John Bennett 12/31/08
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl gav
OFFICE OF THE CITY ClERK, Robert Porcher, City Clerk
TEL: (3051673.7411, FAX: (305) 673.7254
02-08-2007
John Bennett
823 NE 116th 8t
Miami, Florida 33161
SUBJECT:
Disability Access Committee
Congratulations! You have been appointed by Commissioner Matti H. Bower
to the agency, board or committee named above for a term ending: 12/31/2008.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
~~Vb
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Heidi Johnson-Wright
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 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 Employee
We ore commiffed to providing excel/ent public service and safety to 01/ who live. work. and ploy in our vibrant, troplco!. historic community
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (3051 673.7411, FAX: (3051 673.7254
TO John Bennett
RE: Disability Access 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: 12/31/2008.
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 theFlorida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, and understand that as a member
of a City of Miami Beach Board andlor Committee, I must comply with the financial disclosure* require-
ments of Miami-Dade County or the State of Florida (depen' on the board or committee on which
I se"'e) 00 July 1 st, follow;og the closlog of the caleod",,' a' 0 which I hav//,ed. _
V !~
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.
We ore commiffed to providing excellent public service and safety to all who live, work, and ploy in our vibrant, tropical, historic community
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MIAMIBEACH
BOARDS AND COMMITTEE APPLICATION FORM
Pursuant to City Code section 2-22(4) 0 and b: Members of agencies, boards, and committees sholl be affiliated with the city; this requirement sholl
be fulfilled in the following ways: 0) on individual sholl hove been 0 resident of the city for 0 minimum of six months; or b) on individual sholl
demonstrate ownership/interest for 0 minimum of six months in a business established in the city.
Resident of Miami Beach for a minimum of six (6) months: Yes [ ] or No [v{ ~
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes [ or No [ ]
I am applying for a Board appointment because I have special abilities, knowledge, experience: Y~s [
My special abilities, knowledge, or experience is: !\~/I"L.(.)T.4Tf U"d rf.Ji..f'I/.- .... n ~,:r;~'1"'" hl.5it rl( prt!.}J/ft/ltTt
Are you a re~istered voter in Miami Beach: Yes D or No . ~"'f"""""'J .'f't/I'1Ii.Ji!/l,"~t:[:Jc ((V~itYj
NAME: :tSc>> ~lrl{tt J";;hl"\ D
Last Name First Name Middle Initial
Home rJ,~~ N~ 116 STre{1 au (C\~tV +hvl( FL 35 It /
Address: No. Street ity State Zip Code
Phone: ifL. ,/)99rC}fl
Home
~\ S- 5";',) -787U
Work
3C5-.(3 2 - 103 I JC H j\J {3 @ ~c ~ -wr\\~ - l ec;,>, ~. ,(C\,>-\
Fax Email address :.J
(Please check one): I am now a resident of: North Beach 0 South Beach 0 Middle Beach 0
Business Name: ke~)f(,'Na Yr?"TJ V,\j~t'1l) f"l' Applicant's Position: VI ce f re S Itfe "" T
Address: -7b'~ 41 SI 5..J/1-l? C NI/fJrl, 4'/l-h FL-
No. Street City State
DOwner 0 Stockholder/Shareholder ~ Corporate Officer 0 Other Explain: V Ice P!{1-) I cI(i{) 7
3'5/ Yo
Zip Code
Professional License (describe):
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes 0 or NoJ'lf yes, please explain in detail:
Expires:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No)( If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes 0 or N~.'
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: or No.
If yes; which board?
Adu1
What organizations in the City of Miami Beach do you currently hold membership in?
Name: ']empl€ Btf),sjJd~f11 Title: lY}e/11b~;-
Name:
Title:
List all prope~i~owned or ha, ve an interest in, ~~ctl..are located within the City of Miami Beach: /1
9'~ / Jl:~-IH'(-.J(/." live? ;2y; 9:;)/ J("~"" '^" iNe 31: 739 / (k .s 'jtrlt1
3;1.3 /,V/Uhl-:Jlt-1 4ve IfF1 loz,2- Eve/,ei If:; IL.) /'
13'/ 1/ st~9
C\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\ TEMPORARY INTERNET FILES\OLK14\BC APPLICATION NOV 20051Ddc
I am now employed by the City of Miami Beach: Yes 0 or No PD. If yes, which department?
Pursuant to City Code Section 2-25 (b): Do you have a parent OJ, spouse OJ, child OJ, brother OJ, or sister 0] who is
employed by the City of Miami Beach? Check all that apply. I . ntify the department(s):
IJ K
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.
Reqular Boards of City)
o Art in Public Places Committee DHousinq Authority
o Barrier Free Environment Committee ~oan Review Committee* -
o Beach Preservation Boord DMarine Authority *
o Beautification Committee DMiami Beach Cultural Arts Council
o Boord of Adjustment (Flood Management) * DMiami Beach Commission on Status of Women
JR'Budget Advisory Committee DMiami Beach Florida Sister Cities
o Committee on the Homeless DNormandv Shores Local Gov. Neiqhborhood Improvement
o Committee for Quality of Education in Miami Beach DNorth Beach Y ciuth Center Oversiqht Committee
I )iCommunity Development Advisory Committee* . DOversight Committee for General Obligation Bond
o Communitv Relations Boord DParks & Recreational Facilities Boord
o Convention Center Advisory Boord o Personnel Board *
o Debarment Committee o Planning Board *
o Design Review Boord * o Police Citizens Relations Committee
o Fine Arts Board o Production Industry Council
o Golf Advisory Committee o Public Safety Advisory Committee
o Health Advisory Committee o Safety Committee
o Health Facilities Authority o Transportation & Porkinq Committee
DHispanic Affairs Committee o Visitor & Convention Authority *
n___.___
DHistoric Preservation Board * o Youth Center Advisory Boord
*Board Required to File State Disclosure form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes 0 No 0 Years of Service 0
2. Present participation in Youth Center activities by your children Yes 0 No D. If yes, please list the names of your children,
their ages, and which programs. List below:
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
This section is "not required" but desired: Age: JD '36
Ethnic Origin (Check one)
White 1i?f African-American/Block 0 Hispanic: 0
Asianor Pacific Islander 0 American Indion or Alaskan Native 0
Employment Status: Employed ~ Retired 0 Home-maker 0 Other 0
Gender: Male or Female 0 H
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by
Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency
Me ,,"() ~,[! ~_ '
~t>vv<r , :..J iJA~ &)I//\( ti
ate . Name of Applicant (PLEASE PRINT)
Attachment: Please attach a copy of your resume to your application.
NOTE: Applications will remain on file for a period of one (1) calendar year.
Z. e5J
Received in City Clerk's Offic by "- lGLK.e,-';. CJ.!&OYL
Document Control Number (Assi ne by the City Clerk's Offic~ /1 V
_____- Deputy Clerk
Revised 11/15/05
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