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Mark Rabinowitz 12/31/2018 MIA/\AIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov January 17,2017 Mr. Mark Rabinowitz 1550 N.E. Quayside Terrace Miami , FL 33138 SUBJECT:Health Advisory Committee Dear Mr. Mark Rabinowitz: Congratulations! You have been reappointed by the City Commission to the above referenced board or committee,for a term ending: 12/31/2018. 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. Respectful! afael Granado City Clerk cc:Saul Frances, Parking Director Sonia Bridges, 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 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 We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granado,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 Email CityClerk@miamibeach.gov TO: Mr. Mark Rabinowitz RE: Health 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:12/31/2018. 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. Mr.Mark Rabinowitz Sworn to and subscribed before me this 2-3 day of/ W" ,2017. Ramon Quezada 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 are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. t'''i.+ r,l LIO L `:3 Ira ., - 4 t:Ata a.}Ccrt Csr,;?'Tit: P ;&+'i+')N FORM Rabinowitz Mark [ Last Name First Name Middle Initial 1550 NE Quayside Terrace Miami Florida 33138 Home Address City State Zip Code 305/895-6866 305-538-8835 786/288-6674 mrabinowitzimhchc.com Home Telephone Work Telephone Cellular Telephone Email address Miami Beach Community Health Center Physician Business Name Occupation 710 Alton Road Miami Beach Florida 33139 Business Address City State Zip Code Professional License(describe): Medical Doctor Expires: Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a&b:Members of agencies,boards and committees shall be affiliated with the City.This requirement shall be fulfilled in the following ways:a.An individual shall have been a resident of the City for a minimum of six months; or b. An individual shall demonstrate ownership/interest for a minimum of six months in a business established in the City for a minimum of six months. •Resident of Miami Beach for a minimum of six(6)months:Yes or No FL •Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months:Yes a)or No D •Are you a registered voter in Miami Beach.Yes❑or No •I am now a resident of: North Beach D South Beach Middle Beach D None •I am applying for an appointment because I have special abilities,knowledge and experience.Please list below: I am a medical dnrtnr and I am the CFA and Chief Medjcal officer of the Miami Reach Community Health(Teeter a federally Aualified •Are you presently a registered lobbyist with the City of Miami Beach?Yes D or No Please list your preferences in order of ranking[11 first choice[2]second choice, and[3]third choice. Please note that only three(3)choices will be observed by the Office of the City Clerk. ._Affordable Housing Advisory Committee ----'rHeelth Advisory Committee I n Parks and Recreation Facilities Board°o I Art in Public Places Committee J Health Facilities Authority Board 2 Personnel Board Audit Committee __�_ _3 Hispanic Affairs Committee 2 Planning Board'1� Board of Adjustment** 2 Historic Preservation Board* i :Police Citizens Relations Committee -.Budget Advisory Committee Housing Authorityr=Production Industry Council Committee on the Homeless C Human Rights Committee :Sister Cities Pro-ram _0 Committee for Quality Education in MB 2 LGBT Advisory Committee a Sustainabil' Committee U Convention Center Advisory Board ii Marine&Waterfront Protection Authority ❑Transportation,Parking,&Bicycle-Pedestrian — _ Facilities Committee �1 Cultural Arts Council n Miami Beach Commission for Women v C Visitor and Convention Authority ❑Design Review Board* D Normandy Shores Local Government ❑Youth Commission Neighborhood Improvement G Disability Access Committee _ — �—— * Board members are required to file Form 1—"Statement of Financial Interest"with the State. *If you seek appointment to a professional seat(e.g.,lawyer,architect,etc.)on the Board of Adjustment,Design Review Board,Historic Preservation Board or Planning Board,attach a copy of your currently-effectively license,and furnish the following information: Type of Professional License License Number License issuance Date License Expiration Date Page 1 of 4 F.1CLERl9ALUaFORMs19OARD AND COMMIITEES1aC APPLICATION REVISED 0614201e.6xx °° Note:If applying for the Youth Center positions of the Parks and Recreations Facilities Board,please indicate your affiliation with the Scott Rakow Youth Center and/or the North Shore Parks Youth Center • Please describe your past service with the City's Youth Centers(include dates of service): ▪ Present participation in Youth Center activities by your children.Yes P No D If yes,please list below the names of your children,their ages and the programs in which they participate: Child's name: Age: Program: Child's name: _ Age: Program: •Have you ever been convicted of a felony?Yes 1111 or No al If yes,please explain in detail: •Do you currently have a violation(s)of City of Miami Beach Code?Yes❑or Not,A.t If yes,please explain in detail: •Do you currently owe the City of Miami Beach any money?Yes D or No[13— If yes,explain in detail: • ■ •Are you currently serving on any City Board or Committee?Yes or No u If yes,which board/committee? Health Advisory Committee •In what organization(s)in the City of Miami Beach do you currently hold membership? None Name Position Name Position •List all properties owned or in which you have an interest within the City of Miami Beach: •Are you now employed by the City of Miami Beach?Yes❑or No Which department and title? !t--,y r t—1 —� rr--�� • Pursuant to City Code Section 2-25(bo you have- a parent V,spouse❑,child P brother IP or sister ti.l who is employed by the City of Miami Beach?Yes or No If"Yes,"identify person(s)and department(s): The following information Is voluntary and Is neither part of your application nor has any bearing on your consideration for appointment It is being asked to comply with City diversity reporting requirements. Gender: Male UFemale __--____..---------- ------------ Race/Ethnic Categories What is your race? African-A mencanit3fa ck [Li CaucasianNVhite PI Asian or Pacific Islander Native-American/American Indian Page 2 of 4 F.ICLERIfALLWFORsisyso RD AND COMMITTEES'aC APPLICATION REVISED 06142016.Oax I.21 Other—Print Race; � I Do you consider yourself to be Spanish,Hispanic or Latino/a7 Mark the"No"box if not Spanish,Hispanic,Latino/a. `" 'No Dyes Do you consider yourself Physically Disabled? No u Yes NOTE:IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS.THESE LAWS INCLUDE,BUT ARE NOT LIMITED TO: o Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459). o Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office(Miami Beach City Code section 2-26). c Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11 1). o CMB Community Development Advisory Committee:prohibition,during tenure and for one year after leaving office,from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself,or those with whom you have business or immediate family ties(CFR 570.811). o Sunshine Law- Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities. o Voting conflict—Form 8B is for use by any person serving at the county,city or other local level of government on an appointed or elected board,council,commission,authority or committee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143,Florida Statutes. Upon request,copies of these laws may be obtained from the City Clerk. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION;AND I HAVE RECEIVED,READ AND WILL ABIDE BY CHAPTER 2,ARTICLE VII,OF THE MIAMI BEACH CITY CODE,ENTITLED"STANDARDS OF CONDUCT FOR CITY OFFICERS,EM LOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCOR GL ." 0 — I zit/de Mark Rabinowitz Applicant's Signal Date Name of Applicant(PLEASE PRINT) / Received in the Office of the City Clerk by: � /Z!! 1 / z_/ //j Name of Deputy Clerk Control No. Date ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. Page 3 of 4 F\CLER\SALLWFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 0e14201e.0ocx j�fAq;4 t AI BEE F City of Miami Beach 1700 Convention Center Drive, Miami Beach,Florida 33139, www.miarnibeachfl.gov OFFICE OF THE CITY CLERK CityClerk@miamibeochfl.gov Telephone:305.673.741 1 Fox:305.673.7254 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) Board Member's Name' Mark Rabinowitz 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. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though they may have been recently appointed. 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" 2. A"Statement of Financial Interests(Form 1)" 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$500,6 ays in jail or both. Iv1 ii �t� Sig lure Date Updated:Tuesday,October 04,201 B Page 4 of 4 FCLER\EALUaFORMS'BOARD AND COMMITTEESIBC APPLICATION REVISED 09142016.docx • AC# STATE OF FLORIDA d_ I DEPARTMENT.OF HEALTH yr_ DIVISION OF MEDICAL QUALITY ASSURANCE I'C: DATE UCENSE NO. . . CONTROL.NO. 1 k R 1110312015 ME 38822 507597 `"I .0 P'.1 The MEDICAL DOCTOR •,: 1 g named below has met all requirerneni�of .; , 371 I . �. the taws and rules of the state of Flarida Expiration Date. JANUARY 3'f,2018. ,�7,4_' l�» w 1 MARK LAWRENCE RABINO IT2 N . .a Eli . 11845 BISCAYNE BOULEVARD _ SUITE 207 t, lii .5 MIAMI,FL 33181 +�c a • "A [ 1401 C. 4) .0,.........Attml..„,et, �' Rick Six John H.411:ArmsUoncl,MD,FA .,i GOVERNOR STATE SURGEON GENERAL DISPLAY IF REQUIRED BY LAW EXPIRATION OA1TJANUARY 31,2018 tour 11.o&•maw hi is A6i2E7, Phare toe.:1.n a!T vonearitntd,s.won your board/oonnetL lynch kt;oosse is solely res jousil Ls torrron(yiut{My drpornok•ut to outing of lie licerniee'i esurrnt Loading addsesb«M practice locauun addreea. Kyou have not received youtenewat nonce 90 dyes pf:+r to the expkados dote ehoynr oil this license, *Lout t all MGM 444.059% Use dim aectbe to reperL trema t:hafye.Nems chsn ies require legal docrme iaben&honing be Mote ohnwio.ekes snake aloe One a photocopy of one rtf the fellorrh+A accompanies this ibrret a mm traps license,a dsvoico decree Or a court older. Waco)Ons*v Asswaeee dela jai Is.ceiisnai•naca.0 rnwrsi*alta.bi nisi°+ VW!,s n4rs s aptMr x ii its ahiiiity rb rrmerr taw *ram ipis6,ewe sell+it anti part*? ra.rhtth nddrests.s taxi update your VOW fnlmrmthan I iia bEZIFinalliatedleilleC a.Mk on'Provider AMnritses` ,11.Odds on'Waage org'Lizonee" 4 Retort your put ston •p 14usr the taw In rei1 p l rs etd thotvwa podded nava/on yogi now kcono sn4 aids"Slim.in n.Iu ow seem.server' 6 Rya/40 not know yotyt toot IU and ppsatierd,dick on''deet Imps help?'or nail our Ctastous'r Contact C.+Aia at(*50 414 d llb/sr/imamate. ARIL TO DEPARTMENT OF HEALTH IMPORTANT ANNOUNCEMENTDIVISION OF MEDICAL QUALITY ASSURANCE LICENSURE SUPPORT SERVICES UNIT THE DEPARTI ENI OF HEALTH WILL NOW REVIEW P.O.BOX 0320 YOUR CONTINUING EDUCA1 ION RECORDS Al TALIAHASSEE,FLORIDA 323144320 THE TIME OF LICFN8r RENEWAL. I NAME CHANGE ATTACH LEGAL DOCUMENTATION) TO LEARN MORE,PLEASP1 VISIT WWtilfaisla= sal 0 ty jj FI 2103„s188 1C4 L.°'-)W M � f MARK LAWRENCE RABINOWITZ,M.D.,F.A.C.O.G. 11645 Biscayne Boulevard,Suite 308 Miami,Florida 33181 Phone: 305-424-5535 Fax: 305-695-2189 MEDICAL EDUCATION University of Miami School of Medicine,Miami,Florida 1975— 1979 M.D. Degree received June 1979 Medical License: Florida(Issued July 1, 1980)ME0036822 WORK EXPERIENCE Chief Executive Officer: Miami Beach Community Health Center 5/2012--Present Chief Medical Officer: Miami Beach Community Health Center 2003—Present Adjunct Clinical Faculty,Barry University 2011-2012 Clinical Instructor,Florida International University 2009-Present Assistant Clinical Professor,Nova Southeastern University 2008-Present Clinical Instructor: University of Miami School of Medicine 1983—2003 Private Medical Practice,Bay Harbor Islands, Florida 1983—2003 Vice Chairman: Department of OB/GYN Miami Heart Institute 1996— 1997 Member: Credentials Committee: Miami Heart Institute 1993— 1997 Volunteer Physician: Stanley C.Meyers Community Health Center,Miami Beach 1993— 1994 Volunteer Physician: HRS Health Clinic,South Miami Branch 1992— 1993 Chairman: Credentials Committee,Miami Beach Community Hospital/St. Francis Hospital,Miami Beach 1992— 1993 Co-Chairman: Department of Obstetrics and Gynecology, St. Francis Hospital,Miami Beach 1991 — 1992 Co-Medical Director and Developer: Shared Birth Place/Miami Heart Institute 1987— 1996 Intern and Resident: Jackson Memorial Hospital/University of Miami Hospitals 1979— 1983 Research Technician: University of Miami, Biochemistry Department 1974- 1976 SOCIETY MEMBERSHIP National Association of Community Health Centers 2003-Present William A. Little Society 1983-Present Florida Obstetrical and Gynecological Society 1983-Present American College of Obstetrics and Gynecology(Certification 12/85, 12/99& 12/00) Dade County Medical Association (Public Service Committee 1987—1989) Florida Medical Association 1983-Present American Association of Gynecologic Laparoscopists 1987-2000 American Fertility Society 1987-2000 Miami Obstetrical and Gynecological Society 1987-Present American Medical Association 1979-Present PUBLICATIONS Marshall JJ,Rabinowitz ML,Modification of the Properties of Trypsin by Covalent Attachment to Dextran. Arch Biochem Biophys 1976. Marshall JJ,Rabinowitz ML, Stabilization of Catalase by Covalent Attachment to Dextran. Arch Biochem Biophys 1976. Rabinowitz ML,Throat Swabbing in Epiglottitus(Letter). JAMA 1978. Marshall JJ, Rabinowitz,ML,Preparation and Characterization of a Dextran-Trypsin Conjugate. J Biol Chem 1981. Rabinowitz ML,Basson I, Robinson MJ. Sexually Transmitted Cytomegalovirus Proctitis in a Woman: A Case Report. Am J of Gastroenterology 1988. Rabinowitz ML,Gilibert JE,Lenes BE. Avoiding Blood Transfusion: A Report of Two Cases. J. Rep Med 1990. 5 j t � mbekm3 SOURCE OF INCOME STATEMENT COUNTY- 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 Last Name First Name Middle Name/Initial 2016 g eutO t vLO vt.:1.( M V"«— L - Mailing Address—Street Number,Street Name,or P.O.Box City,State,Zip 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.0 Filing as an Employee(check one) County D Public Health Trust ❑ Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member(check one) County \ Municipal: Lit &WA_t 4 • (Municipality) Board where serving ./ (4G.ed Art - Q V sv rti Q_0144- IP✓I t 1 e. Alternate address(if home address is exempt) Work telephone 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.❑ Name of Source of Income Address Description of the Principal Business Activity bce-Is 1(4Yr /3ira.ykL / cvf) ��� � ��� M tt t ci CH '- MtR 13/54—ke%(t (ICI,.4e A-- 44 LM C-R £"s JUNI C cmk4 141 ny w. Hai 'r I hereby swear(or affirm)that e information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑Hardcopy / 111 ❑Electronic Copy Signature of Person Disclosing Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 COE 2016 A l = s '' s \I I � REACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, v✓ww.miamibeachfl.aov CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov Telephone: 305.673.741 1 Fax: 305.673.7254 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) Board Member's Name: UR r 16- ' 12a o t n o .0 i r-Z, 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. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though they may have been recently appointed. 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" 2. A "Statement of Financial interests (Form 1)' 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 days in jail or both. igtAL 2/13 / Signature Date Updated:Monday,April 20, 2015 Page 4 of 4 F:\CLER\SALL\aFORMSGOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.dccx J 1 A \ f BFACH DIVERSITY STATISTICS REPORTING Name: arr ?" t)•\;) 1 h o\A3 i f ;M7 Board / Committee: IA e et[ -tl u. ' \)i c.,,ur�` �i��'' '''�' Iii-ie d Appointment Date: I i 7 / ? Pursuant to City of Mia i Beach Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: MalFemale L. Race/Ethnic Categories What is your race? African-America ;/Biac; ( - 1 CaucaasianiW ite Asian or Pacific islander Li Native-American/American indian 0 Other— Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" 0: Spanish, Hispanic, L^ nova. , :(No; Yes Do you consider yourself Physically Disabled? No 1 Yes information form 05-20-13 F rr"AL do,_ dat3;1: Monday,3anL _ ..