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Mark Rabinowitz 12.31.23MI A MA[BE iv /. - BOARD AND COMMITTEE CHECKLIST APPOINTEE: M a rk R a b ino w itz BOARD/COMMITTEE: Health A dvisory Com m ittee DATE OF APPOINTMENT. 02/03/2023 Aomt«ea y 23"9o" FOR SCANNER Scan o Scan o Scan o Scan o Scan o FOR CLERK STAFF o Letter of Appointment o Letter of Reappointment jf'34" ot AroomenuReaomoment e-mates Board and Committee Application (Completed on _1J)2) o Resume/Curriculum Vi ta e ,] [ c Diversity Statistics Reporting (Completed on 4 20 )3 o Oath TERM END. 12/31/2023 reRour. ([31/23 to Committee Liaison on RECEIVED FEB 1 2023 CITY O F MIA M I BEAC H OFFICE OF THE CITY CLER!_, citywide Permit Application (Parking Department Form) o Booklet - Guide to Sunshine Amendment & Code of Ethics fo r Public Officers and Employees Scan o Scan o Received on: Processed on: Scanned on: IMPORTANT INFORMATION FOR BOARD AND COMMITTEE 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) ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) Highlights of the Miami-Dade County Ethics Code Sunshine Law and Public Records - Frequently Asked Questions v Memorandum - Solicitation by City Board and Committee Members O Source of Income Statement o Acknowledgment of Financial Disclosure Requirement O Board and Committees Liaison Responsibilities O DIVERSITY STATISTICS REPORTING Keep COE.in fjle and ORIGINAL for Annual Report. Febru ary 20, 2023 .sore+syX _[lo. _Lal ve/e[0.3 Date 9ad9fommittee Member February 24, 2023 yEmployee:. _K/] Date c(;~s Office Staff Initials Febru ary 29, 2023 ytrioyeer [/l 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:CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\LB&C Checklist 2015 MASTER.docX City of Miami Beach, I/OO Convention Canter Drive, Miami Beach, Florida 33139 ywy_miIIibgachll_go OFFICE OF THE CITY CLERK, Raf0al E. Granado, Cy Clerk Tel 305.673.7411, Fax 305.673.7254 Email: City Clerk@miamiboochfl.gov February 03, 2023 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: 12/31/2023. 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. Respectfully, R a f~d o City Clerk cc: Monica Beltran, Parking Director Marc Chevalier, 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 an d 2-459 Ordinance No. 2006-3543 - Amen dment 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 1W 4AMI City of Miami Beach, !/00 Convcnton Cantor Dive, Miami Bsach, Florido 33 139 yyyy_miumibggchll.gov OFFICE OF THE CITY CIERK, Rafael E. Granado, Chy Clark Tel: 305.673.7411, Fax 305.673.7254 Email: Ci#Clerk@miambeachfl.gov Oath of Office Oath of Civility and Acknowledgeme nts 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: 12/31/2023. 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. :.e:_·.i-=_-".·"~::,~,;~_-..,,_ DIANA L HERNANDEZ }f Notary Public - State of Florida ~ii@j ii c@riser i 5«s51 P~;kf ,comm. tires an 3, 2027 Bonded through Also get ir. Mark RabinowiG 7 sworn to and subscribed before me this _'' day or Fh._, 2023 Kei~- 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. MIA#IBEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC@miamibeachf] go Telephone: 305.673.7411 RECEIVED FEB 21 2023 CITY OF MIAMI BEACH OFFICE OF THE CITY 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 Section s 2-22 (4), as (check () all that apply): □I am a resident of the City of Miami Beach for six months or longer. Home Address _ □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 month s). Name of Business _ P1Jg[PS \[(f9Sa» 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). Name of Business Miami Beach Community Health Center, Inc. Business Address 710 Alton Road, Miami Beach, FL 33139 "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 stated in it are true al... February 20, 2023 Sig nature 7 ,...'""11! .. -'1!-. ii· ~ii;;,i;;.;;;.;;;;;:;..;;;;;;;;;;::;;;;~---- . $?¢, DAL HERANDEZ Mark Rabinowitz ; '? Notary Pubic · Sate o' Florida #, $; commton # HH 34551 Printed Nam e •• yComm. Expires Jan 3, 2027 NOTARY onded through National Notary Assn. Sworn to (or affirm ed) an d subs cribe d before me, by means of ph ysical presen ce or a online notarization, us.U aay or fbroar y_ , 2o23y Mak kbiowi:z _________ (City of Miami Beach Board/Com mittee Mem ber). Produced ID Form of Identification / personal ly Kn own #ssf (NOT ARY SEAL) Name of Notary, Typed, Printed. or Stamped MIAMI BE, CH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florido 33139 w.miamibeachfl.goy OFFICE OF THE CITY CLERK Emil: BC@miamibeachfl.gov Telephone: 305.673.7411 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) Rabinowitz Mark L Last Name First Name Middle Initial I understand that no later than July1of each year all member s 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 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. 4, '., 2/z._/zc_or Signature 7 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. Page 5 of 6 F CLERISALLREGIBOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMIT TEE APPLICATION REG FINAL.docx Updated: June 2020 MI AMI BEA CH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachtl.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673.7411 DIVERSITY STATISTICS REP ORT R abinow itz Mark L Last Nam e First Nam e Middle Initial The fo llow ing info rm ation is voluntary and has no bearing on your consideration fo r appointm ent. It is being asked to com ply w ith C ity diversity report ing requirem ents. Gender: [J Mate [l remale D O ther D I prefer not to answ er. Race/Ethnic Categories: What is your race? D A frican A m erican/B lack 0 A sian or P acific Islander [l C aucasian /wh ite □Native American/American Indian D O th er - Print Race: _ 0 I prefer not to answ er. D o y o u co n s id e r yo u rse lf to be S p a n is h , H is p an ic , o r L a tin o /a ? v es r7 L'I No El pr ef er not to an sw er. Do you consider yourself Physically Disabled? ve, lo D I prefer not to answ er this question. Page 6 of 6 FACLERISALLREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx Updated: June 2020 M IA M l·DAD E- EII SOURCE OF INCOME STATEMENT 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 I Last Name First Name Middle Name/Initial 2022 Rabinowitz Mark L Mailing Address - Street Number, Street Name, or P,0. BOx 11645 Biscayne Boulevard City, State, Zip Miami, FL 33181 It your hom e address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read instructions on the fo llow ing page and check here.Dl Filing as an Employee (check one) [] county [] 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 E] Municipal: City of Miami Beach (M unicipality) Board where serving Health Advisory Committee Alternate address (if home address is exempt) I Work telephone I Term began on/ended on 11645 Biscyane Boulevard, Miam i, FL 33181 (305) 538-8835 2023 List below every source of incom e you received, along with the address and the principal activity of each source. Incl ude your public salary. Place the sources of Incom e in descendi ng order, with the largest source first. Exam ples of sources of incom e include: com pen sation for services, income from business, gains from property dealings, interest, rents, dividen ds, pensions, IRA distributions, and social security paym ents. Also, include any source of incom e 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 Miami Beach Community Health 710 Alton Road, Miami Beach, Health Care Center, Inc FL 33139 I hereby swear (or affirm} that the information above is a true and correct statement. Signature of Person Disclosing Date signed «avow a"q%±I)Pb Hardcopy Electronic copy., ),1 FEB 2023 CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/Initials: 138.90-14 COE 2016 /\l/A/\/BE, (C} crwDE (Cw) OARD & CoMeEs cy ct Miami seat, PARK I NG DEPARTMENT P AR KI N G AP P [[CATION 1755 Meridion Avenue, Suite 200/Mi ami Beach , FL 33139/Ph: (305) 673-7505 0r (305) 673.7 000 ea. 6200 A city wi d e (C W ) 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 Holl 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 pl at e . 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 Dote of Application: February 20, 2023 Applicant Name: Mark Rabinowitz Board/Committee Name: Health Advisory Committee Address: 41645 Biscayne Boulevard, Miami, FL 33181 E-Mail Address; mrabinowitz@MBCHC.com Work Phone: 3055388835 Home Phone 7866965176 Cell Phone: 7866965176 Preferred Contact Method: 7866965176 Vehicle Information Tag: IE G K 8 2 Color: Silver State: F L Year: 20 10 Make: Lexus Model: LS 4 6 0 L Applicant Si anat ur e : e o- .A Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working hours are 8:30 to 5:00 p.m. or email to: ParkingReception@mniamibeachfl.gov e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME P, ·i D S ar mna epartment ection PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Seriol #: Issued By Print Name: Print Name: Signature: Signature: Dote Issued: Dote Completed: