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Mark L. Rabinowitz Application PackageMIAMI BEACH Rabinowitz BOARD AND COMMITTEE APPLICATION FORM Mark L Last Name 1550 NE Quayside Terrace First Name Middle Initial Miami Florida 33138 Home Address 305/895-8888 305-538-8835 Home Telephone Work Telephone Miami Beach Community Health Center Business Name 710 Alton Road Business Address City State 788/288-8874 Cellular Telephone Physician Zip Code mrabinowitzOmbchc.com Email address Occupation Miami Beach City Florida 33139 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 P • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes OD or No • Are you a registered voter in Miami Beach: Yes ❑ or No • I am now a resident of: North Beach Pi South Beach P Middle Beach P None • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes P or No P 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 Office of the City Clerk. = Affordable Housing Advisory Committee rX Health Advisory Committee 0 Parks and Recreation Facilities Board 0 Art in Public Places Committee 0 Health Facilities Authority Board 0 Personnel Board 0 Audit Committee 0 Hispanic Affairs Committee 0 Planning Board** 0 Board of Adjustment** 0 Historic Preservation Board* 9 Police Citizens Relations Committee 0 Budget Advisory Committee 0 Housing Authority 0 Production Industry Council ❑ Committee on the Homeless 9 Human Rights Committee 0 Sister Cities Program 0 Committee for Quality Education in MB 0 LGBT Advisory Committee 0 Sustainability Committee 0 Convention Center Advisory Board 0 Marine & Waterfront Protection Authority 0 Transportation, Parking, & Bicycle -Pedestrian Facilities Committee 0 Cultural Arts Council 0 Miami Beach Commission for Women 0 Visitor and Convention Authority 0 Design Review Board * 0 Nomtandy Shores Local Government Neighborhood Improvement 0 Youth Commission 0 Disability Access Committee TI * 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:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06 1 42018.docx r-> o° Note: If applying for the Youth Center positions of the Parks and Recreations Facilites 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 Zi No 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 or No a] If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes ❑ or No4AJ If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes ❑ or No raD If yes, explain in detail: • Are you currently serving on any City Board or Committee? Yes QLI or No ❑ 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: None • Are you now employed by the City of Miami Beach? Yes ❑ or No CD Which department and title? • Pursuant to City Code Section 2-25 (b : Do you have a parent 1:=1, spouse ❑, child �1 brother L:1 or sister who is employed by the City of Miami Beach? Yes Lior No W 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 1,1 Female Race/Ethnic Categories What is your race? il�, African-American/l3iack I-" ' ' Caucasian/VVhite Asian or Pacific Islander D Native-American/American Indian Page 2 of 4 F.ICLER\$ALLIaFORMS\BOARD AND COMMITTEESIBC APPLICATION REVISED 06142018.docx Other – Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a. r '"'No Yes Do you consider yourself Physically Disabled? 11:1I—� No 4J 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: c 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 570.611). 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, EMP�LOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORfjINGLY." Applicant's Signa Z'1t JI , Mark Rabinowitz Date Name of Applicant (PLEASE PRINT) Received in the Office of the City Clerk by: d(�'Gt/ 11-6,1 Name of Deputy Clerk LZv�ld 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\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 08142018.docx MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK CityClerk@miamibeachfl.gov Telephone: 305.673.7411 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: 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, 6C,{lays in jail or both. 124 i Sig ture Updated: Tuesday, October 04, 2016 Page 4 of 4 F:ICLER\SALL'aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142018.docx r—. Date AC# STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE . LICENSE NO. -` CON1ROL NO. 11/03/2016 ME 36822 507597 The MEDICAL DOCTOR named below has met all requiremetuz of the Taws and rules of the state of Florida • Expiration Date: JANUARY 31, 2018 MARK LAWRENCE RAISINOWITZ 11645 BISCAYNE BOULEVARD SUITE 2007 �}y MIAMI, FL 53ttS } f Rick Scott GOVERNOR hM. u arc' V John H. Armstrong, MD FA .8 STATE SURGEON GENERAL DISPUCY IF REQUIRE)) BY LAW 64 3 1. SIGNATURE EXPIRATION DAZE' JANUARY 31, 2018 tutu noon. Mandlur is age 36822 pieaor use t <n ctli c, rirniiundrowo wins your l oarrikormciL Rich htienace is solettr rrn{+.vunlrle forr et:lying the dcpaetutr'1tt rat witting of :be hi:emcee octant raaili.ng addscss and practice location addressif you twee not rrccifed you, tt.oewal notice 90 deya ptxsr ria the c'xphn[inn date albs n o,t this license, pleat: c ail (8S0) 488- )1$94 tfye flue section to report n&wir change. Nente chang=e t'equirc legal documentation showing the name chump*, Please make acne Ihatt a photocopy of one of the foliderttg accorapatue8 the form a raw nage lieenee, a dwvoite decree or a court order, tdxeLkce1 pslalsb Asewas -e ratkrat you Or Kvstrrm^re! N eevn':al Thryr s•vo(rta {,live 1oan1 rt a akbilily h+rrtutt•)ooW lk,ne ., rtpstarr t"vrr 9etijoteand tore coutudn eddressa,a and updvto your profile intutmnttan 1 Co to www^IfealthSectroomee 1. Click on 'Wonder 8e:vicee" ,8. Cti of on "Massage my Littoral' 4 11,lentyour protcstuon •5' niter thenetuU)1e141tuswotdthatwasprovidedtoyouon'eautntttallic.onyeoradcick'Sigl lit uotugour aeetue lrver" 6 1f you do not know yotlt user ID and para*+mrd, *INA an 'Clef login Help?" or call otu Cuetornei Contact Canter at (856) 4R8. 0ttf0 for Abstsrante. RAIL TO DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE UCENSURE SUPPORT SERVICES UNIT P.O. BOX 6320 TALLAHASSEE, FLORIDA 32314-6320 NAME CHANGE (ATTACH LEGAL DOCUMENTATION) 144! .1 0 LA gl H 2103,5198 IMPORTANT ANNOUNCEMENT THE 0EPARTMEN1 OF HEALTH WILL NOW REVIEW YOUR CONTINUING EDUCA1)ON RECORDS Al THE TIME OF LICENSE RENEWAL. TO LEARN MORE, PLEASE VISIT WWW.CEatRENEWAL.COM 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 M.D. Degree received June 1979 Medical License: Florida (Issued July 1, 1980) ME0036822 WORK EXPERIENCE 1975-1979 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.