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HomeMy WebLinkAbout2001-02-06 Appointment NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION One Vacancy - Six-Year Term March 1,2001 - March 1,2007 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 Airpod 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. Appointment will be made at the February 6, 2001, meeting of the City Council at 7:00 p.m. in the Council Chambers. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's Office upon request. 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 Appointment Date: February 6, 2001 AIRPORT COMMISSION One Vacancy - Six-Year Term March 1, 2001 - March 1, 2007 M. Richard Mascari [] (previously served one full term) 4542 Canterbury Ct. Dan Grinstead [] 1218 Ash St [] Denotes applicant completed the Confidential page of the application. Jan-2Z-01 01:53pm From-CiTY OF 10WA CITY +3193565009 T~632 P,OZ F-gg6 ;1'1 Y Ui-IUVVA t.;I I Y · ,DVISORY BOARD/COMMISSION F!T ,PPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising, ~h~,Counoi|:im~attere of interest ~ our community and its future. Applicants must reside in Iowa City. i:,j, ,, '.: ,' .,', After a vacancy has been announced, the Council reviews all applications during the .work session. The ~pointment is made at the next formal Council meeting, Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City, wa. 418 APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR ~E PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED 'CONFIDENTIAL" THIS APPLICATION WILL ; CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY JRING THAT TIME. L)VISORY BOARD/COMMISSION NAME Airport Commission TERM 6 ~ME M. Richard Hascar1 HOME ADDRESS 4542 Canterbury your home address {listed above) within the corporate limits of Iowa City? XX Yes __ No ~w long have you been a resident of Iowa City? 22 years 3CUPATION owner Arena Auto Body EMPLOYER tONE NUMBER: HOME 338 2993 BUSINES~ 354 1000 ~PERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: IC A/P Commission raember,1 term,since 1995o Durinq my term, these accom- plishments ~zere achle~ed: Installation o~ weather station, chanqe £requenc~ o£ snow removal, renewed lease w~th TCPS without a~bif. ra~ion, help initiate the NCA project & overseen its progress, contributed to the terminal renovation, involved with the co~str o~ new shop bldg, many more. HAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Chairman o£ A/P Commission 2 years Vi~-. Eh;~irman ] HAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON )R APPLYING)? ~elp oversee the ~omplet~on o£ NC~, continue ~o s~ive £or a/D :in~nni~l independence. Held kee~ costs in check. Contribute in the selection 3f a new FBO. Jan-ZZ-O] 01:540m From-CITY OF IOWA CITY +3193565009 T-632 P.03 F-996 SPECIFIC A~rENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. ~FFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF ~,FFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE, ,/OU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN MPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A ;ITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE ,'ONTACT THE CITY ATI'ORNEY' S OFFICE AT 356-5030. : YOU ARE UNCERTAIN WHETHER OR NOT/, POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE- ~GENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. .- F-: ::: _. YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? X ..YES NO ,O YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? X YES . NO 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 fall to answer all questions on the application you may not be considered for appointment. January 1998 cI1Y OF IOWA CITY 'ADVISORY BOARD/COMMISSION APPLICATION FORM IndiViduals serving on Boards/Commissions play an important role in advising the~p.uncil ion ma~,'er~ 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 ne~ formal Council meeting. Appointees sere as unpaid volunteers. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~,~ rc~O~.~' ~ rv~Tf,~ i 551 o~ TERM ~ o NAME~ ~ ps'~ HOMEADDRESSI~ Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes . No How long have you been a resident of Iowa City? ~ OCCUPATION ~) ~ ~Lc, ~1~ EMPLOYER ~ ~ c PHONE NUMBER: HOME ~ ~ - ~ ~ BUSINESS ~ 3-bl I ~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~ WHAT IS YOU~RESENT KNOWLEDGE OF THIS ADVISORY BOARD? % ~ ;~ ~ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)?~g ~ ~op~ ~ ~ c~ % ~ C~~ ~ SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY A'I'rORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. 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 ~isrepre~entstion~ on this ~pplioBtion will oon~titute ]u~t gsuse for removBI ot Bn 8ppointee. If you fsil to 8nswer BII que~tion~ on the 8ppliastion you m~y not be aon~idered for 8ppointment. cclelk~bdoomapp.do~ January 1998 (2) NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION One Vacancy - Unexpired Term Ending Januar~ 1,2004 The duties of the members of the Parks and Recreation Commission are te recommend and review policies, rules, regulations, ordinances, and budgets relating to parks, playgrounds, recreation centers, and cultural functions of the City and make such reports to the City Council as the Commission deems in the public interest; to exercise broad responsibility for the development of parks, recreation centers~ playgrounds, and cultural bcilities to serve the City--including the creation and appointment of advisor,/groups to make studies. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m. Appointment will be made at the Februar~ 6, 200t, meeting of the City Council at 7:00 p.m. 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 Clerl~ at the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. December 21, 2000 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: 3 Appointment Date: February 6, 2001 PARKS AND RECREATION COMMISSION One Vacancy - Unexpired Term February 6, 2001 - January 1,2004 Doug Ginsberg [] 51 Ealing Drive David Redlawsk [] 26 Gallup Place Joe Eichelberger [] 1428 Keokuk Street [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION DPLICATION FORM Individuals serving on Boards/Commissions 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME PC"2Pu~' '~)~P.(Z_ ::~,~,r{,p4 TERM -.~,'~ NAME,~'~I ~,,452::~rc~ HOMEADDRESS :/) C('~2,~-;V'~ Is your home address (listed above) within the corporate limits of Iowa City? --~ Yes ~ No How long have you been a resident of Iowa City? ~C) ~,~NE NUMBER: HOME ~2~ -- Z~CqBUSINESS WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -- :: . -. S. CIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? /~,YES __NO )O YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES NO 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 questions on the application you may not be considered for appointment. I~ik/bdcomappdoc JanOary 1998 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advisin~:~he COdOCil~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 applic-'~iO'nS during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. ]'HIS 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADvisoRY BOABD/COMM,SS,ON NAME 'P, NAME"~UID'~E lPX~Cdg~ HOMEADDRESS 2~ ~LLuP Is your home address (listed above) within the corporate limits of Iowa City? ~es ~ No How long have you been a resident of Iowa City? I ~ 3CCUPATION A~ ~ , I O~FSgo~ EMPLOYER allONE NUMBER: HOME ,~V- ~5~Z BUSINESS ,¢~' 2,~,~Z EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? VHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON OR APPLYING)? / ~ ~/~ ~ [~'[d~ ~ C$~U~/[K- SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WiTH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A i~ITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE ~ONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. iF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? JYES NO )O YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES V/NO It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all questions on the application you may not be considered for appointment. s~rk~bclcomapp.doc January 1998 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the CounCil oO m~ter$._o.fI 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 wor,k.~session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City, iowa. ~HIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE ~ST PAGE MARKED "CONFIDENTIAL" THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADV~SORYBOARD/COMMISSIONNAME ~s ~ ~~ TERM NAME ~ E ;c~br~ HOME ADDRESS I~Z~ Is your home address {listed above) within the corporate limits of Iowa City7 ~ Yes __ No How long have you been a resident of Iowa City? ~ ~CCUPATION ~ ~h~ ~,~¢ EMPLOYER ~HONENUMBER: HOME ~' OS~t BUSINESS ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~5~ VHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON OR APPLYING)? ~ ~ I~ ~ , ~ SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE SONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. F YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ./~ YES NO ~O YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? __YES y NO 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 questions on the application you may not be considered for appointment. ,rk\bdcomapp.doc January 1998 (2) NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy - Three-Year Term [Art Professional] January 1, 2001 - January 1, 2004 Duties of the Public Art Advisory Committee include developing by-laws and procedures for the Iowa City Public Art Program; administering the Public Art Program by determining the placement of pul~lic art, the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the Public Art Program budget, Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m. This appointment will be made at the February 6, 2001, meeting of the City Council at 7:00 p.m. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. 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: 1 Females: 2 Appointment Date: February 6, 2001 PUBLIC ART ADVISORY COMMITTEE One Vacancy - Three-Year Term (Art Professional) January 1, 2001 - January 1, 2004 Louise Rauh [] 254 Rocky Shore Dr Betsy Klein [] 628 2nd Avenue Connie Peterson [] 1323 Kirkwood Avenue Barbara Asch Camillo [] 1111 Sheridan Avenue [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION FF APPLICATION FORM :::z ,;...': Individuals serving on Boards/Commissions play an important role in ising the q:o,~.'~n On-rn, atti~s of interest to our community and its future. Applicants must reside in Iowa City. adv ,',.;v.;,... ,'. · . 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY OURING THAT TIME. ~IAME ,Z~L,c/sE ~/7~u-~ HOME ADDRESS a S q Qt~<:_ %L~ !s your home address (listed above) within the corporate limits of Iowa City? ~es~''~ No tow long have you been a resident of Iowa City? <-~jJ ~CCUPATION RR~',.%+/p,.a,t-4rz.~,t-- ~L,.t...,~-.%'-/.-,. r_,L~.OlO EMPLOYER ~.j LcJL,-c.[ O ~HONE NUMBER: HOME ,..¢ ,2, ~; .~ [ 6 I BUSINESS 3 q'/5':~ ZXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN PMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. ~F YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. _ F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? YES 70 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES v//NNO ~t 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 questions on the application you may not be considered for appointment. I,~rk\bdcornapp.doc January 1998 (2) CITY. OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM r'; ,\ Individuals serving on Boards/Commissions play an important role in advisingjCfie Council on ,m_a~tters of interest to our community and its future. Applicants must reside in Iowa City. L_,, '. 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ,Dv,soRY BOARD/COMM,SS,ON NAME Pv-bf, ic bur- TERM NAME/~z;('/~/~ HOME ADDRESS b ~4 Is your home address (listed above) within the corporate limits of Iowa City? /Yes __ dow long have you been a resident of Iowa City? io ~. ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .~ ~{g,{St/c~{~ .3 ,,.~ b~ ~, VHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON :o 12~.' 'Kfi~ L~ B~ :~~ b'~~ ~&c,~ :~' SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? v/ YES NO ~0 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES y/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 questions on the application you may not be considered for appointment. I~rk\bdcomapp.doc January 1998 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the ,C9~,ncil 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 3ppointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. ]'HIS 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 SE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY QURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~D~/--/~_.-/-~/Z-7' TERM ~ ~IAME ('~/f/M.)/E }2~'~T'E/~'aA/' HOME ADDRESS/.~/~/~.,~(.4Jc~z~_D s your home address (listed above} within the corporate limits of Iowa City? / Yes __ No ~ow long have you been a resident of Iowa City?//Y~ ~HONa NUMSSR: HOMS ,~/- Y~ SUSaNaSS ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ~~ 'JHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON OR APPLYING}? ~ ~ A H~ ~G ~ ~ ~ ~ ~ SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY"S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN iMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. rF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? "/YES NO )O YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES Y~NO 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 questions on the application you may not be considered for appointment. F/bdcornapp+doc January 1998 (2} CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Coundil on matterse. 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~.'1' ' PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Wa~hingtoff St.,'i~wa City, Iowa. }t .,'-3 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Is your home address (listed above) within the corporate limits of Iowa City? ~s __ No How long have you been a resident of Iowa City? ~ OCCUPATION x~'f~ } ~/~ EMPLOYER / PHONE NUMBER: HOME .~ ~ ~ ' ~ ~ ~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED7 v/YES NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES (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 questions on the application you may not be considered for appointment, (2) B~.RB~-R~- ~.SCD C~,CDILLO VITA EDUCATION: Major Degree Univeristy of Colorado Art Rhode Island school of Design Art University of Bridgeport Art BA University of Bridgeport Art education MS Rutgers University Art MA University of Iowa Writer's Workshop, Fiction MFA ONE PERSON SHOWS: Location Including: Gallery Elisabeth Chicago, IL Tivolis Barcelona, Spain International Club Barcelona, Spain Honeywell Gallery Minneapolis, MN ~} Westlake Gallery Minneapolis, MN :>_ C> Duluth Art Institute Duluth, MN Illinois Central College E Peoria, IL '- Indianapolis Art League Indianapolis, 1N Stone House Gallery Fredonia, KS Quad City Arts Rock Island, IL Mt. Mercy College Cedar Rapids, IA Joan Kuyper Faver Gallery Pella, IA SCC Gallery Waterloo, IA Arts Iowa City Iowa City, IA Hudson River Gallery Iowa City, IA GROUP StIOWS: Including: Gilman Gallery, Chicago ILfRima Greenburg, New York, NY/Desson-Zaks, Chicago IL/Arts Center, Des Moines, IA/Arts Iowa City, Iowa City, IA/Waterloo, IA/Arts on Grand, Spencer IA, Hudson River Gallery, Iowa City, IA, UPCOMING SHOWS: Charles City Art Center, Charles City, IA NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION One Vacancy - Three-Year Term March 13, 2001 - March 13, 2004 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. Appointment will be made at the February 6, 2001, meeting of the City Council at 7:00 p.m. 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 the Civic Center, 410 E. Washington Street. Application forms are available from the Clerk's office upon request. -12/12/00 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: 2 Appointment Date: February 6, 2001 TELECOMMUNICATIONS COMMISSION One Vacancy - Three-year Terms March 13, 2001 - March 13, 2004 Robert L. Kemp [] 1122 Estron Street Darren Pitzele [] 2040 Waterfront Drive Kembrew McLeod [] 109 South Lowell Street [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM " Individuals serving on Boards/Commissions play en important role ' advisi~ ~ffi~ C.09n~ii ~n Imatters of interest !~, ,, ,, ,,. ,:, . , .,,,-\ to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all a~lio~tio~s ~uri~g the work sessiom The ~oimme~t is made ~t the ~ext formal Coupoil meeting. A~ointees sere as u~d volunteers. PL~AS~ USE A BLAQK I~K P~N. ~eturn the ~l~oatio~ to City Clerk, 410 E. W~shi~gto~ St., Iow~ City, THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE ~EP~ODUCED AND DIST~IBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE ~ST PA~E MArlLED 'CONFIDENTIAL' THIS APPLICATION WILL BE CONSIDE~ED FO~ TH~EE MONTHS ONLY AND AUTOMATICALLY CONSIDE~ED FO~ ANY VACANCY DU~IN6 THAT TIME. L./(E P HOMEADDRESS i1 Is your home address (listed above) within the corporate limits of Iowa City? ~es __ No How long have you been a resident of Iowa City? ' ' ' '~L~ oY PHONE NUMBER: HOME 'S ~ ~ f 2/C BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: / % WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. ,F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? YES ~NO ,7>0 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 questions on the application you may not be considered for appointment. (2) STATEMENT OF INTEREST A "yes" answer to any of the following questions will not necessarily exclude you from consideration for appointment to the Iowa City Telecommunications Commission. However, the information will assist our Legal Department in determining whether or not there may exist a conflict of interest which would preclude your further consideration. Are you or is any member of your immediate family or anyone dependent upon you: a. An employee of or a stockholder in either TCI, Inc., or a subsidiary or limited partnership{s} (including C~blevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No ~ b. An employee of or a stockholder in any radio or television station or news publication operating in Iowa City or serving the Iowa City area or of any parent company or subsidiary thereof, or in any other manner affiliated with any of the above? Yes __ No /~ c. An employee, stockholder, partner, or proprietor of any corporation or business which has or is likely to have a significant contract or business connection with either TCI Communications, Inc., or a subsidiary or limited partnership(s) {including Cablevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No ~' If you have answer "yes" to any of the above questions, please include a complete explanation using additional paper if necessary. CITY OF IOWA CITY :: ADVISORY BOARD/COMMISSION ":: APPLICATION FORM IndiViduals serving on Boards/Commissions play an important role in advising the Council~n 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. is your home address (listed above) within the corporate limits of Iowa City? 7~ Yes __ No /¢ "low long have you been a resident of Iowa City? :)CCUPATION ,,~rV ~/v~ EMPLOYER ~HONE NUMBER: HOME ~2-/'~:~5 BUSINESS :XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? //C~,7 ~ - ,/HAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WiTH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS A'FI'ACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? .~ YES NO ~0 YOU CURRENTLY SERVE ON ANOTHER IOWA QTY BOARD OR COMMISSION? YES /Y" 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 questions on the application you may not be considered for appointment. lerk\bdcomapp.doc ~t, January 1998 (2) STATEHENT OF ZNTEREST A "yes" answer to any of the following questions will not necessarily exclude you from consideration for appointment to the iowa City Telecommunications Commission. However, the information will assist our Legal Department in determining whether or not there may exist a conflict of interest which would preclude your further consideration. Are you or is any member of your imediate family or anyone dependent upon you: a. An employee of or a stockholder in either TCZ,.Znc.,' or a subsidiary or limited partnership(s) (including C~blevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No ~ b. An employee of or a stockholder in any radio or television station or news publication operating in Iowa City or serving the Iowa City area or of any parent company or subsidiary thereof, or in any other manner affiliated with any of the above? Yes No X C. An employee, stockholder, partner, or proprietor of any corporation or business which has or is likely to have a significant contract or business connection with either TCI Con~nunications, Inc., or a subsidiary or limited partnership(s) (including Cablevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No X If you have answer "yes" to any of the above questions, please include a complete explanation using additional paper if necessary. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION F!! APPLICATION FORM .... Individuals serving on Boards/Commissions play an important role in adviS,~gg'.the~CoU.nCil~b'~natters 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. PLEASE USE A BLACK INK PEN. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME I (~ TERM NAME F-,~_,~,-'~',L,~-~>,,,,~ ~"v~<-~L,e~ HOMEADDRESS IO~t ,S , C~-~(I ~s your home address (listed above) within the corporate limits of Iowa City? /Yes __ No ~ow long have you been a resident of Iowa City? 5 ~CCUPATION ~FD~G/ EMPLOYER ~ o-~ ~HONENUMBER: HOME ~-~5~ BUSINESS 7XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VHAT 18 YOU~ P~ESENT KNOWLEDSE OF THIS ADVISORY BOARD7 OR APPLYING)? SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENERALLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CITY BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CITY CONTRACT. A COPY OF SECTION 362.5 IS ATTACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CITY ATTORNEY' S OFFICE AT 356-5030. IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. · F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? /YES NO )0 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION7 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 questions on the application you may not be considered for appointment. (2) STATEMENT OF INTEREST A "yes" answer to any of the following questions will not necessarily exclude you from consideration for appointment to the Iowa City TelecommUnications Commission. However, the information will assist our Legal Department in determining whether or not there may exist a conflict of interest which would preclude your further consideration. Are you or is any member of your immediate family or anyone dependent upon you: a. An employee of or a stockholder in either TCI,.Inc., or a subsidiary or limited partnership(s) {including C~blevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No b. An employee of or a stockholder in any radio or television station or news publication operating in Iowa City or serving the Iowa City area or of any parent company or subsidiary thereof, or in any other manner affiliated with any of the above? Yes No c. An employee, stockholder, partner, or proprietor of any corporation or business which has or is likely to have a significant contract or business connection with either TCI Communications, Inc., or a subsidiary or limited partnership(s) (including Cablevision Associates VII), the general partner of which is or is controlled by any of the above? Yes No V/ If you have answer "yes" to any of the above questions, please include a complete explanation using additional paper if necessary.