Ben Mostkoff 12/31/23BOARD AND COMMITTEE CH ECKLIST
APPOINTEE: Benjamin J. Mostkoff DATE OF APPOINTMENT: 11/20/2021 ------------------
BOARD/COMMITTEE: Marine & Waterfront Protection Appointed by: Commissioner Mark Samuelian
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
11/30/2021 11/8/2021
o Board and Committee Application (Completed on _
o Résumé/Curriculum Vitae 1/10/2022
o Diversity Statistics Reporting (Completed on _
o Oath
rea o. """ reno._""°
to Committee Liaison on
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
Received January 10, 2022
Office of the City Clerk
City Code Ordinance Section applicable to the agency, board or committee
City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
✓Sunshine Law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
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o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep çoPy in file and ORIGINAL for Annual Report.
Received on: __ 1_1_10_l_2_0_22 Signed by X __,........,.'-",:1.""_""'·-~-·..;.._· _,__---_· _-·_·· _
,Boar6r Committee Member
Chaola D'qaat2% [reSSed On._by_mpl0/€e. 4-
Date City Cl erk s oRe star Initials
1/10/2022 Claabu 'A »at
__________ By Employee: _,,,:£::~-----------
City Clerk's Office Staff Initials
Date
1/10/2022
Scanned on:
Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
e are commuted to providing excellent
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City of Miami Beach, 1ZOO Convention Conter Driva, Miami Boach, Fonda 33 139 yywy_miamib_achfl_goy
OFFKCE OF THE CITY CLERK, Rofal E. Gran ado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: C ityCl erk @m iam i beoch fl.g ov
Novem ber 30, 2021
M r. Benjam in M ostkoff
4900 Lakeview D rive
M iam i Beach, Florida 33140
SUBJECT: Marine and Waterfront Protection Authority
C ongratulations! Y ou have been reappointed by Commissioner Mark Samuelian to the above
referenced, board or com m ittee nam ed above, fo r a term ending: 12/31/2023.
P ursuant to C ity of M iam i B each C ode S ection 2-22 (5) a, "Notw ithstanding any other provision of the
C ity C ode or of any resolution, com m encing w ith term s beginning on or after Jan uary 1, 2007, th e term of
every board m em ber w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically
expire upon the latter of: D ecem ber 31 of the year the appointing C ity C om m issioner leaves offi ce or
upon the appointm ent/election of the successor C ity C om m ission m em ber."
If you are unable to accept this appointm ent, or have any questions, please call the O ffi ce of the C ity
C lerk at 305.673.7411. P lease read the enclosed m aterials carefully.
C ongratulations and good luck.
R eg/21
Ra¿ranado
C ity C lerk
cc: M onica Beltran, P arking Director
K enneth V arela, C ity Li aison
ATTACHMENTS:
Letter of A ppointm ent
O ath
C ity C ode/O rdinance section applicable to agency, board or com m ittee
C ity Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdinance No. 2006-3543 - Am endm ent to C ity C ode S ection 2-22
M iam i-Dade County C ode S ection 2-11.1 - Conflict of Interest and C ode of Ethics O rdinance
C ity Wi de P erm it Appl ication - (Parking Departm ent Form )
B ooklet - G uid e to the S unshine A m endm ent and C ode of Ethics for P ublic O fficers and Em ployees
City of Miami Beach, 1ZOO Convention Conter Driva, Miami Booch, Forida 33139 y¿w_ILiaribgach[]_go
OFFICE OF THE CITY CLERK, Rofal E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O: Mr. Benjamin Mostkoff
R E : M a rin e a nd W aterf ront Protection Authority
I do so le m n ly sw ea r o r a ffi rm to b ea r true faith, loyalty a n d a lle giance 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
a bo ve-m e ntio n ed board or committee of the City of Miami Beach to which I have been appointed for a
term en din g: 12/31/2023.
T o m y colle ag ue s a nd to all o f tho se I rep resent a n d se rve , I p le dge fairn e ss, inte grity a nd civility, in a ll
a ctio ns take n a nd a ll com m unicatio ns m ade by m e a s a p ublic serv a n t.
I h a ve be e n issu e d a co py o f se ction 2-1 1 .1 of the M ia m i-D a de C o u nty C o d e (C o nflict o f Interest an d
C o de of E thics O rdina nce), a s w ell as F lo rid a C o m m issio n o n E thics G uid e to the S un shine A m e ndm e nt
and C o de o f E thics for P ub lic O fficers and u nde rsta nd that a s a m e m b er o f a C ity of M ia m i B each B o ard
a nd/or C o m m itt ee, I m ust com p ly w ith the financia l d iscl osure* requirements of Miami-Dade County or the
S tate o f F lo rid a (de pe nding o n the b oard or com m itt ee on w hich I serve ) o n July 1st, fo llow i the cl o sing
o f the ca le nda r yea r on w hich I h ave se rv ed.
S w orn to a nd sub scrib ed b efo re m e thi s 10th d ay o f January 2 022
Ciao, D'etio
Charles D'Agostin
Deputy Clerk
*P le a se visit th e C ity o f M ia m i B e a ch w eb site at w w w .m ia m ib e a chfl.g o v und e r C ity C le rk/B o a rd an d
C o m m ittees fo r a dditio na l info rm atio n rega rding the Financi al D iscl osure R equirem e n ts.
MIA] H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AEFIDAVII OF AEEILIATION WITH THE CITY OF MIAML BEACH
ST A TE OF FLORI DA
COUNTY OF MaDa"°
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
0' I am a resident of the City of Miami Beach for six months or longer.
O I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six month s).
O I am a full-time employee of 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).
"Ownership Interest" means the ownership of ten percent (10%} or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perj ry, I declare that I have read the foregoing document and that the fact s
stated in it are tr ·l 1
1/10/2022
Signat
Benjamin J. Mostkoff
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or□online
notarization , this_'0_day of"UaY ,20??_y Benjamin Mostkoft
________________ (City of Miami Beach Board/Com mittee Member).
X Produced ID FL Driver's License ----------------- Form of Identification
Personally Known
Cito v'ge (NOT ARY SEAL)
Signature of Notary Public
Ch ar le s J. D'A go stin
Name of Notary, Typed, Printed, or Stamped .iü., CHARLES J. DAGOSTIN ¿$j; wcouussroN «w is7os
:,94,¿is$ EXPIRES: Docmber 14, 2025 ¿á Bonded Thu Notary Pub lic Underwrit ers iris
Ml MIB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeach[l.gov
OFFICE OF THE CITY CL ERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
M ostkoff Benjamin J.
Last Name First Name Middle Initial
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.
Gender:
[0O Male
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
[] Caucasian/wh ite
DI Native American/American Indian
O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Lyes
q0 No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
t Yes
) I No
O I prefer not to answer this question.
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F:\C LE R\$A LL\RE G \BO A R D A ND C O M M ITT E E A PP LI C A TIO NS FINA L D RA FTS \BO A RD A ND C O M M ITT E E APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
Mostkoff Benjamin J.
Last Name First Name Middle Initial
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 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;" 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 day in jail, or both. -- 1/10/2022
Signature Date
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.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE, EI SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial
2020 Mostkoff Benjamin J.
Mailing Address - Street Number, Street Name, or P.O. Box
4900 Lakeview Drive
City, State, Zip
Miami Beach, FI. 33140
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 Hele.
Filing as an Employee (check one)
DJ county □Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
□County □Municipal:
(Municipality)
Board where serving
Alternate address (if home address is exempt) I Work telephone I Term began on/ended 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. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. 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. O
Name of Source of Income Address Description of the Principal Business Activity
Shoreline Foundation Inc 2781 SW 56 Ave, Pemboke Park, Fl. 33023 Construction
State of Florida Retirement, Soci l Security, Dade County Federal Dredit Union
Stability Reefs LLC 4900 Lakeview Drive, Miami Beach, Fl. 33140 Consulting
einformation above is a true and correct statement.
Signature of
1/10/2022
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
□Hardcopy
Z Electronic Copy
Received January 10, 2022
Office of the City Clerk
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
/\/\\/\/\/\/ CITWIE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Sui te 200/Miami Beach , FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/ or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: 1/10/2022
Applicant Name: Benjamin J. Mostkoff
Board/Com mittee Name: Marine & Waterfront Protection Authority
Address: 4900 Lakeview Drive, Miam i Beach, Fl. 33140
E-Mail Address: artyreef@gmail.com
Work Phone: 305-345-1544 Home Phone 305-345-1544
Cell Phone:
305-345-1544
Preferred Contact Method: 305-345-1544
Vehicle Information
Tag: JW JH9 3 Color: Silver
State: Florida
Make: Ford
Applicant S¡+nature: es
Year:
Model:
2018
F-150 Supercrew
Please provide signed f; m to the Parki Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·ki D ar Ina enartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Cord Serial #:
Issued By Print Name: Print Name:
Signature: e> Signature:
Date Issued: Date Completed:
s
.'.pmng man rar torms cw aatdscommmtees par.mgtorm,doc
IIII IIII III IIIIIII
REST:A-Corr Lenses
END; tone
CA$:E -Any nan-commercial veh with a GVwR ¢ 28.001 ps, or any pt
The tate a! FL retains ak property rigts herein, u I