Jalak K Jobanputra 12.31.24M IA M I BEACH
B O A R D A N D C O M M IT T EE C H E C K L IST
APPOINTEE: Jalak Kishor Jobanputra
BOARD/COMMITTEE: Budget Advisory Committee
DATE OF APPOINTMENT. 02/22/2024
Appointed by: Commissioner Kristen Rosen C
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
o Board and Committee Application (Completed on I I
o R~sum~/Curriculum Vitae \3[
o Diversity Statistics Reporting (Completed on _,'.kl
o Oath
reRM No: _12/3]_[{ TERM LuMrr. 2]slJ1
2/zal2
IMPORTANT INFORMATION FOR BOARD AND COMMITT EE 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)
l _ _ ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
APR 11204 Highlights of the Miami-Dade County Ethics Code
CITY OF M IA M I B E A C HY Sunshine Law and Public Records - Frequently Asked Questions
OF7'£ @F 1$TBA! Memorandum - Solicitation by City Board and committee Members
gpOTE. ·--
OF t' O Citywide Permit Application (Parking Department Form)
RECEIVED
Scan o
Scan o
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment Statement
o Board and Committees Liaison Responsibilities
o Diversity Statistics Reporting
f7l I acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) If any mem ber of an agency, board or committee fails to attend 33 percent of the regularly scheduled
meetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less ro unds down to the next whole number and .5 or more ro unds up to the
next whole num ber.
NOTE: Mem bers of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year; or upon abstaining fro m voting due to a conflict of interest on four different
applications within a calendar year. A member who is removed shall not be reappointed to membership on the
board for at least one year fro m the date of removal.
Received on: ±/sh .x Pe"["r_?
4 ti rot# Processed on. - by Eimpl0ye€.
City Clerk's Office Staff Initials Date
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, 17 OO C on ven tion Cen ter Drivo, Miami Boach, Florida 33 139 yyN_miamniboachhl_go
OFFICE OF THE CITY CLERK, Rafool E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: CiNyClerk @mi amibeachfl.gov
February 22, 2024
Ms. Jalak Jobanputra
2842 Sheridan Avenue
Miami Beach, Florida 33140
R E : B udget Advisory Committee
Dear Ms. Jalak Jobanputra:
Congratulations! You have been appointed by C o m m issio n er K risten R o se n G on zalez to the above-
referenced Board or Committee, for a term ending: 12 /31/2024 .
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
R afl§l o
City Clerk
cc: Monica Beltran, Parking Director
Tameka Otto Stewart, City Liaison
E N C L O S U R E S :
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
M IAMI BEACH
City of Miami Beach, ZOO Conven tion Center Drive, Miami Booc h, Florida 33 139 yyNy _miamiba chllgo
OFF ICE OF THE CITY CLERK, Rafaol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Jalak Jobanputra
RE: Budget Advisory 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: 12/31/2024.
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, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 2 ---
*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.
M IA M I BEA C H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
APR 11 2024
CITY OF AI MI BEACH OFFICE "a ·" -CIC!ER
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
Z] I am a resident of the City of Miami Beach for six months or longer.
Home Address,2842 Sheridan Avenue Miami Beach, FL 33140
Z] 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).
Name of Business: Future Perfect Ventures
Business Address,C50 Lincoln Road Miami Beach, FL 33139
D 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).
[[are f Hy[neSS,
Business Address: -------------------------
"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 perjury, I declare that I have read the foregoing document and that the facts
S!a~ _4_11_1_2_4 _
ska #I owe
Jalak Jobanputra
Printed Name
M IA M I B EA CH
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: 305.673.7411
DIVERSITY STATISTICS REP ORI
Jobanputra Jalak K
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:
LJ at e
[l Femal e
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
[] Asian or Pacific Island er
D Caucasian/W hite
LJ Native American/American Indian
D Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
l ves
No
El prefer not to answer.
Do you consider yourself Physically Disabled?
a ves
z0o
D I prefer not to answer this question.
Page 6 of 6
F:\C LER\$ALL\REG \BO ARD AND CO M M ITT EE APPLIC ATIO NS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl_gov
Telephone: 305.673.7411
Jobanputra
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Jalak K
Last Name First Name Middle Initial
Acknowledgment 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)
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 Copy of your latest Federal Income Tax Return.
Members of the Planning Board and the Board of Adjustment must electronically file a "Statement of Financial
Interests (Form 1)" directly with the Florida Commission on Ethics.
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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
Sign~ -~-::-~-
24
-------------
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 electronically file a Statement of Financial Interests (Form 1) with the Florida
Commission on Ethics by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics 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.
Page 6 of6
F:ICLER\$ALLIBOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION FEB 2024.d0cx
Updated: February 22, 2024
MIAMl·DAD E- EI SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain em ployees and public offi cials file a financial disclosure Statem ent on a yearly basis by July 1st
of every year.
Di sclosure for Tax Year Ending I Last Nam e First Nam e Middle Nam e/Initial
2023 Joban putra Jalak Kishor
M ailing Add ress - Street Num ber, Street Nam e, or P.O. Box
2842 Sheridan Avenue
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 here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(Municipality)
Departm ent
Position or Titl e Em ployee ID Num ber
W ork address I W ork telephone Em ploym ent began on/ended on
Filing as a Board Member (check one)
E] county □Municipal:
(Municipality)
Board w here serving
Budget Advisory Committee
Altern ate address (if hom e address is exem pt) I W ork telephone I Term began on/ended on
(917) 509-8445 02/23/2024 12/31/2024
List below every source of incom e you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Exam ples of sources of incom e include: com pensation for services, income fro m business, gains from
pro pert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of incom e received by another
person for your benefit. How ever, the incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, ch eck here.[]
Nam e of Source of Incom e Address Description of the Principal Business Activity
Future Perfect Ventures 350 Lincoln Road, Miami Venture Capital Firm
Beach, FL 33139
I hereby swear (or affirm) that the information above is a true and correct statement.
e::Er
Date signed
RECEIVED BY ELECTI ONS DEPARTMENT:
D Hardcopy
ear»is ck EIVED
APR 11 2024
CITY O' 1AMI BEACH
).+- + t.+
OFFICE USE ONLY Accepted: Y / N Deficiency: Pro cessed Dat e/Initials: Scanne d Date/initials.
138 SP-14 COE 2016
M IA M I B EA CH
City of Miami Beach, PARKING DEPARTMENT
BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue, Suite 200 Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
La
PARKING
A s a Bo ar d /C o m m itte e m e m b e r you a re e ntitle d to a C ityw id e Par king Perm it, w hich incl udes City Ha ll
g ar a g e (G 7) p ar kin g a c c e ss (A ccess C ar d), or a co m p lim entary C iti Bike /Deco Bike M em bership, or a
d isc o u n te d M D C M o n th ly Tra n sit Pas s throug hout your term .
Board Member Information
D a te o f A p p lic a tio n :
A p p lic a n t N am e: Jalak Kish or Jobanputra
Bo ar d /C o m m itt e e N a m e : Budget Advisory Committee
A d d re ss: 2842 Sheridan Avenue Miami Beach, FL 33140
E-M a il A d d re ss: jalak@fpv.vc
W or k Ph o n e : Ho m e Pho ne:
C e ll P h o ne : 917-509-8445 Preferred C ontact M etho d: Email
Please Choose One 1 O tion:
• C ityw id e Parking Permit/G7 A c c e ss C ar d C iti Bike/Dec o Bike M em bership
Vehicle Information (For Citywide Parking Permit/ Access Card Only)
Ta g : QXQH73 C olor : SILVER
Sta te : FLORIDA Year : 2021
M a ke : BMW M ode l: X2
A cityw id e (C W ) p ar kin g p e rm it is ho n o red a t m etered par king spaces and restricted residential zo nes
p ar kin g sp a c e s. A C W p ar kin g p erm it IS NOT ho no red in prohibited ar eas . A n A ccess Car d will be
p ro vid e d to yo u for C ity H a ll G ar ag e (G 7) a ccess.
IMPORTANT NOTE: Yo u r ve h ic le lice nse p late serv es as your "par king perm it". To avoid any
u n n e c e ssa ry en fo rce m e n t ac tio ns, it is im p orta nt th at our recor ds reflect the m ost current and
a c c u rate infor m a tion reg ar d in g yo ur vehicl e lice nse plate . Inaccurate and/or outdated vehicl e
in for m a tio n m a y le a d to th e issu a n ce of p ar king citation(s) and /or the tow ing of your vehicle.
Ple as e no te th a t th is ne w ac c ess car d CANNOT b e hole-punc hed or perfo rated in any m anner. To use
th e ne w car d p le as e ho ld th e car d a t close p roxim ity to the read er until the gate opens. You m ay
ne e d to try the o th e r sid e o f th e car d . Ple as e e nsure you hold the entire surface of the car d against
th e re a d e r un til th e g a te op e n s.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or damage, I will be
responsible to pay a $10.00 replacement fee.
A
Ple a se pr o vi d e si g n e d fol e irkin g Dep ar tm en t loc ated at 1755 M er idian Aven ue, 2n d floor.
W o rkin g ho u rs ar e 8:30 to 5:0 0 p.m . o r e m ail to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
f:\ping\$man\rar\forms\cw boards&committees parkingform.doc form updated 1/18/2024