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HomeMy WebLinkAbout2007-03-05 Appointment rnJ Stefanie Bowers From: Sehee Foss [sehee.foss@gmail.com] Sent: Friday, October 27,2006 11 :06 AM To: Stefanie Bowers Subject: ICHRC Stephanie, Unfortunately, I have to resign from the commission. My last ICHRC mtg will be in April. I graduate and will be moving in the middle of May. Thank you, -Sehee <><><><><><><><><><><><><><><> Sehee E. Foss University ofIowa College of Law ph. 319.936.1203 10/2712006 20e. 825 South Seventh Avenue Iowa City, IA 5240 RE: Resignation from IPAAC c' '-' -"'-::" "-.-.-- ;:-;:.. ..- ",-~'" j; i",J (.}"l Mark Seabold, Chairperson Iowa City Public Art Advisory Committee 307 College Court Iowa City, IA 52245 Dear Mark, Last week I was appointed to the Senior Center Commission. Current policy of the Iowa City City Council requires that a person may be a member of only one city commission. I must resign from the Iowa City Public Art Committee. The six years I served on the IPAAC are valued memories oflearning from my committee mates and from the many artists, public groups and others with whom we worked. There is much more I could learn and I believe I might even be of help to IP AAC yet the opportunity of a different experience with the Senior Center Commission seems a good move for me while I have what remains of my "vim and vigor". Please convey my gratitude to my comrades on the IP AAC. I look forward to seeing you from time to time at art events. If occasion should arise where I can be of help to IP AAC feel free to call on me. ~;r~ Charles. R. Felling CC: Members of the Iowa City City Council Karin Franklin, City Planning Department Marcia Klingaman, Neighborhood Services ~ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION One Vacancy - Six Year Term March 1, 2007 - March 1, 2013 Duties: To exercise all the powers granted to cities and towns under Chapter 330 of the Code of Iowa, except the power to sell said airport. To annually certify the amount of taxes within the limitations of the Statutes of the State of Iowa to be levied for Airport purposes, All funds derived from taxation or otherwise for airport purposes shall be under the full and absolute control of the Airport Commission, deposited with the City Treasurer, and disbursed only on the written warrants or order of the Airport Commission. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Airport Commission meets the second Thursday of each month at 5:45 p.m. Applications must be received by 5:00 p.m., Wednesday, February 28, 2007, The City of iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Airport Commission should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. i I I i Airport Commission , I February 8, 2007 Page 60f6 Airport Commission ATTENDANCE RECORD YEAR 2007 (Meetin~ Date) TERM 1/11 2/8 NAME EXP. I Randy Hartwig 3/1/09 X X I Greg Farris 3/1/07 OlE X I Jobn Staley 3/1110 X X I Howard Horan 3/1/08 X X I Janelle Rettig 3/1/12 X X I KEY: X = Present I o ~ Absent i OlE ~ AbsentlExcllsed NM ~ No meeting -- ~ Not a Member I I I I Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 1 Council Announcement Date: January 23, 2007 Application Deadline: Wednesday, 5:00 p.m., February 28, 2007 Council Appointment Date: March 5, 2007 AIRPORT COMMISSION One Vacancy - Six-Year Term March 1, 2007 - March 1, 2013 Term expires for Greg Farris Greg Farris I:&l 423 Church 5t Currently serving unexpired term lID Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee A"plication Form I ~ I -....= -14- ~~Wi!:'t ",--... _JIII.'- ....."... .. CITY OF IOWA CiTY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Airport Commission Term Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) D Age 18 to 21 Signature of parenVguardian if Age 15 to 17: ~'d 1'-_.1 ,;::::=:. ~ ~E~: _:-.. ~- !-:;~ v.., Nr'E Greg Farris f'.) en -T] HOME ADDRESS 423 Church Street ;~ig 5~45r! ....--......., X Y~ /. ~ No'oJ w Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 2.5 OCCUPATION Software Developer EMPLOYER Pearson Education PHONE NUMBER: HOME 887-2613 BUSINESS 621-0664 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have server 1.5 years on the airport commission and have had the privilege of calling lowe City Airport my home base as a pilot for 3.5 years. This has been my first experience in thE public sector but in my role as a consultant in software architecture I have worked on project committees that had to juggle the needs of multiple stakeholders, budget constraints, and differing ideas. . . ~isrepresentations on this application will constitute just cause for removal of an appointee. If you fail . .v answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of7 I Reset Form I WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have server 1.5 years on the airport commission. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I would like to continue to work on the commission as some of the largest infrastructure projects of the airports history are completed. I also would like to foster a series of projects that will give the general public greater access to the airport, like theJuture airport viewing area. > (~l _ :.:.~ :=~:_ ~;.-l. - --c\ N 0..... -:.--- C~ ..-, -) -:::: , ' ..._~ .....:';" )7 Cf? N v:> POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. In. .rticular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City, . Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? X Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D Yes X No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) . - ~isrepresentations on this application will constitute just cause for removal of an appointee. If you fail . ,0 answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of? BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I .:::. ~ ::....a~... t~w;!:'"!. -..;;;;....~lIII.' ......,...- CITY OF IOWA CITY Name of City A' C .. Board/Commission/CommitteE Irport ommlSSlon Date 2/2S/~Oe6 ,... 2061 GI- Name Greg Farris Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS rvOWf- ;:::.-: '=i :::::-C:) --\ ~/ c::' ..IJ -, -c ,., a> -.-- " , ~~ , .J>.. ) 1::.- ':;~/' 9? :i> ~ , NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~ ~ After printing, please sign here Signature of parent/guardian if Age 15 to 17: Address 42) ell l.("C h 'S:.'-+V"'~ e.*- . '1isrepresentations on this application will constitute just cause for removal of an appointee. If you fail " .0 answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of7 I 03-05-07 21b I NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HISTORIC PRESERVATION COMMISSION Three Vacancies - Three Year Terms (1) At-Large Representative (1) Summit St District Representative (1) Brown St District Representative March 29, 2007 - March 29, 2010 Duties of the Historic Preservation Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions; furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. This Commission meets the second Thursday of each month at 5:30 p.m and, if necessary, the fourth Thursday of each month at 5:30 p.m. Iowa City appointed members of the boards and commissions must be eligibie electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, February 28, 2007. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Historic Preservation Commission should be directed to Sunil Terdalkar, Urban Planner at 356-5243. 1/24/2007 HiSlOtIt~Commissir.n December 14, 2006 Pall1l24 HiSfuriti Pi&:erv.atii:JJt Commission AttendaDce Record 2006 Term 09/28 Name Expires 01/19 02/9 02/22 03/16 04/13 04/27 0514 05111 05118 0512' 0818 06122 07/13 07/27 08/10 09J14 10/12 11/21 12114 Baker 3/29109 -- -- n__ -- -- X X X X X X X X OlE X X X X X X Brennan 3/29/08 X X OlE OlE X X X X X X X X 0 X OlE X X X X X Carlson 3/29/07 X X X X X X X X X X X X X X OlE OlE X OlE X X Enloe 3/29/06 X X OlE OlE -- ---- --- ---- -- --- --- ---- --- --- -- --- -- ---- Gunn 3/29/07 X X X X X X X X X X X X X X X X OlE X OlE X Maharry 3129/08 X X X X X X X OlE X OlE X ---- -- -- ---- -- ---- --- -- -- McCallum 3129/06 X X X X --- - --- ---- ---- --- --- ---- - ---- ---- ---- ---- --- ---- -- McCormally 3/29108 --- ---- --- -- ---- --- -- --- --- --- - --- --- ---- --- X 0 OlE X OlE Michaud 3/29/09 -- --- -- --- ---- -- -- X X X X X X X X OlE X X Pardekooper 3/29107 X X X 0 -- n__ -- --- ---- -- -~ -- ---- ---- -- -- -- __u Ponto 3/29/07 X X X X X X X X OlE X X OlE X X X X X X X X 5chattaman 3/29/09 --- -- ---- -- X --- ---- -- n__ ---- -- .- ---- -- -- -- -- SWaim 3/29/09 -- -- ~. .- ---- -- -- -- X X X X X X X OlE X X ---- Toomey 3/29/09 --- --- -- -- ---- --- --- .o- -- __d -- X X X X 0 X X X ---- Welssmlller 3/29/06 0 0 0 0 -- -- -- ---- - __n -- -- -- ---- ---- __n -- --- ---- Weitzel 3/29/08 X X X X X X X X X OlE X X X X X X X X X X Key: X = Present o = Absent OlE = AbsenUExcused NM = No Meeting -- -- = Not a Member Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 4 Females: 3 Council Announcement Date: January 23, 2007 Application Deadline: Wednesday, 5:00 p.m., February 28, 2007 Council Appointment Date: March 5, 2007 HISTORIC PRESERVATION COMMISSION Three Vacancies - Three Year Terms March 29, 2007 - March 29, 2010 (1) At-Large Representative Term expires for Richard Carlson Alicia Trimble [j$] 2232 California Ave Richard Carlson [j$] 1305 Yewell 51 (Currently serving unexpired term) (Previously served two 3-year terms) (1) Summit St District Representative Term expires for Michael Gunn (1) Brown St District Representative Term expires for James Ponto James (Jim) Ponto [j$] 618 Brown 5t (Currently serving 2nd 3-year term) [j$] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY Advisory Board/Commission/Committee Application Form I ~ I -".. = "'1tI !~~~-.: '''. ~1III1~.h -.;; ..- CITY OF IOWA CITY Individuals serving on BoardsfCommissionslCommittees play an'important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington SI., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DlSlRlBUTED FOR TI- PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BI CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THA TIME. BOARDfCOMMISSIONfCOMMITTEE NAME Historic Preservation Committee - AI Large Rep. TERM 3/29107 - 3/29/10 NAME Alicia M. Trimble HOME ADDRESS 2232 California Avenue EMPLOYER A.C.T. BUSINESS (319) 337q'T~8f> [Z] Yes Q ?::~' ZIP 52240 DNo ,.--..:; ~'; ,:c.::..;' ~ Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident ot Iowa City? 2 years, 6 months OCCUPATION Certification Specialist -:") i:J .-0 - PHONE NUMBER: HOME (319) 331-5113 N -.J C;::.:i,,! EXPERIENCE ANDfOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POS@1\I: ~ ~:= 'r/ i-.oJ './ In 2000 I served as an intern for the White Mountain Apache Historic Preservation Office where I consui~ with the Tribe's Cultural Resource Director and Cultural Advisory Board, participated in intertribal tribal consultations with Federal agencies and other entities pursuant to the National Historic Preservation Act and the Native American Graves Protection and Repatriation Act, and prepared quarterly reports on the progress and finances of the Historic Preservation Office. I also served as an intern for the Apache Museum and Culture Center where I prepared grants for the continued funding and helped promote tourism of the Fort Apache Historic Fort. Recently, I was appointed to Johnson County Historic Preservation Committee, and believe that serving on both commissions will provide a unique opportunity to both boards. I am also a believe in community building. As such I serve as both a member of the Johnson County Central Committee and as the 2nd-Vice Chair. I am an active member of Access Iowa, serving on four committees. I have also completed sixty-one hours of graduate study in courses, which include archaeology, history, architecture, and education. As such, I have been trained in the survey and reporting of historic and archaeological sites. I also served as the teaching assistant for the Plum Grove Field School. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My knowledge of the commission comes through both my interest In historic archaeology in Iowa and my recent appointment to the Johnson County Historic Preservation Commission. The Historic Preservation Commission has been key in creating and maintaining a strong community through their stewardship of historic buildings and neighborhoods in Iowa City. The commission serves as a medium through which interested citizens of Iowa City can become active in their local communities. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application November 2006 Page 1 ot8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOI APPLYING)? My education provides the background to handle practical matters,such as survey and reporting of historic properties and districts. Further, I have experience in consultations with cultural advisory boards, Federal agencies and other entities pursuant to the National Historic Preservation Act, as well as other federal, state, and local laws and regulations. I am experienced in the management and retention of historic and archaeological materials and the associated.documentation. I am also skilled in the preparation of reports, grants, and budgets for preservation activities. I have experience in the promotion of tourism and economic growth through historic preservation. I also believe that serving on the Johnson County Historic Preservation Commission will provide increased opportunity for communication between Iowa City and Johnson County commission, as well as an increased in my skills that contribute to both commissions. In general, as a student of Iowan archaeology and history I have a broad background that I believe will provide contributions to the commission on a number of levels. Further, I feel that my interest in community outreach and community involvement can be of great benefit. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds. please list any present affiliations you have with agencies that apply for funding from the City. MAffiliation- includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached lsee page 71. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of th, Code of Iowa, please contact the City Attorney's office at 356-5030. None o ;-s.:C) .~;. ~--- ,.,~., 'C""-, <;;:...:. -, ;.; r-.. .~ N -.J -11 ;".b-,. ,'j :') IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [Z]YES D~ C'J DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES [2] NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the Questions, Council may not consider your application. HCDC Application November 2006 Page 2 of 8 BOARD. COMMISSION. & COMMITTEES BUSINESS LISTING 1 ~ 1 !filii'llt "'"'--- ~"J~ _ &.L In CiTY OF IOWA CITY Name of City Board/Commissi on/Committee Historic Preservation Commijtee - At Large Rep. Name Alicia M. Trimble Date 02/26/2007 Section 362.5 of the Code of Iowa generally prohibits. with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None , 1'~_.J' - c:.-:-;, ~ _...J ~C) y',:::", CD 11 ,r'~ -< " .' -' >"" . 'r:: :l.':'~ r-"l _._~: _.!!~ ~o:/",. - ---- .. .Y m A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~ t'V'-. ~.~ NOTE: Address 2232 California Avenue Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application November 2006 Page 3 of 8 City of Iowa City Advisory Board/Commission/Committee Application Form I! i -....= -~... !~~~~~ -..::;:.... "'I!!!" .."... .I..L. CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name H .A-"r:c. f'rt.J orv<,;g..... (".......,.1.1 ~~ Term z.o., 7- - 2-0 (0 Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: O.Age 1~0 21 o ~ :;:-:;:C) ~ C' :;:t'J --n "-' C) .~~. ,.-- JAME_I2-l(.l.,.",-,J C<irU"", HOME ADDRESS 130,) Y~j,.Ic:.-(I ffr~ '-r' , ,I _,_ __. ::2 -, ~si3.- yif ...;:.- NYes'> ~o 'Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 10 Y ~q,- ~ OCCUPATION QrcJ" ,-+-t.c;..t...",{ L.. 'J../-Qr''l-. EMPLOYER U","vl/J: h of- (0,,"< PHONE NUMBER: HOME "3 11 ~"J r 'i - ,,'( f ~ BUSINESS 311-"3 f '(- t) 71-7 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: M. 4- Jl-jr<.e... ,'- K:;;../.".....-{. Pr'-5~r"".j.,'1h f (.,,,,^ ''y; t"l. Y ("Gr~ rr. fu.".,,~ ( ""ode.. v q COn5~ 1h''';) 'lrJ-,;+~(.,tv<.At ( i,.>-I..cr..", r t' c.i~d,';1 ("l-i e,i-1 (' '::;" YUv--./ (r'(Y- 5(rv;0<... "'"' {oH e.l-r G_,"f/,a- r .~d,.,{.y' I.[-s- "-z v'-<-<.. c.L,qlr' {o yav-" i, I-f '"' .j.Q,..;-~ ( /"'tW ,,..,... .f..., '" Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? 1. ".. r;.!'>,1:..,..- t 11,/- l.oo 'i -'. w,jt.,fu.. bawd L~v:-, - ( ./ "WN7 J - 2-007- I ,'- J...J,":) ffU~ .5"<K~~' ""'_ t~ (17,""" -'."(So, f..-q,...., Yc-crJ 04-- V-'<L c-L..:...- WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE- REASON FOR APPLYING)? 1- ","o...(ot I:I<.<-.t. Lo/).k~v-<- j" SVV'<- -""1"'- (o"",,,;J):'o", 'l-<- L i,~v-A-." t"'- (v+,~.., (,<-.JUv-~l...'':J, ..,,--L'J c.--J- rc-v,'e-.,..'y (9,,,J ~ ;V4./..'~-Y- ~./+-&- cI'f+l'~ ~ (~-.,<vl<- l'Ia....,,'^~-l-'Q"" c...J.- ^,)~!,Q/-~aC2~ J'v"~'t'.I, Iwr',-!--y }~/- q(rl'<A. 'io-v -/? F' CW-"'-- f........J/ fr>- 10'-"( f'r<-.J"r~'i-l--...... I'rV'e.~ ~ o1f..v.vv::Lc- 4.1'Y "'1 Iv\a....L.l.tx_ J 'V<-L..'-~'-dv~, 1,'':Jf--or-y ~ l..>i-.c,,'c !i'.-<-J-',,,,,Va-, (q",-,/ t'ol:,-,'t--Lw-.J- i'r<,<-'l-'(~ 7-0 ~r,<<--r'+ f~" (17'1;';>''''-'_'0-, ~ I-9Vvr C/.-'1; :~ :::; '" Q:) J"'.."- POTENTIAL CONFLICTS OF INTEREST ('"'.~ / ,~._- --'-1 -"', ......... .: Please identify any potential conflicts between membership on the advisory bO<;lrl{Jlnd :1Durpersonal interests, including financial interests and your duties to an employer. ;;,~ ~/: "::' .J j> U1 In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency_Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contactthe City Attorney's office at 356-5030. No u;,ff:~tJ- O.')t.- rc-JU>.-...l, <v.~f ,'~ "''1 off,I.;< CIi..-- O:-~..e",1 C.....i,...",.h fro.}/"r"" ;" -j~ or-kC<.. Jf K<-- 1../.,,4: ~r..~u(o/../t J /"';.J 1....,( "" c:l-r (. "" fry cf.7 i" <tu-- p~.f (~. fI-."y J. ,f", "5'\'\-' M 1~ f4'fv~ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? IXr Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes IXrNo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of? BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 ~~~~'t -.:::... ~""" ....,.... ....... CITY OF IOWA CITY Name of City Board/Commission/Committee H;;-i-",-~ (ru,,-,,,, -J.-,'..... C~,.,.:".,.- Date 2(2F{ Z pc> ~ Name fZ~"t,/lr-.-l G.-- v.... Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city' Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner. or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS "",onc..,....-- ~. i' . ~. 'c'~n -r~ c' .- :.:;U ! ! - . ,-',... OJ \ ., .<:' -(J '...:...'T 5~.~ -, ,j ~ .- Q1 "];:"' NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature flvl-zJ c.------. Signature of parent/guardian if Age 15 to 17: Address t:1""F 'te.,^<-I( J'i. rCll,v! C:'7 JJ-J-Y" ( Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 3 of7 City of Iowa City Advisory Board/Commission/Committee Appli,cation Form I ~ I -...= -IQ' :f~W~~ -.;:.-:. ...!'!.~ ....... .. CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. J Advisory Board/Commission/Committee Name Jt; s 10 r-; '- f?es. e.rV ,J.. 0", Term 'Joo 7 - 20 10 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) 0 Age 18 to 21 Signature of parent/guardian if Age 15 to 17: lAME HOME ADDRESS ~I ~ Sam€.S (:J.~) ~Ylto g,OW", r:;+ ZIP 5 2.2.1 ~ ~Yes D No "Is your home address (listed above) within the corporate limits oflowa City? How long have you been a resident of Iowa C" y? c'). 9 'I€t>..~ 5 OCCUPATION hlAc...'tt",r l4Y"h-,c..~,J ~oPessor tMPLOYER Un1vv-d-, ) ;[;w<< I PHONE NUMBER: HOME S 3 'il - C;io BUSINESS 3S ~ - ;;l. 7 41 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITIO~~ -,- <;;;:;~ BroWh <;-h--eet- Htsf-o,..,'(. j),\J..-rc...r ::c::c; ..,.., _~--~ _. .f r:;l $e-rV;"'1 0"" H:Stz,r~L Pn.s<l.fl/...J-;.", G.....rn:SS,~h< ;::; -n , CD -.'. '!'~l cv..ae.....t'7 ',-j :>- ::i> r-.,) N Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? LiAi"~r.J11 ') e.- \/,' '"") 0,"" 11..i s c..o "",,,,,' S S,'." WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ctJ-lY"-,,,tI, <;'UV;l O,,",1(:S Cil.....""':ss;o>, CL5 fi~ re..RY~ S'4.fCcJ,,-e- fH.... Brow,", ~frH.f- I+'-sto-r~'- j) 1'rJ.,-.'J. T I/cJ",,- k;sf.,-;c.. f re.Su 1(<.....;.,.... ; V\ W,7 j/l2-ljll,o~iooJ,_, o.,....J else. VI ~ ue- ,...... f(e- c...,' 7' ~ Q ~ .~ , i r0 CD ..,-'1 : i .---, POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds. please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. ,. :.::/~, ..r:- ~ r~) N board and your personal You should also know that Section 362.5 ofthe Code oflowagenerally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. :r Cllr\ Y\ at CLWcu~ <9 t 0-.-1 po (U.,. 'e.. C67\ /,& ') IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes mNO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 2 of? BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING i ~ I ::=:~ - -~~ ~~W~~ ~.. ~..,~ ....~ CITY OF IOWA CITY Name of City \ I , I ,() I Board/Commission/Committee --1J1 S t~ r, c lJ r eser 1/ ,,--1<'0 '" Name .ICLlMQ..V ~ h +0 Date ;;'/2-If/07 { Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS I ATolJE / ...~ .~-.., --- :C-..;' '-.J ~ -=->r.... -t--' >" :~~, ;:" -on ,OJ ':.';? .--.-- ...-~- .-: e::, ~:~-- " T1 ,-:,':r, ~- .,- _.... ,-,.I "":".. .. """--- N . NOTE: A new form must be completed if acquired in an additi usiness. ove information changes or an ownership interestis + "-" W" c.:- ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 30f7 -- --- -----.--_.._._-_.__._--,._._-----_._--~--~'~--~-_.-_.---_..~---_._-_._-_._.-.--------_.__._..