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Jack Benveniste 12/31/2015 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 1/17/2014 Jack Benveniste 8075 Noremac Avenue Miami Beach, Florida 33141 SUBJECT:` Budget Advisory Committee Congratulations! You have.been reappointed by Commissioner Joy Malakoff to the above referenced agency, board or committee for a term ending: 12/31/2015. If you are unable to accept this appointment,_ please notify the City Clerk's Office at (305) 673-7411. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, Rafael E. Granado City Clerk cc: Saul Frances, Parking Director John Woodruff ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency, board or committee City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-2458, 2-459 Ordinance 2006-3543 -Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application -(Parking Department Form) Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. MIAMIBEACH City of(Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO Jack Benveniste RE: Budget Advisory Committee I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2015. I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and Code of Ethics Ordinance), as well as the Florida Commission on Ethics Guide to the Sunshine Amend- ment and Code of Ethics for.Public Officers and Employees, and understand that as a member of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure* requirements of Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve)on July 1, following the closing of the calendar year on which I have erved. Jack Benveniste Sworn to and subscribed before me this�� day of J4/��A�2014. n Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm for additional information regarding the Financial Disclosure Requirement We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. AN'1� B LE Ak'0_7"H B-CARD AND TEE APPLICATION FO;-Nl 1?0 Last Name First Name Middle Initial Home Address city State Zip Code -% Ya4 0a J-A ew POW%rw ic, 2 RAI Home Telephone W rk Telephone Cellular Telephone Email address A P PAPA JV_VA&e VY .80^8.c" Business Name Occupation 04- 0 ?:rOAe Business Address Ci State Zip Code Professional License (describe): 4.0 q("o 1-�? Expires: Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees 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 1_R or No E-1 C-7) • Demonstrates ownership/interest in a business in Mi Beach for a minimum of six months: Yes�jro�%b zaj • Are you a registered voter in Miami Be4aZ�. es 9 or No ED • I am now a resident of: North Beacham South Beach IZI Middle Beach IZI r lo • I am applying for an appointment because I have special abilities, knowledge and experience. Pleaie,liSt Sb W:_ • Are you presently a registered lobbyist with the City of Miami Beach?Yes 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 Fine Arts Board ❑❑Affordable Housing Advisory Committee Normandy Shores Local Government ighborhood Improvement 0 Art in Public Places Committee ❑Disability Access Committee ❑Parks and Recreation Facilities Board 0 Beautification Committee 0 Gay, Lesbian, Bisexual and Transgender 0 Personnel-Board Enhancement Committee(GLBD 0 Bicycle Pedestrian Advisory Committee 0 Golf Advisory Committee APlanning Board YZoard of Adjustment* * 0 Health Advisory Committee 0 Police Citizens Relations Committee udget Advisory Committee ❑ Health Facilities Authority Board ❑Production Industry Council !!�R� - C 0 Capital Improvements Projects 0 Hispanic Affairs Committee 0 Safety Committee Oversiqht Committee 0 Committee on the Homeless 0 Historic Preservation Board 0 Single Family Residential Review Panel ❑Committee for Quality Education in-MB 0 Housing Authority 0 Sustainability Committee 0 Community Development Advisory ❑Loan Review Committee 0 Tennis Advisory Committee 0 Community Relations Board 0 Marine Authority ❑Transportation and Parking Committee ❑Convention Center Advisory Board 0 Miami Beach Commission for Women 0 Visitor and Convention Authority 0 Debarment Committee 0 Miami Beach Cultural Arts Council 0 Youth Center Advisory Board '0 ❑Design Review Board* ❑Miami Beach Human Rights Committee ❑Waterfront Protection Committee 1 ❑Miami Beach Sister Cities Program 1 A 4,13 J 6a 111 41 9- f J Page 1 of 4 I °O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: Yes LJ No U Dates of Service: 2. Present participation in Youth Center activities by your children:Yes 0 No ED 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 1-:1 or NoZ If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes I-D or No Z5 If yes,explain in detail: • Are you currently serving on an City Board r Co ittee?Yes __._or No Eyes,which board/committee? 4Vp• In whaat�organization in t City of Miami Beach do you currently fold memb rship? Name Position a - 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 or No u Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent EZI, spouse 1-:3, child Z34 brother [_:I or sister Z). who is employed by the City of Miami Beach?Check all that apply. s, If"Yes,"identify person(s) and department(s): /1 The following nformation is voluntary and is neither art of 9 ry p 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 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 '"®°"DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 0 0--ov pe-*,/.v ;�--013 Mailing Address—Street Number,Street Name,or P.O.Box City,State,Zip ID Number If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here.❑ Filing as an Employee ❑County Employee ❑Municipal Employee, Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as a Board Member ❑ County Board Member unicipal Board Member, Name of Municipality: � G - Board where serving jR T -® v/se,&-Y Work address Work telephone Term began on List below every source of income you received,along with the address and the principal activity of each source. Include your public salary.Place the sources of income in descending order,with the largest source first.Also,include any source of income received by another person for your benefit.However,the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here.❑ Name of Source of Income Address Description of the Principal Business Activity ,&11Z6,6Ay,7- F4,*.V I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT. ❑ Hardcopy ❑ Electronic Copy Si ture of person disclosing Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/Initials: 133 SP-14 2/13 i MIAMIBEACH - DIVERSITY STATISTICS DEPORTING Name: el Board l Committee: Appointment Date: Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male ZJ� Female Race/Ethnic Categories What is your race? Mark,one or more races to Indicate what,you consider yourself to be. African-American/Black i Caucasian/White Asian or Pacific ISlander Native-American/American Indian E Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box ii not Spanish, Hispanic, Latino/a. No Yes Do you consider yourself Physically Disabled? No ZJ Yes F:\CLER\SALL\aPOR!MS\BOAP.D AND C0MMITTEES\BC minority information form 05-20-13 Revised by Mr. Papy.doo I Vlvt 1AAA I B I:AC H City of Miami Beach, 1700 Convenhon Center Drive, Miami Beach,Florida 33 139, 'NMN.miamibecchfl.ao� C(1(CLERK Of ice CiyClerk @micmi beach A-gov e(:305.673.7411 ,Fax: 305.673.72.) .. Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code Section 2-1 1.1(i) (2) Board Member name: understand that no later than .JULY i 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 Disclosure Requirements. This means"hatthe members of City Advisors Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission: must file,even though you may have been recen'ly appointed. You must file one of the follovifng with the City Clerk: of Miami Beach, 1700 Convention Center Drive, Miami Beach; Florida. by July 1, 2010. 1. A`Source of Income Statement(attached)or 2. A'Financial Statement(attacneri I A Copy of the person's current Federal Income Tax Return Failure to file, according to the Miami-Dade County Code Chapter 1, General Provision, Section 1-5 may subject the person or firm to a fine not to exceed $500.00 or by imprisonment in the county jail for a period not to exceed sixty days, or both. (2&'Z �1. ature: Date: