Benjamin Mostkoff 12.31.25IA MI BE
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Benjamin J. Mostkoff DATE OF APPOINTMENT: 11/30/202 3 -----------------
BOARD/COMMITTEE: Marine & Waterfront Protection Appointed by: Commissioner Laura Dominguez
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy, g. letter of Appointment/Reappointment e-mailed to
l 3O]23
o Board and Committee Application (Completed on __ - _
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on_[_[_@_[)j
o Oath
reRM No:. LD[3\/2 TERM LIMrr: 12/3/]-
Committee Liaison on
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
REcE\VED ✓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
[MN (09 2074 amended through December 2010)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
EM4AMI BEACH Highlights of the Miami-Dade County Ethics Code
([TY OF_+Ee C/CLERK Sunshine Law and Public Records - Frequently Asked Questions
FFICE OF :" 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 COPY in file and ORIGINAL for Annual Report.
Received on: 10+ Signed by 'l
/}°// sos4 to
Processed on. '_By Employee: '
fate City Clerk's Office Staff Initials
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ByEmployee. _'d Scanned on:
Date 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:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
We are commuted to providing excellent public service and safety to ail who five, work, and play in our vibrant, topical, historic community.
M IA M I BEACH
City of Miami Beach, I/OO Convonlion Coner Drive, Miami Boach, Florida 33 139 yNyw_miaIibeachll.gov
OF FICE OF THE CITY CIERK, Rafael E. Granado, City Clerk
Tl: 305.673.7411, Fax: 305.673.7254
Email: CiyClerk@miamibeachfl.gov
November 29, 2023
Mr. Benjamin Mostkoff
4900 Lakeview Drive
Miami Beach, Florida 33140
SUBJECT; Marine and Waterfront Protection Auth ority
Congratulations! You have been reappointed by Commissioner Laura Dominguez to the above
referenced, board or committee named above, for a term ending: 12/31/2025.
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 and good luck. , .- City Clerk
cc: Monica Beltran, Parking Director
Tasha Byars, City Liaison
ATT ACHMENTS:
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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City of Miami Beach, I/OO Convention Conler Drive, Miami Boo.h, Hord+ 33 139 yyywy_miariboachf]_go
OFFICE OF THE CITY CLERK, Rofaol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci#Clerk@miamibeachtl.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 m y colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all com m unications m ade by m e as a public servant
I have been issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C ode of Ethics O rdinance), as w ell as Florida Com m ission on Ethics G uide to the S unshine A m endm ent
and C ode of Ethics fo r P ublic O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C om m ittee, I m ust com ply w ith the financi al di scl osure requi rem ent s of M iam i-Dade County or the
State of Florida (depending on the board or com m ittee on w hich I serve) on July 1st, fo llow i ~ the cl osing
of the calendar year on w hich I have served.
Sworn to and subscribed before me this~ry 2024
T cnarles D'Agostin
Deputy Clerk
p lease vi si t the C ity of M iam i B each w ebsite at w w w .m iam ibeachfl.gov under C ity C lerk/B oard and
Com m ittees fo r additional info rm ation regarding the Financial Discl osure Requirem ents.
1\\#l
City of Mi ami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@ miamibeachf.gov
Telephon e: 305.673.7411
RECEIVED
JAN 09 2024
CITY OF MIAMI BEACH
OFFICE Or T CIT 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
/)all that apply):
«{ lam a resident of the City of Miami Beach for six months or longer.
ome A@ares /70o /aMete D«at, than c, • 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).
[[qr9 (9[ [1JS[[@S}
P S[[eSS J\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).
[]3/ OF pJ[[]Si....»
HS[[es [\(Sr9SS
"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
ail 1.. sa,
-have read the foregoing document and that the facts stated in it
/ , 2oz3
Date °
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ~I presence or o online notarization,
aay _Mack oz27 , leg! r /losroff
(City of Miami Beach Board/Committee Member).
Signature of Notary Publjo (7cha& T f6DA!
Name of Notary, Typed, Printed, or Stamped
IAMIB
City of Miami Beach
1 700 Convention Center Drive
Mi am i Beach , Flor id a 33139
www._miamibeachfl, gov
OFFICE OF THE CITY CLERK
Email: BC@m iamibeachfl.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 require ments.
Gender:
[KJ Mate
LIremale
D Other
L prefer not to ans wer.
Race/Ethnic Categories:
What is your race?
LO Amnican American/Black
D Asian or Pacific Islander
LX} Caucasian/wh ite
0 Native American/American Indian D Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
J ves
q0 No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
I ves
0 No t prefer not to answer this question.
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F:IC LE R\$A LL\R E G \BO A RD A ND C O M M ITT E E A PP LI C A TIO N S FIN A L D R A FTS\BO A R D A N D C O M M ITT E E A PP LI C A TIO N RE G FIN A L.docx
Updated: June 2020
1l /A MI
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 .7 41 1
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 for s, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 dw n jail..,.or both.
2, JJi-
1/9/2024
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:\C LER \$A LL\RE G \BO A R D A ND C O M M ITT E E A P P LI C A TIO N S FIN A L DR A FT S\BO A RD A ND CO M M ITT E E A P P LI C A TIO N REG FINAL.docx
U p da ted : June 20 20
M IA M I
Eml SOURCE OF INCOME STATEMENT
Section 2-11.1(0) of the County Ethics Code requires that certain em ployees 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 ID 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. D
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 redit Union
Stability Reefs LLC 4900 Lakeview Drive, Miami Beach, Fl. 33140 Marine Habitat Consulting
/ nforrnation above is a true and correct statement.
Signature of
1/9/2024
Date signed
swag/PR7PP%"
L]Hardcopy
LJ Electronic,gg'
1ANY 2024
CITY OF MIAMI BEACH
OFFICE r CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
(\/\IA \I CITYW IDE {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 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
D ate of A pplication: 1/9/2024
A pplicant N am e: B enjam in J. M ostkoff
Boar d/C om m ittee N am e: M arine & W aterfro nt P rotection A uthority
A ddress: 4900 Lakeview D rive, M iam i Beach, Fl. 3314 0
E-M ail A ddress: 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
App licant Si anat ur e : ef
Please pro vi de sign e d form to th e Park ing Depar tm ent 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, ·¢ D ar Ina epartment ection
PERM IT SYSTEM GARAGE ACCESS
Expiration Date: I ID Card Serial #:
Issued By Print Name: l o Print Name:
Signa ture: «ur 1 Signa ture:
Date Issued: 7 " Date Completed:
s
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