Dolores Hirsh 12/31/2013 City of Miami Beach, 1700 Convention[enter Drive,Miami Beach, Florida 33139'
OFFICE OF THE CITY CLERK, Rafael Grano6o City Clerk
Tel: (3O5)673-74l1' Fax: (3O5)b73-7254
1O-O2-2O12
Dolores Hirsh
1385N. Biscayne Point Road
Miami Beach, Florida 33141
045 Ten sory Corn
Congratulations! You have been appointed b» Commissioner Jonah YN. Wolfson
bo the agency, board or committee named above for a term ending: 12/31/2013.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1, 2007, the term of board members who are directly appointed by a member of
the City Commission ohe|| aubzrnotioo||y 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 at3O5-873-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
8inoara|y.
Rafael E. Goanodo
City Clerk
cc: SmmU Frances, Parking Director
�
Julio KNagrissm
ATTACHMENTS:
Letter ofAppointment
wuu/
City Code/Ordinance section applicable toagency, board orcommittee
City Code Section 2'22, 2'23, 2'24, 2'25, 2'20, 2458 and 2'459
Ordinance No. 20OO'3543 -Amendment ho 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 are committed to providing excellent public service and safety to all who live, work and p lay m our vibrant, tropical, historic community.
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
TO Dolores Hirsh
RE: Tennis 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: 12/31/2013.
1 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 the Florida Commission on Ethics Guide to the Sunshine Amend-
ment and Code of Ethics for Public Officers and Employees, 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 ithe State of Florida (depending on the board or committee on which I serve)on
July 1, following the closing of the calendar year on whic hav erved.
Polores
Sworn to and subscribed before me thisZ day of � u�� , 2012.
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical, historic community.
1^1T Y 01F- I 11AM11 BEkICHI
MIAMI BEACH
SOAR-D AND GOF M!Tn�__ APPLICATION FORM
_17, �A, 4
NAME: Hirsh Dolores M.
Last Name First Name Middle Initial
HOME ADDRESS: 1.365 N.Biscayne Miami Beach FL 33141
Point Road
Apt No. Home No./Street city State Zip Code
PHONE: 305-582-3522 dhirsh@atianticbb.net
Home Work Fax Email Address
Business Name: Position.-
Address: Miami Beach FL
No. Street City State Zip Code
Professsional License(describe): Expires: A3Och a co,,zov fhe licansa
X
Pursuant to City Code section 2-22(4)a and 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.
• Resident of Miami Beach for a minimum of six:(6)months', Yes
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six.(1 6)months.: Yes
•Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: North Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below'.
Tennis Advisory Committee
•Are you presently a registered lobbyist with:the City of Miami Beach? No
Please list your preferences in order of ranking [1]first choice[2]second choice,and[3]third choice. Please note that only three
choices will be observed by the City Clerk's Office.(Regular Boards,of City)
Affordable Housing Advisory Committee Housing Authority
Art in Public Places Committee Loan Review Committee
Beautification Committee Marine Authority
Board of Adjustment* Miami Beach Commission for Women
Budget Advisory Committee Miami Beach Cultural Arts Council
Capital Improvements Projects Oversight Committee Miami Beach Human Rights Committee
Committee for Quality Education in MB Miami Beach Sister Cities Program
Committee on the Homeless Normandy Shores Local Gov't Neigh.Improvement
Community Development Advisory [1] Parks and Recreation Facilities Board
Community Relations Board Personnel Board
Convention Center Advisory Board Planning Board*
Debarment Committee Police Citizens Relations Committee
Design Review Board* Production Industry Council
Disability Access Committee Safety Committee
Fine Arts Board Single Family Residential Review Panel
Gay,Lesbian,Bisexual and Transgender(GLBT) Sustainability Committee
Golf Advisory Committee Transportation and Parking Committee,
Health Advisory Committee Visitor and Convention Authority
Health Facilities Authority Board Waterfront Protection Committee
Hispanic Affairs Committee Youth Center Advisory Board
Historic Preservation Board
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: No Years of Service:
2. Present participation pation in Youth Center activities by your children No if yes,please list the names of your children,their
ages, and which programs. List below.:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony: No 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 Money Beach any money: No If yes,please explain in detail:
•Are you currently serving on any City Boards or Committees: No If yes,which board?
•What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:.
Name: Title:.
•List all properties owned or have an interest in,which are located within the City of Miami Beach:
• I am now employed by the city of Miami Beach: No Which department?
• Pursuant to City code Section 2-25(b):do you have a relative who is employed by the
City of Miami.Beach?Check all that apply. Identify the 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 federal equal opportunity reporting requirements.
Gender: Female
Ethnic Orgin: Check one only(1)
Hispanic
Physically Challenged: No
Employment Status: Employed
NOTE: If appointed,you will be required to follow certain laws which apply to city board/committee members.
These laws include,but are not limited to,the following:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before board/committee you have served on for period of one year after leaving office(Miami
Beach Code section 2-26).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
(re: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).
Upon request,copies of these laws may be obtained from the City Clerk.
N 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 Members."
I Dolores Hirsh agreed to the following terms on 8/10/2012 5:16:48 Plyl m „/
.2—�j -
Received in the City Clerk's Office by: Date: 1 /2012 Control No./ � Date: / !101 2
.Name of Deputy derk
DOL ORES HIRSH
1365 North Biscayne Point Road
Miami Beach, Florida 33141
Telephone: 305-861-5358
Cell: 305-582-3522
E-mail. dhirsli@atlantichh.net
LICENSE: Certified Public Accountant
EDUCATION: Florida International University
Masters of Business Administration
Florida International University
Bachelors of Business Administration
EMPLOYMENT:.
10/2011 to present The Parker Company
Chief Financial Officer.Responsible for all financial reporting for a
multinational hospitality group
02/2003 to 10/2011 Dolores Hirsh C.P.A.P.A.
President. CPA firm specializing in financial reporting,budgeting and
forecasting,compilations and tax return preparation.
04/1991 to 02/2003 Leonard Parker Company/The Parker Company
Vice President of Finance/Controller. Direct the financial
affairs of.a multinational leader in the procurement of hotel
.furnishings and supplies. .
11/1980 to 04/1991 National Corrections Management Inc.
Controller. Prepared interim and final financial statements
and supporting schedules. Maintained and reconciled trust
accounts. Handled all human resource functions.including
hiring and terminating personnel. Coordinated and prepared
proposals to various government agencies.
AFFILIATIONS: Florida Institute of Certified Public Accountants
American Institute of Certified Public Accountants
LANGUAGES. Fluent in English and Spanish
INTERESTS: Tennis,golf,sailing,gourmet cooking
EXTRACURRICULAR:: 2003 to present:
Captain of three ladies tennis teams out of North Shore Park
North Dade Tennis League
USTA tennis league
USTA senior women tennis league
2011:
Captain—SFWDTL Fisher Island team
CIVIC SER VICE: CPH Homeless Shelter
Attend shelter monthly to prepare food for and feed the
homeless
M I A M hDAM
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name
Disclosure
For Tax Ending:Y e r /
Name: r tf`5 l fl
_ r
Mailing Address: 704.6 d �
City/State/Zip: L /A uir►
Social Security Number:
Filing as a: ® County Employee: ,� t
® Municipal Employee of: �V
Position held or sought: 00(40-j
Gfib�
Board where serving: iCnn� Term or Employment
an on.
nt where employed:eparture N I P y A- 3
Work Address: ry l ft
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read instructions): ® Work Telephone:
Home Address: ��Im 6
Street Address
City State Zip Code
Please list below in descending order with the largest source first,the name,address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet,check here:
Description of the Principal
Name So rce of Income Address Business A 'vi
S G �OCv
r
0 ras %le �,cry
I hereby swea (or affirm)tha the aforesaid information is a true and correct statement.
/a
Signat of n disclosing Date signed
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeochfl.aov
CITY CLERK Office CityClerk@m i amibeochfl.gov
Tel: 305.673.741 1 , Fax:305.673.7254
Acknowledgement of fines/suspension for Board Mern bars for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11 .1(i) .(2)
Board Mem bar name:
I understand that no later than July T/ 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 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 you may have been
recently.appointed.
You must-file one of the following with the City Clerk of Miami.Beach, 1700 Convention
Center Drive, Miami Beach, Florida, -by July I each year.
1. A"Source of Income Statement".(attached) or
.2. A"Financial.Statement" (attached(.or]
I A Copy.of-the person's current Federal income Tax Return
Failure to fife, according to the Miami-Dade .County Code Chapter 1, General
Provision, Section 1-5 may subject the person or firm to a fine not to.exceed
$500.00 or by imprisonment in the county jail for a period nvt to exceed.sixty
days, or both.
Signature: pate: