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2019-12-03 Ex 0155 Southeast 3' Avenue * Okeechobee * Florida * 34974 * (8 APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APP Please print or type all information. The Council in considering action on your appointment. FULL. Answer "None" "Not Applicable" or ----.4,---- information from this application will be used by the City The application MUST BE COMPLETED IN "N/A" where appropriate. CHECK (0) THE A COPY OF EACH BOARDS DUTIES, Planning Board/Board of Adjustment & Appeals/Design Okeechobee Utility Authority Board of Directors --Police Officers Pension, Firefighters Pension, o (City Resident Trustee: kif OR Fifth BOARD(S) OF INTEREST TO YOU MEETING DATES, AND TIMES ARE ATTACHED Review Board (City Residents Only) General EmployeeS- Retirement System Board of Trustees Member Trustee: ) Other: APPLICANT=S FULL NAME: TA', ?,%1,4 f-‘, V N CAI\ NAME COMMONLY USED: RESIDENCE ADDRESS: vEke.4-S\i,t -:)I-1- Nii,-)oi-E-GctieJcIE, --•(,, „Yix?-74- HOW LONG AT ADDRESS: Years: Is this in the City Limits? 12Yes No MAILING ADDRESS: S 1-VME TELEPHONE/CELL: C',. -2)::)\ (0 (0.;) CM -Y.) ' '''' 4t , . , EMAIL: ARE YOU AN US CITIZEN? /Yes No, explain: FLORIDA REGISTERED VOTER? vs County Registered in: No EDUCATION: High School Name & Location Year Graduated Okk 5 t Ct P) CI POST SECONDARY EDUCATION: College Name(s) Certificate/Degree(s) Awarded Date(s) Attended Riv 0.koLuirl 89 - (4 MILITARY SERVICE: Branch(es) Dates of Service Discharge Date gliN CURRENT OR MOST RECENT EMPLOYER: f CC AVOn c.-_-/kiw c.p \.\)1\1,--Nc-b ecb). - )Lixtclo:Aqt,VE--: JOB TITLE/DESCRIPTION: CLN\m5 IREcichz) DVv\C-1 WORK ADDRESS: 1 LLX)k, "i'k OfYI \ A o'vi WORKTELEPHONE: 0C15*. --4--\(,0 - c'tb74- ' ARE YOU CURRENTLY EMPLOYED AS: (CHECK T ALL THAT APPLY) General Contractor Business Person Architect Engineer Sub -Contractor Realtor Attorney Doctor Surveyor Lay Person Urban Planner Landscape Architect Have you ever been appointed to, or do you currently serve on, a citizen or community board for any other agency or government? Yfo 0 Yes*, and list: *If you are currently serving on another Board that the State deems an "office," your application cannot be considered. Each Board will have to be reviewed and verified. AGENCY BOARD NAME POSITION DATE(S) Are you now, or have you ever been, elected or appointed to any public office? 1I4/o 0 Yes, and list: LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM(S) Do you work with or have any association with a current member of the board/committee to which you are requesting appointment? I/No 0 Yes, and list: NAME OF BOARD/COMMITTEE MEMBER(S) RELATIONSHIP/ASSOCIATION Are you related to, or employed by, any City of Okeechobee employees or elected officials?lo ❑ Yes, and list: NAME OF EMPLOYEE/ELECTED OFFICIAL RELATIONSHIP/ASSOCIATION Have you ever been fou ,d to be in violation of Florida Statutes Chapter 112, Part 111, Code of Ethics for Public Officers and Employees?o 0 Yes, and list: DATE(S) NATURE OF VIOLATION Have you ever been convicted of a FELONY, plead guilty or no conFtest, or entered into an agreement setting forth the terms leading to the reduction or dismissal of the charges? o 0 Yes, and list: DATE(S) VIOLATION CITY AND STATE ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with a specific public records exemption can be withheld. In order to claim the exemption complete the following: Are you a current or former, the spouse of a current or former, or the child of a current or former sworn or civilian law enforcement personnel, certified firefighter, EMT, paramedic, code enforcement officer, or other covered employee who is exempt from public records disclosure under Florida Statute 119.071? Review list of other covered employees before responding. o 0 Yes, and list: JOB TITLE OR COVERED POSITION TITLE RELATIONSHIP Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the Board you wish to serve on. Include personal accomplishments that qualify you for the appointment. If more space is needed, please attach an a¢d dit9ionalll page. � � lug! ( y� "^*-✓ @ dSw.�+ 4 F. �ttO f 4 . x d THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY, OR MARITAL STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES, VETERANS, AND DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL PURPOSES ONLY AND HAVE NO BEARING ON YOUR APPOINTMENT: 11 SEX: MALE MALE ETHNIC GROUP: AUCASIAN BLACK SPANISH HERITAGE NATIVE AMERICAN ASIAN OR PACIFIC ISLANDER OTHER(specify): MALL THAT APPLY: WARTIME PERIOD VETERAN DISABLED VETERAN VIETNAM VETERAN 1.4 f A, HANDICAPPED STATUS: NO YES, AND LIST THE HANDICAP: Al/A, STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all liability for any damage for issuing this information. 1 understand that the City may request a copy of my driver's license. 1 have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports upon request to the Office of the City Clerk. 1 further understand all information provided becomes a matter of public record. CERTIFICATION: I understand that falsification, omission, misleading statements, or misrepresentation is cause for rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida Statutes Chapter 119. FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a Financial Disclosure Form 1 -Final upon my resignation/sunset of term. PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State Constitution regarding public records, records retention, public record requests, and the open public meeting requirements. I hereby acknowledge that I have read and urid'erstand each of the above statements. Signature of Applicant: J. Date: 9 1. The City Code Book Sec. 70-151, 70-171, 70-19170-211 read: "....membership of the board, where possible, shall consist of any of the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor, realtor, business person, and lay persons. 2. Other covered jobs include current or former, their spouse, and children: correctional and correctional probation officers; juvenile probation officers, supervisors, detention superintendents and assistants; Department of Juvenile Justice: detention officers I and II, detention office supervisors, residential officers, residential officer supervisors I and II, counselors and supervisors, human services counselor administrators, senior human services counselor administrators, rehabilitation therapists, and social services counselors; certain personnel of: the Department of Children and Families; the Department of Health; the Department of Financial Services; and the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement; investigators or inspectors of the Department of Business and Professional Regulation; the Office of the Inspector General or internal audit department; justices of the Supreme Court; judges of the district court of appeals, circuit court, and county court; general and special magistrates, judges of compensation claims, administrative law judges of the Divisions of Administrative Hearings, and child support enforcement hearing officers; state attorneys and assistants, statewide prosecutors and assistants; public defenders and assistants, criminal conflict and civil regional counsel and assistants; guardians ad litem; human resource, labor relations, or employee relations directors and assistants, managers or assistant managers of any local government agency or water management district whose duties include hiring and firing employees, labor contract negotiations, administration, or other personnel -related duties; tax collectors; certain impaired practitioners and consultants; [see ' 119.071, Florida Statues). PLEASE RETURN COMPLETED APPLICATION TO: CITY OF OKEECHOBEE OFFICE OF THE CITY CLERK 55 SE 3RD AVENUE, ROOM 100 OKEECHOBEE, FLORIDA 34974 CITY CLERK=S OFFICE USE ONLY Boards Applicant is appointed to: #1 #2 ,#3 Verified State's consideration as an "Office": #1 #2 #3 APPOINTED TO: CITY COUNCIL MEETING: INITIAL TERM DATES: NOTIFICATION SENT: RE -APPOINTED TERM DATES: RE -APPOINTMENT NOTIFICATION SENT: RESIGNED/TERM SUNSET: CERTIFICATE OF APPRECIATION PRESENTED: Being an American provides me with a deep sense of pride and an overwhelming sense of gratitude. In todays busy, fast paced climate it is very easy to say to yourself that you don't have time to give back to your community. However, other people have laid down their lives to afford us our freedoms. I may not be a trained soldier but I could definitely rearrange my schedule to include serving on one of our City's Citizen Boards. It would be my honor to help Okeechobee City in any way needed. I work from home so my hours are somewhat flexible. You can reach me on my work phone (954) 416-9674 or my cell phone (321) 662-8080. My personal email is donnavdasilvaPyahoo.com and my work email is donna.howard@advancedesgroup,com. Sincerely, Donna V. Hpward Donna V. DaSilva Phone: (321) 662.8080 Email: donnavdasilva0vahoo.com Address: 1804 SW god AVE, OKEECHOBEE FL 34974 EXPERIENCE 2006- Present Hollywood, FL Brokerage Claim Director/Manager Advanced E&S Group • Management of all new and existing commercial line claims • Responsible for forwarding new losses to pre -contracted adjusting firms • Daily respondent to retail agents, appointed adjusting firms & assigned counsel for swift claim resolution • Review & remittance of claim acknowledgments, reports, denials & closing notices • Status updates & loss runs to various Florida retail agents • Responsible for bordereaux issuance/maintenance, loss & expense payment issuance and subsequent correspondence with London syndicates • Responsible for department procedures, various claim audits, dual database management, monthly claim tracking & integrity 2004- 2006 Gateway Insurance Agency Ft. Lauderdale, FL Senior Commercial Lines Marketer • Established relationships with wide range of commercial carriers in various markets • Responsible for marketing large accounts, both new and renewal, for various commercial line coverage • Communications liaison for agency producers and various carriers and brokers • Daily duties included quote generation, proposal issuance & coverage binding for the entire organization • Created and updated weekly, quarterly & yearly marketing reports for agency management 2002- 2004 Philadelphia Insurance Company Altamonte Springs, FL Commercial Lines Account Executive • Responsible for maintaining 700+ client files • Reviewed & processed new business policies for both commercial & specialty line divisions • Duties included generation of renewal policies for existing clients/accounts • Responsible for binding new policies, endorsement processing, issuance of cancellation notices & COI's • Provided customer service for VIP commercialline accounts 1998-2001 Lake Mary, FL Personal Lines Team Leader/Supervisor American International Group (AIG) • Duties included call center management, problem resolution & overall customer service of commercial auto division • Performed quality evaluations & subsequent retraining to ensure adherence to company guidelines/procedures • Handled irate customers, billing disputes & endorsement errors • Large scale project management with regards to proof of insurance cards SKILLS Word, MS Excel, MS Outlook, TAM, AMS, AIM, CIS, Internet Navigation, & Windows Vista. Proficient in basic Spanish, excellent communication skills & problem solving abilities. Fast learner who works well under pressure. LICENSES/CERTIFICATIONS/DEGREES 2007 - C.R.1.S. (Construction Risk Insurance Specialist) 1998 - 220 Property & Casualty License for General Lines 1996 - Bachelor of Arts, Psychology, University of Central Florida (UCF)