GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. No Contact 1- General Title Mrs. First Name Sheela Middle/Maiden Venero Last Name VanHoose Email Address sheelavanhoose@gmail.com Cell Phone 954-305-6157 Race Unknown/Other Gender Female Fax Disability No Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 1631 NE 28th Avenue Address Line 2 City Pompano Beach State Florida County Broward Zip / Postal Code 33062 Phone Number 954-305-6157 3- Business Address Line 1 600 SE Third Ave Address Line 2 City Fort Lauderdale State Florida Zip / Postal Code 33301 Phone Number 954-321-2608 Other Residences 4-A. List all your places of residence for the last ten (10) years. 2/5/2016 9:12:01 AM Page 1 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM Address City & State Start Date End Date 11731 Northwest 22nd Street Pembroke Pines, FL Mar 1999 Jan 2012 2314 Vintage Drive Lighthouse Point, FL Jan 2012 Jan 2014 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth 05/07/1986 Place of Birth Miami, FL 6- Driver License # V52078086667 Issuing State Florida 7- Social Security # s. 119 071(5)(a) F.S. 8- Have you ever used or been known by any other legal name? Yes Sheela Vana Mooti 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1986 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Republican Education 12-A. High School Sagemont Upper School Year Graduated 2004 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Nova Southeastern University, Davie, FL Florida Atlantic University, Boca Raton, FL Employment 2004 2009 BA English 2011 2014 MPA 2/5/2016 9:12:01 AM Page 2 of 7
13- Are you or have you ever been a member of the armed forces of the United States? No A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Broward County Public Schools, 600 SE 3rd Avenue, Fort Lauderdale, FL 33301 Executive Office of the Governor, 400 S Monroe Street, Tallahassee, FL 32399 Executive Office of the Governor, 111 East Las Olas Blvd, Fort Lauderdale, FL 33301 Rick Scott for Florida, 700 NW 57th Place, Suite 3, Fort Lauderdale, 33309 Office of Senator George LeMieux, 642 N Federal Hwy, Fort Lauderdale, FL 33304 Republican Party of Florida, 420 E Jefferson Street, Tallahassee, FL, 32301 GOVERNOR'S OFFICE Boards and Appointments Education Director of Legislative Affairs Start Date End Date Jul 2013 Current Government Director of Scheduling Apr 2012 Jul 2013 Government Political Special Assistant to the Governor Broward County Field Director Jan 2011 Apr 2012 Aug 2010 Jan 2011 Government Staff Assistant Oct 2009 Aug 2010 Political Date Submitted: 6/21/2014 12:36:12 PM Regional Victory Director Mar 2008 Nov 2008 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Yes Position Employing Agency Start Date End Date Director of Legislative Affairs Broward County Public Schools Jul 2013 Current Director of Scheduling Executive Office of the Governor Apr 2011 Jul 2013 Special Assistant to the Governor Executive Office of the Governor Jan 2011 April 2012 Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes 2/5/2016 9:12:01 AM Page 3 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM Significant experience in reviewing and analyzing Florida s state education budget as Director of Legislative Affairs to monitor Broward County Public Schools policy and budget priorities. Relevant coursework in public financial management through Florida Atlantic University s Masters in Public Administration program. C. Have you received any awards or recognitions relating to the subject matter of this appointment? No Master's in Public Administration in progress. D. Identify all association memberships and association offices held by you that relate to this appointment Florida Education Legislative Liaisons 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? No 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? No Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? No Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) No Date Place Nature Disposition 2/5/2016 9:12:01 AM Page 4 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? No Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? No Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? No Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? No Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? No A. Did you receive any compensation other than reimbursement for expenses? No B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? No Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? No Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency 2/5/2016 9:12:01 AM Page 5 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Superintendent Robert W. Runcie 600 SE 3rd Ave, Fort Lauderdale, Fl 33301 7543212600 David DiPietro 12 SE 7th St #606, Fort Lauderdale, FL 33301 9547123070 William D. Rubin 450 E Las Olas Blvd, Suite 1250, Fort Lauderdale, FL Senator George LeMieux 450 East Las Olas Boulevard Suite 1400 Ft. Lauderdale, Florida 33301 9544673993 33301 9544681339 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Broward Days Florida Education Legislative Liasons Junior League of Greater Fort Lauderdale 512 N.E. Third Avenue Fort Lauderdale, FL 33301 208 S. Monroe Street, Tallahassee, Fl 32301 704 SE 1st St, Fort Lauderdale, FL 33301 Member Member Active #Error #Error #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? No 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? No Boards of Interest 2/5/2016 9:12:01 AM Page 6 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 6/21/2014 12:36:12 PM Functional Category Medical & Health Misc Misc Board Name Seat Seat Qualification Reappointment Board of Commissioners, North Broward Hospital District South Florida Regional Planning Council, Region Eleven South Florida Regional Planning Council, Region Eleven 2 subdistrict #2 No 1 Broward County No 2 Broward County No 2/5/2016 9:12:01 AM Page 7 of 7
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. No Contact 1- General Title Ms. First Name Maureen Middle/Maiden Spieker Last Name Canada Email Address mcanada@lhpmarina.com Cell Phone 954-261-6251 Race Caucasian Gender Female Fax 954-941-3223 Disability No Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 2521 NE 31st Court Address Line 2 City Lighthouse Point State Florida County Broward Zip / Postal Code 33064 Phone Number 954-261-6251 3- Business Address Line 1 Marina Circle Address Line 2 City Lighthouse Point State Florida Zip / Postal Code 33064 Phone Number 954-941-0227 Other Residences 4-A. List all your places of residence for the last ten (10) years. 2/5/2016 9:10:55 AM Page 1 of 6
Personal Information GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM Address City & State Start Date End Date 2521 NE 31st Court Lighthouse Point, FL 33064 9/1/1996 Present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date 28141 Via Luis Laguna Niguel, CA 1/1/1994 7/1/1995 5- Date of Birth 10/02/1967 Place of Birth Fort Lauderdale, FL 6- Driver License # C53055767862O Issuing State Florida 7- Social Security # s. 119 071(5)(a) F.S. 8- Have you ever used or been known by any other legal name? Yes Maureen Spieker 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1995 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Republican Education 12-A. High School Cardinal Gibbons High School Year Graduated 1985 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Florida State University 1985 1989 NA Broward Community College 1989 1991 Associate of Arts Florida Atlantic University 1991 1993 Bachelor of Arts Communication Employment 2/5/2016 9:10:55 AM Page 2 of 6
13- Are you or have you ever been a member of the armed forces of the United States? No A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Lighthouse Point Marina, Inc. 2831 Marina Circle, Lighthouse Point, FL 33064 GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM Start Date End Date Marina President 6/1/1996 Present 15- Have you ever been employed by any state, district, or local governmental agency in Florida? No Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? No I have an extensive background in business, executive experience and ability. I am privileged to have deep roots in our community which call me to public service. I believe in maintaining a fiscally sound, practical healthcare delivery system for the benefit of all members of our community. C. Have you received any awards or recognitions relating to the subject matter of this appointment? No D. Identify all association memberships and association offices held by you that relate to this appointment 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? No 2/5/2016 9:10:55 AM Page 3 of 6
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? No Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? No Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) No Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? No Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? No Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? No Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? No Error: Subreport could not be shown. 2/5/2016 9:10:55 AM Page 4 of 6
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? No A. Did you receive any compensation other than reimbursement for expenses? No B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency Lighthouse Point Marina, Inc. President The company is the leasee pursuant to a submerged land lease by Department of Enviromental Protection Lighthouse Point Marina, Inc. President Lease slips to the US Department of Homeland Security for customs vessels B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? No Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number County Commissioner Chip LaMarca Rep. George Moraitis, Dist. 93, Fla House of Reps Rep. George Moraitis, Dist. 93, Fla House of Reps 2605 NE 24th Street, Lighthouse Point, FL 2132 East Oakland Park Blvd, Suite 2, Ft. Lauderdale, FL 2132 East Oakland Park Blvd, Suite 2, Ft. Lauderdale, FL 33064 9544443200 33306 9547623757 33306 9547623757 2/5/2016 9:10:55 AM Page 5 of 6
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 3/19/2014 7:20:46 PM Rep. George Moraitis, Dist. 93, Fla House of Reps 2132 East Oakland Park Blvd, Suite 2, Ft. Lauderdale, FL 33306 9547623757 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Rotary Club of Pompano Beach, FL PO Box 94, Pompano Beach, FL 33062 Director, Secy 3 years #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? No 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? No Boards of Interest Functional Category Medical & Health Board Name Seat Seat Qualification Reappointment Board of Commissioners, North Broward Hospital District 1 subdistrict #1 No 2/5/2016 9:10:55 AM Page 6 of 6
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. No Contact 1- General Title Mr. First Name Christopher Middle/Maiden Todd Last Name Ure Email Address ctoddure@msn.com Cell Phone 954-261-2597 Race Caucasian Gender Male Fax 888-886-5087 Disability No Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 2770 Stirrup Lane Address Line 2 City Weston State Florida County Broward Zip / Postal Code 33331 Phone Number 954-261-2597 3- Business Address Line 1 1800 N Military Trail Address Line 2 City Boca Raton State Suite 300 Florida Zip / Postal Code 33431 Phone Number 561-367-1870 Other Residences 4-A. List all your places of residence for the last ten (10) years. 2/5/2016 9:09:41 AM Page 1 of 6
Personal Information GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM Address City & State Start Date End Date 2770 Stirrup Lane Weston, FL March 2007 Current 2876 Kinsington Cir Weston, FL June 2005 March 2007 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date 150 East 49th St New York, NY April 1995 August 1998 9907 Lake Avenue Cleveland, OH March 1993 April 1995 5- Date of Birth 05/31/1970 Place of Birth Portsmouth, VA 6- Driver License # U600118701910 Issuing State Florida 7- Social Security # s. 119 071(5)(a) F.S. 8- Have you ever used or been known by any other legal name? No 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1998 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Republican Education 12-A. High School Spanish River HS Year Graduated 1988 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received University of Florida Gainesville June 1988 December 1992 Employment BSBA Finance 2/5/2016 9:09:41 AM Page 2 of 6
13- Are you or have you ever been a member of the armed forces of the United States? No A. Date of Service B. Branch or component C. Date & Type of Discharge GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title UBS Financial Services Financial Services Advisor Senior VP March 2009 Citigroup Smith Barney Financial Services Advisor Senior VP August 1998 Ernst and Young LLP Financial Services Senior Consultant March 1993 Start Date End Date Current March 2009 August 1998 15- Have you ever been employed by any state, district, or local governmental agency in Florida? No Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have spent my entire career in the financial services industry. I have strong analytical and relationship skills which I believe qualify me for the position. Perhaps most importantly, I have a sincere, deep desire to give back to my community because of the many blessings I am so fortunate to have had bestowed on me. C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes BSBA Finance University of Florida D. Identify all association memberships and association offices held by you that relate to this appointment Barron's Magazine Inaugural list of the Top 1,000 Advisors in the U.S. 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? No 2/5/2016 9:09:41 AM Page 3 of 6
GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? No Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? No Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) No Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? No Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? No Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? No Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes 2/5/2016 9:09:41 AM Page 4 of 6
Error: Subreport could not be shown. GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? No A. Did you receive any compensation other than reimbursement for expenses? No B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency UBS Financial Services Employee Insurance broker dealer B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? No Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Rev Dr Russ Ritchel Lonnie Bergeron First Presbyterian Church 401 SE 15th Ave Bergeron Land Development 19612 SW 69th Place 33301 9545989310 33332 9546806100 Matt Williams 3448 NE 31st Ave 33064 9548957867 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 2/5/2016 9:09:41 AM Page 5 of 6
Name Mailing Address Office(s) Held & Term Date of Membership First Presbyterian Church Efficient Frontier Consultancy GOVERNOR'S OFFICE Boards and Appointments Date Submitted: 9/30/2015 10:52:21 AM 401 SE 15th Ave 33301 Vice President Board of Trustees #Error 2770 Stirup Lane 33331 Founder and President #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? No 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? No Boards of Interest Functional Category Medical & Health Board Name Seat Seat Qualification Reappointment Board of Commissioners, North Broward Hospital District 5 subdistrict #5 No 2/5/2016 9:09:41 AM Page 6 of 6