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Release # 1 3-05-2014 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Em ail: CityClerk@miamibeachfl.gov MEMORANDUM TO: Mayor Philip Levine and Members of the City Commission CC: Jimmy L. Morales, City Manager Jose Smith, City Attorney FROM: Rafael E. Granado, City Clerk DATE: February 26, 2014 SUBJECT: City Commission At-Large Nominations for March 5, 2014 – Release # 1 Below please find the City Commission At-Large Nominations received to date. BOARDS AND COMMITTEES Affordable Housing Advisory Committee (Effective May 31, 2014: Vacancies: 11) No nominations received to date. Capital Improvements Projects Oversight Committee (Current Vacancies: 6) Note: Committee will sunset on May 31, 2014 Design Review Board (Current Vacancies: 2) No nominations received to date. Health Advisory Committee (Current Vacancies: 3) • Dr. David Facyr – (Release 1 – Page 7) Nominated for appointment (Private Individual Position) by Commissioner Michael C. Grieco. Health Facilities Authority Board (Current Vacancy: 1) No nominations received to date. Historic Preservation Board (Current Vacancy: 1) No nominations received to date. Parks and Recreational Facilities Board (Effective May 31, 2014: Vacancies: 6) Youth Center (Vacancies: 1 Scott Rakow Youth Center and 1 North Shore Park Youth Center) • Dana Turken – (Release 1 – Page 25) Nominated for appointment (Scott Rakow Position) by Mayor Philip Levine. Golf (Vacancies: 2) • Gail P. Williams – (Release 1 – Page 33) Nominated for appointment (Golf Position) by Commissioner Joy Malakoff. 1 Tennis (Vacancies: 2) • David J. Berger – (Release 1 – Page 45) Nominated for appointment (Tennis Position) by Commissioner Joy Malakoff. F:\CLER\$ALL\REG\COMMISSION MEETINGS\2014\03052014\AT LARGE NOMINATIONS RELEASE 1 03052014.docx 2 Health Advisory Committee • Dr. David Faycr 3 THIS PAGE INTENTIONALLY LEFT BLANK 4 Dr. David Faycr 5 THIS PAGE INTENTIONALLY LEFT BLANK 6 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Faycr David A --~-----------------------------------------------------------------------Last Name First Name Middle Initial HOME ADDRESS : 6515 collins ave 1805 Apt No. Home No./Street PHONE : 3066062363 Home Work Business Name: Mount Sinal Medical Center Address : 4300 alton rd Street Miami Beach City 8883154822 Fax FL State dfarcy@me.com Email Address Position : Chairman, deptarment of emergency medicine Miami Beach FL City State 33141 Zip Code 33140 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; 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 bus i ness i n Miam i Beach for a minimum of six (6) months : Yes • Are you a registered voter in Miami Beach : Yes • (Please circle one): I am now a resident of: North Beach • I am applying for an appointment because I have special abilities , knowledge and experience . Please li st below: run the emergency room at mount sinai with a volume approaching 65000 visits per year, volunteer on florida disater team, 15 y • 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 three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Health Advisory Committee Choice2: Health Facilities Authority Board Choice 3: 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 : • 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 serving on any City Boards or Committees: No If yes , which board? • What organ izations in the City of Miam i Beach do you currently hold membership in? • List all properties owned or have an interest in, which are located within the City of Miami Beach : Property 6515 collins ave 1805 miami beach 33141 7 • I am now employed by the city of Miami Beach : No Which department? 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. Gender: Male Race/Ethn ic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. White Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish I Hispanic I Latino. No Physically Challenged: No NOTE : If appointed, you will be required to follow certain laws which apply to city boardlcommlttee members. 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 (Miam i-Dade County Code section 2-11.1 ). o Prohibition from lobbying before boardlcommittee 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 (Miam i-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 rece iving any benefit from Commun ity 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. "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 David Faycr agreed to the following terms on 2/17/2014 11 :59:17 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 8 David A. Farcy, MD, FAAEM, FACEP, FCCM. Professional Experience: 6 5 15 Coll ins Av e. Ap t. 180 5 Miam i B each , FL 33 141 Cell : (305) 606-2363 dfarcy@me.com dfarcy@msmc.com 01/12 -present: Mount Sinai Medical Center. Miami , FL Chairman, Department of Emergency Medicine. 05/09-present: Mount Sinai Medical Center. Miami, FL Medical Director, Surgicallntens ivist Program . Critical Care Attending Physician 07/06-present: Mount Sinai Medical Center. Miam i, FL Director , Emergency Medicine Critical Care Emergency Medicine Attending Physician 02/09-02/10: Jackson Memorial Hospital. Miami , FL Department of Emergency Medicine Emergency Medicine Attending Physician (Per-Diem) 07/06-09/07: Southwest Regional Medical Center . Fort Myers , FL Acute Care Specialists Critical Care Attend ing Physic ian Postgraduate Training: 07/05-07/06 : R Adams Cowley Shock Trauma Center , Baltimore , MD Emergency Medicine/Critical Care Fellowship 07/02-07/05: Maimonides Medical Center , Brooklyn , NY Eme rgency Medicine Residency 07/01-07/02: New York Medical College, Valhalla , NY Fifth Pat hway Program St. Mary's Hospital , Brooklyn , NY 9 Education : 07/96-06/00 : Universidad Autonoma de Guadalajara , Jal isco , Mexico Medico Cirujano (Medical Degree) 09/92-05/96: Texas Tech University , Lubbock , TX B.A . in Psychology Professional Experience: 07/00-06/01: Research Assistant, Department of Orthopedic Surgery Maimonides Medical Center, Brooklyn , NY 01/94-05/96 : Ass istant Director, Emergency Medical Services Shallowater EMS, Shallowater, TX 09/90-09/93: Medical Technic ian United States Air Force , Wichita Falls , TX Certification and Licensure: Faculty Appointment: ABEM Diplomate , exp . 07/2018 New York License: 235076 Florida License : ME 96083 ACLS , exp. 10/2014 02/09-present: Clinical Assistant Professor NOVA Southeastern University 01/1 0-present: Clin ical Assistant Professor Florida International University College of Medicine Awards and Honors: 1. Medical Procedure Coordinator. Maimonides Medical Center 2. Robert Brandstetter Memorial Award . New York Medical College, Award for highest academic record . 3. Semi-finalist in the 2004 CPC competition sponso red by Society for Academic Emergency Medic ine 4. Emergency Medicine Resident Association 2005-2006 -President of Critical Care Committee 5. Chair, Florida American Academy of Emergency Medicine/Resident Student Association: 2004-2006 Crit ical Care Comm ittee Task Force 6. Shock Trauma Hero Award 2007 10 7. Florida American Academy of Emergency Medicine: Board of Directors 2009-2011 8. Founder and President of Florida American Academy of Emergency Medicine, 151 Scientific Assembly held in Miam i Beach . Aug 2011 . 9. Florida American Academy of Emergency Medicine, President 2011-2013 10. Florida American Academy of Emergency Medicine, Pres ident 201 1-Present 11 . Medical Director: International Med ical Surgical Response Team (IMSuRT)-South NDMS/HHS/ASPR/OPEO 12 . President Florida American Academy of Emergency Medicine, 2nd Sc ientific Assembly held in Orlando , Fl. Jan 2013 . 13 . American Academy of Emergency Medicine oral board examiner: Fall Orlando course 2013 Professional Society Membership: American College of Emergency Physicians (Fellow) Amer ican Academy of Emergency Medic ine (Fellow) Society of Critical Care Medicine (Fellow) European Society of Intensive Care Med icine (Associate) Eastern Association for the Surgery of Trauma (Assoc iate) Disaster Training and Law Enforcement Experience: Training: Paramedic , Search and rescue , Confined space rescue, Fire train ing (basic, advanced), under water rescue, radiation emergency , agent of opportunity or bioterrorism Position : Medical Director for Internationa l Medical Surgical Response Team -South Consultant: Drug Enforcement Agency , Miam i Dade , FL "Clandestine Laboratory Team " Disaster experience: Hurricane: "Andrew", Florida 1992 Earthquake: Queretero , Mexico 1996 Terrorist act: New York City 2001 Hurricane : "Mitch ", Nicaragua 2003 Earthquake : Port au Pri nce , Ha iti 2010 Professional Committees and Administrative Services: Member, Intensive Care Committee , Mount Sinai Medical Center , 2009-present Member, Medication Safety Committee , Mount Sinai Medical Center , 2009-present Member, Pharmacy and Therapeutics Committee , Mount Sinai Medical Center , 201 0-present Member, Ethics Committee, Mount Sina i Medical Center, 2010-present Founder and Member , Hypothermia Post Card iac Arrest Committee , 2011-present 11 Research, Presentations & Publications: Posters Presentations 1. Schwab, F.J.; Farcy, D.; Hoffman, B.; Farcy, J-P .C.; Schechter, C.: Sagittal Plane Pelvic Rotation : A compensatory mechanism in spinal deform ity . Poster Presentation. Annual Meeting of the lntemational Society of Study of the Lumbar Spine. June 1999 . 2. Schwab , F.J.; Farcy, D.; Hoffman, B.; Farcy , J-P.C.; Gamez , L The Turkey as animal model for spinal degeneration : prelim inary findings. Poster Presentation. Annual Meeting of the International Society of Study of the Lumbar Spine . June 1999. 3. Schwab , F.J., Farcy, J.P., Farcy , D., Gamez, L., Pagala , M: Une analyse quantitative, radiologiue et clinique de Ia scoliose chez l'aduite avec un essai preliminaire de classification. Annual Meeting of the Group d'Etude sur Ia Scoliose . Bruxelles , 2004 4. Rouhizad , R. A.; Farcy, D.; The Usage of Recombinant Activated Factor VII for an Intracerebral Hemorrhage: A Case Report ; AOAJACOEP, San Diego, 2007 5. Scumpia , A.; Fernandez J.;, Cajina J.;, Longenecker B.;, Farcy D. EMTALA Knowledge Among Emergency and Medicine Residents : A Need to Become Educated! Annual meeting of ACOEP, San Francisco. Oct. 2010 and Florida ACEP , Boca Raton Fl , July 2010 . 6. Campfield N., Farcy D. Paraphimosis : A case Presentat ion . Florida AAEM Scientific Assembly , Miami Beach , Fl. Aug 2011 7. Suarez, J. Azubuike F. Cajina J., Farcy D. Aortic Dissection in the setting of end stage renal disease and bicuspid aortic valve . Florida AAEM Scientific Assembly, Orlando, Fl. Jan 2013. 8. David Farcy, Janelle Suarez . Therapeutic Hypothermia in post cardiac arrest patients : How long to reach target temperature, a retrospective study . 7 th. Mediterranean Emergency Medical Conference . Marseille , France. Sept 2013 1. Clinical Pathologic Conference. "Hypokalemia Period Paralysis " SAEM annual meeting , Orlando Fl, May 15 2004 . 2. Clinical Pearls and Visua l Diagnosis finalist. "Pacemaker failure " SAEM annual meeting , New York , May 23 2005 . 3. Sepsis Update. Medicine Grand Round . Mount Sinai Medical Center , Miami beach , FL. September 2006 4. Ultrasound Basic. Emergency Medicine Conference . Mount Sinai Medical Center , Miami beach, FL September 2006 5. Thoracic Trauma. Emergency Medicine Conference. Mount Sinai Medical Center , Miami beach, FL October 2006 6. IUP and Ultrasound. Emergency Medicine Conference. Mount Sinai Medical Center, Miami beach, FL November 2006 7. Mechanical Ventilation. Emergency Medic ine Conference. Mount Sinai Medical Center , Miami beach, FL January 2007 a. Ultrasound of Aorta Emergency Medicine Conference . Mount Sinai Medical Center, Miami beach , FL February 2007 9. Arterial Blood Gas Emergency Medicine Conference . Mount Sina i Medical Center, Miami beach, FL April 2007 12 10. Ultrasound Guided central line placement. ACOEP , COLA essentials Feb 6, 2007 11. Hypothermia in Post Cardiac Arrest. Medicine Grand Round . Mount Sinai Medical Center , Miami beach , FL November 14 2008 12 . Sepsis update . Medicine Grand Round. Mount Sinai Medical Center, Miami beach , FL May 2009 13 . Sepsis update . Medicine Grand Round. Mount Sinai Medical Center , Miami beach , FL June 2009 14. EKG interpretation for EMS . Grand round EMS week , Mount Sinai Medical Center, Miami beach , FL May 2010 15 . Hypothermia Grand Round . North Broward Hospital System , Broward, FL. June 2010 16. Mechanical Ventilation . Medic ine Grand Round . Mount Sinai Medical Center, Miami beach , FL Aug . 2010 17 . Sepsis update . Medicine noon Conference . Mount Sinai Med ical Center, Miami beach , FL Oct . 2010 18 . EMS hypothermia Post Cardiac Arrest. ACEOP Spring Seminar , Fort Laude rdale , FL , April2011 19. Disaster Response in Haiti. ACEOP Spr ing Seminar, April 2011 20 . Mechanical Ventilation . Florida American Academy of Emergency Medicine, Scientific Assembly , Miami Beach , FL Aug 2011 21. Sepsis Update . Florida Amer ican Academy of Emergency Medicine , Scientific Assembly , Miam i Beach , FL Aug 2011 22. Shock Update . Surgical Grand Round. Mount Sinai Medical Center , Miami beach , FL Oct 2011 23 . EKG : STEMI recognition . Emergency Department Teaching day , Mount Sinai Medical Center , Miami beach , FL Nov 2011 . 24 . Bedside Ultrasonography in Critica l Care . 3rd Annual State of the Science Symposium , Miami , FL. June 2012 25. Hypothermia in Post Cardiac arrest. Surgical grand Round , Mount Sinai Medical Center , Miami beach , FL , Aug 2012 26 . ACLS update and Hypotherm ia update , Emergency Med icine confe rence , Mount Sina i Med ical Center , Miami beach , FL. Aug 2012 27 . Critical Care Update. Florida American Academy of Emergency Medicine Sc ientific Assembly, Orlando , Fl. Jan 2013 28 . Scvo2 vs Lactate in EGDT. Mediterranean Emergency Medicine Congress , Marseille , France. Sept 2013 29 . Neuromuscular blockade or deep sedation in hypothermia for post cardiac arrest patient. Mediterranean Emergency Medicine Congress , Marseille , France. Sept 2013 30 . Scvo2 vs Lactate in EGDT . Emergency Medic ine conference , Mount Sinai Medical Center , Miami beach , FL. Oct 2013 31. Update in Sepsis Management , Temp le Un iversity , EM day . Ph iladelphia , PA Nov 2013. 32 . Surgical Airway. Emergency and crit ical care medicine : the cutting edge , Aruba, Jan 27-31 ,2014. 33 . Scvo2 versus Lactate in severe sepsis and sept ic shock . Emergency and critical care med icine: the cutting edge , Aruba , Jan 27-31 ,2014 34. Transvenous Pacemaker, 20 th Amer ican Academy of Emergency Medicine , New York , NY , Feb 12-15 2014 . 35 . C, 20 th American Academy of Emergency Medicine , New York , NY , Feb 12-15 2014. 36. CVP is useless . Dynamic marker of fluid responsiveness . 20 th American Academy Emergency Med icine , New York , NY , Feb 12 -152014. 13 Publications Chapter 1. Farcy D. Abu Khan . Sergey Motov. "Infant with Persistent Umbilical Discharge". Consultant for Pediatricians, 2005, val 4;2 , 81-82. 2. Sergey Motov . Abu Khan . Farcy D. "5 year old with Frost bite " Consultant for Pediatricians , 2004 ;vol 3,1 0, 488-491 3. Farcy, D. Hannan , H. Cohen, H. Marshall , J "My hand is swollen " Consultant 2005; vol.46 , 6, 703-704 4. Hernandez , C. Williams , J. Farcy , D. "Emergency Medicine -Critical Care Medicine: Are You Ready For the Critically Ill Patient?" EM Resident , October-November 2005 5. 'The Sepsis Card ". Emergency Medicine Residency Association pocket card. Endorse by ACEP , Surviving Sepsis Campaign , 2006 6. Menaker J, Farcy D et al. Cocaine-induced agitated delirium with associated hyperthermia: A Case Report , Journal of Emergency Med icine , sept 2008. 7. Hoffman RJ, Farcy D, Scalea T. Ethics , equipoise , and evidence : when should investigators decide to not test their hypothesis American Journal of Emergency Medicine-October 2009 Vol. 27 , Issue 8:983-985. 8. Farcy D. Petersen P. Rabinowitz D. Scalea T. Controversies in Fluids Resuscitation. Emergency Medicine Reports. 201 O,Vol. 31 ;14:157 -168. 9. Farcy D. Chan J. Rabinowitz D., Illuminating community acquired pneumon ia. Emergency Medicine . 2010, Vol42 :12; 14-20 10. Farcy D. Rabinowitz D. Marshal J. Ectopic glandular breast tissue in a lactating young female: a clinical communication , Journal of Emergency Medicine, 2011 , val 41:6 . 1. Farcy D., Chiu W., Scalea T. Critical Care Fellowship in Emergency Medicine. Emergency Medicine , The medical student survival guide. EMRA.2007 2. Gens D., Farcy D., Yeatts D.J. The Failed Airway . Critical Care Emergency Medicine . 1th ed . New York : McGraw-Hill ; 2011 . 3. Farcy D., Petersen P., Heard D., DeBiieux p. Mechanical Ventilation. Critical Care Emergency Medicine. 1th ed. New York: McGraw-Hill; 2011. 4. Farcy D., Rabinowitz D., pieri P. Extracorporeal Cardiopulmonary Membrane Oxygenation . Critical Care Emergency Medicine. 1th ed. New York: McGraw-Hill ; 2011 . 5. Farcy D., Yashou J., Rivers E. Sepsis and Septic Shock. Critical Care Emergency Medicine . 1th ed. New York : McGraw-Hill ; 2011. 6. Osborn T.M., Farcy D. Classification of Shock. Critical Care Emergency Medicine . 1th ed . New York : McGraw-Hill; 2011 . 14 Pod cast: 1. Albert David ; David Farcy,; Keeping our children Safe and Healthy from pre-K through High School. Abey World Press , 2007 2. Senior Editor of Critical Care Emergency Medicine. 1th ed. New York : McGraw-Hill; 2011. American Academy of Emergency Medicine Critical Care Podcast 1. Review of the Updated Surviving Sepsis Campaign 2. Scvo2 vs Lactate Clearance in Early Goal Directed Therapy 3. Hypothermia for Post-Arrest Patient with ROSC part 1 4. Hypothermia for Post-Arrest Patient with ROSC part 2 s. Post Cardiac Arrest Syndrome s. Central venous Pressure versus dynamic maker like ultrasound May 2013 July 2013 Sept2013 Sept 2013 Dec 2013 Jan 2014 Unpublished Research, Pending Publication Personal: References: 1. Church , A. Farcy , D. Utility of an Off-service Orthopedic Rotation for Emergency Medicine residents . Manuscript is in process. 2. Farcy, D. Suarez J. Hypothermia for post cardiac arrest in a community teaching hospital , Article submitted to WEST. Special Interest: Tactical medicine , Critical Care , Hypothermia, Early Goal Directed Therapy and Ultrasound Languages: Fluent in French and Spanish Thomas M. Scalea, MD, FACS Physician-in-Chief R Adams Cowley Shock Trauma Center 22 south Greene St. Suite T3R32 Balt imore , MD 21230 ( 41 0) 328-8976 tscalea@umm.edu 15 02/17/2014 10:33 3056742602 ER CARDIC PAGE 01/01 16 17 Granado, Rafael From: Grieco , Michael Sent: To: Tuesday, February 25 , 2014 6:10 PM Granado, Rafael Cc: Subject: Hatfield, Liliam ; Prieto, Silvia ; Martinez, Maria; Bonini, Danila ; Granado, Rafael Re : Board and committee package submitted by Dr. David A. Farcy Private individual Sent From my I Phone , please excuse any typos. Michael C. Grieco Commissioner, City of Miami Beach Emails from and to this address are subject to public records laws pursuant to Florida Statutes. >On Feb 25, 2014, at 5:49 PM, "Granado, Rafael" <RafaeiGranado@miamibeachfl.gov > wrote: > >Good afternoon Commissioner Grieco, > >You have nominated Dr. Faycr to the "Mt. Sinai" Administrator Position in the Health Advisory Committee. That position is occupied by Steven Sonenreich. > > Currently there are three vacancies, to wit: > > . The chief executive officer (CEO) from Stanley C. Myers Community Health Center or his designated administrator. >. The administrators from an adult congregate living facility (ACLF); and/or an assisted living facility (ALF). >. One private individual. > >Would you like to nominate Dr. Faycr to one of these three positions, possibly the Private Individual Positions? > >Regards, > > MIAMIBEACH > Rafael E. Granado, Esq ., City Clerk > CITY CLERK'S OFFICE > 1700 Convention Center Drive, Miami Beach, FL 33139 >Tel: 305-673-7411 www.miamibeachfl.gov > >We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. > > > >-----Original Message----- > From: Grieco, Michael >Sent: Thursday, February 20, 2014 12:01 PM >To: Hatfield, Liliam > Cc: Mayor's Office; dfarcy@me.com ; Prieto, Silvia; Martinez, Maria; 1 18 >Granado, Rafael; Bonini, Danila >Subject: Re: Board and committee package submitted by Dr. David A. > Farcy > > Please nominate Dr. David Farcy for the designated Mt. Sinai administrator position on the health advisory committee and ensure placement on the march commission agenda. > > Sent From my I Phone, please excuse any typos . > > Michael C. Grieco >Commissioner, City of Miami Beach > > Emails from and to this address are subject to public records laws pursuant to Florida Statutes . > »On Feb 19, 2014, at 9:29AM, "Hatfield, Liliam" <LiliamHatfield@miamibeachfl.gov> wrote: >> >> »Attached please find board and committee application, resume, license and photograph, submitted by David A. Farcy, M.D., who is interested in serving in one of the following boards: >> » Choice 1: Health Advisory Committee »Choice 2: Health Facilities Authority Board >> » Respectfully submitted, >> >> » MIAMIBEACH » Liliam Hatfield, Office Associate V » CITY CLERK'S OFFICE » 1700 Convention Center Drive, Miami Beach, FL 33139 »Tel: 305-673-7411/ Fax: 305-673-7254 I >> www.miamibeachfl.gov<blocked::blocked ::http://www.miamibeachfl.gov/> >> »We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. >> >> »<David A. Farcy, M.D. board application package.pdf> <imageOOl.gif> 2 19 THIS PAGE INTENTIONALLY LEFT BLANK 20 Parks and Recreational Facilities Board Youth Center • Dana Turken 21 THIS PAGE INTENTIONALLY LEFT BLANK 22 Dana Turken 23 THIS PAGE INTENTIONALLY LEFT BLANK 24 G //1/AJ /\!EACH NAME :~ JuAJ( ~ Last Name~ \ HOME AOORESS~O.f> -j/ LJrrL-/~o 7E(vt CfTY OF MIAMI BEACH BOARD AND COMMrTTEE APPLICATION FORM First Name Middle Initia l ~ ~, & 3.S/.Y ") Apt No . House No./Street PHONE: ;) aJ' ~ -f5 b) -So Ool._ '"'J;J-.Jr1 -f'<f ?t ~c~rt~y~~--------~s~~·'---~~~P-~~o-d~e- s£/n 0/)'7C/I\ k~ 6 #}/f-.{_,~ Home Work Fax Email address Business Name :-------------------------------Position :----------------------- Add~ss : __________ ~--------------~~------------~~---------~----~~~~--No . Street City State Zip .Code Professional Ucense (describe)-------------------------------Expires : ______ Attllr:h • copy of the /icen•t Pu111uant to City Code aection 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 individua l shall have · been a resident of the city tor a minimum of six months ; or b) an individua l shall demonstrate ownership/interest for a minimum of six months in a business established in the city . • Resident of Miam i Beach to r a minimum of six (6) months : Yes 0 or No 0 • Demonstrate an ownership/interest in a business in Miam i Beach tor a minimum of six (6) months: Yes o or No o • Are you a registered voter in Miami Beach : Y• 0 or No D • (Please grm one): I am now a resident of: Norttl BNch Soutil Beach Mldd6e Beach • 1 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? Yes 0 or No 0 Pleue list your pnnrances in order of ranking [1] firat choice [2]second choice , and [3] third choice. F'IH!t nota thlt ontv th!!! (3 ' chola. will be ot.erwd bv the Cltv Clertr:'a Offtce (Regular Boartts of City) 0 At'tord.tM HoUiing Advillory Commltble 0 Houaing Authority 0 Art In F'ublic F'l8ce& Commlbee 0 Loan Review Commltile 0 Buuttticdon Cornmttt.e 0 Marine Author1ty 0 eo.d of Ad;UibnBnt* 0 Mt.ml Beach Cammiaion for Women D Buc:IDBt .,.,.,;.., 1 Commltile D Mt.mi a.ch Cultural Arts Council 0~1 F'raiect& Cammlbae D Mt.ml Buch Siltllr Cltills Proarwn 0 Ccmmltllle on the Homeills ON Shcns Local Govarrment Neiah . 0 Commlblle fer QualitY Education in MB 0 F'artcs and Recreation Facilities Board o Communttv O.V.acmwrt Advisory 0 Personnel Board 0 Communtty R*tions BOIIrd 0 F'lannina Boan:r 0 Convention Cenlar Advisory Board 0 Police Citizens Relations Commlbe 0 Debarment Commltile o F'roduction Ina~ Council 0 Deeign Review Boartr 0 F'ublic Saf8tv ~ ... ;...,, Commltlae D Disability Aetas Commltllle 0 Sa1atv CommiUee 0 Fine Arts Board 0 Singte Family Residential Review Panel 0 Gay , Lesbian. Bilexual and Transgencier (GLBT) D Sustainablllty Commltllle 0 Golf ....... ~. r Commlbae DTra Reliablltty & ,6.,..,.... I Commllble 'TRAC" 0 HMith Commlttlle 0 Transportation and Parking CommiUBe D Health F aclllties Author1tv Board o Visitor and Convention Authority 0 HiBPanic Aftairs Commmae 0 ,~_ .. .,...,· ... nt Protection CommiUee D Historic Preservation Board ~'outh Center Advisory Board "Board Required to File State Discl011ure Form Note : If applying for Youth Advisory Board . please indicate your affiliation with the Scott Rakow Youth Center: 1 . Past service on the Youth Cente r Advisory Boa~ No ~ Years of~: __ _ 2 . PreHnt participation in Youth Center activities oy you r children Yes J ~If yes , please list the names of. your children , thei r ages , and whiCh programs List below Child's name · Age : __ Program : --------------- Child 's name : Program : 0 · \~lEP. ·,~AI.~ \cF':>RIII'.S \B':>AR C AND :OMMITTEES\BC Accl•cct•on062609 N:W .do: 25 •Have you eve r oeer. :;:>nv1::tec o7.1on y Yes · ~ i' ves . please explai.etail: • Do you currently have a vio latlon ts) oi City of Miami Beach ::odes : Yes ~ o r No : yes . p lease explalr; 1r. detai !: • Do you currently owe the City oi Miam 1 Beach an y money: Yes : o r No ~s explain m detail • Are you currently serving o n an y Cit y Boards o r Committees : Yes · r No ~--If yes whd·; board? '1crv1-A (!_ ~n:tt. w • What organizations m the City of Miam i Beach do you currently hold membership m? Name : ____________________ T itle ·------------------- Name : Title : __________________ _ • List all p~rties owned or have an interest in , which are located within the City of Miami Beach: trw.trlL ·. • I am now employed by the City of Miami Beach : Yes rJ • Pui"Buant to Ctty Code Section 2-25 (b): Do you have a parent 0 , spoUBe D, child C, brother C:, or sister D who is employed by the City of Miami Beach? Check all that apply . Identify the department(&): The foflowtng information is volum.ry and Is Mltlwr pllrt of your application nor ha any t..rtng em your constct.rdon tor appointment. being uud to comply with federal equal opportunity reporting reCfUINmenta. Gender: 0 Male ~le Ethl)ie"Origin: Check one only (1) ~ (Not of Hispanic Origin): Al l penons haVIng origins In any of the original peoples of Europe , North Africa or the Middle East . 0 Afric:a~mericaniBaack (Not of~ Origin): .All penons having origins in any of the Black racial groups of Africa . 0 ~: All p8I"SDn6 of Mexican. F>latD Ran. eut.r\, c.wra1 or South Amertcan . or other Spanilh ClJture or origin .~ of race . It is 0 --or P.clftc ..._!dar. All ~ twWig Drigln5 In any at the orlginlll peoples of the Far Eat. ScKiheest Alia, the lndl8n Sl.ix:ontlnent. or the Pacltc latanaa. Thll .. inc&!~*, tar ..... Ct*w., India . Japan , Korea . the Pt-..ne tallmds lnd Soma&. o ~ • ......, • ~ ......_: All ~ ~wv~ng origins in lnY of the original peop~es of North America, n who IMinlllln Cdllnl id&i dlllcidkJ; 1 through trt.l ~ or comrrullty recognition . Pnyaicalty CnaUengect: Y• o or NoD. Employment Status: Employed 0 ~ro __________________________ __ NOTE : If appotm.cl., you wll be -.-q'*-1 to tolkJw certain laws which apply to Ctty boardlcomm.._ membera. TheM laws mctude , but are not lmllacl to, the tollowtng : o Prohibition from directly or indirectly lobbying city personne l (Miam i Beach City Code section 2-459). o Prohlbttion from contracting with the city (Miami-Dade County Code section 2-1 1 . 1) o Prohibition from lobbying bBfcre boardiCDTtmltiBe you have sei'V'8d on for period of one year nr leaving office (MI&m t Beach City Code II8Ction 2-28). o Requirement to d~ certain financial intBreats and gifts (Maam i-Dade County Code 98Ciion 2-11 .1 ). (re : CMB community o..elopnent AdYtsory Commlbae): prohibition . during tenure and for one year llflllr luving offl:::e from having any ~ in or rao8Mng any benefit from Community Development Block Gnmt funds for either yourself or those with whom you hhe buairas or immediat!e family ties (CFR 570.611). Upon ,.queat, ~ of tt..e l8ws may be obtained from the City Clert.. "I hereby 11tt11et to the accur~~cy and truthfulnees of the application and h•ve received , naad •nd will abide by ChaDte r Z. A cle vtl -of the City Code "Standards of Conduct tor City Officers;, mployees and ~ency Membeno ." /. 8--/) I 0 If-A) ,f T c.) I(. IC.JvJ of Apol1can l (PLEASE PRINT ) /Jv,~~vLC~ Rece•vec 1r1 tne 8 ity ::1erk·s :::>ff1ce oy 26 Granado, Rafael From: Sent: To: Cc: Subject: HI all, Miranda, Alex Thursday, February 13 , 2014 10:58 AM Malakoff, Joy; Granado, Rafael Stewart, Bonnie ; Rebar, John; Hernandez, Leonor RE : Tennis and Golf Mayor Levine would like to nominate Dana Turken. to fill the Scott Rakow position . Thanks, Alex -----Original Message----- From: Malakoff, Joy Sent: Thursday, February 13, 2014 9:17AM To: Granado, Rafael Cc: Miranda, Alex; Stewart, Bonnie; Rebar, John Subject: Tennis and Golf The Mayor and Commission will now need to select two tennis players and two golfers plus one parent with child or children at the Scott Rakow Youth Center and one with children at North Shore Youth Center to serve on the new combined Parks and Recreation Board . I am nominating David Berger for tennis and Gail Williams for golf. Thank you. Joy Sent from my iPhone Commissioner Joy V. W . Malakoff 1 27 THIS PAGE INTENTIONALLY LEFT BLANK 28 Parks and Recreational Facilities Board Golf • Gail P. Williams 29 THIS PAGE INTENTIONALLY LEFT BLANK 30 Gail P. Williams 31 THIS PAGE INTENTIONALLY LEFT BLANK 32 MIAMI BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME : Williams Last Name HOME ADDRESS : 1000 5. Pointe Dr. #2101 Apt No . PHONE : 301-910-5111 Home Home No./Street 786~359-4321 Work Gail First Name Miami Beach City Fax Fl p Middle Initial State gpwill1 @aol.com Email Address 33139 Zip Code Business Name : Williams McCall Gallery LLC Address : 110 Washington Avenue, CU-3 Street Position : Owner --------------------------------------- Miami Beach City FL State 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; 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 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 registered voter in Miami Beach : Yes • (Please circle 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: I have extensive business experience in marketing strategy, business development, customer operations, retail management, a • Are you presently a registered lobbyist with the City of Miami Beach? No Pl~ase list your preferences in order of ranking [1) first choice [2] second choice , and [3] third choice . Pl«iase note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Golf Advisory Committee Choice 2: .Fine Arts Board Choice 3: Miami Beach Cultural Arts Councii Note: If applying for Youth Advisory Board , please indicate your affiliation with the Scott Rakow Youth Center: 1. Past serv ice 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 If yes , please explain in detail : • Do you currently owe the City of Money 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 membership in? • List all properties owned or have an interest in, which are located within the City of Mia.mi Beach : 33 t:•rty 1000 S . Pointe Dr ~210~---·------------_j j11 0 Washington Ave . .CU-3/4 ---~ • I am now employed by the city of Miami Beach : No Wh i ch department? 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 . Gender: Female Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. African-Americ;:an/Biack Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish I Hispanic I Latino. No Physically Challenged: 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 Prqhibition from directly or indirectly lobbying city personnel (Miami Beac;h City Code section 7-459). 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 lei disdose certain financial interests and gifts (Miami-Dade County Code section 2-11.1 ). (re : CMB Community Development Adv isory Committee): prohibition , during tenure and · for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties (CFR 570.611 ). 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 Gail Williams. agreed to the following ·terms on 9/16/2013 6:09:26 PM Received in the City Clerk's Office by : Name of Deputy Clerk Control No . Date 34 Experience: 2/12-present 1/09-2/12 2/06-12/08 4/03-2/06 5/98-4/03 7/93-5/98 GAIL P. WILLIAMS 1000 S . Pointe Drive #21 01 Miami Beach, FL 33139 301-910-5111 (Cell) gpwill1@aol.com WILLIAMS MCCALL CALLERY, LLC Owner Miami Beach, FL The Williams McCall Gallery is the newest addition to the trendy South of Fifth neighborhood of South Beach, an9 the first fine art gallery in the area. The stylishly minimalist gallery exhibits emerging, mid-career and established artists creating contemporary works on paper, paintings, fine art photography, encaustic collage and sculpture . The mission of the Williams McCall Gallery is to bridge various artist · communities and provide its artists greater exposure to new markets . INTERNATIONAL MEDIA & ENTERTAINMENT PARTNERS, LLC Interim Managing Partner! CFO Miami Beach, FL/Washington, DC Advising media companies on how to build or strengthen their businesses outside their home borders. Leverage expertise in marketing strategy, account'management, and finance to develop solutions that meet the needs of clients. Responsible for the fi.nancial .management of the finn . CAlL P. WILLIAMS, CFP® Bethesda, MD . CFP ®Professional Served individuals and small businesses with comprehensive financial planning services. Developed and implemented financial solutions that helped clients create, grow, preserve and transfer their wealth in the most tax-advantaged way. SUNTRUST BANK Wealth and Investment Management First Vice President/Private Client Advisor Washington, DC Served as a trusted advisorto the bank's most affluent clients. Primary relationship manager on $120 million in investment assets. Annual production in excess of $3 million. Promoted from Vice President in 9/06 . Licenses included NASD Series 7, 66, and 65; Life/Health/Variable Annuity in multiple states. PRUDENTIAL SECURITIES IN CORPORA TED Private Client Croup Wealth Advisor Miami FL/Bethesda, MD Certified Financial Planner in the Bethesda, Maryland branch office. Provide individuals and businesses with comprehensive fee-based financial planning and investment advisory services . Built successful practice from scratch . CW CONSUL TINC SERVICES President Miami,FL Advised emerging businesses in the cable television and new media industries on .consumer marketing and sales strategy, product management, strategic ·partnering, business development and customer operations . Clients included Sega Channel and America Online . 35 GAIL P. WILLIAMS 1000 S. Pointe Drive #2101 301-910-5111 (Cell) gpwilll @aol.com Pagel 8/90-7/93 1179-8/90 6/77-7178 Education: Boards: 2007 -present 2010-present 2002-2012 Other: TIMES MIRROR CABLE TELEVISION, INC. Irvine, CA Vice President of Marketing and Sales (6/92-7/93), Vice President of Field Marketing and Sales Development (8190-5/92). Actively managed the national marketing, sales and customer operations functions . Responsible for all acquisition, retention and value-building programs. Developed award-winning direct response marketing, brand and usage campaigns. Instituted product line organization; managed $16 mi Ilion budget and staff of six. HOME BOX OFFICE, INC. New York, NY Regional Director (7/87-7/90); National Accounts Director (1/84-6/87); National Accounts Manager (5182-12/83); Regional Manager (2/80/8180); Account Executive (J/79-2/80). Progressively responsible sales executive positions in national accounts and regional operations in San Francisco, New York and Los Angeles. Exceeded goals every year; negotiated HBO and Cinemax .distribution contracts; designed deal valuation models; and created marketing strategies to promote premium subscriptions and re.tention. CHASE MANHATTAN BANK, N.A. New York, NY Credit Ana~}·st Recruited out of college for top credit training program on Wall Street. Performed financial analyses of mid-sized companies for credit purposes . MBA, Harvard Business School, 1982 BS, The Wharton School, University of Pennsylvania, 1977 Web Design Certificate, University .of Miami, 2011 Travel Video Certificate, The Travel Channel Academy, 2010 PROVINCETOWN ART ASSOCIATION AND MUSEUM Provincetown, MA Board of Trustees and Dev.elopment Committee Membe.r The mission ofPAAM is to promote and cultivate all branches of the fine arts, to asse1nble and maintain a collection of works of art of merit, to hold exhibitions, and to promote education of the public in the arts. PROVINCETOWN FILM SOCIETY Provincetown, MA Board of Trustees, Finance, and Development Committee Member The Provincetown Film Society is dedicated to showcasing new achievelnents in independent American and intemationa.l film; honoring the work of acclaimed and emerging director5 1 producers and actors; and preserving film as an art form. FOOD AND FRIENDS Washington, DC Bqard ojDirectors, Treasurer, and Finance Chair The mission of food & Friends is to foster a community caring for men, women and children living with HIV/AIDS, cancer, aild other life-challenging illnesses by preparing and delivering specialized meals and groceries in conjunction with nutrition counseling. Certified as a CFP Licensee by the Certified Financial Planner Board of Standards; 9199; member of Highland Links Golf Course, Truro, MA. 36 37 MIAMI BEACH OFFICE OF THE MAYOR AND COMMISSION TO : FROM : DATE: Rafael E. Granado, City Clerk Joy V. W . Malakoff, Commissioner January 13, 2014 MEMORANDUM SUBJECT : BOARD & COMMITIEES APPOINTMENTS FOR YEAR 2014 Please appoint as follows: Board & Committee Appointee Golf Advisory Committee (Parks & Recreation Facilities Board-Golf Position) Gail Williams If you have any questions, please contact Bonnie Stewart at extension 6722. JVWM/bhs We ore commiffed to providing excellent public service and safety to all who live , work. and ploy 1n our vibrant , tropical, historic community . 38 Granado, Rafael From: Sent: To: Cc: Subject: Malakoff, Joy Thursday, February 13 , 2014 9:17AM Granado, Rafael Miranda, Alex; Stewart, Bonn ie; Rebar, John Tennis and Golf The Mayor and Commission will now need to select two tennis players and two golfers plus one parent with child or children at the Scott Rakow Youth Center and one with children at North Shore Youth Center to serve on the new combined Parks and Recreation Board . I am nominating David Berger for tennis and Gail Williams for golf. Thank you . Joy Sent from my iPhone Commissioner Joy V. W. Malakoff 1 39 Granado, Rafael From: Sent: To: Cc: Subject: Malakoff, Joy Thursday, February 20 , 2014 1:30 PM Granado, Rafael Miranda, Ale x; Stewart , Bonnie Parks and Recreation Committee The Commissioners need to select two representatives from the Tennis community, two from Golf, one from Scott Rakow Youth Center with children in programs there, and one from North Shore Youth Center with children there, to the new Parks and Recreation Committee . I have already nominated David Berger (chair of the old Tennis Advisory committee) and Gail Williams, member of the former Golf Advisory committee to serve in these capacities . Other commissioners may want to make nominations as well, along with members for the P&R from the two Youth Centers . Joy Sent from my iPad Commissioner Joy V,W . Malakoff 1 40 Parks and Recreational Facilities Board Tennis • David J. Be r ger 41 THIS PAGE INTENTIONALLY LEFT BLANK 42 David J. Berger 43 THIS PAGE INTENTIONALLY LEFT BLANK 44 MIAMI BEACH NAME: Berger Last Name HOME ADDRESS : 1836 WEST 23 STREET Apt No. PHONE : 3055329500 Home Home No./Street 3055329500 Work David First Name Miami Beach City Fax CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM FL J Middle Initial State 33140 Z ip Code bergerdav@aol.com Email Address Business Name: ________________ Position : --------------------- Address: Miami Beach FL Street City State 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 ; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a bus iness 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 min imum of six (6 ) months : Yes • Are you a registered voter in Miami Beach : Yes • (Please circle 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: Former Chair of Tennis Advisory Committee and Tennis Management Contract Evaluation Committee, former Special Counsel t • Are you presently a registered lobbyist with the City of Miami Beach? Yes 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: Tennis Advisory Committee Choice2: Planning Board* Choice 3: Health Facilities Authority Board 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 deta il: • Do you currently have a violation(s) of City of Miam i 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 : No Chaired Tennis Advisory Committee untll12/31/13 • What organizations in the City of Miami Beach do you currently hold membership in? If yes , please expla in in detail : If yes, please explain in detail: If yes, which board? • List all properties owned or have an interest in , which are located within the City of Miam i Beach : • I am now employed by the city of Miami Beach : No Which department? 45 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. Gender: Male Race/Ethn ic Categories What is your race? Mark one or more races to indicate what you consider yourself to be . White Other Description : Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish I Hispanic I Latino. No Physically Challenged : No NOTE : If appointed, you will be required to follow certain laws which apply to city boardlcommlttee members. These laws Include, but are not limited to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miam i Beach City Code section 2-459). o Proh ibition from contracting with the city (Miam i-Dade County Code section 2-11 .1 ). o Prohibition from lobbying before boardlcommittee 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 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. "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 David Berger agreed to the following terms on 1/18/2014 4:06:23 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No . Date 46 IV\ I AMI BEAC AN C0 111 ,11TT cE ?PLICAT ION FORt>.l Bt:re.Gt t R.. Last Name Firs Name Middle Initial ,·~~·· Bett(.k FL 33/tfO Home Address State Zip Code { her9erda.V~Cl.O .co~ 3oS" w.r-ll'f'i Email address VIe! .::r""ve.1f.or AAcH\ 11 ) ...l Home Te lephone Work Telep h one Cellular Telephone R~o.l Es-kif( E. 1> Occupa tion Busi ness Name Business Address City State Pro fess ional License (des cribe): A+fov"t'le ~, ~eo..( E~We. 'Broke y-Expires: ..:.fw.;._..:..:..:...:..:;;..:;.....;..;:;..-=..;..:.,_;;,~ Please attach a copy of currently effecti ve professional license. on lv three (3) choices will be observed by the City Clerk s Office. 0 Ad Hoc Charter Review and Revis ion Board 0 Debarment Committee 0 Miami Beach Huma n Rights Committee 0 Ad Hoc Committee Centennial Ce le bratio n ~esign Review Board' -& 0 Mia mi Beach Sister Cities Proa ram 0 Ad Hoc Committee Flooding Task Force 0 Disability Access Committee 0 Normandy Shores Loca l Govern ent Neigh borhood Improvement 0 Affordab le Housing AdVISory Committee 0 Fine Arts Board o Parks and Recreation Facil ities Soard 0 An in Public Places Com littee 0 Gay, Lesbian . Bise xual and Transg ender 0 Personn el Boa rd Enh ancemen t Comm ittee IGL BT ) I C! Beautification Comm ittee o Go lf Advisory Committee }!(P ianninQ Board 't:r LlA.a 0 Blcvcle-Pedestrlan Advisory Committee 0 Hea lth Advisorv Co mmittee ..... D Police Citizens Re lations Co mmi ttee w Board of Adjustment ' * ~earth Fa clfitles Authority Bo ard 31a... 0 Produc ti on Industry Cou ncil D 5udQet Advisory Committee 0 Hisoamc Affairs Committee 0 Sa{ety Commi tt ee Capi!al Improve ments Projects Overs ight 0 Historic Preservatio n Board 0 Sing le Family Resident ial Review Pan el Committee T:r 0 Committee on the Home ll:l::.::. 0 Housing Authority D Sustainability Co mmittee 0 Committee for Quality Ed ucatio n in Ma 0 Loan Review Committee )(Tennis Advisorv Committe e J ~,..Ale) 0 Commun ity Development Advisory Committee D Mari ne Authority 0 Transportat ion and Park ing Committee~ ~0 Com mumr~ Relations Board 0 Miami Beach Commiss ion for Women 0 Visitor and Convention Authori ty I :Convention Center AdVJSO!}: Board 0 Miami Beach Cultural Arts Council 0 Youth Center Advisory Soard .. 0 Waterfront Protection Committee * Board members are re quired to file Form 1 -"Statem ent of Financi al Interest" with the State. "kIf you seek appointment to a professional seat (e .g ., lawyer, architect , etc.) on the Board of Adjustment. Design Rev iew Boa rd , Hist o ric Pre se rvation Board or Planning Board, atta ch a copy of your currently -effectively license, and furnish the foll owing information : Type of Prof essiona l License i='lo v:d" Sc.r-License Num ber 2..(3>~1Q License I ssuance Date l'\l j License Expi rati on Dat e tJ I A 47 00 Note : If applying for Youth Center Adv isory Board. pl ease indicate your affiliation with the Scott Rakow Youth Center. 1. Past service on the Youth Cent er Advisory Board : Yes 0 No 0 Dates of Service : --------------- 2 . Present participatio n in Youth Center activities by your children : Yes (]j No 0 If yes . please list below the names of your children, their ages and the programs in which they participate : Child 's name :----------------- • Ha ve you ever bee n convicted of a felo ny? Yes Age:___ Program: -------------- Age :___ Program : -------------- If yes. please explain In deta il: • Do you currently ha ve a vi olation (s) of Ci ty of Miami Beach Code? Yes 0 or N If yes, please exp lain In detail: • Do you currently owe the City of Miami Beach any money? Yes 0 or No~ If yes , explain in detai l: • Are you now empl oyed by the City of Miami Be ac h? Yes Which department and title?---------------------------------- • Purs uant to City Code Section 2-25 (b): Do you have a parent , spouse 0 . child 0 brother 0 or sister 0 who is emp loyed by the City of Miami Beach ? Check 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 be in g asked to comply with City diversity reporting requirements. Gender : Male Race /Ethnic Categories What is your race? 0 Af rican-American/Bl ack ~ Caucasian hite 0 Asian or Pacifi c Islander 0 Native-American/American Ind ian 0 Other -Print Race ·------------------------------- Pag e 2 of 4 "F·1CLER ALL\aFOR SIBOA RD AND COM ITIEES',SC AP PLIC ATION 46 BOARDS I ·16-2 013 doc 48 Do you consider yourself to be Spanish, Hispanic or Latina/a? Mark the "No' box if not Span ish, Hispanic , Latinola . [8)No Oves Do you consider yourself Physically Disabled? [E) No Oves NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD /COMMITTEE MEMBERS. THESE LAWS INCLUDE , BUT ARE NOT LIM ITED 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 boa rd/committee you hav e served on for period of one yea r 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 ). CM B Community Development Advisory Committee : prohibition , during tenure and for one year after leavi ng office , from having any inte rest in or receiving any benefit from Community Development Bloc Grant fu nds for either yourself, or those wi th whom you have business or immediate family ties (C FR 570.611). o S nshine Law -Florida's Government-in-the-Sunshine Law as enacted in 1967 . Today, the Sunshine Law regarding open government can be fo und in Chapter 286 of t he Florida Statutes. Th ese statutes establish a bas ic right of access to most meetings of boards , commissions an d other governi ng bodies of state and local governme ntal agencies o r authorit ies . Voting confl ict -Fo rm 8B is for use by any person serving at the county, city or other local leve l of government on an appointed or elected board , council. commission , authority or committee . It applies equally to members of advis ory a nd non-advisory bodies who are presented with a voting conflict of interest under Section 11 2 3143 , Fl orida Statutes . Upon request, copi es of these laws may be obtained from the City Clerk. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION ; AND I HAVE RECEIVED , READ AND WILL ABIDE BY CHAPTER 2 , ARTICLE VII , OF THE MIAMI BEACH CITY CODE , ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLY." cw , J T. .:& e. r-e v Date Name of Applicant (PLEASE PRINn R ece~ed~~eOyCier~s Officeby:~~~~~~~~~~~~~~~~~~~~~~~~~~~~~- Nam e of Deputy Cle rk Contro l No. Date 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 •CL!:R SALL.aFORMS1BOARD AND COMMrrTEES BC APPUC:,TION 4 BOARDS 12,16-2013 dec 49 MI AMI BEAC H City of Miami Beach 1 700 Convention Center Drive, Miami Beach , Florida 33139, www.miamibeocbA.9ov CITY CLERK'S OFFICE Telephone: 305 .673.7411 Fox : 305.673.7254 CityCierk@miomibeochA .gov 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) I understand tha t no later than July 1, of each year all members of Boards and Committees of the City of Miami Beach, includin g those of a purely advisory nature , are required to comply with Miam i-Dade County Financial Disclosu re Requirements . This means that the members of City Advisory Boards whose so le or primary respons ibili ty is to recomme nd legislation or g ive advice to the City Comm ission , must file , even though they may have been rece ntly appointed . One of the fo llowi ng forms must be filed with the City Clerk of Miami Beach, 1700 Convention Cent er Dr ive , Miami Beach , Florida , no later than 12 :00 noon of July 1, of each year. 1. A "Source of Income Statement" For your convenience , the form is attached . The form can also be down loaded at: http://www.miamidade.gov/elections/library/source of i ncome statement.pdf 2. A "Stateme nt of Financial Interests (F orm 1)" For your convenience , the form is attached . The form can also be downl oaded at: http://www.ethics.state.fl.us/ethics/forms.html 3. A Copy of yo ur 2013 Federal In come Tax Return Failure to file one of these forms , purs ua nt to the Miami-Dade County Code may subject the person to a fine of no more than $500 , 60 days In jail or both . Signature Update d : Monday, Dec em ber 16, 2013 Page 4 of 4 F:\CLERISA LLi aFO RMS'.SOt,RO AND CO M MITIEESIBC APPLI CATION 6 BOARDS 12·16-20 13.doc Date 50 DAVID J. BERGER David J . Berger is the founder, president and principal shareholder of Mega Capital Corporation, a privately held real estate and corporate investment business and a licensed real estate brokerage entity . All investment transactions originated by Mega Capital are conducted through separate special purpose private investment entities. Mr. Berger is an attorney , real estate and corporate investor, real estate dev eloper and merchant and investment banker. Mr. Berger brings a broad base of talents and multi-dimensional experiences to his ventures. For sixteen years, Mr. Berger practiced law as a prominent real estate and business attorney. He was a senior partner in the statewide Florida law firm of Broad and Cassel , resident in the Miami office and a member of its management committee and head of its real estate group in Miami . As a lawyer, Mr. Berger has extensive legal experience in the areas of real estate , corporate business, finance , government contracting, lending and other areas . While a practicing lawyer, Mr. Berger handled a great number of sophisticated and complicated projects well in excess of one billion dollars and has repre sented creditors, debtors, owne rs and government agencies involved with a multitude of real estate , business, financing, financial and other creative matters in virtually every product type. Mr. Berger has served as Special Counsel to the City of Miami Beach and to its Redevelopment Agency in connection with a variety of transactions including various public private ventures , acquisitions , negotiations, eminent domain, RFPs (including the Loew's Hotel and African-American Hotel RFPs) and tax increment financing transactions . In this capacity he has worked closely with the City Attorney and City Manager office. He has also served as Chair of the Tennis Advisory Committee, Chair of the Tennis Evaluation Committee, Chair of the City 's Health Facilities Authority and member of the Convention Center Capital Improvements Committee. Mr. Berger left the practice of law and went into business full time in 1995 as an active real estate and business investor as well as an investment and merchant banker. David is a founding member of a merchant banking and investment banking business involved in debt and equity fundings , business and financial negotiations , strategy , consulting and advisory se rvices , business analysi s, turnarounds , debt restructures and other matters. David Berger has been a successful real estate and business inve stor and developer for more than thirty years through a variety of entities and a myriad of product types. His proj ects includ e office , indu strial, retail , multi- family , leisure, government occupied , and other uses, including a vari ety of mixed uses, with primary focus on industrial , office , retail and leisure . Mr. Berger's real estate and busines s activities focus on value-creation wh ere he and his partners develop and implem ent strategic solutions and structures fo r hi s real estate business interests . David Berger received his Bachelor 's Degree from the University of Florida and his Juris Doctor Degree from the University of Miami where he was an editor of the law review . Mr. Berger has an A V rating from Martindale- Hubbell which represents the highest rating for legal skills and ethical considerations as determined by other lawyers in Florida . David Berger is a licensed member of the Florida Bar and a licensed Florida real estate broker and Mega Capital Corporation is a licensed Florida brokerage company . Mr. Berger is involved in , and has served on the boards and as chair of numerous charitable and civic organizations, including th e Greater Miami Hebrew Academy where he served as Chair of the Board for many years . Perhaps most relevant is that David Berger is an avid sportsman, with particular interest in tennis and golf. He grew up in Miami Beach where he continues to reside. He regularly plays tennis at the various City parks (usually Flamingo Park) several times per week and is familiar with th e City 's te nnis centers and has insight into the needs of th e tennis sports community and the managem ent and operations of the tennis facilities . 1111 14 51 52 MIAMI BEACH OFFICE OF THE MAYOR AND COMMISS ION TO: FROM : DATE : Rafael E. Granado, City Clerk Joy V . W . Malakoff, Commissioner January 13, 2014 MEMORANDUM SUBJECT : BOARD & COMMITIEES APPOINTMENTS FOR YEAR 2014 Please appoint as follows : Board & Committee Appointee Tennis Advisory Committee (Parks & Recreation Facilities Board-Tennis Position) David Berger If you have any questions , please contact Bonnie Stewart at extension 6722 . JVWM/bhs We ore comm itted to pro viding excellent public service and safety to all who live , work , and ploy in our vibrant , tropical, historic community. 53 Granado, Rafael From: Sent: To: Cc: Subject: Malakoff, Joy Thursday, February 13 , 2014 9:17 AM Granado , Rafael Miranda , Alex; Stewart, Bonnie ; Rebar, John Tennis and Golf The Mayor and Commissio rt-will now need to select two tennis players and two golfers plus one parent with child or children at the Scott Rakow Youth Center and one with children at North Shore Youth Center to serve on the new combined Parks and Recreation Board . I am nominating David Berger for tennis and Gail Williams for golf. . I Thank you . Joy Sent from my iPhone Commissioner Joy V. W. Malakoff 1 54 Granado, Rafael From: Sent: To: Cc: Subject: Malakoff, Joy Thursday, February 20 , 2014 1:30 PM Granado, Rafael Miranda, Alex; Stewart, Bonnie Parks and Recreation Committee The Commissioners need to select two representatives from the Tennis community, two from Golf, one from Scott Rakow Youth Center with children in programs there, and one from North Shore Youth Center with children there, to the new Parks and Recreation Committee. I have already nominated David Berger (chair of the old Tennis Advisory committee) and Gail Williams, member of the former Golf Advisory committee to serve in these capacities . Other commissioners may want to make nominations as well, along with members for the P&R from the two Youth Centers . Joy Sent from my iPad Commissioner Joy V.W. Malakoff 1 55 THIS PAGE INTENTIONALLY LEFT BLANK 56