Benjamin Mostkoff 12.31.23B OARD AND COMMITTEE CHECKLIST
APPOINTEE: Benjamin J. Mostkoff DATE OF APPOINTMENT: 12/29/2022 -----------------
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BOARD/COMMITTEE: Marine & Waterfront Protection Appointed by: Commissioner Laura Dominguez
FO R SCA NNE R FO R CLE RK STA FF I" 11.l.., 1~ { , ,..., /,,,
scan• ·Letter ot Appointment rRM ND:a'TO. TeRMurr:(]2l, '
Scan o o Letter of Reappointment
o COP.Y o~ tter of AppointmenUReappointment e~d to Committee Liaison on
o Boar and Committee Application (Completed on _
o R6sum~/Curriculum Vitae [a[]
o Diversity Statistics Reporting (completed on_lo_ )])
o Oath Scan o
RECEIVED
JUN 30 2023
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓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 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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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
Received on: 1/10/2023 Signed by X
Processed on: ,15 [» By Employee:
7 Scanned on: [30,_2 By Employee:
Date
Cy ci once san initials
(
City Clerk's Office Staff Initials
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 COMMITT IES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
to ail who five, work an d pla y in ur vibrant, topical, historic community.
City of Miami Beach, 1/OO Convention Canlar Drive, Miami Bsach, Florida 33 139 yywy_miamibaachhl gov
OFFICE OF THE CITY CLERK, Rafa.l E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci#yClerk@miamibeochfl.gov
December 29, 2022
Mr. Benjamin Mostkoff
4900 Lakeview Drive
Miami Beach, Florida 33140
SUBJECT: Marine and Waterfront Protection Authority
Congratulations! You have been reappointed by Commissioner Laura Dominguez to the above
referenced, board or committee named above, for a term ending: 12/31/2023.
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 Jan uary 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 and good luck.
cc: Monica Beltran, Parking Director
Tasha Byars, 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 an d 2-459
Ordinance No. 2006-3543 - Am en dmen t 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 - (Par king Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City of Miami Beach, 1ZOO Convention Center Drive, Miami Bach, Florida 33 139 yew._IiaIIibgachf]_go
OFFICE OF THE CITY CLERK, Rofaal E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Cit/Clerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Benjamin Mostkoff
RE: Marine and Waterfront Protection Authority
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: 12/31/2023.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a public servant.
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, followi g the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 10th day ofJanuary 2022
Ciao&a DO'peat
Charles D'Agostin
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.
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7411
RECEIVED
JUN 30 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(s/)all that apply):
«( lam a resident of the City of Miami Beach for six months or longer.
ome Ares /74o /alee ,Drat, /"ha fc, 1. 33//0
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 months).
[[qr[9 (of [1[Pe,5-
[[[S[[eSS S f@S3..
lam a full-time employee of a business (for a minimum of six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
Name of Business ------------------------
[}yS[Pe8S H(]Hr9S_
"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.
Signature Date
aiool 1 snoot
-have read the foregoing document and that the facts stated in it
/lo 2. 2a23
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of 4cal presence or□online notarization,
ay _Mack 2oz7 , leg! T [losr a ff
(City of Miami Beach Board/Committee Member).
Name of Notary, Typed, Printed, or Stamped
M IA M I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33 l 39
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Mostkoff 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:
[/ Male
Llremale
L.loner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
LO Caucasian/white
D Native American/American Indian D Other- Print Race: _
LI prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Jes
0 No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
lves
0 o
D I prefer not to answer this question.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl._gov
Telephone: 305.673.7 411
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. .--
1/10/2023
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:IC LE R\$A LLIRE G \BO A RD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI-DAD E-
EEl 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
2022 Mostkoff Benjamin J.
Mailing Address - Street Number, Street Name, or P.O. Box
4900 Lakeview Drive
City, State, Zip
Miami Beach, Fl. 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)
□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. [l
Name of Source of Income Address Description of the Principal Business Activity
Shoreline Foundation Inc 2781 SW 56 Ave, Pemboke Park, Fl. 33023 Part Time Consultant
State of Florida Retirement, Soci l Security, Dade County Federal Credit Union
Stability Reefs LLC 4900 Lakeview Drive, Miami Beach, Fl. 33140 Marine Habitat Consulting
e nforrnation above is a true and correct statement.
Signature of
1/10/2023
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy RECEIVED
D Electronic Copy
JUN 30 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
/\/\//\/\/\/ WI DE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 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 lo you for Cily 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
D ate of A pplication: 1/10/2023
A pplicant N am e: Benjamin J. Mostkoff
Board/Committee Name: Marine & Waterfront Protection Authority
Address: 4900 Lakeview Drive, Miami 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: 63BPIC Color: Silver
State: Florida Year: 2018
Make: Ford Model: F-150 Supercrew
Applicant Sianature: e
Please provide signed form to the Parking 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 epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: I ID Card Serial #:
Issued By Print Name: l ,,,.-,H''° Print Name:
Signature: sat Signature: e
Date Issued: 1/ ---------------- Date Completed:
s
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