Gavin Basner Application PackageBasner Gavin A
Last Name First Name Middle Initial
4628 Alton Rd Miami Beach
Home Address City
Florida 33140
State Zip Code
305-861-5080
HomeWork
gbaz@hotmail.com
Email Address
1-305-240-9973
Cellular
Business Address City State Zip Code
Occupation:Business Name:
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)
Choice 1:
Choice 2:
Choice 3:
Youth Commission
BOARD AND COMMITTEE
APPLICATION FORM
Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below
questions:
Have you ever resided in one of the City's Historic Districts for at least one year?Yes
No Address in City Historic District submitted.
Professional License
No Professional Licenses Submitted.
Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of
your currently effective corresponding professional license.
Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be
affiliated with the city. This requirement shall be fulfilled in the following ways:
YesResident of the City for a minimum of six (6) months:
Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:No
AFFILIATION WITH THE CITY OF MIAMI BEACH
a.
● I am resident of:Middle Beach
Or
b.
"Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10%
or more of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
c.Full-time employee of such a business (for a minimum of six months); and I am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months):No
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be
approved by a 4/7th vote of the Mayor and City Commission.
NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City
affiliation requirements of section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit,
stipulating that they have met either (or both) of said affiliation requirements. The original affidavit shall be filled
with the Office of the City Clerk prior to being sworn in as a member.
Or
No● Have you ever been convicted of a felony:If yes, please explain in detail:
● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail:
● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail:
● Are you currently serving on any City Boards or Committees:No If yes, which board?
● Are you presently a registered lobbyist with the City of Miami Beach?No
● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
I have a desire to meet with my city leaders and fellow appointees to discuss and make informed decisions to
improve the City of Miami Beach. I have worked with Commissioner Richardson for the past year, and want to
create new opportunities to make a positive impact on my community.
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:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office
(Miami Beach Code section 2-26)
o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
o 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.
o 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 equality to members of
advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143.
Florida Statutes.
● In what organization(s) in the City of Miami Beach do you currently hold membership in?
No Organization Information Submitted.
● List the address of all properties owned or in which you have an interest within the City of Miami Beach:
No Owned Property Information submitted.
If so, which department and title?No● Are you now employed by the City of Miami Beach:
● 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?No
If "Yes", identify person(s) and department(s):
No relative's information submitted.
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with
Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2)
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.
One of the following forms must be filled 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;" or
2. A "Statement of Financial Interests (Form 1)¹ ;" or
3. A Copy of your latest 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.
_____________________________
¹ Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant
to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervisor of
Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the
County Supervisor of Elections automatically satisfy the County’s financial disclosure requirement as a Miami Beach
City Board/Committee member and need not file an additional form with the Office of the City Clerk. However,
compliance with the County disclosure requirement does not satisfy the State requirement.
DIVERSITY STATISTICS REPORT
The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to
comply with City diversity reporting requirements.
WhiteRace/Ethnic Categories
What is your race?
No details providedOther Description:
Gender:Male
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No
Physically Challenged:No
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.”
I Gavin Basner agreed to the following terms on 8/20/2021 3:23:19 PM
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
Board and Committee Application Checklist: Please ensure you have provided all information before applying or
reapplying to any Board and Committee.
YES
YES
YES
YES
I have answered all questions fully.
I have uploaded a current resume, photograph, and a copy of any applicable professional license.
I have completed and attached the Board & Committee Financial Acknowledgment Statement.
I have completed and attached the Diversity Statistics Report.
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or
telephone: 305.673.7411
Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as
public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you
do not wish your home address, telephone numbers, and/or photograph to be made public, please:
1) Use your office or other address for your mailing address;
2) Use your office or other telephone number for your contact number; and
3) Do not attach a photograph.
Gavin Basner
4628 Alton Road
Miami Beach FL, 33140
305-240-9973
gbaz@hotmail.com
Miami Beach Senior High School, Class of 2022
Unweighted GPA: 3.75
Weighted GPA: 4.9
HONORS & AWARDS
Superior Honor Roll – 9, 10, 11, and 12
IB Diploma-12
Selected as the teen representative from Temple Beth Shalom to interview former U.S
Representative Donna Shalala 9 (https://www.facebook.com/TBSMB/videos/631059397490250/)
Appointed to the Miami Beach Youth Commission by Commissioner Richardson
CARS Award*
EXTRACURRICULAR ACTIVITIES
Varsity Track Team
Two-time Captain
Grades 9-12
10 hours per week, 20 weeks per year
Selected to run the 400m and 200m for my school’s team. Attended practice every day and
meets on weekends. Voted team Captain by my teammates and coaches. Attended districts
every year.
Youth Program
Founder
Grades 11-12
1 Hour a week (hours may vary depending on activities)
Founded a youth program at Temple Beth Shalom, centered around kids ages 10-15.
Designed engaging activities where kids have the opportunity to branch out socially.
Collaborated with temple rabbis, board members, and parents to construct a robust
program that pools an increasing number of new kids each month. Maintained a
professional persona with colleagues and parents when addressing business manners, but
also relates to the kids on a personal level.
Big Brother Big Sister
Vice President
Grades 9-12
1 Hour per week, 36 weeks per year (3 more hours one week every month for activities with
program)
Helped start club at my school. Recruited over 15 members who attended meetings and
participated in events once a month. Partnered with Big Brothers Big Sisters of Miami to
host events at our local community center for underprivileged kids.
Best Buddies
Grades 10-12
1 hour per week, 36 weeks per year (Not including 3 hours a month for events)
Participated in every meeting and event. Became friends with some of the students with
disabilities at my school that carried on outside of the events.
Beshty/Justice League
Grades 9-12
1 hour per week, 44 weeks per year
Joined the Beshty program at my temple (grades 9-10). Coordinated events and activates
for teens who also attend the Temple Beth Shalom. One of six teens selected to join the
justice league at my temple (grades 11-12). Formed new and deep friendships within the
cohort and with diverse communities throughout Miami Beach and the region. Engaged in
social action, partnering with representatives, governors, doctors, commissioners, mayors,
and organization leaders. Built skills and experiences that allow me to enforce change in my
community.
Basketball
9th Grade
24 hours per week, 25 weeks per year
Balanced a full academic course load with weightlifting sessions, study hall, games, and
practice six days a week. Fought my way up the depth chart until I became a starter
towards the end of the season.
COMMUNITY SERVICE
Give Kids the World
Head Volunteer Coordinator
Grades 9, 10, 12
12 hours per week, 1 week per year
Participated in Give Kids the World’s Village in Orlando, Florida by feeding and entertaining
families who have a family member with a life-threatening or terminal illness.
Beshty Retreat
Counselor/event coordinator
Grades 9,10,12
40 hours per week, 1 week per year
Served as a role model for 3rd-5th graders during a weekend retreat which targeted learning
and team building activities that focus on Jewish values and ethics.
Mitzvah Day
Project Co-Captain
Grades 9-10
5 hours per week, 1 week per year (not accounting for weeks of planning)
My friend and I started “Super Snacks for Seniors”. Provided snacks and entertainment for
a local senior citizen home (grades 9-10).
Mitzvah Day*
Project Co-Captain
Grades11-12
5 hours per week, 1 week per year (not accounting for weeks of planning)
Partnered with one of the commissioners of Miami Beach to hold a drive-through food
distribution site that fed over 500 families.
EDUCATIONAL PROGRAMS / SUMMER ACTIVITIES
Summer 2020
Sports Management virtual class taught by UCLA Professor
1 week-****
Summer 2021
Pre-College Enrichment Course at USD
3 weeks-June 27th-July 16th
WORK EXPERIENCE
Counselor
Jewish Community Center
Summer 2020
8 hours per week, 6 weeks per year
Helped lead drills, conditioning, and competitions at the basketball camp. Maintained a
healthy and safe environment to provide a great experience for campers. Responded to
behavioral issues as well as questions and concerns by parents.
SKILLS
Foreign Languages: Spanish (proficient), Hebrew (can read)
Project Manager: Led multiple successful projects, collaborating with adults and experts in
their respective fields.
Problem Solving: Identified problems around the community and devised numerous solutions to
help cope with these issues.
Active Listener: Always note-taking and open to ideas from my superiors and mentors.