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Jack Benveniste 12.31.2017 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.qov • OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 December 31, 2015 Mr. Jack Benveniste 8075 Noremac Avenue Miami Beach, Florida 33141 SUBJECT: Police/Citizens Relations Committee Dear Mr. Jack Benveniste: Congratulations!You have been appointed by Commissioner Joy Malakoff to the agency, board or committee named above for a term ending: 12/31/2017. Pursuant to City of Miami Beach Code Section 2-22 (5)a,"Notwithstanding any other provision of the City Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointment/election of the successor City Commission member." If you are unable to accept this appointment, or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations again and good luck. Regards, gr,770709rmx,3,rowly, afael Granado City Clerk cc: Saul Frances, Parking Director Chief Daniel Oates, City Liaison 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, 2-458 and 2-459 Ordinance No. 2006-3543 -Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics 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: Mr. Jack Benveniste RE: Police/Citizens Relations 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: 12/31/2017. 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 Florida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Officers 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 the State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing of the calendar year on which I have served. Z .1‘,// ,- 74-- Mr. Jack Benveniste Sworn to and subscribed before me this i 2.- day of 'col , 2010 44 di bt—p dG Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. i MIAMI•DADE SOURCE OF INCOME STATEMENT 7I1tf tDisclosure for Tax Year Ending Last Name First Name Middle Name/Initial. 2014 >c-,.G_-- Mailing Address—Street Number,Street Name,or P.O.Box F--4g r ///, /7, ,A — City,State,Zip ID Number TV/3—VW 1qh-1A / .,f ' 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.n Filing as7an-Fmployee — County Employee 7 Municipal Employee, Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as e Board Member _ County Board Member ri unicipal Board Member, Name of Municipality: Board where serving_ I PL/ c-/7-72.F-- -f? . • Work address lWork telephone I Term began on 1 -Taw 12-0 - i a.4--5-3 d=2-2/4e____. I 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 ..C, - "-.2./)- it7, 7VX---e)/cle rif,-475/ 2."-ef$4/t/a/, ' p/2,0vv,ofi--4_ ri-o-A_ f"1„/J • I '-// ��9 p ia-�e/4_ �-/� T/tR,.. P--C' "Y 7�r7-/Ar',- tit A --eft , . , ,-- 0- /m.. • ,e--/i2-e—,---e--/Y -(7/,-/e. I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT Q Hardcopy - ❑ Electronic Copy ature of person disclosing ,7-. Ae,..fd6e7r../e-- a°) -7/,‘-- Print name Date signed OFFICE USE ONLY Accepted: Y i N Deficiency: Processed uc ell i li2 I_• Scanned Dateilnitiais: ?3S SP-12 2h3 F t NAME: N ti/ /3 T ar-A Last Name s�1 First Name Middle Initial l HOME ADDRESS: E 0 17� A/0 LE- / /rL 'U_ `•t7/J¢jiJ $,�i52G%' Fe— $ :? No. Street City State Zip Code PHONE: ��.5=�` � /i�y 3 j-60-G/c- 8 v//As-v/J.7 . Home Work Fax Email address GO Business Name: SO, � sT G Al 0 To/c C ,e Position: Address: if<j/ Ala/ /d-3 R7 / Tin '7/, f G:S2' No. Street City State Zip Code Professional License(describe) /9- 0/ v Expires: "4/51- :; t w 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 No ❑ • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: Yes No ❑ • Are you a registered voter in Miami Beach: Yes or No ❑ • (Please check one): I am now a resident of:.North Beach South Beach ❑ Middle Beach ❑ • I am applying for an appointment because I have special abilities, knowledge, experience. Please list below: 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) 0 Art in Public Places CommitteeI-lousing Authority* ❑Beach Preservation Board ❑Loan Review Committee* ❑Beautification Committee ❑ ayor's Green Ad-Hoc Committee 01;1-Berard of Adjustment* dp a Marine Authority* ❑Budget Advisory Committee ❑Miami Beach Cultural Arts Council ❑Committee on Homeless 0 Miami Beach Commission on Status of Women ❑Committee for Quality Education in MB ❑Miami Beach Florida Sister Cities ❑Community Development Advisory* ❑Normandy Shores Local Gov't Neigh. Improvement ❑Community Relations Board 0 Oversight Committee for General Obligation Bond ❑Convention Center.Advisory Board r cs and Recreation Facilities Board ❑Debarment Committee nnel Board* ❑Design Review Board* 0 Planning Board* 0 Disability Access Committee ®- ariEee Citizens Relations Committee -; n, 0 Fine Arts Board s ❑Production Industry Council 0 Golf Advisory Committee ❑Public Safety Advisory Committee 0 Health Advisory Committee 0 Safety Committee ❑Health Facilities Authority Board 0 Transportation and Parking Committee 0 Hispanic Affairs Committee ❑Visitor and Convention Authority* 0 Historic Preservation Board* ❑Youth Center Advisory Board `0 * Board Required to File State Disclosure form a,,:.$),T..,. ..n and ,J,ft;6 c ;\,,m L €Ir :«'s , 3 :. } f I l'-1:'l:.:5\13;:;Application Re,sa,-i.t i i'f 18 2007.Aoc 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: Yes❑ No❑ Years of Service: 2. Present participation in Youth Center activities by your children Yes❑ No O. If yes, please list the names of your children, their ages, and which programs. List below: Child's name: Age: Program: Child's name: Age: Program: •Have you ever been convicted of a felony: Yes❑ or No Ga'lf yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes❑ or No k. If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ❑or No 44es, explain in detail • Are you currently serving on any City Boards or Committees: Yes, -No D. If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: • Title: Name: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: 6o91- /V-0 &Ai / • I am now employed by the City of Miami Beach: Yes❑or No hich department? • Pursuant to City Code Section 2-25(b): Do you have a parent❑, spouse❑,child❑, brother❑, or sister❑who is employed by the City of Miami Beach?Check all that apply. Identify the department(s): This section is"not required" but desired: Age: 77' years old Gender: Male Female ❑ Ethnic Origin (Check one) White frican-American/Black ❑Hispanic: ❑Asian or Pacific Islander ❑American Indian or Alaskan Native ❑ Employment Status: Employed ❑Retired ❑Home-maker ❑Other ❑ "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." / /1— /2—ga/J cT j0L/5— R,6-/l/U /t'/S' Ap.,.cant's Signature Date Name of Applicant(PLEASE PRINT) Please attach a copy of your resume to this application i NOTE:Applications will remain on file for a period of one(1)calendar year. ' 7/__/1-7-1// Received in City Clerk's Office by C./al-a D ate Name of Deputy Clerk = - rV Document Control Number(Assigned by the City Clerk's Office) Entered By DateLl ���� R jsed 1/25/07 jo CD 2 _ 1 \:."...3 a # .ee..:g s\c 1 £ oca. ,:.. . .".D . 1C s \B i Application - /0 " d r 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. / ® r N.M.- \ / y f 4 I I\i"i\ b E:I\(0 ,Fl City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, wv/w.m iami beachfl.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.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(i) (2) &,Ul- / S� Board Member's Name: ei 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: htto://v+rww.miamidade.gov/elections/Library/source of income statement.odf 2. A"Statement of Financial Interests (Form 1)" For your convenience, the form is attached. The form can also be downloaded at: httc://www.ethics.state.fl.us/ethics/forms.html 3. A Copy of your 2013 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. / --- ir Signatu" Date Updated:Wednesday,April 09, 2014 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMIITTEES\BC APPLICATION REVISED.docx MIAMI iti, ! DIVERSITY STATISTICS REPORTING Name: c. lG %vie /- Board / Committee: �I� t-e L-Is zec►S' • £e4S=e4i C644-1,1- �AG-e Appointment Date: V3/41,-/‘ 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: I I Female Gender: Male Race/Ethnic Categories What is your race? . �1 African-American/Black aucasian/White LJI Asian or Pacific Islander Native-American/American Indian IZ:h Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. No L:11 Yes Do you consider yourself Physically Disabled? No 1 Yes C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015