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HomeMy WebLinkAbout2002-02-19 Appointment NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION One Vacancy - Six-Year Term March 1, 2002 - March 1, 2008 Duties: To exercise all the powers granted to cities and towns under Chapter 330 of the Code of Iowa, except the power to sell said airport. To annually certify the amount of taxes within the limitations of the Statutes of the State of Iowa to be levied for Airport purposes. All funds derived from taxation or otherwise for airport purposes shall be under the full and absolute control of the Airport Commission, deposited with the City Treasurer, and disbursed only on the written warrants or order of the Airport Commission. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Airport Commission meets the second Thursday of each month at 5:45 p.m. Applications must be received by 5:00 p.m., Wednesday, February 13, 2002. 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 or on the City website at www.icgov.org. Questions about the Iowa City Airport Commission should be directed to Ron O'Neil, Airport Manager 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: December 11, 2001; January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2002 AIRPORT COMMISSION One Vacancy - Six-Year Term March 1, 2002- March 1, 2008 Term expires for Howard Horan Howard Horan [] (currently serving 6-yr term) 2407 Crestview Michelle Robnett [] 3375 Wentworth Place [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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, ]owa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPROD. U. CED 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 j~ I ~'/2 o r'+ (~ P~l~; ,~ $~. TERM NAME /J~I'~' ~' r~ '~ [='~ O/'~ ~ HOME ADDRESS~/~ O ~ dl~¢'-~ ~-J~ Is your home address (listed above)within the corporate limits of Iowa City? ¢~Yes ~Np? ~ How long have you been.,,., ,a resident of Iowa City? / 4.~'~ ..... ~ r ~ '-~ , _ EMPLOYER c.~. [.D_;_~_ ,- ¢~--:z DCCUPATION CHONENUMBER: HOME 3.,.~" ! ,~'~) ~' ¢'¢ BUSINESS ~-~,~-f ~ E-MAIL ADDRESS (Optional): ~ J"l ~OP~.~ /'~ £XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: -~-a,,,,~ ~'~"o.,.I'/~' q-o ~,Oorl~ '¢~ ['¢f~. 4L.~. ~¢rpo~-- m~,~,~ ~r4.?, /~,~r~4ra~ ; l:::~ll ,/VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ~ ~.. ~,, ~.. ~ er*~,. ~ I Misrepresentations on this application will constitute just cause for removal of an appointee. J I If you fail to answer all the questions, Council will not consider your application. clerk\bdcomapp(1) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)?_~" ~&V"-- ~..¢.~¢2~/,i'~,~¢,.~ I~I. f~6r.-~',~.l ~,~,,.~ SPECIFIC A~ENTION 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 CI~. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE'AGENCY. OTHER ~PES OF AFFILIATION MUST BE E~MINED ON A CASE-BY-CASE BASIS BY THE CI~ A~ORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENE~LLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CI~ BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CI~ CONTACT. A COPY OF SECTION 362.5 IS A~ACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CI~ A~ORNEY'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 CI~ A~ORNE~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 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 will not consider your application. derk~bdcomapp{l ) doc September 2001 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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 ,.3fl r~£~ ~o-~}&r~LsS i o~q TERM NAME ~{(~ ~L~,b~qE~ HOME ADDRESS ~ ~~ Flac~ Is your home address (listed abovo) within the mrporate limits of Iowa Ci~? ~Yes No How long have you been a resident of lowa Ci~? ¢c~cu~>E~'qq irZm~o OCCUPATION - [(~ ,~ EMPLOYER ~lq~ ' U PHONE NUMBER~ HOME ¢1~-~I-7~o'1 BUSINESS E-MAIL ADDRESS (Optional): t?~O~ i lff -- CO[;~- (~' t-qocOO EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I ~isrepresentaUons on th,s app,ic.t,on .m constitute iust ~ause ,or mmov. I o, an appo'ntee. I ~1 If you fail to answer all tho quostions, Counc I w not consider your application. ;clerk\bdcomapp( 1 ).doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? SPECIFIC A~ENTION 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 CI~. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER ~PE8 OF AFFILIATION MUST BE E~MINED ON A CASE-BY-CASE BASIS BY THE CI~ A~ORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENE~LLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A Cl~ BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CI~ CONTACT. A COPY OF SECTION 362.5 IS A~AGHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CI~ A~ORNEY'8 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 CI~ A~ORNEY'S OFFICE. ;F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? v/YES NO 30 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES u/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. /I /I If you fail to answer all the questions, Council will not consider your application. clerklbdcomapp(1) doc September 2001 (2) Curriculum Vitae Michelle Robnett, PhD, RN/NP 3375 Wentworth Place (319) 341-7807 (H) Iowa Cit¥~ Iowa 52240 (319) 335-7380 EDUCATION 1999 Acute Care Nurse Practitioner Certification ANCC 1998 University of Maryland, School of Nursing, Baltimore, Maryland Post- Doctorate/Trauma/Critical Care Advanced Practice Nurse 1992 University of Iowa, College of Medicine, Iowa City, Iowa Hospital and Health Administration and Finance Ph.D. 1989 University of Iowa, College of Business Administration, Iowa City, Iowa M.B.A. 1986 University of Iowa, College of Nursing, Iowa City, Iowa Administration/Adult Health M.A. Nursing 1979 Marycrest College, Davenport, Iowa B.S.N. and B.A. in Biology 1979 Registered Nurse, Iowa and Maryland license (2) PROFESSIONAL APPOINTMENTS ~ ~ ~z~ r'~c~ --.~ University of Iowa, College of Nursing, Iowa City, Iowa :-< ~ ~ ~ ~-~ 2000-Present Associate Dean, Faculty Practice Plan (~ -~ -~ " Locum Tenens Medical Associates, PC, Baltimore, Maryland 2000 President & CEO Care Source LLC, Baltimore, Maryland 1999 Staff Nurse, Med-Surg ICU, Saint Josephs Medical Center, Towson, MD University of Maryland Medical Systems, Baltimore, Maryland 1999-2000 Nurse Practitioner, Bone Marrow Transplant Unit 1998-1999 Senior Director, Office of Philanthropy 1998-2000 Registered Nurse, Critical Care & ER., Supplemental Staffing 1997-1998 Full Partner, Shock Trauma Center, Neurotraurna Critical Care Johns Hopkins Bayview Medical Center, Baltimore, Maryland 1997 Director, Nurse Practitioner Group Practice 1995-1997 Vice President, Patient Care Curriculum Vitae Michelle K. Robnett, PhD, RN/NP PROFESSIONAL APPOINTMENTS CONT. 1995-1997 Adjunct Faculty, Johns Hopkins School of Nursing 1996-1997 Adjunct Faculty, The University of Maryland, School of Nursing 1996-1997 Adjunct Faculty, The Catholic University of America University of Iowa Hospitals and Clinics, Iowa City, Iowa 1992-1994 Associate Director, Department of Nursing 1994 Associate Director, Office of Outcomes Evaluation and Management 1991-1992 Assistant to the Associate Director, UIHC, and Director - Dept. of Nursing 1985-1989 Clinical Nursing Specialist 11 - Critical Care Nursing Division 1983-1985 Nurse Clinician III / Supervisor - Central Nursing Office Supervisor 1983 Nurse Clinician 11 / Head Nursing (acting) - Surgical Intensive Care Unit 1983 Nurse Clinician I / Assistant Head Nurse - Surgical Intensive Care Unit 1982-1983 Staff Nurse - Surgical Intensive Care Unit University of Iowa, College of Medicine 1990 Teaching Assistant, Health Economics - Graduate Program in Hospital and Health Administration 1989-1992 Manuscript Reviewer, Hospital and Health Services Administration Journal University of lowa, College of Nursing 1992-1994 Adjunct Assistant Professor 1986-1992 Adjunct Faculty 1982-1983 Research Assistant to Myrtle K. Aydelotte, R.N., Ph.D., F.A.A.N. St. Lukes Hospital, Davenport, Iowa 1980-1982 Charge/Staff Nurse - Hemodialysis 1979-1980 Charge/StaffNurse - Intensive Care Unit Mercy Hospital, Davenport, Iowa 1981-1982 Charge/Staff Nurse - Hospital Float Pool - 1979 Staff Nurse - Cardiac Step-down Unit "-~ 1978-1979 Licensed Practical Nurse - Surgical Floor PROFESSIONAL SOCIETIES AND HONORS 2001-Present American College of Nurse Practitioners 200 l-Present Iowa Nurse Practitioner Society 2000-Present Medical Group Management Association 1998-Present American Academy of Nurse Practitioners 1997-Present Instrument Pilot 1995 Leadership Award, National Multiple Sclerosis Society 1995 Silver Level Achievement Award Juvenile Diabetes Association, Chairman Bayview Medical Center 1995 Commendation for Contributions to the AONE Policy & Legislative Program 1994-1995 AONE Region 6 Commissioner - Policy and Legislative Advocacy Curriculum Vitae Michelle K. Robnett, PhD, RN/NP PROFESSIONAL SOCIETIES AND HONORS CONT. 1992-Present Editorial Review Board, Healthcare Financial Management 1993-Present Editorial Review Board, Nursing Economics 1993-1995 Editorial Review Board, Healthcare Forum Journal 1994-1995 Editorial Review Board, Obstetrics and Gynecology 1992-1997 American Organization of Nurse Executives 1993-1995 American Finance Association 1994-1997 Association for Health Services Research 1988-1997 American College of Healthcare Executives 1989-1995 Healthcare Financial Management Association 1992 Distinguished Service Award, Ma~crest College 1988-1989 Who's Who in American Nursing 1975-Present Private Pilot GRANTS Principal, Iowa City-Coralville Convention Center grant to fund Fly Iowa 2001 in Iowa City, $1,000. Co-Investigator, Proposed Gerontology Research Center Utilities Contract and Baltimore Longitudinal Study of Aging B3N Contract Co-Investigator, Proposed Trial of Different Treatments of Patients With Degenerative Spondylolisthesis, National Institute of Health, $3,000,000 Consultant, "Hospital Based Managed Care for Liver Transplant Patients", Stadlanders/ITNS Excellence in Nursing Research Grant $2,500 Commonwealth Fund, Executive Nurse Fellowship, 1987, $25,000 Principal Investigator, Student Research Grant, Sigma Theta Tau, Spring 1985, "The Growth of a Nursing Leader: Myrtle Kitchell Aydelotte", University of Iowa, May 1986, $300 Principal Investigator, Student Research Grant, Sigma Theta Tau, Spring 1984, "Monitoring to Ensure Reliability of Hemodynamic Pressure Readings", Journal of Nursing Oualily Assurance, May, 1989, 3(3):36-44, $100 BIBLIOGRAPHY Working Papers Robnett, M., Levitz, G., and Fellows, P. (1995) Stability and Validity of Variables Used In Capital Structure Research. Robnett, M. (1995) Determinants of Capital Structure in Not-for-Profit Hospitals. Robnett, M. (1995) Agency Cost Value of Not-for-Profit Hospitals. Robnett, M. (1992). Why Nursing Needs to Change thc Way We Do Business. Curriculum Vitae Michelle K. Robnett, PhD, RN/NP BIBLIOGRAPHY CONT. Robnett, M. (1994). Major issues to address prior to successful transition to a capitated Prospective Payment System for Medicare. Robnett, M., Anderson, M. and Helms, L. (1994). Reimbursement of Nursing Services in an Era of Health Reform. Book Reviews Mathis, S. and Robnett, M. Differentiated Nursing Practice, Journal of the Midwest Alliance in Nursing, 3(2) Fall 1992. p.26-28. Associate Author. In Search of Excellence: Harper and Row Publishers, 1982, and Magnet Hospitals: American Nurses Association, 1983; Journal of Nursing Administration, September/October 1984. Book Reviews cont. Associate Author. Diagnosis Related Groups: A Practitioner's Guide, Pluribus Press, Inc., 1982, in Nursing Outlook April 1984. C)=~-~' Thesis r'~ "The Growth of a Nursing Leader: Myrtle Kitchell Aydelotte", Masters Thesis, University _o~I_~wa, ~ay 198~ ~-'7 CZ9 Dissertation ' ' r ~ ~ ~ "Determinants of Capital Structure in Not-for-Profit Hospitals in Iowa", Doctoral Dissertati¢!],~niveTgity of 2gwa, August 1992. ~ '~ ~ Book Chapter Robnett, M. and Schaub-Rimel, A. (1998). Chapter: Financial Management for Department Managers. In: Dienemann, J. 2nd Edition, Nursing Administration, Managing Patient Care. Connecticut: Appleton & Lange. Journal Articles Robnett, M. (1995). Care MapsTm: The Strategic Management of Quality-Cost, Bulletin of American Academy of Otolaryngology-Head and Neck Surgery, September, 14(9): 24-27. Robnett, M. (1995). Management Perspectives - Patient Complaints, The Nursing Spectrum, 5(20):4. Helms, L., Anderson, M, and Robnett, M. (1993). Reimbursement for Nursing Education: Opportunity Versus Inertia, Nursing & Health Care. September, 15(7): 344-349. Robnett, M. (1994). The Strategic Planning Process, Iowa Nurse, Spring, 2-3. Hilsenrath, P., Robnett, M., and Smith, W. (199 1). "Labor Productivity in Radiology", _Administrative Radiology~_ August, 10(8):60-62. Alpen, M., Robnett, M., and Dolter, K. (1989). "Monitoring to Ensure Reliability of Hemodynamic Pressure Readings", Journal of Nursing Quality Assurance, May, 3(3):364t4. Robnett, M. (1986). 'The Incidence of Skin Breakdown *in a Surgical Intensive Care Unit, Journal of Nursing ~)uality Assurance. 1(1):77-81. 4 Curriculum Vitae Michelle K. Robnett, PhD, RN/NP BIBLIOGRAPHY CONT. Robnett, M. (1986). Historical Research, Iowa Nurse Fall, 2-3. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: JOHNSON COUNTY/IOWA CITY AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy - Five-Year Term January 1, 2002 - December 31,2006 The powers and duties of the Johnson County/Iowa City Airport Zoning Board of Adjustment are: 1. To hear and decide special appeals where it is alleged there is an error in any administrative action in the enforcement of the ordinance. 2. To hear and decide on special exceptions that are specifically provided for in the ordinance. 3. To authorize, on appeal in specific cases, variances from the terms of the ordinance. Variances granted by the Board of Adjustment may only be granted in the case of "unnecessary hardship." The hardship must be substantial, serious, real, and of compelling force, as distinguished from reasons of convenience, maximization of profit, or caprice. 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, February 13, 2002. 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 or on the City website at www.icgov.org. Questions about the Iowa City Airport Commission should be directed to Ron O'Neil, Airport Manager 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: 1 Council Announcement Date: October 8, 2001; November 27, 2001; January 8, 2002 Application Deadline: Wednesday, 5:00p.m., February 13, 2002 Council Appointment Date: February 19, 2002 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy - Five-Year Term January 1, 2002 - December 3t, 2006 Term expires for Karen Countryman No Applications as of 5:00 P.M., February 13, 2002 [] Denotes applicant completed the Confidential page of the application. NOTICE THE CiTY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: CIVIL SERVICE COMMISSION One Vacancy - Four-Year Term (April 1, 2002 - April 3, 2006) Duties: Approve all entrance and promotional examinations used by the City of Iowa City; holds hearings involving employee discharge or reduction in rank or compensation and ascertains to the best of its ability the facts of the case. After weighing all evidence, takes action as provided in Chapter 400 of the Code of Iowa. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. Members of the Civil Service Commission must be residents of the City of Iowa City preceding their appointment. The Commission meets when deemed necessary. Applications must be received by 5:00 p.m., Wednesday, February 13, 2002. 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 or on the City website at www.icgov.org. Questions about the Iowa City Civil Service Commission should be directed to Sylvia Mejia, Personnel Administrator at 356-5026. 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: 0 Council Announcement Date: January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2001 CIVIL SERVICE COMMISSION One Vacancy - Four-Year Term April 1, 2002 - April 3, 2006 Term expires for Lyra Dickerson Lyra Dickerson [] (currently serving 4-year term) 324 Post Road [] Denotes applicant completed the Confidential page of the application. ClT,Y OF IOWA CITY 'ADVISORY BOARD/COMMISSION APPLICATION 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 dudng 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 "CONFIDEN"¢IAL" THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME C_.',,j; ~ $¢,r~; ~.~ ~o,~g,s~,.,,, TERM NAME t~ ~. ~;cl~ HOME ADDRESS 52ff F~+ Is your home address (listed above) within the ~rporate limits of Iowa Ci~? eYes How long have you been a resident of lowa Ci~? I~q ~ ~ ~ OCCUPATION ~ ~, ~, ~"i ~ ~ ~ ~ ~>o~¢ ~ EMPLOYER U PHONE NUMBER: HOME ¢¢(-~ ~ 6~ BUSINESS 3J E-MAIL ADDRESS (Optional): 1~~ ' ~; ~ ~*~*~ ~ ~"~, ~J ~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: J WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -'~ J~,.~ ,~¢¢,~cJ ~,~ -/~._ /2- Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. ccl e rk'C~lcomapp( 1 ).doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? -r. - SPECIFIC A'I-DENTION 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 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 will not consider your application. c clerk'~t:~lco rnapp( 1 ),doc September 2001 (2) NOTICE THE CiTY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HISTORIC PRESERVATION COMMISSION Three Vacancies - Three-Year Terms March 29, 2002 - March 29, 2005 (One Moffitt Cottage District Representative) (Two At-Large Representatives) 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, February 13, 2002. 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 or on the City website at www. icgov.org. Questions about the Iowa City Historic Preservation Commission should be directed to Shelly McCafferty, Urban Planner at 356-5243. 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: 2 Council Announcement Date: December 11, 2001; January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2002 HISTORIC PRESERVATION COMMISSION One Vacancy - Three-Year Term March 29, 2002 - March 29, 2005 (Moffit Cottage District Representative) Term expires for Doris Malkmus No Applications as of 5:00 P.M., February 13, 2002 Two Vacancies - Three-Year Terms March 29, 2002 - March 29, 2005 (At-Large Representatives) Term expires for Ann Freerks, Susan Licht Michael Maharry [] 903 E. College St. [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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. Retum 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. ADVISORYBOARD/COMMISSION NAME ,f'~/~'/'~/'~_ /~//---5, ry~/l~;'~ .~/~.,~,m.~.sy~TERM NAME ,,/~/-~/,4,:/ ,~?,//¢r(,Y HOME ADDRESS "~,D'~ ~. -'¢]~',//d,.Ce .~' Is your home address (listed above) within the corporate limits of Iowa City? /"Yes __ No Now long have you been a resident of Iowa City? ~ .V~".~-z 3CCUPATION ~/V3'/2./2~ ,~ EMPLOYER ~/'/~,~ ,;/~ 'HONE NUMBER: HOME ~'.S'~-/~)Z~ BUSINESS ~ ,~~ E-MAIL ADDRESS (Optional): ~g~rf~ ~A ~n- ~;~,~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSlTION; ~VHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I M isrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. clerk~bdcomapp(1) dcc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~-~ '~'~ f~.¢/ /~, ,,~' ,~/,~ 7Z',,. ,.~-J~ r/e-. ~ ~/~ 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 AI-~ORNEY'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? l-." YES NO OO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES ~O (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 will not consider your application. '.clerk'tb~comapp( 1 ) do~ September ;]001 (2) NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PLANNING AND ZONING COMMISSION One Vacancy - Unexpired Term Ending May 1,2003 The duties of the Planning and Zoning Commission members include making (or causing to be made) surveys, studies, maps, plans, or charts of the whole or any portion of the municipality and any land outside which-in the opinion of the Commission-bears relation to a comprehensive plan; also include recommending to the City Council from time-to-time amendments, supplements, changes, and modifications to the Zoning Ordinance. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. This Commission conducts formal meetings the first and third Thursdays of each month at 7:30 p.m. (Informal workshops are held the preceding Mondays at 7:30 p.m.) Applications must be received by 5:00 p.m., Wednesday, February 13, 200'1. 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 or on the City website at www.icgov.org. Questions about the Iowa City Planning and Zoning Commission should be directed to Robert Miklo, Sr Urban Planner at 356-5240. 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: 2 Council Announcement Date: January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2002 PLANNING AND ZONING COMMISSION One vacancy - Unexpired Term Ending May 1, 2003 Pam Ehrhardt resigned Anna Buss [] 830 Miller Avenue David Redlawsk [] 26 Gallup Place Ann Freerks [] 443 S. Governor St Patricia Moore [] 25 Edgewood Circle [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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 ' [,c~',~ v,?_~ 4. <:. ~. NAME ~ ~,, ~ .... ~'~ HOME ADDRESS Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes How long have you been a resident of Iowa Ci~? ,~ ~ c~. ~:~," '[),~.~) ?~q'L EMPLOYER - )NENUMBER: HOME )~ ] } ) l ~ /~ .) BUSINESS ~-MAIL ADDRESS (Optional): '~3~ ,~ l~ < ~) ~ ~X~[RI~C~ A~D/OR ACIIVITIfiS WHICH YOU F[fik OUAklFY YO~ FOR THIS iNHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? /_b-~ ~ '~,,_~,.~ I'l~lisrepresentations on this application will constitute just ca~se for removal of an appointee. ~1 If you fail to answer all the questions, Council will not consider your application. derk\bdcomapp( 1 ) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR 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 ]-HE AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE. ,, : iF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ YES NO 90 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? v YES NO It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) IMisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. clerk\bdcomapp(1 ) doc September 2001 (2) CITY OF IOWA CITY Fl! ADVISORY BOARD/COMMISSION .4PPLICATION FORM zIo? J, ,~ 31 [;ii 37 Individuals serving on Boards/Corn missions play an .... impodant role m adv~ lje,C,b,~acll/i;~atters of interest to our community and its future. Appli~nts must reside in Iowa City. /L)~r~ 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 se~e as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the appli~tion 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 ~ST 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 ~AMB~ ~0 ~G TERM OA NAME '~Ot0 '~~ HOME ADDRESS ~ ~¢P PL 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? ~ ~z ~ ~3 / OCCUPATION ~ O F ~ S ~ EMPLOYER PHONE NUMBER: HOME ,~-~- ~2 ,ec~/~,.;~//a.~ BUSINESS ~.~' EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FQR THIS POSITION: · / / ...../-- / WHAT OONTRIBUTION8 DO YOU FEEL YOU OAN ~AKE TO THIS ADVI$ORY BOARD (OR 8TATE REASON / / / I - .. i / . - / / / 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 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. 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 v//NO DO 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. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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 REPROD. UCED 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. /q~,,/ i ADVISORY BOARD/COMMISSION NAME '~O.~,',~, '~'~_~:~:~v C't~t~J%'~O~ TERM ~c~c~: Is your home address (listed above) within the corporate limits of Iowa City? X/ Yes ,::q'xl~ - c~ ~__ How long have you been a resident of Iowa City? I ~ i J~r;,n ,OJ'~ ' ~ "~ E-MAIL ADDRESS (Optional): Ur)r).-- .fr~,~ ,-' r'-J~-,,~ ~.~ t.(;o t.~,rA ~. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~C,~r~,~-A~ £,-,,~s~,~,~ WHAT IS YOUR PRESENTKNOWLEDGE OF THIS ADVISORY BOARD? ~..,,,,-,,,.,,. k,-,,,,,~k~ ~. ~et-~',-,~ ~ o c.j <3 Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council will not consider your application. :clerk\bdcomapp( I ) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? "~','~-, ,- ~:,z~,'~ n.,~ SPECIFIC A~ENTION 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 CI~. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE'AGENCY. OTHER ~PES OF AFFILIATION MUST BE E~MINED ON A CASE-BY-CASE BASIS BY THE CI~ A~ORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENE~LLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CI~ BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CI~ CONTACT. A COPY OF SECTION 362.5 IS A~ACHED, IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CI~ A~ORNEY'8 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 CI~ A~ORNEY'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 .',It has been Council policy not to permit an individual to serve on two Boards or CommissionC-at the sameqfmel)] Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. :clerk\bdcomapp( 1 ) doc September 2001 (2) cITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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 ¢~/'~/7/?/il¢ ~ ¢?.,¢f/ ~-,¢~/'~ TERM NAME '~,~o..'~r:' CL'O. J~"'l ©Or-e- HOME ADDRESS 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? L~ L~ ~- <, 'OCCUPATION t,.]ic~: - ~,.<,i4~n.Jc EMPLOYER ~(~.oov~- ~HONE NUMBER: HOME ~ - ~[. J ~ BUSINESS 33 ~ - 3~ E-MAIL ADDRESS (Optional): ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVlSORY BOARD? ~¢ ~ ~j~' Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. ;clerk\bdcomapp( 1 ) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I SPECIFIC A~ENTION 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 CI~. AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER ~PES OF AFFILIATION MUST BE E~MINED ON A CASE-BY-CASE BASIS BY THE CI~ A~ORNE~S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENE~LLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A CI~ BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CI~ CONTACT. A COPY OF SECTION 362.5 IS A~ACHED. IF YOU HAVE ANY QUESTIONS, PLEASE ,.CONTACT THE CITY A~ORNEY'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 CI~ A~ORNEY'S OFFICE. " F 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 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 will not consider your application. lerk/bdcomapp( 1 )doc September 2001 (2) Marian Karr From: paula o. brandt [pobrandt@avalon.net] Sent: Monday, February 18, 2002 6:23 AM To: cou ncil@iowa-city.org Subject: P&Z opening Dear Council Members: I would like to encourage you to elect Ann Freerks to the Planning and Zoning Commission. As I have observed the work she has done with and for the Longfellow Neighborhood Association, I have found her to be supportive of the needs of all its residents and respectful of the rights of property owners, homeowners and tenants. Ann is also someone who works hard and does her homework before forming an opinion. I believe she will be a fair and reasonable Commissioner and a welcome addition to P&Z. Best wishes, Paula Brandt 824 N. Gilbert Iowa City 52245 354-6948 18f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION One Vacancy - Unexpired Terms Ending December 31, 2004 The duties of members of the Senior Center Commission are to: 1. Serve in an advisory role to the City Council with regard to needs of the Senior Center. 2. Make recommendations with regard to policies and programs at the Senior Center. 3. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. 4. Encourage full participation by senior citizens in the programs of the Senior Center. 5. Ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens. 6. Serves in an advocacy role with regard to the needs of senior citizens in Iowa City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Applications must be received by 5:00 p.m., Wednesday, February 13, 2002. 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 or on the City website at www.icgov.org. Questions about the Iowa City Senior Center Commission should be directed to LJnda Kopping, Senior Center Coordinator at 356-5225. 1/30/02 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: 5 Council Announcement Date: January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2002 SENIOR CENTER COMMISSION One vacancy - Unexpired Term Ending December 31, 2004 William Kelly passed away Betty Kelly [] 1108 Sunset Street Kennard (Ken) Fearing [] 605 Manor Drive Charles B. Thayer, D.V.M. [] 7 Montrose Avenue [] Denotes applicant completed the Confidential page of the application. CiTY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION 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 dudng 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/COMMISSlON NAME i,E lltl g C. Et4TE: . O::'I4Iv~I~$iOI'~TERM ~0°2-2-°°c/' NAME ~V ~U-~ HOME ADDRESS I IOS ~I~5~TST 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 ~Ti~ ~0~ T~6~ EMPLOYER ~"~-- PHONE NUMBER: HOME ,'~t-~0~ BUSINESS %~. ~: ., E-MAIL ADDRESS (Optional): b ~ ~ I~ ~q ~h, ti ,1~. ~ -- EXPERIEN~ AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ilqd~ If you fail to answer all the quostions, Council will not consider your application. cerk\bdcomapp{ ~) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? SPE~-- ~"Am;*~[~D- ' ~ B[~S ~A--"~PO~L~ i~ ~ INTERE~.i~ D~ ~[~)g LIST ANY PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE Cl~. AFFILIATION M~NS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER ~PES OF AFFILIATION MUST BE E~MINED ON A CASE-BY-CASE BASIS BY THE CI~ A~ORNEY'S OFFICE. YOU SHOULD KNOW THAT SECTION 362.5 OF THE CODE OF IOWA GENE~LLY PROHIBITS, WITH CERTAIN IMPORTANT EXCPETIONS, A MEMBER OF A Cl~ BOARD OR COMMISSION FROM HAVING AN INTEREST IN A CI~ CONTACT. A COPY OF SECTION 362.5 IS A~ACHED. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CI~ A~ORNEY'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 CI~ A~ORNEY'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 l/NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) If you fail to answer all the questions, Council will not consider your application. cclerk'~lxlcornapp(1 ) I:lo~; September 2001 (2) CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an imporlant 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 dudng 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? /Yes How long have you been a resident of Iowa City? ~ ~ / ~ ~ )CCUPATION ~ EMPLOYER PHONE NUMBER: HOME .~ ~ ~Z ~ ~F.~ BUSINESS 5-MAIL ADDRESS (Optional): ~ ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~HAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ~:~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. lerk\lxlcoll~app( 1 ) do~ September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .J ?/~'-~-~/-~/.g~:T<' .~,~':~J2~ cx.~_~ ~/ ~ ~ ~ ~ ~ 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 MF_.ANS 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 NOTIFIED? ,X" 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 will not consider your application. :lerkVad¢omapp(l ).do;; September 2001 (2) CITY OF IOWA CITY _ ADVISORY BOARD/COMMISSION ¢ APPLICATION FORM ~ i~,~ --rT Individuals se~ing on Boards/Commissions play an impodant role in advising the Council on ~Mters o~terest to our community and its future. Appli~nts must reside in Iowa Ci~. ~' After a va~n~ has been announ~d, the Council reviews all appli~tions during the work session. The appointment is made at the ne~ focal Coundl meeting. Appointees se~e as unpaid volunteem. PLEASE USE A BLACK INK PEN, Return the appli~tion to Ci~ Clerk, 410 E. Washington St., Iowa Ci~, Iowa. THIS 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 ~URING THAT TIME. Is your home address (listed above) within the ~rporate limits of Iowa City? ~ Yes No How long have you been a resident of Iowa City? ~-~ ?/~,~ ~dJ. 3CCUPATION /~z,.. ~ }, /_~ ).¢ ~// /~. ~: /V. EMPLOYER ~ ¢ ~ >::- ~' ~,;,/: ~HONE NUMBER: HOME .~ ~' - ~ ~-~ BUSINESS ~ ]~.. ~-MAIL ADDRESS (Optional): ~XPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~/-E- / ~ / r..~ , ; C~c~,,'~c. /~, ~'~:~c~ ~tv 2.~--. );-.-2~,"I:' ' NHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD~ ~ ¢~ ¢¢ ~.-- k/'.d-- '. //}' ~ ' .'  Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council will not consider your application. lerX/bdcomapp(1) doc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR SPECIFIC A~-FENTION 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~TORNEY'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 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 will not consider your application. ;le~k',bdcomapp( t ) doc September 2001 (2) 02-19-02 18g I NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION Two Vacancies - Three-Year Terms March 13, 2002 - March 13, 2005 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, February 13, 2002. 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 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. 1/4/o2 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 Council Announcement Date: December 11, 2001; January 8, 2002 Application Deadline: Wednesday, 5:00 p.m., February 13, 2002 Council Appointment Date: February 19, 2002 TELECOMMUNICATIONS COMMISSION Two Vacancies - Three-year Terms March 13, 2002 - March 13, 2005 Term expires for Terry Smith, James Pusack Terry Smith [] (Currently serving lS~ three-year term) 2220 Balsam Ct James Pusack [] (Currently serving 1st three-year term) 4750 Inverness Ct [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to ou~ 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 appointmen' is made at the next formal Council meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to_Cit,/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 adUress (listed above) within the ~rporate limits of Iowa City? ~ Yes No How long have you been a resident of Iow~ City? 7 ~ ~ ~C ~ E-MAIb ADDRESS (Optional): ~,'~ ~_ ~,'~m~¢;¢~. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. cclerklbdcomapp(I) dcc September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? r ! 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 NOTIFIED? ~,.YES NO ~O YOU CURRENTLY S~RVE ON ANOTHER ~OWA CI~ BOARD OR COMMISSION? YES ~NO (It has been Council policy not to permit an individual to se~e on ~o Boards or Commissions at the same lime.) Misrepresentations on this application will constitute just cause for removal of an appointee. II II If you fail to answer all the questions, Council will not consider your application. , c~e~k\bdcor~app( 1 ) do<; September 2001 (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 or stockholder in either AT&T Broadband and Internet Services, 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 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 AT&T Broadband and Internet Services 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 answered "yes" to any of the above questions, please include a complete explanation using additional paper if necessary. cableh'/ICTCinterest,doc CITY OF IOWA CITY ADVISORY BOARD/COMMiSSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to ou~ community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications dudng the work session. The appointmen 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 FOF 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. NAME ~'"'~l,t'~.$ /'~, U~S~E~--L HOME ADDRESS ~'75'''~J'-t-'''~M''84/'L'z'4L4 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? '~ ~) ~'~'~ OCCUPATION ¢ ¢'~ ¢,0"4.4¢-~ EMPLOYER PHONE NUMBER: HOME 3')3,~'-/.~-yZ--- BUSINESS EXPERIENCE AND/OR ACTMTIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ Misreprosentat,ons on this appl,cation will constitute iust causo for romoval of aa app6~ntee. If you fail to answor all the quest}ohs, Council will not consi~or your application. ,:clerklbdcornapp{ 1 ) doC September 2001 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)?_ _~' SPECIFIC A'I-FENTION 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 A'I-rORNEY'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 L"~NNO (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 will not consider your application. clerk\bdcomapp{ 1} doc September 2001 (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 or stockholder in either AT&T Broadband and Intemet Services, or a subsidiary or limited partnership(s) (including Cablevi$ion 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 AT&T Broadband and Internet Services 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 answered "yes" to any of the above questions, please include a complete explanation using additional paper if necessary. Cabletv/ICTCinterest.doc