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HomeMy WebLinkAbout2009-03-24 Appointment03-24-09 12a NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Unexpired + 5-yr Term Ending December 31, 2011 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, March 18, 2009. The City 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 Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. 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: 0 Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009 Application Deadline: Wednesday, 5:OOp.m., March 18, 2009 Council Appointment Date: March 24, 2009 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:OOp.m., March 18, 2009 Denotes applicant completed the Confidential page of the application. 12b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-yr Term January 1, 2006 -December 31, 2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, March 18, 2009. 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 Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. 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: 0 Council Announcement Date: September 20, 2005; November 1, 2005; December 13, 2005; January 23, 2006; February 28, 2006; March 21, 2006; April 18, 2006; June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009 Application Deadline: Wednesday, 5:OOp.m., March 18, 2009 Council Appointment Date: March 24, 2009 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2006 -December 31, 2011 Term expires for Mark Anderson No applications as of Wednesday, 5:OOp.m., March 18, 2009 ~ Denotes applicant completed the Confidential page of the application. 12c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HISTORIC PRESERVATION COMMISSION One Vacancy -Three-Year Term March 29, 2009 -March 29, 2012 (1) College Green District Representative 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 eligible electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, March 18, 2009. 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 Christina Kuecker, Associate Planner at 356-5243. 2/26/2009 Historic pr~servafitn Commission Attendance Record 2009 e N Term Expires 1108 _~ am Baldrid a 3/29/11 X Baker Downin Eubanks 3/29/09 3/29!10 3/29/1'1 X X X _ -- 1 " '- Hirschman 1 3/29/ -- -- Michaud Ponto 3129/09 3/29/10 X __ X Swaim 3/29/09 X Trimble Wagner 3/29110 3/29109 X X - Key: X =Present O =Absent O/E = AbsenUExcused Historic Preservation Commission Attendance Record 2008 Term 1110 2128 3113 M10 5/8 5122 6/12 7170 7/24 8114 6/28 9111 1019 1113 11113 12111 N8R18 Exprzes X O/E X _._ X X X X X X OlE X X Baldrid a 3/29/11 -- -- -- -- -- -- X X O/E X X X O/E O!E Baker 3/29/09 X X X O/E X X X X Brennan 3129/08 X OIE 0/E ° -- --'- X -- -- X --'- X -- -- OlE -- -- X -- -- X -- -- 0/E -- -- 0/E Downin 3129!10 X X X O/E X X 0/E 0/E Eubanks 3129/11 O/E X X X X X X O/E X X X X X X X X X Michaud 3129109 X X X X O/E O/E X X X X X X X X O/E _ 3/29/10 X X O/E X X X X X 0/E X O/E X 0/E X X X Ponto 3/29/09 X O/E X O/E X O/E O/E X X X X OJE X X X O/E Swaim OIE X O/E O/E OlE 0/E 0/E O/E O O -- -- -- -- •- -- Tich 3129/11 -- -- -- -- -- -- Toome 3/29/09 X OIE X X X X X -- -- -- -- X -- -- O/E -- -- X ° -- X -- -- X -- ° X -- - X Trimble 3/29/10 x O/E X X X X O/E X X X X X X X Wa ner 3/29109 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ° X Weitzel 3!29/08 O/E X X -- -- -- -- -- -- -- -- -- -- -- -- Key. X =Present O =Absent O/E = AbsenUExcused 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: 5 Females: 4 Council Announcement Date: January 12, 2009; February 24, 2009 Application Deadline: Wednesday, 5:00 p.m., March 18, 2009 Council Appointment Date: March 24, 2009 HISTORIC PRESERVATION COMMISSION One Vacancy -Three Year Term March 29, 2009 -March 29, 2012 (1) College Green Term expires for Pam Michaud Pam Michaud D (Currently serving unexpired term) 109 S. Johnson St Kevin Burford ~ 528 E College St Denotes applicant completed the Confidential page of the application. City of Iowa City rl r i Advisory Board/Commission/Committee ~;~= Vc~''~~ ~®~~~ . _pplication Form -n-~- 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 RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Historic Preservation Commission Term 3 years Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: ME Pam Michaud HOME ADDRESS 109 S. Johnson St. ZIP 52240 Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes How long have you been a resident of Iowa City? 35 years OCCUPATION landlord EMPLOYER self PHONE NUMBER: HOME 339-1247 BUSINESS College Green Guest House EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU'FOR THIS POSITION: In 1990, I bought 109 S. Johnson and recognised the historic significance of the 16 historic buildings on College Green Park, half of which were owner occuppied. I initiated a petition to have my neighborhood designated a historic district. I served a 3 year term on the Historic Preservation Commission in the late 1990's and from 2006 to present 3-09. I renovated and restored two historic homes on College Green Park for my business. ~ ~.; 3S P - m . ~1AR - 5 2009 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. No General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have served two terms on the HP Commission. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I love the University of Iowa as a resource for this community and Iowa. Clty's responsive governance. In addition to this diverse community of rural and urban backgrounds, I enjoy meeting faculty from around the world. Part of my work is orienting internationals to in Iowa City community resources. I was raised in architecturally rich Chicago, visited historic Galena, IL many times as a youth, and enjoyed the architecture of many European cities and towns. I feel this background gives perspective to local development. This winter, I researched about 18 properties for the Manville Heights Survey 2008-09. have researched materials and techniques to be used in vmy own house restoration projects over 18 years. 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. ,articular, 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 knowthat 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 ofSection 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 z: 3s P. ~,., ~~!~R ' 5 ?_009 n. .i IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ 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. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City ~~~ //' _/ -, Board/Commission/Committee ~_S°f-~~ / ~- ~h°s ~ ~ ' ~~~ ~ ~r _~ _~ -~®~~~ -~c.a~._ CITY OF IOWA CITY Date ~ ~~~ Name p n~ ~ i ~ ~~~~ 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 Cv ~ e Gee Gu c,s--~ .sue ~ .S` ~ S ~ 57~ ~~ // `~ ~ C.~7lE'. ' S~ q-• `1 Z: 3s' P ri. ~~aR -5 ~no9 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. i Applicant Signature G~ i~~ Lam---~ ~'~ Signature of parent/guardyian/(Youth Advisory Commission only): Add ress ~~ ~ --S i/ v ~t ~ s o ~ -S ~ --~~~ y~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail io answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 City of Iowa City ~ r ~.~ _ _ Advisory Board/Commission/Committee ~!'-~! +~~'~~ ,~~,~-~ Application Form -~-~-- 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 Historic Preservation Commission Term 3/29/09-12 !i Youth Advisory Commission (shall not be more than 18 years of age at the time of appl~tion) ''~, Name of Iowa City High School or high school equivalent: ~n Signature of parent/guardian: c} -~ ~' NF"9E Kevin Burford HOME ADDRESS 528 E. College Street, Iowa City, IA -< r~ . m Ci ~ ~~ P Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes How long have you been a resident of Iowa City? 1950-1974 & 2002 to present a N 520 No OCCUPATION Circulation Supervisor-Law Library EMPLOYER University of Iowa PHONE NUMBER: HOME 319-341-9889 BUSINESS 319-335-9015 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I am a native Iowa Citian, and have therefore witnessed many local architectural changes in my lifetime. I worked in the library of the State Historical Society in Iowa City for nearly four years and developed a special interest in Iowa City's historic homes, buildings and neighborhoods. I have participated in salvages and activities with The Friends of Historic Preservation and have been involved in the renovation of my own historically significant home as well as that of my parents, both located in the College Green Historic District. lisrepresentations on this application will constitute just cause for removal of an appointee. If you fail II ~o answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have basic knowledge of the functioning of the Board, know some of its members, and have been present more than once at its meetings as ahomeowner-petitioner. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? Having had personal experience renovating my own home, I'm very aware of the balance which must be struck between historical authenticity and financial pragmatism and the need for use of more contemporary materials in situations where historical authenticity is prohibitively expensive. My philosophy is that the historic Preservation Commission should do all it can to promote and support historic preservation without being punitive to the well-intentioned property owner. _ O ~; ?' ~ ~ ~ ~ -C _ ~ ~ °~ ri'i c~ ~ ~ ~ ~x 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 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 ofSection 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? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ 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 to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Historic Preservation Commission Name Kevin Burford _- r ~~~~ ~"m1~ ~ '"r'®'~~ -+~a.aL_ CITY OF IOWA CITY Dat@3/17/2009 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 Q ~ ~ ::~ c~ _ _ --°- --~ c ~ c:o m ~~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature, Signature of parent/guardian (Youth Advisory Commission only): Address _528 E. College Street, Iowa City, IA 1isrepresentations on this application will constitute just cause for removal of an appointee. If you fail co answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 12d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION Two Vacancies -Three Year Terms March 13, 2009 -March 13, 2012 The duties of the Telecommunications Commission include serving as a review board to resolve disputes between any subscriber or potential subscriber and the cablevision company; reviewing and auditing reports by the cablevision company to the City as required by the Cable Television Ordinance; working with the public, the media, the City, and the cablevision company for the purpose of making recommendations on various issues; engaging in other activities pursuant to the effective monitoring and evaluation of the CATV system in the City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m. Applications must be received by 5:00 p.m., Wednesday, March 18, 2009. 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 Telecommunications Commission should be directed to Drew Shaffer, Cable Television Administrator at 356-5046. 2/26/2009 TELECOMMUNICATIONS COMMISSION 12 MONTH ATTENDANCE RECORD 01/01/03 to CURRENT l b i Saul Meikes Brett Castillo Terry Smith Jim Pusack Meeting Date er y m K Thrower _ 6/2/03 x x x x x 7/28/03 x X X x - x 8/25/03 X X X X OTC 9/22/03 X X X X 0/C 10/27/03 x x x x o/c 11 /24/03 x x o/c x x 12/15/03 o/c o/e X x x 1 /2/04 x o/c X x x 1 /26/04 x x X x x 2/23/04 x o/c x o/c x __ 3/22/04 x x x -- x x 4/ 26/04 x x x x O/C 5/24/04 x x O/C x x _ 6/28/04 X X X O/C x 7/26/04 o/c X X x x 8/26/04 did not meet did not meet did not meet did not meet did not meet 9/27/04 X --- X X X X 10/25/04 X _ X eet t Did Did not meet Did not meet Did not Did not meet 11/04 no m meet 12/20/04 }{ X X X X 1 /24/05 X X X X X _ 2/28/05 X X X X Gar Ha en 3/8/05 X X X X X 3/25/05 X O X X X 4/25/05 x o/c X X X 5/23/05 X o x_ vacanc X James Ehrmann X x Bebe Balantyne x 6/27/05 X x X X X X Michael Chritians _ 7/25/05 O X X X X __ 9/26/05 0 X X 0 X 10/31 /05 X X o/c _ __ X_ X 11 /28/05 X X X X X , 1 /23/06 o/c X X O X 2.27/06 X_ X X 0 X 3/27/06. o/c X X John Weaterson X X 4/24/06 X X X_ X X _ 5/22/06 0 x x/o 0 X 6/26/06 0 X Vacant 0 X Nick Parker 7/24/06 x x x X 8/24/06 X_ x M. Wietin o/c X _ 9/25/06 x x x 0/c X 10/23/06 x X x o/c X 10/30/06 x x x vacant X 11 /27/09 X x x X 12.18/06 X X X X Brett Gordon 1 /22/07 X X X X X 2/26/07 X_ X X X X 3/26/07 Vacant x o/c x X 4/23107 Vacant X_ X X X Hoerschelm an 521 /07 X X o/c X x 6/26/07 X X X X X 7/23/07 X X X X X 9/24/07 X X o/c o/c X 10/22/07 x x o/c o/c x 11 /26/07 X X X X X 12/18/07 X X o/c X X 1 /28/08 X x o/c x X 3/3/08 X X_ X X_ X 3/24/08 Bob Kem x x o/c X X 4/28/08 X X X X X 6/3/08 X X X_ X X 6/23/08 X X X_ X 0/C 7/28/Og X X X X X g/25/pg X X X o/c X 9123/08 X X X X X 10.27/08 X X X o/c X 11/24/08 Did not meet 12/15/08 X_ X X X X 1 /26/09 X X X ~ X o/c 2/243/09 X' x o/c o/c x ____ (X) =Present (O) =Absent (O/C) = Absent/Called (Excused) 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: 0 Council Announcement Date: January 12, 2009; February 24, 2009 Application Deadline: Wednesday, 5:00 p.m., March 18, 2009 Council Appointment Date: March 24, 2009 TELECOMMUNICATIONS COMMISSION Two Vacancies -Three-year Terms March 13, 2009 -March 13, 2012 Term expires for Brett Gordon, Saul Mekies Saul Mekies D (Currently serving 2"d 3-yr term) 2151 Abbey Ln Laura Bergus ~ 2231 California Ave Brett Gordon D (Currently serving unexpired term) 224 N. Dubuque St Denotes applicant completed the Confidential page of the application. City of Iowa City ~ r 1 ~_ _ ~' Advisory Board/Commission/Committee ~; =-°' ''~~ Application Form ~-~-- 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 atl 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 Telecommunications Commission Term 3/,.09 to 3/12 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Saul Mekies HOME ADDRESS 2151 Abbey Lane, T~wa c'.i t~, TA ZIP 52246 Is your home address (listed above) within the corporate limits of Iowa City? x^ Yes ~ No How long have you been a resident of Iowa City? ~ a ~,Pa,-G OCCUPATION Professor, Economics EMPLOYER Kirkwood Community College PHONE NUMBER: HOME 351-6809 BUSINESS 887-3617 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have a background in the economics of utilities, including. telecommunications I have previously served on the Commission, and acquired knowledge and experience I have never missed a meeting and take my appointment seriously. I have put in many hours of my time to be an effective contributor to the commission and represent the Ci and the consumers to the best of my ability. 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. ,. ~ ~.~ ~n1 General Application FEB 2 5 2009 December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have previously served on the Commission WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? It takes a lot of time to come up to speed and understand the vast array of information before the commission. That means not only understanding the role of Mediacom, but also the role of the local channels. It is also important to understand the technical issues as well as the budgetary issues. I feel I am prepared for the task. My background in economics (utilities, regulation)will be helpful. I never miss a meeting and I am diligent at being prepared for the meetings, including reading the material before hand, and doing some research on my own. 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. ,n 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 knowthat 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 ofSection 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? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes x^ 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. ~~, General Application ,2o Pal 3= December 2008 Page 2 of 7 FEB 2 5 20~J9 ._ :,a BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Telecommunications Commission Name Saul Mekies r _,~ ~~~ ~~~ wr,®~w~ -~.a~ CITY OF IOWA CITY Date 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 ~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature, Signature of parent/guardian (Youth Advisory Commission only): Address 2151 Abbey Lane, Iowa City, IA 52246 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. N.,-.-- - ;. General Application FEB 2 5 2099 December 2008 Page 3 of 7 ~ ~3o P~ 1 City of Iowa City i r 1 ~_.:.®~ Advisory Board/Commission/Committee ~ ~"'~'~~ ~w~~~ ..pplication Form -~-~-- 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 Cterk, 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 RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Telecommunications Commission Term Starting 3/09 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: ' P Signature of parent/guardian: ~~AR - 5 2009 M''`ME Laura Bergus HOME ADDRESS 2231 California Ave. ZIP 52240 Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? Since 1981 OCCUPATION Student, U of I College of Law EMPLOYER -- PHONE NUMBER: HOME (319) 541-9677 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I was director of the City of North Liberty's telecommunications dept. from 1998 to 2008 and was staff liaison to the telecom. commission. I was in charge of cable franchise oversight with two providers. I negotiated an amendment to North Liberty's Mediacom franchise in 2001 and a new cable franchise with a telephone cooperative (South Slope) in 2003-2004. Having lived in Iowa City my whole life, I am familiar with all of the local access channels and how they operate. I have experience producing video for local access channels in Iowa City, Coralville and North Liberty. Over the past decade I have served as an advisor to several Iowa communities that have started new access channels, including Coralville, Carroll, Wellman and Anamosa/Monticello. I worked with the Iowa League of cities in amending and opposing the statewide video franchising legislation that was adopted iri 2007. 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. Yes ~ No General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I know that they oversee enforcement of the cable N franchise with Mediacom. I believe they also oversee operations of City Channel and InfoVision and have some advisory role to some of the other access channels. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? In my years working with PEG access, I developed a reputation for producing high-quality, locally-relevant community programming on a minimal budget. I would expect the same from Iowa City's access channels and could help hold them accountable to the citizens to this end. I also have a good working relationship with many Mediacom staff, am familiar with local, state and federal law governing cable television, and am comfortable assisting in enforcement of these laws. I am familiar with the text of Iowa City's cable franchise agreement. I am a proud resident of Iowa City and am glad to be raising my family here. While f am currently a law student, I am interested in using my expertise in cable franchise oversight and PEG access to help the City further its telecommunications goals. Having been on the staff side of this equation, I greatly look forward to serving as a citizen. a,~ yip ,~T MAR - 5 2009 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. articular, 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 ofSection 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. None IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ 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. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committedelecommunications Commission ~ r i ~~~~~ ~ ~~~~~ ~ -•~a.at~ CITY OF IOWA CITY Dat@3/05/2009 Nam~aura Bergus 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. i r~. Applicant Signature ' ' ' ` ~~ Signature of parent/guardian (Youth Advisory Commission only): Address 2231 California Ave. 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 2008 Page 3 of 7 City of Iowa City i r 1 ~~.®~x Advisory Board /Commission/Committee ~: -="'"~~'`'~~ ,~~~~~ Hpplication Form ~-~-- 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 RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name _Telecommunictions Commission Term _2009-12_ Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: AME Brett Gordon HOME ADDRESS _224 N. Dubuque St ZIP 52245 Is your home address (listed above) within the corporate limits of Iowa City? X Yes No How long have you been a resident of Iowa City? Since 1959 OCCUPATION Therapist/ Telecomunications Specilist KWKB/KUBU/WAZU_ EMPLOYER: KWKB-DTV PHONE NUMBER: HOME 319-337.4545 BUSINESS 319-248-5050 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: -~' Prior Public Service ~, ~~°~- BA/UIGommunications Studies : ~~ r~. _ tit . C.3 ?'= 9 :~'` .. ~' v, o• 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 200 8 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Sitting Member WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? Offer Constructive Guidance for Community Media <:; 4~~ *. + ~_ :v> /T 'a / " • l"ai' ~ml r ~ r.g 14.: ~_ ""1 S}~ f^I..+ gg 9 O ~~ f •• y ~ CTS 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. 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 ofSection 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. FCC Agent for New Bohemia Group, INC 2007 NCE Application attached IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes X No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes X 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. General Application December 2008 Page 2 of 7 ~ r i ~1.=.®~ BOARD, COMMISSION AND COMMITTEES ~.~`~~ ,~`~*~ BUSINESS LISTING .,,~~ CITY OF IOWA CITY Name of City Board/Commission/Committee ~ C ~ ~ Date ~ Z ~~~~ Name ~'~ ~ e-, ~-r-~. 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 t~ -~' "" ~~ N m v +,~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~ ` Signature of parent/guardian (Youth Advisory Commission only): Address 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 2008 Page 3 of 7 Page 1 of 1 ~~ Marian Karr From: Regenia Bailey [bailey@avalon.net] Sent: Thursday, March 19, 2009 7:23 PM To: Marian Karr Subject: FW: Telecommunications Commission Council correspondence From: Saul Mekies [mailto:smekies@kirkwood.edu] Sent: Tuesday, March 17, 2009 5:05 PM To: 'regenia-bailey@iowa-city.org' Subject: Telecommunications Commission The Honorable Regenia Bailey, Mayor Hi Reginia, I am interested in being reappointed to the Telecommunications Commission for the 2009-2012 term. My previous service has enabled me to contribute more effectively to the Commission. I take my responsibility seriously. I have perfect attendance at the meetings. I am a professor of economics at Kirkwood Community College. I am also the only one of the three candidates to have applied on time, before the deadline was extended. If you have any question, please contact me. Thanks for your consideration. Saul Saul Mekies Prof., Economics Tel.: 319-887-3617 E-mail: smekies kirkwood.edu 3/20/2009 Page 1 of 1 -~ ~~ ~ Marian Karr From: Laura Bergus [laura.bergus@gmail.com] Sent: Monday, March 23, 2009 8:05 AM To: Council Subject: Telecommunications Commission Appointment Dear Mayor and Councilors, In your agenda packet for Tuesday's meeting is my application to serve on the Telecommunications Commission. I have ten years of experience administering cable franchise agreements as director of the Telecommunications Department for the City of North Liberty (1998 to 2008). I worked directly with representatives from Mediacom and South Slope Cooperative Telephone (North Liberty's franchised cable providers) to oversee enforcement of the agreements, negotiate amendments and, most importantly, to resolve subscriber complaints. I am a lifelong Iowa City resident and have been very much looking forward to the opportunity to serve the City in a volunteer capacity. Please feel free to contact me with any questions you may have about my background or qualifications. Thank you for your consideration for appointment to the Telecommunications Commission. Sincerely, Laura Bergus (319) 541-9677 laura.ber~~is. cr ~malcom 3/23/2009 12e NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION Two Vacancies One Unexpired Term Effective upon appointment -December 31, 2009 One (1) person - At Large One Two-Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High The mission of the youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, March 18, 2009. The City of fovea 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.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. ~DOX u m m ~ u zzyD~ V N y rf rF ~ = m 3 ~ x ~~ c ~o~' c~ A~ 0 c ~ ~ ~ ~ ~ m ~ ~ _ 3 ~ ~ ~ ~ c ~ ~ ~ ~ ~ ~ ~ D ~ ~ .. ~ .-~ ~ m ~ `~ ~ `` c~ c Z6 .~ m -~ N N N N N N N N X rn W W W W W ~ Z) W W W O O \ \ \ O O O W ~ ~ ~ W W W z z z z z ~ ; ~ ~ ~ ~ ~ X X X X ~ m Z . . Z Z Z Z N N Z Z Z Z Z i i i ~ ~ ~ ~ ~ N 1 1 1 3 ~~v ,f D~ D D ~• N ~ ~ m °o ~ ~' ~ m ~ C7 `'' O v O C D v O n O O z 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: 2 Females: 3 Council Announcement Date: February 10, 2009 Application Deadline: Wednesday, 5:00 p.m., March 18, 2009 Council Appointment Date: March, 24, 2009 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High One Vacancy -Unexpired Term Effective upon appointment, ending December 31, 2009 One (1) person - At Large Danielle Malatek resigned One (1) Tate High No applications as of Wednesday, 5:00 p.m., March 18, 2009 One (1) At Large Jerry Gao D 29 Coll Court D Denotes applicant completed the Confidential page of the application. i City ofi Iowa City r ~...®~ Advisory Board/Commission/Committee ~:~~"',1'`'~~ . pplication Form "`-"- 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 RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Youth Advisory Commission Term 2009 Youth Advisory Commission (shall not be more than 18 years of a eat the time of application) Name of Iowa City High School or high school equivalent: W25'~ ~~~ ~ ~-~o° t Signature of parent/guardian: _T~-- C~°/ ~~4ME Jerry Gao HOME ADDRESS 29_coll court ZIP ~22L~b Is your home address (listed above) within the corporate limits of Iowa City? Q Yes ~ No How long have you been a resident of Iowa City? Since July 2003 OCCUPATION Student EMPLOYER West High School PHONE NUMBER: HOME 319-466-9411 BUSINESS 319-688-1050 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS PC~ITIOI West High Student Senate (2006-present) ~' W - -_ National Youth Leadership Forum ~ ~` -- ~- Community Youth Leadership Program "~ ~' ~'~' co Volunteering: UIHC (60 hours), Iowa City Public Library (150 hours) ~ -aa Band (2003-present) O West High Mu Alpha Theta (2006-present) ~ ~ West High Academic Decathlon (2008-present) ,~,~ ~I Swimming/Tennis (2006-present) 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 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Youth Advisory Commission is comprised of seven members. The goal of the commission is to promote communication between youth and adults and an awareness of Iowa City. The commission also increases dership abilities for its members by allowing them to make decisions that affect not only them, but other youth as well. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As a member of West High Student Senate for the past few years, and as a member of the Community Youth Leadership Program, I have noticed that many youth are apathetic of what goes on around them. I feel that much can be done in order to increase teenagers' awareness of Iowa City. Current youth are often isolated from the world around them, unwilling to engage in discussion with older adults or to appreciate what Iowa City has to offer. If I am a member of this commission, I think that I would be able to help increase enthusiasm and understanding of Iowa City, and help youth become more involved with other adults. Also, as a responsible student, my decision-making skills would be well-suited as a liaison between the general youth population and the City Cowlcil. .y ~ ,~ .~. ...; ~ „~„ .`~. co m -r' n :V POTENTIAL GUNFLIGI 5 UF- IN I tKtS I q -~- v Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. 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 knowthat 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 ofSection 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. None IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ 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. General Application December 2008 Page 2 of 7 ~ r BOARD, COMMISSION AND COMMITTEES ~,, ,~ ~ BUSINESS LISTING ...~,,~._ CITY OF IOWA CITY Name of City Board/Commission/Committee Youth Advisory Commission Date /(l~j ~ ~ ~1 Name Jerry Gao 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 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 Yb ~ ~...> O ~ ~, "'f"1 t~ -r _,.. r- rv -.a NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature Signature of parent/guarc~ian (Youth Advisory Commission only): Address 29 Coll Court 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 2008 Page 3 of 7