex perie nce developing a nd managing annual budgets, adm inistering a nd improvin g programs, and maintaining efficiency in a ll day-to-day o pe rations. Hi ghly e ntrepreneurial and efficie nt at building and maintaining cu stomer relationships. Ded icated t eam pl ayer with proven leadership seeking an opp ortunity to leverage my interpersonal skills to brin g a solid c us tomer service pe rs pec tive . EDUCATION UNIVERSIDAD INTERAMERICANA DE PUERTO RICO -1988 -1990 • Major in Educatio n FLORIDA NATIONAL COLLEGE -2006 • Certifi ca tion in Medical Admini s tration, Coding and Billing WORK EXPERIENCE MEALS PROGRAM COORDINATOR I UNIDAD OF MIAMI BEACH I 12/2019-PRESENT • Day to day operation of a ll as pects of Seni or Meals prog r am • Co mplete intake forms of n e w partic ipa nts • Comp le t e initial year 7 01C assessm e nt for program p a rtic ipa n ts • Fo llow up on participa nts attendance • Supervise c heck in p rocedu r es • Responsible for s upervising the quantity a nd quality of meals -including m ea l temperatures upo n a rrival • Maintain d a ily log of t e mpera ture of food a nd refrigerators • Sup e r v ise t he set-up, serving and cl ea n -up of the meal s ite • Coordinate and k ee p a schedule of weekly activities o f the m eal s ite • Maintain daily attendance r ecord s • Maintain a nd monitor CIRT S • Coordinate dis tributio n of m eals • Monitor and supervise rela ti o n s hip with Catering comp a n y and food qu a li ty • Sup e rvise and manage a ll kitche n staff and volunteers RECREATION LEADER I CITY OF SUNNY ISLES BEACH I 10/2019 -12/2019 • In c h arge of o ver see ing daily ope r a tio n s of after school program • Progra m a nd pl a n daily activiti es • Create an d s usta in a safety, secure and p ositive e n vironme nt 622 DIREC TOR OF FAMILY SE RVI CE S AND SO CIAL SERVICES I YMCA OF SOUTH FLORIDA I 04/2015-08/2018 • Adminis t e r a nd m a n age a n a nnua l budge t of o ve r $200,000.00 • Ma intain a ll p a rtic ipant d a t a • Imp le m e nt Co mmunity e ducati o n • Supe rvi se staff of co unselo r s, p rogr a m coo rdina to rs a nd s p ec ialty in s truct o rs • Supe rvi se aftercar e p rogr a m o f 1 5 0 parti ci p a n ts • Resp o ns ibl e for staff d eve lo pme nt • Respons ibl e for q u ality assura nce • Supervise all as p ect s o f prog r a m m a n agem e nt a nd d eve lo pme nt • De ve lop a nd impl e m e nt e ducati o na l, e nric hm e nt, a nd s kill-based progr a m s for a ll ages • Exp e ri e nce in ha ndling a nd co aching p a rticipa nts o f a ll a ge gro ups • Provide v is ib le a nd carin g cli e nt se rv ice tha t r es ulte d in 100 p e rce nt o f assig n e d m e mbe rs t o re m ai n e ligibl e fo r g r a n ts SUPERVISOR I YM CA OF BROWARD 11 1/ 2 008-20 1 5 • Adminis t e r prog r a m e valua ti o n a nd p rogress r e ports. • Supe rvise staff sch e duling • Adminis t e r , p la n, sch e du le, a nd imple m e nt s truc ture d, h ig h -qua lity p rogra m s. • Supe rvise a nd m o nito r program partici p ation , staff a tte nd a n ce, a n d secure d e li ve ry o f p rogr a m fe es. SKILLS • Bilin g u a l Spa ni s h /E nglis h • Co mpute r Lite rate • Ge n e r a l office e quipme nt • Knowledge o f co mmunity resources • Supe rb orga n izatio n s kill s • Good communi cat or • Mu lt itask e r -Ca n h a ndle m a n y ass ign men t s • Abili ty t o prio ritize ind e p e nd e n t ly • Decisio n Ma ker • Proj ect m a nage m e nt a bilities • Ac curacy a nd punctuality • Willi n g t o stre t c h extra hours t o comple t e ass ig ne d w o rk • Goal o r ie nte d • Tea m player REFERENCES Ava il a b le upo n r e quest 623 .,, - 624 • Linsey Lovell 625 THIS PAGE INTENTIONALLY LEFT BLANK 626 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Lovell Last Name HOME ADDRESS: 1215 Meridian Ave ., Apt. 10 Apt No. Home No./Street PHONE: 3053581001 Home Work Bu s ine ss Name: Pardo Jackson Ga lnsb urg, PL Address: 200 SE 1st Street, Suite 700 Street Linsey First Name Middle Initial FL Miami Beach City State llovell@pardojackson.com Position: Attorney Miami City FL Email Address State 33139 Zip Code 33131 Zip Code Pursuant to City Code section 2-22(4) a and b : Members of agencies, boards, and committees shall be affiliated w ith the city; this requirement shall be fulfilled in the foll owing ways: a) an individua l shall have been a resident of the ci ty for a minimum of six months; orb) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city. • Re sident of Miami Beach for a minimum of six (6) months Yes • Demonstrate a n ownership/intere st in a business in Miami Beach for a minimum of six (6) months: No • Are you a rei:iistered voter in Miami Beach : Yes •(Please~ one): I am now a resi dent of: South Beach • I am applyinQ for an appointment because I have special abili ties, knowledQe and experience. Please list below : Construction & real estate attorney, member of Miami Beach chamber of commerce board of governors • Are you presently a registered lo bb yist with th e Ci ty of Miami Beach? No Pl ease lis t your preferences in order of ranking [1] first choice [2] second choice, and (3) thi rd choice. Pl ease note that only three 131 choices will be observed by the C ity Clerk's Office. (Regular Board s of City) Choice 1: Transportation , Park ing and Bicycl e-Pedestrian Faci lities Committee Choice 2 : Choice 3: * 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 ______________ _ Li ce nse Number Li cense Issuance Date ________________ _ Li cense E xpi ra tion Date Note: If applying for Youth Advisory Board , please indicate your affiliation with the Scott Ra kow Youth Center : 1 . Past service on th e Youth Center Advisory Board : No Years of Service: ---- 2. Present participation in Youth Center activities by your children _N_o __ ages, and which programs. Li st below: ---------------- if yes, please list the names of you r children, their 627 • Have you ever been convicted of a felony: No If yes, please explain in detail: • D o you currently have a violation(s) of City of Miami B each 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: No If yes, which board? • What organizations in the City of Miami Beach do you cu rrently hold membership in? Name Title Miami Beach Chamber of Commerce Board of Governors • I am now employed by the city of Miami Beach : No Which department? • List a ll properties owned or have an interest in , which are located within the City of Miami Beach: Gender: Female The following information is voluntary and i s neither part of your application n or has any beari ng on your c o nsiderati on for appoi ntment. It is being asked to comply wi th federal equal opportunity reporting requ irements. Ra ce/Ethni c Categories What is your race? Mark one or more races to indica te what you consider yourself to be . White Other Description : Are yo u Spanish/Hispa nic/ La tin o? Mark the "No" box if not Spanish / Hispanic / Latino . No Physicall y Challe nged : No NOTE: If appointed, you will be required to follow certain laws whic h apply to city board/committee members. These laws include, but are not limited to, the following: a Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). a Prohibition from contracting with the city (Miami-Dade County Code section 2-1 1.1 ). a Proh ibition from lobbying before board/committee you have served on for period of one year after leavi ng office (Miami Beach Code section 2-26). o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11 .1 ). (re: CMB Community Development Ad visory Committee): prohibition, during tenure and fo r one year after leaving office, from having any interest in or re ceiving any ben efit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties (CFR 570.611 ). Upon request, copies of these laws may be obtai ned from the City Clerk. "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII-of the City Code "Standards of Conduct for City Offic ers, Employees and Agency Members." I Linsey Lovell agreed to the following terms on 3/11 /2019 5:18:01 PM Re ceived in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 628 LINSEY LOVELL 12 1 5 Merid ian Ave. I Miami Beach, FL 33139 I (954) 881-6469 I ll ove ll @pard ojackso n .eom EXPERIENCE PARDO JACKSON GAINSBURG, PL, Miami, Florida Attorney, 2015-Present Represent a wide variety of c li ents in matters co n cerning construction, real estate, contracts and bankruptcy. CBEYOND , Fort Lauderdale, Florida Senior Sales Con sultant, 2011 -2012 Managed exis t ing referral partner r e latio n s hips and recruited new referral p artners to drive incremental bus iness. Mentored new territory sales r e presentatives. Deliv e r e d trai n ings to t eam . CISCO SYSTEMS, INC ., Fort Lauderdale, Florida WebEx Select Account Manag er/Territory Acco unt Manager/Associate Sales Representative, 2006 -2010 Ma intain e d top performing territory t o beco me T op Acco unt Manage r in the South Fl orida Regio n. Worked with client business leaders to improve a r eas s u ch as marketing, sales a nd training. De veloped p artner base t o yield $150k in net n ew revenue. Nurtured r e lationship w ith i n c umbent partner to drive YoY g rowth of 6442%. EDUCATION UNIVERSITY OF FLORIDA LEVIN COLLEGE OF LAW, Gainesville, Flo r ida Juris Doct or, May 2015 MCCOMBS BUSINESS SCHOOL, THE UNIVERSITY OF TEXAS AT AUSTIN , Au stin, Texas Bachelo r of Busin ess Administration, May 2006 PROFESSIONAL & COMMUNITY INVOLVEMENT Board of Governors, Miami Beach Chamber of Co mmerce Co-Chair, law Council, Miami Beach Chambe r of Co mmer ce Pillar Board of Tru s tees, Miami Beach Chamber of Co mme rce President, Texas Ex es South Florida Chapter Chap te r leader, Mccombs School of Bus iness Alumni Cha pter -Mi a mi Member, Florida Association for W om e n lawyers, Miami -Dade Chapter Member, The Florida Bar, Young lawyers Division Me mber, Bankruptcy Bar Association of th e Southern Dis trict of Florida 629 630 • Al Feola 631 THIS PAGE INTENTIONALLY LEFT BLANK 632 MIA/v\l BEACH Feola Last Name 220 West Rivo Alt) Dr. Home Address 305-773-8094 305-531=9478 Work Telephone Alfred First Name Miami Beach C ity Home Telephone BOARD ANO COM ITTEE APPUCA TION Florida State A Middle Initia l 33139 Zip Code ohfeo@atlanticb J . net Email address Cellular Te ephone Altanini Realty Corp . Commercial Real Estate Developer Business I\ ame 760 Ocean Or. Suite 9 Business .Address Occupation Miami Bea ch City Florida 331 39 State Zip Code Please li st your preferences in order of ranking: (1) first choice , (2) seco nd cho ice, and (3) th ird choice . Please note that only three (3) choices will be observed by th e Office of the C ity Clerk. Affordable Housing Advisory Health Advisory Committee Normandy Shores Loca l Government Committe:? Neighbor hood Improvement District Adv isory Council Animal W:?lfa re Committee Health Fac ilities Authority Board Parks and Recreational Facilit ies Board Art in Pu~ic Places Committee Hispan ic Affa irs Committee Personnel Board Audit Committee Historic Preservation Board • Pl anning Board Black Aff.;irs AdvIso rv Committee Housinq Authori ty Police/C it izens Relations Committee Board of Adiustmer t Human Riqhts Committee Production Industry Council Budget Advisory Committee LGBTQ Advisory Committee Program for Public Information Committee Committe-3 for Quaity Education in Marine & Waterfront Protection Senior Affairs Committee Miami Beach Authority Committe-3 on the Homeless Mayor's 41 st Street Committee Sustainability Committee Conventicn Center Advisory Board Mayor's General Obligation Bond Transportation , Parking, a1d Bicycle- Oversiqht Committee Pedestrian Facilities Committee Cultural Arts Council Mavor's Panel on Ocean Drive Vis itor and Convention ALihority Desicin Review Board Miami Beach Commission for Women Youth Comm ission Disability Access C ,mmittee Next Generation Council 1 . 2 . 3 . Transportation, Parking & Bicycle-Pedes trian Facilities Committee Professional License Type of Professional License License Number State of Issuance License Issuance Date License Expiration Date Note: If yo u are seeking appoin tme nt to a professional seat (e .g . attorney, ar chitect , etc .), you must attach a co py of your current! effective c::mes ondi n rofessional li cense . Page 1 of 6 F ICLER\SALLIBOARO A ND •:OMMITTIE S OATABASE\CHECKLIST MASTERIBOARO ANO COMMITTEE APPLICATION docx Updated: June 2020 633 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code s ect ion 2-22 (4 ) a , b , and c: Members of Agencies, Boards, and Committees shell be affiliated with the City. This r:quirement shall be fulfilled in the following wa y s : a. Resident of the C ity for a minimum of s ix months· Yes W or O No • I am a reside 1t of: South B e ac h CXJ Middle B e a c h O North Beach D O r b . Demc,nstrates a n ownershie.J.Qterest (for a minimum of six months) in a business established in the City (k:lr a minimum of s ix months): Yes @ or U No "OwMrship In te rest" s hall mean the ownership of ten percent (1 0%) or more (including the ownership of 10% or more of the outstanang capital stock) in a business. "Business " sha1I mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or busin"7ss association. Or c . Full-ti11e emplcyee of such a business (for a minimum of si x months); and I am based in an office or other location of the business tret is physically located in Miami Beach {for a minimum of six months): Yes ~ or D No Notw;thstandinQ the requirements set forth herein, the qualified full-time employee o f a business must be approved by a 417th vote of ·he Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requiremf:nts of se ;tions 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulsting that they have met e ither (or both) of said affiliation requirements. The original affidavit shall be filed with the Office of the City Clerk prior to being swor,, in as a member. • I am applyin g for a, appointment because I have special abilities , knowledge, and experience. Please li st be low : Page 2 of 6 F \CLERISAU\SOARO ANO ;QMM ITTIES OATABASEICHECKUST I\AASTERIBOARO AND COMMITTEE APPLICATION door Updated· June 2020 634 • Are you a registered active lobbyist with the City of M iami Beach ? Yes O or No (X} • Have you ever been convicted of a felony? Yes O or No [29 If yes, please explain in detail. • Do you currently h3ve a violation(s) of City of Miami Beach Code? Yes O or No (29 If yes, please expla n in detail : • Do you currently ONe the City of Miami Beach money? Yes O or No rn If yes , please explain i n detail : • Are you currently ~erving on any City Board or Committee? Yes Gu or No O If yes, which Board/Comm ttee? Tra'lsportation , Parking and B icycle-Pedestrian Fa cil ities Committee • In what organizatic n(s) i n the City of Miami Beach do you currently hold membership? Ocean Drive Improvement Association Treasurer Name Position Name Position • List the address of all properties owned or in which you have an interest within the City of Miami Beach : 760 Ocean Dr., Miami Beach , FL 33139 • Are you now employed by the City of Miam i Beach? Yes O or No □ If so, which department and title? • Pursuant to City :ode Section 2-25 (b): Do you have a parent D, spouse 0, child O brother O or sister 0 who is em~loyed by ·he City of Miam i Beach? Yes Dor No au If "Yes ," identify pers::>n(s) and department(s): _________________________ _ • Note : If applyirg for the At-Large position of the Historic Preservatio n Board , please answer the below questions: • Have you ever resided in one of the City's Historic Districts for at least one year? Yes O or No D If ycu answer:d "Yes," pl ease indicate : Add·ess Add·ess Page 3 of 6 From : Dates From : Dates F ICLERISALL\BOARD AND •~OMMITTIES DAT ASASE\CHECKLIST MASTERIBOARO ANO COMMITTEE APPLICATION dooc Updated June 20 20 To To 635 NOTE: IF APPOI NTED, 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 di ·ectly or indirectly lobbying City personnel. (Miami Beach City Code Section 2-459) o Prohibition from ccntracting with the City. (Miam i-Dade County Code Section 2-11 .1) o Prohibition from lcbbying before the Board/Comm ittee 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 . (Miam i -Dade County Code secti on 2-11.1) o Sunsh ine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open go,ernment can be found in Chapter 286 of the F lorida Statut es. These statutes establish a basic rigrt of access to most meetings of Boards, Comm issions , and other governi ng bod ies of state and local governmenta agencies or authorit ies . o Voting conflict -F:irm 8B is for use by any person serving at the county , city , or other local l evel of government on an appointed or elected Board, Counc il, Commission, Authority, or Committee. It applies equally to members of advisory and non-advisory bodies who are pre sented with a votin g conflict of intere st under Section 112.3143, Florida Statutes . 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 "ST ANDA RDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY hND/OR STATE LAWS AND STATUTES ACCORDINGLY." Nove m ber 4 , 20 20 A lfr ed Feola Applicant '; SignatL re Date Name of Applicant (PLEASE PRINT) Board and Commi:tee Application Checklist: Please ensure you have p rovided all informat ion before applying o r reapplying to any Board and Committee 0' I have answered all questions fully. 0' I have attached additional sheets , if necessary , t o provide requ ired information. 0 I have attached a current resume, photograph , a nd a copy of any applicable professional license . 0' I have completed and attached the Board & Committee Financial Acknowledgement St atement. 0' I have complete-d and attached the Dive rsity Statistics Report D Subm t complete applicat ion package. Via Email: BC@lm 1amibeachfl.gov Via U.S . Mail or in Person: City o' Miami Beach Office of the City Clerk I Board and Comm itte e Section 1700 Gonventicn Center Drive, 1'1 Floor Miami Beach, Fl 33139 If you have any que-stions , please contact the Office of the Ci ty Clerk via email : BC@m1am 1beachfl.gov ::>r telephone: 305 .673.7411 . Note: Florida Statu:es §119 .071 : The ro le of t he Office of the Ci ty Clerk is t o receive and m aintain forms filed as public records . If yo ur homa address, telephone numbers, and/or photograph ar e exempt from disclosure and you do not wish your home add r ess , :ele phon e numbers , and/or photograph to be made pu blic, plea se : 1) Use your office or other address for your mailing address ; 2 ) Use your office or othe r t ele phone number for your contact number; and 3) Do not att ach a photograpr . Page 4 of 6 F ICLERISALLIBOARD ANO ;QMMITTIES DATABASEICHECKLIST MASTERIBOARD AND COMMITTEE APPLICATION doo< Updated: June 2020 636 MIAMI BEACH City of Miami Bee ch 1700 Com·ention Crnter Drive Miami Bea,:h, Florida 33 139 www.miarribeachfl.gov O FFI CE O f THE CITY CLERK Email : 8 C@miam1beachfl .gov Tel ephone: 305 .673.741 l B JARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT ST A TEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dace County Financial Disclosure Code Provision Code Section 2-11 .1(i) (2) Feola Alfred A La st Name F irst Name Mjjdle In itial I understand that no later than July 1, of each year a ll members of Boards and Committees of the City of Miami Beach . includi ng those of a purely advisory nature. are requ ired to comply w ith Miami-Dade County Financial Disclosure Requ irements . One of the followi ng forms must be filed with the City Clerk of Miam i Beach . 1700 Convention Center Dr ive. Miam i Beach . F lorjja, no later than 12:00 noon of July 1, of each year: 1. A "Source of In come Statement;" or 2. A "St a:ement of Financial Interests (F orm 1)1;" or 3. A Cop{ of your latest Federal Income Tax Return . Failure to file one of these forms , pu rsuant to the Miami-Dade County Code, may subject the person to a fine of no more than $500 , 60 days in jail , or both . ~ November 4 , 2020 Signatu re Date 1 Member:;; of the Planning Board and Board of Adjustment will be notified d irectly by the State of Flori da , pursuant t•) F.S . §112 .3145(1 )(a), t o fil e a Statement of Financia l Interests (Form 1) with the M iami-Dade County Superviso · of Elections by 12 :00 noon , July 1. Planning Board and Board of Adjustment members who file their Form 1 v,ith the County Supervisor of Elections automat ically satisfy the County's finan cial d isclo s ure requ irement as a M iami Beach C ity Board/Comm ittee member and need not file an add it ional form wlth the Office of the Cit:t Clerk. However, compl ian ce with the County disclosure requi rement does not satis)! t he State requ irement. Page 5 of 6 F \CLERI SALLIEOARD AND COMMITTIES DAT ABASEICHECKU ST MASTER\BaARD AND COMMITTEE APPLICATION docx Updated: June 2020 637 MIAMI BEACH City of Miami Beach 1700 C onvention C enter Drive Miami Beach, Florid a 331 3 9 www.miamjbeachfLg ov O FFI CE O F THE CITY CLERK Email : BC@m1amibe-a c hfl gov Tel ephone: 30 5 .673.74 1 1 Feo la Last Name DIVERSITY STATISTICS REPORT A lfred A First Name Middle Init ial The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comp ly with City diversity reporting requirements. Gender: W Male 0 Female 0 Other 0 I prefer not to answer. Race/Ethnic Ca:egories : What is your ra ce? 0 African American /Black 0 Asian or Pacific Islander Cil CaucasianfVl/hite 0 Native American/American Indian 0 Other -Print Race : D I prefer not to answe_r_. ----------- Do you consider yourself to be Spanish, Hispanic , or Latino/a? D Yes U No 0 I prefer not to answer. Do you consider yourself Physically Disabled? □Yes W No 0 I prefer not to answer this question. Page 6 o f 6 F.ICLERISALLIBOARD AND ::OMMITTIES DATABASEICHECKLIST MAST ERIBOARD AN D COMMITT EE APPLICA TI ON docl< Updated : June 2020 638 Al Feola 220 West Riva Alto Drive Miam i Beach , FL 33139 • 1968 to 1970 Sales , Lascivious Boutique -Poughkeepsie , New Yc ,rk • 19?0 to 1974 Manager, Armad illo Cl oth ing -Poughkeepsie , New Yo r k • 19?4 to 1976 Manager, Armadillo Clothing -Beston , MA • 1976 to 1978 Worked for Fleetwood Mac -Los Angel es , CA • 19?9 to 1983 Manager, P iccione Boutique -New Yo rk , NY • 1983 to 1988, Owner, Feola Construction -Ne·N York, NY • 1989 to present , Owner, Altanini Realty Corp. Commercial Proper1y at :'60 Ocean Dr., Miami Beach , FL 639 • 1991 to present , Owner of Helium , Inc .-Gift and home accessories store -Miami Beach, FL • 1994 to 1996 Owner, 8th St Coffee Bar -Miam Beach , FL • 2001 to present , Officer of The Ocean Drive Association • Alth ough I don 't remember the dates , I served 3S Assistant Chairman on the Personal Board for The City of Miami Beach as Mayor Neisen Ka5din's appointment. • 2004 to present , serving on The Transportation , Parking and Bicycle- Pejestrian Facilities Committee . Serving as the representative fo r The Ocean Drive Association . First as a comm ittee member and as Vice Cha irman and for the past 3 years , as Cha irman . I am a single father to a son and daughter , ages 23 and 20 respect ively . Both of my children were born at ~ount Sinai , Miami Be 3ch . Both are now in college . No·,ember 4, 2020 ~ A l Feola 640 • Esteban Porcelli 641 THIS PAGE INTENTIONALLY LEFT BLANK 642 MIAMI BEACH BOA RO ANO COMMITTEE AP PUCA TION Porcelli Last Name 3411 Indian Creek Dr. Apt. 903 Home Address 917-294-3511 Cellular Telephone None Business Name None Business Addres s None Work Telephon e Esteban First Name Miam i Beach C ity None Home Te lephone Retired O ccupation City FL Mid dle Initial 33140 State Zip Code erporcelli@yahoo.com Email address State Z ip Code Please list your preferences in order of ranking : (1] firs t choice , [2] second choice , and [3] th ird choice. Pl ease note that only three 131 choices w ill be observed by the Offi9! of the City Clerk. Affordable Housing Advisory Health Advisory Committee Committee Animal Welfare Committee Health Facilities Authority Board Art in Public Places Committee Hispanic Affairs Commi ttee Audit Committee Historic Preservation Board * Bla ck Affai rs Advisorv Committee Housina Authoritv Board of Adjustment Human Rights Committee Budget Advisory Committee LGBTQ Advisory Committee Committee for Qu ali ty Education 1n Mari ne & Waterfront Protection Miami Beach Authoritv Committee on th e Homeless Mayor's 4 1 st Street Committee Convention Center Advisory Board Mayor's General O bl igation Bond Oversiaht Committee Cultural Arts Council Mayor's Panel on Oc ea n Dnve Desion Review Board Miami Beach C ommission for Women Disability Access Committee Next Generation Council 1 _ Transportation , Parking and Bicycle-PFC 2 . 3 . Professional Li cense Normandy Shores Local Government Neighborhood Improvement District Advisorv Council Pa rks and Recreational Facilities Boa rd Pe rsonnel Board Plannina Board Police/Citizens Relations Committee Production lndustrv Council Program for Public lnfonmation Committee Senior Affairs Committee Sustainabil ity Committee Transportation , Par1<ing, and Bicycle- Pedestrian Fac il ities Committee Visitor and Convention Authority Yo uth Commission Type of Professional License License Number State of Issuance License Issuance Da le License Expiration Date Note: If you are seeking appoin tment t o a professiona l seal (e.g . attorn ey, archi te ct, etc.). you m us t attach a copy of yo ur currentl effective oorres ndin rofess1onal license. Page 1 of 6 F•ClERISALLISOARO AN O CO•A•A TTIES DATABASEICHECK LI ST MASTERISOARO ANO COMMITTEE APPt.lCAT l()N CIO<x U pd at ed: June 2020 643 AFFILIATION WITH THE CITY OF M IAMI BEACH P urs u ant t o C i ty Code section 2 ·22 (4 ) a , b , a n d c : Members of Agencies. Boards, and Committees shall be affiliated with the C ity. This requ rement s hall be fulfilled in the following ways. a . Resident of th e City for a minimum of si x months: Yes GLJ or D No • I am a resident of: S o u th Beach D M iddle Beach [X} North Be ach 0 Or b . Demonstrates an owner ship interes t (for a minimum of six months) in a business established in the C ity (for a minimum of six months): Yes D or ODNo ·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 busin ess. "Business• shall mean any sole propr,etorship, 5Ponsorsh1p, corporat,on, /Jmlled liability company, or other entity or business assoCtation Or c . Full-time emp loyee of such a b u siness (for a m inimum o f six months); a nd I am based in an office or other locauon of the business that 1s physically localed in M i am Beach (for a minimum of six months)· Yes O or QUNo Notwiths tanding the requirements set forth her ein. the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies. Boards, and Committees shall be requ,red to demonstrate compliance with the City affillat,on requirements of sections 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 requir ements. The original affidavit shall be filed with th e Office o f the City Clerk prior to being swom in as a member • I am applying for an appointment because I have special abilities. knowledge, and experience. Pleas e li st below : Permanent resident in Miami Beach since 2010 . Electronic engineer with more than forty years in private activi t y. Currently retired . MidBeach Neiborhood Assoc iation Board Director. Collaborating with the City of Miami Beach in the Transportation ,Garage , Bicycle, Pedestrian Facilities Committee since 2019 Page 2 of 6 F ICLERISAW BOARO AND COMM ITTIES DATABASE 'CHECKI.IST MASTERIBOARD AND COMM ITT EE APPLICAT ION IIOC> Updated June 2020 644 • Are you a re gistered active lobbyist with the City of Mia m i Beach? Yes O o r No IXl • Have you ever been convicted of a felony? Yes O or No IX) If yes, please explain in detail: • Do you currently have a violation(s} of City o f Miami Beach Code? Yes O or No [)Q If yes, please expl ain in detail: • Do you currently owe the City of M1am1 Beach money? Yes D or No lXi If yes , please explain in detail: • Are you currently serving on any City Board or Committee? Yes IX} or No O If yes, which Board/Committee? • In w hat organization(s} in the City of Miami Beach do you currently hold membership? Transportation-Garage-Bicycle-Pedestrian Facilities-Represent MBNA Name Pos1t10n Name Position • List the address of all properties o wned or in which you have an interest within the C ity of Miami Beach : 3411 Indian Creek Dr. Apt. 903 -Miami Beach , FL 33140 • Are you now employed by the City of Miami Beach? Yes O or No CXl If so, which department and title? • Pursuant to C ity Code Section 2-25 (b}: Do you have a parent D . spouse 0 , child D brother D or sister 0 who 1s employed by the Crty of Miami Beach? Yes D or No (X) If "Yes." identify person(s} and department(s): _________________________ _ • Note: If applying for the At-Large position of the Histor1c Preservation Board , please answer the below questions: Have you ever resided 1n one of the City's Historic Districts for at least on e year? Yes O or No 0 If you answered "Yes ," p lease ind icate : From: Address Dates From: Address Dates Page 3 of 6 F I CL ER\SALLIBOARO AND COMMITTI ES OATABASE\OiEC KLIST MASTER\BOARD AND COIIIMITTEE APPLICATION doc:.< Upd11tf!d June 2020 To To 645 NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INC L UDE, BUT ARE NOT LIMITED TO : o Proh ibition from directly or indirectly l obby ing City personnel. (Miami Beach C ity Code Section 2 -4 59) o Proh ibition from contracting with the City. (Miami -Dade County Code Section 2-1 1.1 ) o Proh ibition from lobbying before the B oard/Committee you have served on for period of o ne year after leaving office. (Mi ami Beach City Code Section 2-26 } o Requirement to disclose certain fi nancial interests and gifts. (Miam i-Dade County Code sectio n 2-11 .1) o Sunshine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. T oday, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statu tes esta blish a basic ri ght of access to mos t meetings of Boards, Commissions . and other governi ng bod ies o f slate and local governmenta l agencies or aut horities. o Voting conflict -Form 88 is for use by any person serving a t the county , city , or other local level of government on an appointed or elected Board, Council, Com m ission , Auth ority, or Co mmittee. It applies equally to membe rs of advisory and non-advisory bodies who a re presented w ith a voting conflict of interest und er Section 112.3143 , Florida Statutes. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED, READ AND WILL ABIDE BY CHA E 2, ARTI CLE V II , OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT R CITY OFFI R , EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AN TATE LAWS STATUTES ACCOR INGLY ." Board and Comm ittee Application Checklist: Please ensure you have provided all i nformation before applying or reaplyi ng to any Board and Committee rJ I have answered all q uestions fully . [QI' I have atta ched additi onal shee ts, if necessary, to provide requ i red in formation . [g' I have attached a cu rrent resum e , photograph, and a copy o f any appl icable professional licen se. ~ I have co mpleted and attached the Board & Committee Financi al Acknowledgement Statement. GY I have completed and attached the Diversity Statistics Report . ~ Subm it complete app licat ion package. Via Email : BC@m1am1beachfl.gov V ia U.S . Mail or In P erson: City o f Miami Beach Office of the City Cler',(/ Board and Committee Section 1700 Convention Cen ter Dnve. 1" Floor Miami Bea ch , FL 33139 If you have any questions , please contact the Office of the City Cler',( via email: BC@miam1beachft .gov or telephone: 30 5.673.7 4 11 . Note : Florida Statutes §119.071 : Th e role of the Offi ce of the City Cler',( is l o rece ive and maintain fo rms filed as public re cords. If your home address, telephone numbers, and/or photograph a re exempt from disclosure and you do not wish you r home address, telephone n umbers. and/or p hotograph lo be made public. p lease: 1 ) Use your office or other add re s s for your maili ng address; 2} Us e your office or other telephone number fo r your contact number: and 3) Do not attac h a photograph. Pag e 4 of 6 F I CLER\SALL'BOARO ANO COt.'M ITTI ES DAT ABASE,CHECKU ST MASTERIBOARO AND COMMITTEE APPLICATION .doe>< Updated: June 2020 646 MIAMI BEACH City of Miami Beach 1700 Conven ti on Center Drive M1om1 Beoch, Florido 331 39 www .miamibeochR gov OFF ICE OF THE CITY CLERK Email : BC@miamibeachfl .gov Telephone : 305.673.7 411 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Porcelli Esteban Last Name First Na me Middle Initial I understand that no later than July 1, of each year all members of Boards and Committees o f 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 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;" 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 , pu of no more than $500, 60 days in jail , t to the Miami-Dade County Code, may subject the person to a fine th . Signature Date 1 Members of the Planning Board and Board of Adjustment w ill be notified directly by the State of F lorida , pursuant to F .S . § 1 12.3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervi sor of Elections by 12:00 noon, Ju ly 1. Planning Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the Count y 's financial disclos ure requirement as a M iami Beach City Board/Committee member and need not fi le an additional form w ith the Office of the City Clerk. However, compliance with the County disclosure requ irement does not satisfy the State req uirement. Page 5 of 6 F~CLERISAU.IBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIBOARO AND COMMITTEE APPLICATION docx Updated · June 2020 647 MIAM I BEACH City of Miami Beach 1700 Convention Cen ter Drive Miami Bea ch, Florido 33 139 www,miaroiboocbB gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl .gov Telephone : 305 .673.741 1 Porcelli Last Name DIVERSITY STATISTICS REPORT Esteban First Name Midd le Initial The following information is voluntary and has no bearing on your cons iderat ion for appointment. It is being asked to comp ly with City dive rs ity reporting requirements . Gender: ~Male 0 Female 0 Other 0 I prefer not to answer. Race/Ethnic Categories: What is your race? 0 African American/Black 0 As ia n or Pa cific Islander CXI Ca ucasia n/White 0 Native American/American In dian 0 Other -Print Ra ce: ___________ _ 0 I prefer not to answe r. Do you consider yo urse lf to b e Spanish, Hispanic, or Latino/a? [2;'i Yes □No 0 I prefer not to answer. Do you consider yourself Phys lcally D isabled? OYes rzl No 0 I prefe r not to answer this question. Page 6016 F ICLERISALL1BOARO AND COM MITTI ES OATABASEICHECKLIST MASTERIBOARO AND COMM ITTEE APPLICATION ck>c> Updated June 2020 648 Prof il e: M amI Beach resident srnce ?o · 0 •et red sarne year. Esteban Porcell i 3411 Indian Creek Dr. Apt. 903 Miami Beach, FL 33140 917-2943511 erporcelli@yahoo .com Ac t wil Boa rd DirPrt or ,1• r-~rcibP;:ich Ne,ghhorhooci Assocr;:i• or 1MBNA) Experience: 1990 to 2010 -Vice President, Gasetena O il Corp, New York , NY. Des gn. co"st ruction . operation ana riaIrterance of gas stat Iors car wash and conenierce stores Ir the 5 borouq11s of NYC Operation o f fue te•rn ral o• 'T'O re than a 100 r1ll1or gallons per year. Nu·nber of e'T'o ioyees 500 1973 to 1990 -Head of engineering departments, Aluar Alumin io Argentina, Puerto Madryn, Chubut Argentina. l'v1a i r t enance ana operation . Irstru'11ertat1on and e ect nca equIprrents. Opcrat1or of '00 MW qas turbirie pov,cr station ano au xii ares serv·cc,; wa:er gas. a r a·10 Co·nni ur1ca t 1or1 1ns·all2t1ons 1970 to 1973-Department of Engineering , Kaiser Aluminum , Buenos Aires Argentina. Pro1ec t s and ma1n t cnarce area. Education: 1970 -Electronic Engineer -Universidad Nacional de la Plata, Argentina 649 Esteban Porcelli 650 • Christopher Rollins 651 THIS PAGE INTENTIONALLY LEFT BLANK 652 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM _R_o_lli_n_s ________________ C_h_ri_st_o.._p_he_r ___________________ _ Last Name First Name Middle Initial _6_50_N_E_3~2_n~d_S~t~re~e~t_,_,_U_n_it~3_0~0~3 _______ M_i a_m_i _______ F_lo_ri_da ______ 33137 Home Address City State Z ip Code .._(3_0_5_,_) _77_2_-4_67_2 ____________ ~(3_0_5~)_7_7_2-4_6_7_2 ___ c hris.rolli ns@southbeachgroup.com Cellular Work Home Email Address South Beach Group Hotels Inc . Chief Operating Officer Business Name: Occupation: 855 Collins Ave Miami Beach Flori da 3 3139 Business Address City State Zip Code P lease l ist 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: Visitor and Convention Authority Choice 2: Choice 3: Professional License No Profession al Li ce nses Subm itted . Note: If you are seeking appointment to a professional seat (e .g . attorney , architect , etc .), y ou must atta c h a c opy of your currently effe ct ive corres po nding professiona l license. * Note: If applying for the At-Large position of the Historic Preservation Board , p lease answer the below questions: • H ave you ever resided in one of the City's Historic Districts for at least one year? Yes No Address in City Historic District su bm itte d . 653 AFFILIATION WITH THE CITY OF MIAMI BEAC H Pursuant to City Code section 2-22(4) a , band c : Members of Agen cies, Boards , and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: a . Resident of the City for a minimum of six (6) months: • I am resident of: N/A Or b . Demonstrate an ownership interest in a business established in the City for a min imum of six (6) months: ~ "Ownership Interest" shall mean the ownership often percent (10 %) or more (including th e 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 en tity or business association. Or 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): ~ Notwithstanding the requirements set forth herein, the qualified full -time employee of a business must be approved by a 417th 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 th e Office of the City Clerk prior to being sworn in as a member. • I am applying for an appointment because I have special abilities , knowledge and experience . Please list below: 20 years hospitality Management & Development in Miami Bea ch . A cti ve Member and Board Member of the following : Miami Beach Chamber of Commerce Greater Miami Convention and Visitors Bureau Fl orida Restaurant and Lodg ing Association • Are you presently a reg istered lobbyist with the City of Miami Beach? NQ • Have you ever been convicted of a felony: NQ • Do you c urrently have a violation(s) of City of Miami Beach codes : No • Do you c urrently owe the City of Miami Beach any money: No • Are you currently serving on any C ity Boards or Committees : No If yes, please explain in detail : If yes , please explain in deta il: If yes , please explain in detail : If yes , whic h board? 654 • 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: No Owned Property Information submitted . • Are you now employed by the City of Miami Beach : If so , which department and title? • Pursua nt to City Code Section 2-25 (b): Do you have a parent, spouse , child , brother, or sister who is employed by the City of M iami Beach? If "Yes", identify person(s ) and department(s): No relative's information submitted. 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 fo r 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 2-1 1.1 ). o Sunshine Law -Florida's Government-in-the-Sunshine Law was enacted in 1967. Today , the Sunsh ine 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 gov erning bodies of state and local governmental agenci es 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 , Commi ssion , Authority, or Committee. It applies equality to members of advisory and non-advisory bodies who are presented with a vot ing conflict of interest under Section 112.3143 . Flo rida Statutes . 655 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply w ith 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 yea r : 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 fi le 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 th e P lan ning Board and Board of Adjustment will be notified directly by the State of Florida , pursuant to F.S . §112 .31 4 5(1)(a), to file a Statement of Rnancia l 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 Cou nty Supervisor of Elections automatically satisfy the County's financial disclosure requi rement as a Miami Beach City Board/Committee member and nee d not file a n additional form with th e Office of the City Clerk. However, compliance with the Co unty disclosure requirement does not satisfy the Sta te requirement. DIVERSITY STATISTICS REPORT The fo ll owing infor mation is volu ntary and has no bearing on your con sideration for appoint ment. It is being asked to comply with City diversity repo rt ing req uire m ents . Gender: Race/Ethnic Categories What is your race? White Are you Spanish/Hispanic/ Latino? Ma rk the "No" box if not Span ish / Hispanic / Latino . No Other Description : No details provided Physically Challenged : 656 Board and Committee Application Checklist : Pl ease ensure you have provided all information before applying or reapplying to any Board and Committee . YES I have answered all questions fully . YES YES I have uploaded a current resume , photograph , and a copy of any applicable profes sional l icense . I have completed and attached the Board & Comm ittee Financial A cknowledgment Statement. YES I have completed and attached the Diversity Stati s tics Report. If you have any questions , please conta ct the Offi ce of the City Clerk via email : BC@m iamibeachfl .gov or te lephone : 305.673. 7 411 Note: Florida Statutes 119.071 : Th e 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 d isclosure and you do not wish your home add re ss, telephone numbers , and/or photograph to be made publi c , please : 1) Use your office or other address fo r your mailing address ; 2 ) Use your office or o th er telephone number fo r your contact number; and 3 ) Do not attach a photograph . 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 ACCORDINGLT . I Chri stopher Rollins ag r eed to the following terms on 11 /5/2020 3:49: 19 PM Re ce ived in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 657 Christopher Rollins 855 Collins Avenue Miami Beach , FL 33139 chris .rollins@southbeachqroup .com Chris Rollins is the Vice President of South Beach Group Hotels Inc, a 20-property conglomerate of over 1,500 hotel rooms. The single largest most successful operator of hotels in Miami Beach . Chris is responsible for overseeing the strategic vision and daily operations. From the moment he greets you , Chris d isarms you with his charm , upbeat personality, and friendly demeanor. He was born and raised in a small town called Cocoa, Florida, just 10 miles west of Cape Canaveral , home of NASA's Kennedy Space Center. Chris ventured further south upon his acceptance to the University of Miami as a Finance Major. While attending the university, he worked for the Biltmore Hotel where the seed for hospitality was planted . Post- graduation , he began his finance career at PaineWebber Financial services as a Financial Advisor. Chris quickly realized his passion was elsewhere and sought employment where he cou ld uti lize his exception al people skills and charismatic personality. Before long , he began working for Tommy Hilfiger. Thi s was a major turning point as he realized his persuasive talent to converse with potential buyers and close sales. This expounded in to a National Sales Representative and Corporate Trainer position where he traveled extensively promoting the brand and was now able to s hare his knowledge with a wide array of people. Th is strengthened his adoration for Travel , Tourism, and Hospitality. Chris Rollins possesses strong leadership qualities which encourages communication and cooperation among his team . He also believes in an open-door policy that speaks to his passion and devotedness towards his co-workers. Chris has said, "We are a big company with a small co mpany's heart." To that end , their culture strongly adheres to a promotion from within policy which encourages career development and dedication . South Bea ch Group now boasts a diverse employee community with over 30 nationalities. Above all , Chris has a passion for our city. As a proud member of the Miami Beach Visitor and Convention Authority Board , he facili tates partnerships with local leaders and elected officia ls for decision making in the city 's future , convention center, infrastru cture , and new development. He cares about the success of Miami Beach and works tirelessly to bring exci tin g events and programming to the city. The passion for hospitality runs deep in his blood . Being a member of the award -winning VCA Board enables Chris Rollins to promote the image of Miami Beach locally, nationally , and internationally as a vibrant community and a beautiful tourist destination. His goal is to put Miami Beach in the dazzling spotlight it deserves . 658 659 THIS PAGE INTENTIONALLY LEFT BLANK 660 • Steven Adkins 661 THIS PAGE INTENTIONALLY LEFT BLANK 662 MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Adkins Steven N ---------------------------------- Last Name First Name M iddle Initial _1 _75_6_N_B_a__.y._s_h_o_re_D_r ._3_7_G _________ M_ia_m_i _______ F_L _______ -'-3-'-31_3"--2 ___ _ Home Address City State Zip Code _30_5_8_0_7_05_9_5 ______ 30_5_6_7_344_4_0 ____ 30_5_8_0_7_05_9_5 ____ sadkins819@comcast.net Cellular Work Home Email Address MDGLCC PresidenUC EO Business Name: Occupation : 1130 WASH INGT ON AVE MIAM I BEACH FL 33139 Business Address City State Zip Code Please list your p references in order of ranking (1) first choice (2) second c h oice, and (3) third c h oice. Pleas e note that only three (3 ) choices will be observed by the C ity Clerk's Office. (Regular Boards of City) Choice 1: Visitor and Convent ion A utho rity Choice 2 : LGBT Q Advisory Committee Choice 3 : H uman Rights Committee Professional Li c ense Licen se Number Issuance Date Exp ire D ate N/A N/A 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. * 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 No Address in City Historic District submitted . 663 AFFILIATION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2-22(4) a , b and c: Members of Agen cies , Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways : a. Res ident of the City for a minimum of six (6) months : • I am resident of: N/A Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months : ~ "Ownership Interest" shall mean the ownership often 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. Or 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): ~ Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the Cit; 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. • I am applying for an appointment because I have special abilities, knowledge and experience . Please list below : Current Chair of the Board of VCA • Are you presently a reg i stered lobbyist with the City of Miami Bea ch? 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: ~ If yes , please explain in detail: • Do you cu rrently owe the City of Miami Beach any money: ~ If yes , please explain in detail : • Are you currently serving on any City Boards or Committees: ~ If yes , which board? 664 • In what organization(s ) in the City of Miami Beach do you currently hold membership in? Name M iami-Dade Gay & Lesbian Chamber of Commerce Position PresidenVCEO • List the address of all properties owned or in wh ich you have an interest within the City of Miami Beach : Property None • Are you now employed by the C ity of Miam i Beac h: N/A • Pursuant to City Code Section 2-25 (b): If so , which department and title? Do you have a parent, spouse , child , brother, or sister who is empl oyed by the City of Miami Bea ch? If "Yes", identify person (s) and department(s): No relative's information submitted . 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 finan ci al interests and gifts (Miami-Dade County Code section 2-11 .1 ). o Sunshine Law -Florida's Government-in -the-Sunsh ine Law was ena cted in 1967. Today , the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basi c 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 ele cted Board , Coun ci l, Commission , Authority, or Comm ittee. It applies equality to members of advisory and non -advisory bodies who are presented w i th a voti ng c onfli ct of interest under Sec tion 112.314 3. Florida Statutes . 665 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 Comm ittees of the City of Mi ami Beach , includ ing 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 "Sourc e of Income Statement;" or 2. A "Statement of Financial Interests (Form 1 )1 ;" or 3 . A Copy of your latest Federa l 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 .3 145(1)(a ), to file a Statement of Rnancial 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 finan c ial disclosure requirement as a Miami Beach City Board/Committee member and need not file an add it ional form w ith the Office of the City Clerk . However, compliance with the County d is closure requirement does not s atisfy the State requ i rement. DIVERSITY STATISTICS REPORT The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply w ith City d iversi ty reporting requirements. Gender: Race/Ethn ic Categories What is your race? White Are you Spanish/H ispanic/ Latino? Mark the "No" box if not Spanish / Hispan ic/ Latino. No Other Description : No d etai ls provided Physically Challenged : No 666 Board and Committee Application Checklist: Please ensure you have provided all information before applying or re applying to any Bo ard and Committee. YES I have answered all questions fully. YES YES I have uploaded a current resume , photograph , and a copy of any appl icable professional license . I have completed and attached the Board & Committee Financial Acknowledgment Statement. YES 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 . 7 411 Note: Florida Statutes 119.071 : The role of the Office of the City Clerk is to receive and maintain forms filed as publ ic records. If your home address, telephone numbers , and/or photograph are exempt from disclosure and you do not wish your home add ress , telephon e 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 . 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 ACCORDINGLT. I Steven Adkins agreed to the following terms on 11 /4/2020 8:41 :41 AM Received in the City C lerk's Office by: Name of Deputy Clerk Control No. Date 667 Biography -Steven oel Adki ns Miami-Dade Gay & Lesbian Chamber of Commerce President Steve Adkins is presently the Pres ident of the Miami-Dade Gay & Le bian Chamber of Commerce, the largest not-for-profit corporation in th e county for gay and lesbian businesses. In the two years si nce Mr. Adkins took over the rei gns MDGLCC membership has grown to become th e 2nd la rge t LGBTQ Chamber in the USA. In 1999, Steve moved from hi s native San Diego, California to South Florida and immediately became interested in promoting Miami as a year-round, gay and gay-friendly tourist des tination, when he owned and operated the Jeffer on House, a South Beach Boutique B ed & Breakfast Hotel. Prior to his move to the East Coast, Mr. Adkins held severa l pos itions in the banking world. Steve spent the majority of his banking career first at Bank of America ( 1975 to 1984) and Security Pacific Bank A (now part of BofA; I 984 to 1995). From 1995 to 1999, he served as Vice Pres ident International Trade Finance Manager for the Un ion Bank of California (part of Bank of Tokyo Mitsubishi), Southern California; his portfolio included pres tigi o us accounts such as t he San Diego Pad.res, Jenny Craig, Aldila, In c. (Golf); C ubi c Corporation, Titan, Inc ., ASI Aeros pace Group; and University Contractors (UMEC). Steve holds a Bachelor of Science degree from San Diego State Unive rsity's school of Business Adminis tration (Management with Concentration in Finance). He is currently the President of the Miami-Dade Gay & Lesbian Chamber of Commerce , the largest not-for-profit corporation in the County for gay and les bian bus inesses. MDGLCC membership has increased from 50 to 700 members in th e even years si nce Adkins took over the rein s in 2006. Steve Adkins is immediate past C hair of the Miami Beach Visitor and Con venti o n Authority. Mr. Adkins currently serves on th e board of the Greater Miami Convention & Visitors Bureau, the Coaliti on of Chambers, and th e Pride Coalition. He is also Vice C hair of Miami Beach Gay Pride and. the Miami Gay & Lesbian and Ft. Lauderdale Film Festivals. Mr. Adkins received the 2009 Eddie McIntyre Community Service Award from the ational Gay & Lesbian Task Force. 668 the 2010 Bacardi/Grey Goose lcon Award and the Miami-Dade Gay & Lesbian Chamber of Commerce received Equality Florida 's first "Equality Means Bus in ess•· Award 2012 . Steven Noel Adki11s curre11tlv serves 011; Board Member -Greater Miami Convention & Visitors Bureau Marketing Cou ncil for th e GMCVB One Community One Goal Coo rdinating Council (Beacon Council) Miami-Dade Gay & Lesbian Chambe r of Commerce -Board MDGLCC Fou ndation In c. - C hair Miami Beach Visitor & Convent ion Authority -Chair National Gay & Lesbian Chamber of Commerce -South Region Chair 669 670 • Jeff Lehman 671 THIS PAGE INTENTIONALLY LEFT BLANK 672 MIAMI BEAC H BOARD ANO COMMITTEE APPLICATION FORM -=-Le..;;.;h...;.;m..;.;.;;;.an;.;__ _______________ Je_ff ________________ .;.;.M.;...._ ____ _ Last Name F irst Name M iddle Initial _9_5 _32_B~y_ro_n_A_v_e _____________ S_u_n _si_d_e _______ F_L _______ 33154 Home Address City State Zip Code .;;..30.::;_5;;..;7-=2=-=0-=-9..::..5.::;..99::,__ _____________________ jlehman@the-beach .net Cellular Work Home Email Address F irstService Residential R egional D irector B usiness Name: Occupation: 6000 Blue Lagoon Miami FL Business Address City State Zip Code P lease list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choi ce . Pl ease note that only three (3) ch oices will be observed by t he City Cle rk 's O ffice . (Regular Boards of City) Choice 1 : Visitor and Convention Authority Choice 2 : Choice 3 : Professional License License Number Community Association Manager C A M49072 Issuance Date 10 /1/2020 Expire Date 9/30/2022 Note: If you are seeki ng appointment to a professional seat (e .g . attorney, architect, etc.), you must attac h a c opy of your currently effec t ive corresponding professional l icense. * Note : If applying for the At-Large position of the H istori c Preservation Board, please answer the below question s : • Have you ever resided in one of the C ity's H istoric Di strict s for a t least one year ? No No Address in City Historic District submitted. 673 AFFILIATION WITH THE CITY OF MIAMI BEACH 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: a . Resident of the City for a minimum of six (6) months: • I am resident of: NIA Or b. Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months: No "Ownership Interest" shall mean the ownership often 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. Or 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): Yes Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 417th 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. • I am applying for an appointment because I have special abilities, knowledge and experience . Please list below: I have more than 20 years experience in hotels in Miami Beach. My current role as Regional Director for FirstService Residential has me overseeing 9 Miami Beach properies: APOGEE, Ocean House , IL Villaggio , 1500 Ocean Drive , Setai , Beach House 8 , Caribbean Condominium , Mosaic and Bel-Aire on the 0 • Are you presently a registered lobbyist with the City of Miami Beach? 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 : If yes , please explain in detail: • Do you currently owe the City of Miami Beach any money: If yes, please explain in detail : • Are you currently serving on any City Boards or Committees: If yes, which board? Visitor & Convention Authority. Requesting reappointment. 674 • In what organizati on(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 Miam i Beach : Property None • Are you now employed by the City of Miami Beach : • Pursuant to City Code Section 2-25 (b): If so , which department and title? Do you have a parent, spouse , child , brother, or sister who is employed by the City of Miami Bea ch? 0 If "Yes", identify person(s) and department(s): No relative's information submitted . 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 Prohibitio n 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 (Mia m i Beach Code section 2-26) o Requirement to disclose ce rtain 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 loca l governmental agencies or authorities . o Voting conflict -Form 8B is for use by any person serving at the county, city , or other local le vel 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. 675 BO ARD & COM MITTEE FINANCIAL ACKN OWLEDG EMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for f ai lu re t o comply w ith Miami -Dade County Financial Disclosure Code Section 2-11 .1 (i)(2) - I understand that no later than July 1. of e ac h y ear 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 followi ng forms must be fille d with the City Clerk of Miam i Beach , 1700 Convention Center Drive , Miami Beach , Florida , no later than 12:00 noon of July 1 , of each yea r: 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 T ax 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 Pl an ning B oard 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 Rnancial Int erests (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 requ irement 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 di sclosure requirement does not satisfy the State requ irement. DIVERSITY STATISTICS REPO RT The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity report ing requirements. Gender: Race/Ethnic Categories What is your race? White A re you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispan ic/ Latino . No Other Description : No details provided Physically Challenged: 676 Board and Committee Application Checklist: Please ensure you have provided all information before applyi ng or reapplying to any Board and Committee. YES I have answered all questions fully . YES YES 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. YES 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@m iamibeachfl .gov or telephone : 305 .673 .7411 Note : Florida Statutes 119.071 : The role of the Office of the City Clerk is to re ceive and maintain forms filed as public records. If your home address, telephone numbers , and/or photograph are exempt from di sc losure and you do not wish your home address, telephone numbers, and/or photograph to be made publi c , please: 1) Use your office or other address fo r your mailing add ress; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph . 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 ACCORDINGLT. I Jeff Lehman agreed to the following terms on 11 /9/2020 10:34 :01 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date 677 Jeff Lehman 9532 By ron A venue S urfs ide, FL 33 154 jlch man(a atlant,cbb.nct (305) 720-9599 Dynamic leader with extensive lu xury General Manager and Managing Director experience. Proven s u ccess in creati ng award winning culture, driving profitability in unde rp erform ing assets, garn e rin g va lu able PR in hig hly competitive markets, and streamlining efficie n cy resulting in greater profitability and owne r satisfactio n. Core Competencies Revenue Management Quality E nha nce me nt Awa rds & PR va lu es Honest & Transparent CAM Licensed (Florida) Career Strengths Financial A nalysis G u est Re lation ships E n gin ee ring a nd P M Luxury Markets Biling ual En g li sh/S panish Financial Creati ve with Prove n Results Legal & Contracting Creative Sa les Ri s k Man agement Strateg ic Marketing Respected Community Leader • Pro duced 20% Re v Par gains year o ver year in l " 3 years w ith the Betsy • Cons is te ntl y achieved 12 0% o r more RevPar pe ne trati o n agains t Comp Sets • C reated a n en vironment where EC & entire tea m s hares in profitability s uccess es • Personally developed over $2 MM in revenue in s hort tim e in c urre nt po it io n Proven Luxury Leader • A c hie ved Conde Nast G o ld Li st in 201 7 -1 of onl y 4 Florida I lotels • 1 '1 Forbes Four Star Bo utique I lotel in South Florida • Led Be tsy to unprecedent ed luxury press accola des Operation a l Expert & Stron g Motivator • Managed 14 5 person Housekeeping Department at th e Biltmo re Hotel , Los Angeles • Handled ultra -luxury, celebrity driven Front Office pos ition in W est H ollywood (Sunset M arq uis) • Several years in basic training wi th core brand Ho lida y Inn and Crown e Pl aza • 30+ years ' experience in Accounting, Eng ineering, Front Office. Guest Services. Banquets , and HR, with 20 years as General Manag er o r Ma naging Directo r Associations & Personal C urrent Board Membe r & Vice C hair: Mi am i B each Visitor & Convention Authority Past Board Member: Surf ide To uris t Board Past Board Memb e r: Greater Miami Convention & Visitors Burea u Past Board Member: Miami Beach Con venti o n Center Adv isory Board V ice C hairperson : Collin s Avenue (Miami Beach) Recons trnc tion T ask Force Diplomatic Vis it: to Fujisawa, Japan in March 2009 with Miami Beach Mayor & Delegation Ke y to the C i ty of Miami Beach: Recei ved in 2006 for exte nsive hospitality community service 678 Professional Experience FIR T S ERVICE R ES IDE 1TIAL Regio nal Director. 2017 -Pr esen t Miami Beach, FL North America ·s largest residential manage ment company, oversight over ele ve n hig h rise c ondominiums in Miami Beach & Miami : Apogee, Ocea11 House. Beach Ho use 8, Caribbean, Mo saic, IL Villaggio , 1500 Ocean , Bel-Aire, Paraiso Bay, Paraiso Bay Mas ter and Setai Residences • Direct suppon for finances. HR , Board of Directors· relationships , Co rporate v ision and imp lementation • Board of Director relationship , contracting a nd de ve lopment of new projects • Cost sav in g analysis a nd bidding, quality ass urance throughout propcn ies • Ra isi ng hospita li ty standards in hi g h-e nd propenie • Coordination wi th City of Miami Be ac h on capita l projects and quality of life issues THE B ETSY SOU TH B EA CH Managin g Director, 20 I0 -20 17 Mi ami Beac h, FL Lifestyle Ocea11 Drfre Hotel-Project managed expansion to 130 rooms. 2 restauram s. 4 lounges. 225 e mployees and revenu es ofS25MM • Oversaw $35MM expansion, maintained top 10 TripAd viso r rating & achieved Cond e ast Gold List • Drove ADR by over $100 while maintaining occ upancy and Guest ratings • Managed third-party BLT Steak contract for S years . as well as the transi t ion to a proprietary F&B operation TH E CLARIDG E H OTEL Genera l Manag er. 2007 -2 0 I 0 Boutique Ho tel lo cated in de veloping area of Mid Beach • Migrated property from C larion Hot e l to Preferred Hotels & Rcso n s Mi ami Beach , FL • Improved rating and facility: Property e ventually so ld to new "Faena Di strict'' development • I landled all executive operations fo r small (SO room ) prope n y TH E A TIO AL H OTEL Managing Dire ctor, 199 7-200 7 Miami Be ac h, FL Pre-opening and launc h of 15 2 room historic property located next door lo Miami Bea ch 's De lano Ho tel. Arguably 1/re mos1jamous swimming pool a11h e tim e. with 100 employees and re venues of$/ 5mm annual • Achieved sub sta nti a l financial profitability by end of year 2 in thi s hi g hl y competitive market • Ass isted with the creat ion of Preferred I lote l 's "Preferred Boutiq ue" brand , and helped launc h this nationwide • Crea ted ervice culture and hote l product which achie ve d record hotel sale in 2007 o f $394 K per ke y TH E PALM SOUTH BEACH Managing Directo r , 200 1-2003 Miam i Beach, FL Took over managem ent of 1his 242 room I 160 employee ho te l lo renovate and rep osition during tenure at The Na1io na/ Hote l with 1h e same o wn ership group. • Project managed S8MM renovat ion (200 I budget for renovation) 679 • Compl ete ly replaced Executive Committee to a lign n ew hote l with o wner' expectations • Re p ositio ned ho tel from 3 s tar FIT to 4 star resort and drove corresponding RevPA R Pri o r Positions: Bass Ho te ls & R eso rt s: Seattle, WA; L.A . and Santa Monica, CA; Cocoa Beach FL T h e S un set M arquis. W est Ho ll ywood, C A A me ri can Hawaii C ruises, SS Inde pe ndence, SS Cons titution, SS Libe rt e -Ho nolulu, HI & Papeete, Tahiti Le Pare Ho tel De lu xe, West Holly wood, CA T h e BiH more, Los Angeles. CA Other kills • CAM licensed #49072 • Eng lis h / Spanis h Biling ual • Mi crosoft Excel, W ord , Power Poi nt • Ope ra, Room Mas te r , Nuvola, many o ther PMS and QA programs • US C iti zen (Hometown Los Ang eles ) Professional References (Contact information on request) William Talbert. Preside nt & CEO, Greater Mi a mi Con vention & Vi si tors Bureau W e ndy Ka ll e rg is, C EO . Greater M iami & th e Beaches Hotel A ssoc iation J orge Gonzalez, City Manager, Town of B a l Harbour Heiko Dobri kow. EVP & General M a nager, The Las Olas Co I The Ri verside H otel eisen K asdin, Attorney & Forrner Mayor of Miami Beach 680 681 THIS PAGE INTENTIONALLY LEFT BLANK 682 • Diane C. Connolly Graham 683 THIS PAGE INTENTIONALLY LEFT BLANK 684 C. Last Name Middle Initial Horne Address Crty State Z ip Code 3~:;_~ o/5~ -55j-, 9-58' Cellular Telephone Wori< Telephone ~@,t_o]::"mQclio-.U>nsu Jtc?nis ,·11c. c_, .J.h.£-411-:±ta_ 8a:-Y\~ lo~ Home Telephone '6\.t~ V\.O~~ Occupation H,'ayyt', Email address S)~~pmort Business Address State Zip Code Please list your preferences m order of ranking (1) first choice, (2) second choice and (3) third chotee Please note that only three f3l c hoices will be observed by the Office of the City Clerk. Affordable Housing Advisory Health Advisory Commi ttee I Normandy Shores Local Government Committee Neighborhood Improvement D1stnct Advisory Council Animal Welfare Committee Health Facilities Authority Board -Parks and Recreational Fact1 1t1es Board Art 1n Pubhc Places Committee Hispanic Affairs Committee Personnel Board Audit Committee Historic Preservation Board * P lann1nQ Board Black Affairs Advisory Committee HousmQ Authoritv -Pohce/C1tizens RelatJons Commrttee Board of Ad1ustment Human RtQhts Commrttee Production Industry Council Budget Advisory Committee LGBTQ Advisory Committee Program for Public Information Committee Committee for Quahty Education m Marine & Waterfront Protection SenlOf Affarrs Committee Miami Beach Authontv Commrttee on the Homeless Mayor's 41 st Street Committee Sustamab1lrty Committee Convention Center Advisory Board Mayor's General Obhgabon Bond Transportation Parking, and Bicycle- OverstQht Committee Pedestnan Fac1hties Committee Cultural Arts Council V 1srtor and Convention Authontv -Mayors Panel on Ocean Drive Design Review Board Miami Beach Commiss10n for Women Youth Commissron Disabdrty Access Committee Next Generation Cou.nol I Profe$$ional License Type of Professional License License Number State of Issuance LJCense Issuance Date License Expiration Date Note If you are seeking appoi ntment to a professional seat (e g . attorney architect. etc ) you must attach a copy of your curren effective corres ndm rofessional license Page 1 of6 ~ IC LERISALLIBOAAO AN O COMMITTIE S 0.-. T ABASC\CHEC K.UST MASTER'80ARD AN O C~MITTEE APPUCA T10N doca Updaled June 2020 I I I I 685 AFFIUA TION WITH THE CITY OF MIAMI BEACH Pursuant to City Code section 2 -22(•) a , b , and c : Members of Agencies Boards and Committees shall be affihated with the City ThtS requirement shall be fulfilled in the followmg ~ a . Resident of the City for a minimum of six months Yes O or ~No • I am a resident of South Beach O Middle Beach O North Beach 0 Or b . Demonstrates an ownersh1~rest (for a minimum of SIX months) in a business established in the Crty (for a minimum of SIX months) Yes O °'4No ·0wnersh1p Interest · shall mean the ownership of ten percent (10%) or more (mcludmg the ownership of 10% or more of the outstanding capita/ stock) m tt business 'Business shall mean any sole propnetorsh1p. sponsorship corporation hmlled hab1/1ty company or other entity or business aSSOCJabon Or c . Full-time employee of such a business (for a rrummum of six months); and I am based 1n a~e or other locat10n of the business that 1s physic.ally located in M ia mi Beach (for a minimum of six months) Yes)t' or DNo Notw1thstandmg the reqwrements set forth herein. the qua/,fl#KJ full-time employee of a business must be approved by a 4/lth vote of the Mayor and City Commission NOTE Members of Agenaes, Boards. and Committees shall be required to demonstrate oompliance with the City affil1at,on requ,rements of sections 2-22 (4) a and b of the M1am1 Beach City Code by executing an affidavit stJpulating that they have met either (or both) of said affll1at,on requirements The onginal affidavit shall be flled with the Off,ce of the C,ty Clerk pnor to being swom ,n as a member • I am applying for an appointment because I have special abthttes, knowledge and expenence Please list below: ~ <>-M o.~,01~~"'6.<_ o~ 'bt~w_~•,~ :~i~ Md :GJ~s,'oYlur}tJ 6Jo ~(aml {b ~L o ~ -:C'--<Y"\ a c a c :b ~ ffi.C2. '('(\ 'o~ @-.,. o f Tu ,v A l'7 c. P a. M µA.A Page 2 of 6 F C LER\$All~ A.'fO COM IES 0A TABASEICHECKUST MASTER,a(WlO ANO TTE F APPi. IC.AT doer Update<! June 2020 686 • Are you a registered active lobbyist w ith the C rty of Miami Beach? Yes O or No ~ • Have you ever been convicted of a fel ony? Yes O or No M,f yes, please explain in detail • Do you currently have a v1ola llon(s ) of C rty of Miami Beach Code? Yes O or No ~f yes, please explain m detail • Do you et.1rrently owe the City of M1am1 Beach money? Yes D or No ~If yes, please explain in detail • Are you currently serving on any City Board or Committee? Yes O or No ~f yes , wh ich Board/Committee? • In what orgamza t1on(s ) in the Crty of M1am1 Beach do you currently hold membership? Co , t--,U o.nu ~c.h °'9rAb~ t},,a_\~ Wol\l\?,t 1!> ~t.1-S.\N S.S U,)Gl l) f; lb tt Boa~ Name Posit10n ()..r\Ol ~o~-«.d-o ~ 6-o v'e.(t.y)o "-~ Name Position • List the address of a ll properties owned or in which you have an interest w 1th 1n the Crty of Miami Beach A) ,4- • Are you now employed by the City of Miami Beach? Yes D or No ~f so , which department and title ? • Pursuant to City Code Sectio n 2 -25 (b ): Do you have a ~ D . spouse 0 . child D brother D or si ster D who 1s employed by the Crty of M1am 1 Beach? Yes Dor No~ If "Yes," identify person(s) and department(s). _________________________ _ • Note If applying for the At-Large posrt,on of the H 1stonc Preservat10n Board please answer the below questions. • Have you ever resided in one of the Crty 's H1stonc D1stncts for at least one yea r? Yes D or No D If you a nswe,ed "Yes," please ,nd,:ate /1/ / Ir Address Address From Dates From Dates Page 3 of 6 F ~LER\$ALL B OARO AND COMMITTIES 0A T ASASE\CHECKLIST MASTER,aQARO AND COMMITTEE APPI.ICA TlON c10C>< Upoated June 2020 To To 687 NOTE I F APPOINTED, YOU W1L L BE REQU IRED TO FOLLOW CERTAI N LAWS THAT APPL Y TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE , BUT ARE NOT LIMITED TO: _ Proh1b4bon from directly or indirectly lobbying City personnel (M iami Beach Crty Code Section 2--459 ) Proh1b1bon from contracting w ith the City (M1am1-Dade County Code Section 2-11 1) Proh1b1t10n from lobbying before the Board/Committee you have served on tor penod of one year afte r leaving office (M iami Beach Ci ty Code Section 2-26) ~ Requirement to d isclose certain financial interests a nd gifts (M 1am1-Oade County Code sect10n 2-11 1 ) Sunshine Law -Flonda 's Govemment-1n-the-Sunshine Law w as enacted in 1967 Today the Sunshine Law regard ing open government can be found in Chapter 286 of the Flonda Statutes These statutes estabhsh a basic nght of access to most meetings of Boards. ComrmsS10ns , and other governing bodies of sta te and local governmental agencies or authonbes Voting conflict -Form 88 1s for use by any person serving at the county , city or other IOcal level of government on an appointed or e lected Board , Council , Comm1ss10n , Authonty , or Committee It applies equally to members of advisory and oon-adv1sory bod ies who are presented with a voting conflict of interest under Sect10n 112 3143 Flonda Statutes 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 AN ~RS TE LA A ST TUTES ACCORDINGLY." Board and Comm ittee App · ation Chec kl ist : Please ensure you have provided all information before applying or rea~ing to any Board a nd Commrttee 0 I have answered a ll q uesoons fully ~ve attached a d drbonal sheets rt necessary. to provide required informabon ✓,ha ve attached a current resume photograph and a copy of any applicable profess10na1 license ~ve competed and attached the Board & Committee Financial Aunowledgement Statement ~I have completed and attached the Diversity S tabsbcs Report ✓submit complete a pplicabon package Via Email BC@m,am beachfl gov Via U S Mail or in Person City of M 1am1 Beach Office of the Crty Cieri( / Board and Committee Sect10n 17 00 Convenbon Center Drive. 1 • Floor M iami Beach, FL 33139 If you have any quesbons , please contact the Office of the City Clerx via email BC@rr1a m•beachf 9 01, or telephone 305 673 7 4 11 Note : F lorida Statutes §119.0 7 1: The role of the Office of the Crty Clerk 1s to receive and maintain forms filed as pubhc rerords If your home address. telephone numbers, and/or photograph are exempt from d isclosure and you d o not w i sh your home address telep hone 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 Page 4 of 6 F \Cl.ER.$Al.l '80ARO ANO COMMITTIES OATABASE>CHE UST MASTER',SOARO ANO COMMITTEE APPLICATION ooo Updated June 2020 688 A'v I BEACH Ci ty of Miami Beach 1 700 Convention Center Drive M1om1 Booe Florido 331 39 www m1am ,beochf gov OFFICE O F THE CITY CLE R Emo, BC@m,am beactifl go Telephone 305 67 3 7 A 1 1 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dade County Fi nancial D i sclosure Code Provision Code Secti on 2-11 .1 (I) (2) C_. Last Name Fi rst Name Middle Initial I understand that no later than July 1, of each year all members of Boards and Committees of the Crty of M1am 1 Beach , including those of a purely advisory nature. are required to comply w ith M1am1-Dade County Financi a l Disclosure Requirements. One of the fo llowing forms must be filed with the Crty Cieri< of Miam, Beach , 1700 Convention Center Dnve M1am1 Beach Flonda , 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 Federa l Income Tax Retum . Failure to file one of these forms . pursuant to the M iami -Dade County Code , may subJect the person to a fine of no more tha 500 days in ·ail, or both. ~ Sig nature Date I I · Members of the Planning Board and Board of Adjustme nt wi ll be notified directly by the State of Flonda , pursuant to F S §112.31 4 5(1 )(a). to file a Statement of Financial Inte rests (Form 1) with the Miami -Dade County Supervisor of Elections by 12 00 noon , July 1 Plann ing Board and Board of Adjustment members who fi le their Form 1 with the County Supervisor of Elections automatically satisfy the County's financia l d isclosure req uirement as a Miam i Beach City Board/Committee member and need not fi le an additiona l form wi th t he Office of the City Cieri< However, compliance with the County disclosure requirement does not satisfy the State requ irement. Page 5 of6 F 'Cl.ERISALL,80AAO AHO COMMlmes 0.-.TABASE,CHECKllST Mot.STER-BOARD ANO COMMITTEE AP91.ICAT 000 Updat ed June 2020 689 BEACH City of Miami Beach 1700 Conve ntion Center Dnve M1om1 Beoc h. Flon do 3 3 139 NWW rn 1om1b eo chA gov OFFIC E O F THE CITY CL ERK Emai l BC@m1am1be achfl g ov Telepho ne . 3 05 6 7 3 7 4 11 Last Name DIVERSITY STATISTI CS REPORT 0 . First Name Middle lnrtial The following information 1s voluntary and h as no beanng on your consideration for appointment It 1s being asked to comply wrth City drversity reporting requirements . Gender: ale ma le Other D I prefer not to answer. Race/Ethn ic Categories : ~~t is your race ? African Amencan/Black 0 Asian or Pacific Islander 0 Caucas1an/VVhrte 0 Native Amencan/Amencan Indian 0 Other -Pnnt Race· 0 I prefer not to answe_r ___________ _ Do you consider yourself to be Spanish , Hispanic, or Latino/a? 0 es ~ No prefer not to answ er Do you consider yourse lf Phys ically Disabled? c:lxes J&l.No 0 I prefer not to answer this question Page 6 of 6 F 'IC LER~>BOARO ANO COMMJTTIES OATABASE'ICHEC 1ST M.t.STER,ao...Ro AHO COMMITTEE APPI.ICATION dool Upd ated June 2020 690 DeAnne Connolly Graham Work Experience April 2013 -Present: ROI Media Consultants Inc. (954) 559-1758 dee@ROimed1aconsultantsmc com Business Oevelopment -The Charter Agency, 1680 Meridian Avenue, Moamo Beach Jan 1992 -March 2013: Welcome & Boenvenodos Visitor Magaz,nes, North M,am, Beach Director of Sales & Marketing Sept 1989 -Dec 1991 : Chase Private Bank, Moam, Office Manager Volunteer Experience • Chair of the Board, Ayuda Moamo, 7118-7144 Byron Ave, Moa mo Beach (Jan 2004 -Present) • Chair, Women's Business Council Moam, Beach Chamber (Oct 2019 -Present) • Founding Member, Doversoty, Equity & Inclusion Council Miami Beach Chamber (Feb 2020 -Present) • Board Member, The Women's Fund Moam, Dade (April 2019 -Present) • Board Member, Florida Restaurant & Lodging Assoc Moam, Dade (May 2012 -Present) • Advisory Board Member, Academy of Hospitality & Tourism Moam, Dade (Jan 201 I -Present) • Arts & Business Council, Mi ami Arts Marketing ProJect Committee (Sept 2008 -Pr esent) • Board Member, Focus M,am, (Jan 2019 -Present) • Member, NAACP Miami Dade • Chair, Women's Business Roundtable Moam, Beach Chamber (Oct 2016-Sept 2019) • Chair, Pillar Trustee Board Moam, Beach Chamber (Oct 2013-Sept 2014) • Voce Chair, Pillar Trustee Board M1am1 Beach Chamber (Oct 2010 -Sept 2013) • Voce Chair, Women's Business Council M,am, Beach Chamber (Oct 2009-Sept 2011) Honors & Awards • Woman Worth Know,ng, M,am, Beach Comm,ssoon for Women (March 2020) • Golden Footprint Award, Miami VR Expo (June 2019) • Vessels : Woman of Substance, Moam, Dade County Black Advisory Board (Feb 2017) • 25 Most Innuent,al & Prom,nent Black Women on Business, Legacy Magaz,ne (2017) • Better Beach Citizen at Large, Moam, Beach Chamber (2014) • Tafari Award, Women Empowerment Conference (2013) • Rookie Advisory Board Member of the Year, Acade my of Hospotahty & Tourism (Dec 2011) • Ayuda's Woman of the Year, Ayuda M,am, Foundation (Oct 2010) • Rosing Star Award, Meeting Professional s Int'I South Florida (June 2007) 691 692