Jack Benveniste application package •
' A,�V'd B Q'A R D A i,1.,,j C 10 T TEHE A P P L I C A T 10 N F OrRiNI
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Last Name First Name Middle Initial
Home Address city State Zip Code
A/a 5/
AFIA y4ola J-,,k 'PASM/Kow
Home Telephone W k Telephone Cellular Telephone Email address
A P P h:OVA o9plAk;;P5
Business Name Occupation
OXAj000 0�1- Al "
Business Address Ci State Zip Code
Professional License (describe): C Expires:
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a & lb: 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 ownershipAnterest for a minimum of six months in a business established in the City
for a minimum of six months.
• Resident of Miami Beach for a minimum of six(6) months: Yes[-a or No
• Demonstrates ownership/interest in a business in M'
�i Beach for a minimum of six months: Yes��jror4lo
C=3
• Are you a registered voter in Miami Beach.�es LO—'*3* or No
• I am now a resident of, North Beacham South Beach ZI Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Pleai.e`listCFelow,.:-1
• Are you presently a registered lobbyist with the City of Miami Beach? Yes I-D or 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.
0 Affordable Housing Advisory Committee ❑ Fine Arts Board i ❑ Normandy Shores Local Government
Neighborhood Improvement
❑Art in Public Places Committee ❑ Disability Access Committee 0 Parks and Recreation Facilities Board
❑ Beautification Committee 0 Gay, Lesbian, Bisexual and Transgender 0 Personnel Board
Enhancement Committee (GLBT)
❑Bicycle-Pedestrian Advisory Committee ❑ Golf Advisory Committee )K.Planning Board
Y�302rd of Adjustment* * ❑ Health Advisory Committee ❑ Police Citizens Relations Committee
At?5'u-`dget Advisory Committee ❑ Health Facilities Authority Board 0 Production Industry Council
❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑Safety.Committee
Oversight Committee J
❑ Committee on the Homeless ❑ Historic Preservation Board ❑Single Family Residential Review Panel
❑Committee for Quality Education in MB ❑ Housing Authority ❑Sustainability Committee
0 Community Development Advisory ❑ Loan Review Committee ❑Tennis Advisory Committee
0 Community Relations Board ❑Marine Authority ❑Transportation and Parking Committee
❑Convention Center Advisory Board ❑Miami Beach Commission for Women ❑Visitor and Convention Authority
0 Debarment Committee 0 Miami Beach Cultural Arts Council ❑Youth Center Advisory Board 00
0 Design Review Board* ❑ Miami Beach Human Rights Committee ❑Waterfront Protection Committee
❑Miami Beach Sister Cities Program
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Page 1 of 4
I CO Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
i
1. Past service on the Youth Center Advisory Board: Yes LJ No _] Dates of Service:
2. Present participation in Youth Center activities by your children:Yes ED' No
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes _._..or No ____ If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code?Yes[Za or Nam If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes ZI or No If yes, explain in detail:
• Are you currently serving on any City Board r Co ittee?Yes or No
oa zDfyes,which board/committee?
� e,. co `�
• In what organization in t City of Miami Bea h do you currently old memb rship?INAd TD W Name Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
• Are you now employed by the City of Miami Beach?Yes ED or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent spouse 1—D, child Z34 brother `—1 or sister ZD-1. who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s) and department(s): A10
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for
appointment. It is be>asked to comply with City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories 70*10r#
What is your race?
'' an-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
ED Other—Print Race:
Page 2 of 4
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
No
ZDA Yes
Do you consider yourself Physically Disabled?
2—TN o
�-9 Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
• Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the City (Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office(Miami Beach
City Code section 2-26).
• Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
• 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).
• Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
• Voting conflict—Form 8B is for use by any person serving at the county,city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
Upon request,copies of these laws may be obtained from the City Clerk.
I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
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."
X�fe
YTIcant's Signature Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by:_ C' �Qcj:�=L,
�Q_
me of Deputy Clerk Control No. Dat
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.
Z �
Page 3 of 4
_ A
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
.www.mlamlbeachfl.gov
CITY CLERK'S OFFICE CityClerkCm lam ibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2)
Board Member's Name: 4 -Ceq, e AGWve/y/.s7E
I understand that no later than July 1, of each year all members of Boards and Committees of the City of
Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County
Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or
primary responsibility is to recommend legislation or give advice to the City Commission, must file, even
though they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A"Source of Income Statement"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pdf
2. A"Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fl.us/ethics/forms.html
3. A Copy of your 2012 Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
S' ture Date
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application revised 5-22-13 FINAL.doc
Updated:Tuesday,September 24,2013
Page 4 of 4
Jack Benveniste
8075 Noremac Avenue
Miami Beach, Florida
(305) 538-1124
• Born February 26,1941
New York City, New York
Education:
Attended the University of Miami
Miami Beach resident: 40 years
Personal:
• Married 44 years to Michaele
2 children
5 grandchildren
• Business:
President of All Dade Bail Bonds - 45 years
President of Southeast Florida Motorcycle Safety School
(provider for DSHMV Florida Rider Training Program) - 13 years .
President TOAD Program (court ordered youthful offender traffic
program) 7years
President of Gun Depot-32 years
President All Florida Driver License Testing (provider for Florida
Department of Highway Safety and Motor Vehicles to administer the Florida
Driver License Permit exams.)
• Community service involvement:
Currently a member of City of Miami Beach Budget Advisory Board - 12 years.
Currently serving as Flotilla Commander- United States Coast Guard Auxiliary
Served on City of Miami Beach Police Citizens committee as well on Parks and
Recreation Board.
Currently Vice President of Ohev Shalom Congregation.
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N.M.-
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