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Curtis Slipman Application Package (2)Slipman Curtis w Last Name First Name Middle Initial 1455 Ocean Drive, Ste 710 Miami Beach Home Address City FL 33139 State Zip Code 30584214843058421484 HomeWork cslipman@mac.com Email Address 3058421484 Cellular miami beach Business Address 1455 Ocean Drive City fl State 33139 Zip Code Curtis W Slipman MDPA Occupation:Business Name: Physician 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. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Budget Advisory Committee Board of Adjustment BOARD AND COMMITTEE APPLICATION FORM Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below questions: Have you ever resided in one of the City's Historic Districts for at least one year?Yes If you answered "Yes", please indicate: Address From:To: 1455 ocean drive, Ste 710 4/1/2003 2/12/2020 Professional License License Number Issuance Date Expire Date curtis slipman MD115211 6/1/2013 1/31/2025 Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: YesResident of the City for a minimum of six (6) months: Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:No AFFILIATION WITH THE CITY OF MIAMI BEACH a. ● I am resident of:South Beach Or b. "Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more of the outstanding capital stock) in a business. "Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. c.Full-time employee of such 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):No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4/7th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements of section 2-22 (4) a ,b or c of the Miami Beach City Code by executing an affidavit, stipulating that they have met one or more of said affiliation requirements. The original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. Or No● Have you ever been convicted of a felony:If yes, please explain in detail: ● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail: ● Are you currently serving on any City Boards or Committees:Yes If yes, which board? Budget Advisory Committee ● Are you presently a registered lobbyist with the City of Miami Beach?No ● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: Having served as a board member at il villaggio for over 10 years, CEO of a medical company, founder and director of a major medical academic program has provided me within an opportunity to acquire a variety of skills that would be helpful for each of the committee's to which i have applied. 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 board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). 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 equality to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes. o 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, each applicant must voluntarily agree that in the event the applicant files 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, and the member's automatic resignation shall thereby immediately create a vacancy in the agency, board, or committee. o If an appointee is engaged to provide services, for compensation, to either (1) a candidate for City elected office, or (2) a political committee or electioneering communications organization expending funds for or against candidates for City elected office, such engagement shall be deemed a tender of resignation from such City agency, board, or committee. (Miami Beach City Code Section 2-22) ● In what organization(s) in the City of Miami Beach do you currently hold membership in? No Organization Information Submitted. ● List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property curtis slipman If so, which department and title?No● Are you now employed by the City of Miami Beach: ● Pursuant to City Code Section 2-25 (b) and 2-448: Do you have a parent, spouse, child, brother, or sister who is employed by the City of Miami Beach?No If "Yes", identify person(s) and department(s): No relative's information submitted. BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-Dade County Financial Disclosure 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 filled 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)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 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. Acknowledgment to Comply with Miami Beach Code of Ordinances Sec. 2-22 (24) I understand that if I am engaged to provide services, for compensation, to either (1) a candidate for City elected office, or (2) a political committee or electioneering communications organization expending funds for or against candidates for City elected office, such engagement shall be deemed a tender of resignation from the City agency, board, or committee. _____________________________ 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. DIVERSITY STATISTICS REPORT 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. WhiteRace/Ethnic Categories What is your race? No details providedOther Description: Gender:Male Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No Physically Challenged:No UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND THAT THE FACTS STATED IN IT ARE TRUE. ADDITIONALLY, I AGREE AND ACKNOWLEDGE THAT ANY FALSE STATEMENTS OR FALSE INFORMATION SUBMITTED AS PART OF THIS APPLICATION SHALL BE A BASIS FOR MY REMOVAL FROM A CITY BOARD OR COMMITTEE. 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, EMPLOYEES AND AGENCY MEMBERS” AND ALL OTHER APPLICABLE CITY, COUNTY, AND/OR STATE LAWS AND STATUTES ACCORDINGLY. I Curtis Slipman agreed to the following terms on 11/14/2024 3:27:33 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES YES YES YES I have answered all questions fully. I have uploaded a current resume, photograph, and a copy of any applicable professional license. I have completed and attached the Board & Committee Financial Acknowledgment Statement. I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone: 305.673.7411 Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph. YES I voluntarily agree to the resignation from the City agency, board, or committee, if I file a Statement of Candidate for a City Elective Office (1). (1) 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 must 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. YES I understand that (2). (2) If am engaged to provide services, for compensation, to either (1) a candidate for City elected office, or (2) a political committee or electioneering communications organization expending funds for or against candidates for City elected office, such engagement shall be deemed a tender of resignation from the City agency, board, or committee. Brief C.V. for Curtis W. Slipman, MD Professional: 1972-75 Bronx HS of Science 1975-79 SUNY @ StonyBrook B.A Psychology, Suma Cum Laude 1979-83 Baylor College of Medicine 1983-86 Columbia Presbyterian New York City Residency in PM&R, Chief Resident 1986-92 Private Practice Jackson, MS 1992-2008 University of Pennsylvania Health System Founder & Director Penn Spine Center Chief, Division of Musculoskeletal Rehabilitation Director Interventional Physiatry Fellowship 2000 Consultant, NASA 2002-08 Member, Arthrocare Scientific Advisory Board 2005-07 Senate Executive Committee, University of Pennsylvania Health System Representative 2005-08 Member, Stryker Physician Advisory Council 2008- International medical and business consulting 2013-19 Cutting Edge Medical Solutions, CEO 2019- Interventional Spine Consultant, Kuwait 2019-22 Member, Scientific Advisory Board Cyphi, LLC 2021-23 Member, Board of Directors, Quantaira Inc 2024- Member, Advisory Board, Orgenesis Civic 2012- Member, Il Villaggio Condominium Board, Miami Beach 2017- Vice President, Il Villaggio CondominiumBoard 2019-20 Member, Mayor Blue Ribbon Panel on Ocean Drive, Miami Beach 2021-22 Member, Police Citizens Relations Committee, Miami Beach 2021-22 Member, Mayor’s Art Deco Cultural District Panel, Miami Beach 2024- Member, Budget Advisory Committee, Miami Beach Medical Biosketch Dr. Slipman is one of the world’s foremost authorities on medical, interventional and rehabilitation approaches to treating back and neck pain and has been recognized internationally as a leading researcher and educator on the subject. He authored the definitive textbook on interventional spine techniques; written more than 130 articles and book chapters on a wide range of subjects ranging from the diagnosis and treatment of spine pain to treating pain caused by sports injuries; and has been repeatedly recognized as one of the “Best Doctors in America” a distinction awarded by one’s peers to less than 1% of all physicians in a particular specialty. Dr. Slipman graduated from Baylor College of Medicine in Houston Texas and did his post graduate training at Columbia Presbyterian Medical Center in New York. Following 6 years of private practice in Mississippi and academic appointments at the University of Mississippi Medical Center he was jointly recruited, by the Departments of Rehabilitation Medicine and Orthopedic Surgery at the University of Pennsylvania to initiate and develop the first academic spine center to be led by a physiatrist. One year later he established the first academic interventional physiatry fellowship. Dr. Slipman went on to serve as Director of the University of Pennsylvania Spine Center for nearly 20 years; as assistant Professor in Penn’s Department of Orthopedics and Associate Professor in the Department of Rehabilitation Medicine; and Director of Penn Medical Center’s Interventional Physiatry Fellowship Program. Dr. Slipman has also served as a Team consultant for the University of Pennsylvania’s sports teams for more than 15 years. Dr. Slipman has been the invited speaker at more than 200 conferences and physician meetings including lecturing internationally including China, Italy, Germany, Korea, Spain, Portugal, The Czech Republic, Canada, France, Turkey, and Japan. Dr. Slipman has been an editor/reviewer of more than10 medical journals and served as editor in chief of Pain Physician 2002-2004. Among his accomplishments is receipt of the 1999 Rosenthal award for for notable innovations in clinical achievement in the treatment of lower back disorders from The American Academy of Physical Medicine and Rehabilitation, the Justus Lehman Lectureship from the University of Washington, the William Baer Lectureship from Ohio State University Dr. Slipman’s diverse body of work includes producing videos on back pain for the Department of Labor; Time Life; and WebMD.