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HomeMy WebLinkAbout2009-12-01 Appointment21a NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Unexpired + 5-yr Term Effective Upon Appointment, ending December 31, 2011 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. , 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 0 Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:OOp.m., November 18, 2009 Denotes applicant completed the Confidential page of the application. 21b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Five-Year Term January 1, 2009 -December 31, 2013 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 0 Council Announcement Date: September 23, 3008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Five-Year Term January 1, 2009 -December 31, 2013 Term expires for Dennis Keitel No applications as of Wednesday, 5:OOp.m., November 18, 2009 ~ Denotes applicant completed the Confidential page of the application. 21c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-Year Term January 1, 2006 -December 31, 2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: September 20, 2005; November 1, 2005; December 13, 2005; January 23, 2006; February 28, 2006; March 21, 2006; April 18, 2006; June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2006 -December 31, 2011 Term expires for Mark Anderson No applications as of Wednesday, 5:OOp.m., November 18, 2009 ~ Denotes applicant completed the Confidential page of the application. 12-01-09 21d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-yr Term January 1, 2010 -December 31, 2015 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www. icgov. org. Questions about the Iowa Ciry Airport Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: September 15, 2009; November 2, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2010 -December 31, 2015 Term expires for Brian Sponcil No applications as of Wednesday, 5:OOp.m., November 18, 2009 D Denotes applicant completed the Confidential page of the application. 21e NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Five-Year Term January 1, 2009 -December 31, 2013 One (1) Mechanical Professional It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. 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: Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 BOARD OF APPEALS One vacancy -Five-Year Term (1) One Mechanical Professional January 1, 2009 -December 31, 2013 Term expires for Tim Fehr (Mechanical Professional) No applications as of Wednesday, S:OOp.m., November 18, 2009 ~ Denotes applicant completed the Confidential page of the application. 21f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Unexpired Term Effective Upon Appointment -Ending December 31, 2010 One (1) Licensed Electrician It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. ~z~OlOx;~i In to D ol~.~~ i nI~ miulu',~j Flo ,ni,~ a'~~' ~ IZ N'. f6n ',N ~'I (7 ~i SIN 0 °''07~ m'o;N~l~ 3 pIa~T~I ilz 3 3'm v o ~'~~ FI D ~i~.m'~ i ~ ~ ~, I ~sv~ 'm N ~ ii it ~ I, a~ I ~ ~I ~ ~' ,~ I !~ I I ~I~i~~' I~ , ~~NN~N'N~N~N~ ~~ I 'w w wl,ww ~ Im I I~ ~i~l~l~' ~~ N~~iN N N~NN ''-X ~ O'~, O Oi 0.0 O, I~_ '., W'; ~, OI ~I NIA ', I I , ~ li I IN i i ~_ _i~ ~ -~- -- y II~ '~ ~ X ~~X X~,X ~'X 3 ' I I ~~ iO ~_~ ~ _~ ~- ~I ~i ~ i ~, i I Zm -~ ~ ~I, - -~;-~~-~-~- ~~ ~-- i I I~ iZ~~ ~ I; I ~ I~ j i ' ~ c°o -i ~-}--- ~ ~-r- ' I I I i t I 'D ~ ~ ~ ~~~~ ~ ~ ~ ~ ~~ ~ o ~ '~I '-~-~- -- --;~-fi- ~- 1 , ~± ~--- ri ~, Z~3 ' ~! i I ~ - - ~-~-' - I I I~ Zc ~ o `a I ~ I ~I` i I ~ i ~ C t~0 ~- -~ li ~ i Z Ico ~ o - ~ - -- I ~ -'-~-- ~ ~- I I i i I i{ ~t_o__- I ;I f ~ i +-- 1 fi~~ + ~-~ I' I ~ i Ic li i ~x~x~ xlx,x < I ;°m a- I I I ~ !- ~, ,v i l ~ o i co D W ~ O 7 ~ ~a ~ o, ~a ~~ ~ ~ n ~ o ~' ~ y Q. 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: Council Announcement Date: October 6, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 BOARD OF APPEALS One vacancy -Unexpired Term Effective Upon Appointment -Ending December 31, 2010 (1) Licensed Electrician Alan Gerard resigned Matt Neumiller ~ 839 Kennedy Pkwy ~ Denotes applicant completed the Confidential page of the application. City of Iowa City ~ r ~~®~ Advisor BoardlCommission/Committee ~~~"',~'°~~ Y _,pplication Form 'r`-"- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name ~~` °"A~i~i~~t/f Term Youth Advisory Commission (shall not be more than 18 years of age at the time of application) , Name of Iowa City High School or high school equivalent: ~ ~. Signature of parent/guardian: --~ AME j~~/~~~ ~~~'.<.J/ui.~~Gf.~J ~~ /® ~~a HOME ADDRESS ~ ~ ~ ~n n n ~~ ~lL~/ -/` ZIP ~i ~~ S/a 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? ~ '~ ~/Q~~ t OCCUPATION ~'LQ~,/~.'~-~ EMPLOYER ~c~•~l ! ~`~~.~"G~ Z ~° PHONE NUMBER: HOME ~/~ - G ~~°~~~ ~ BUSINESS 5/ ~° ~~> ~ `~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOI~ FOR THIS POSITION: /fir-- dl ~~~ SY~~ G/Gy~'c~a.~ i`' ~a~ ~a ~ !.i /oLq~ b/S,:,Lff ~^v/~i '7 ye~Gfrsj G/L.•~ l,i~ Gt~•r t drr.• ~ -~ ls: I Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail ~'~ to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~.-~ L~ o~ t~~~.., ~~~ is L~G,~,/ ~~. ~+a ~. o...~./ ea'dl~ S'Ay K WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes -~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City /~ Board/Commission/Committee ~~~d~/''io~~is Name 1 %Gt ~~ ~:..r ®a7 ~.,~ CITY OF IOWA CITY Date l~ /~ Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6}. List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS JGI~ ~ ~ ~-~ ~-, NOTE: A new form must be comp ed if the above information changes or an ownership ir~terests~ acquired in an additional bu ~ ~=- ~; Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address ~ ~ 9 _,L~~~~ ~,~ ~~rlCv~x ,~,...~ C~ ~Y Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 21 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Five-Year Term January 1, 2010 -December 31, 2014 One (1) Building Design Professional It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. z O OiX~T. (7 cn D o'D'~I ul~m u~~ul~i I, °' ° O~ °-<j ~' ~ u n vv n~~ ~~' o:Z v N ~ ,i ~C)j~liv ~ d W v I,o y a m ~ p!al'~~ T ~ Z m ~c ~ -- ~ D ~m ~ ° ~ c I i j L °_ I __ _ - II m ~I I , ~ ~~~~~~~: ~ I i ',~ ~ N j N N N N N ', ~ 3 ~ ~, NIN',iNIN'~.N~N ')C I ~. i ~~ O O O_' O; O~Oj ~ Ili ' ~ ~ 'W O~'NI I'll I I N 1_ . II I ~ . _ ~ r +-~ -- i - --__.. t._~~ ~ - ~ I I X ~x X ~'x ix ~ ~ ~~ ~. _ ~-i__ _ ~T- '. i j ~ i, Z',. fD ~~ I I~~~ III,I ~ ~ j ~o I ~ . I', + _ ~I ~ ', ~ i3 I II ~~ i I I I 1 it I;, I I ~I Izl~ ~I i I i ' ~b I _~` - ,__ ~_._ ~ -L-I - _ -- '~ i--I %z~ I i~ b I ~_ -~I - - - z~ iI I' ~ ~ ~ ~~~Ie°o I I i f zE i ~ ~ ~ ~ ~i ' ~ ~ I I ~ o I ~ so I _~ _ . ~~ -r ' - _ --- ~ - ~I i~ ~ w ~~ ~ i.__:! _ _. _ __ - - ~~, z ~ ~ ~ ~ CIO ~~ i io I jec _+ - fi I ~ ~ ~ i 'x''x'~ x ~,x x to I ' ' ' ~' ~o - I!__ ~- I_ ~ j rt_- ~_ I I ICI I I '~I II D I I ~ 'I a II ~ ~ ~ o ~ ~ fl- a ~ o~ ~ D ~~ ~ ~ ~ ~ o ~' a ~' 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: Council Announcement Date: September 15, 2009; November 2, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 BOARD OF APPEALS One vacancy -Five-year Term (1) Building Design Professional January 1, 2010 -December 31, 2014 Term expires for Stephen Buckman Stephen Buckman D (Currently serving unexpired term) 215 Amhurst St ~ Denotes applicant completed the Confidential page of the application. ri ~, City of Iowa City r .~,- := - .~ Advisory Board/CommissionlCommittee ~;~ ~~''~~ Application Form ~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PACE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Board of Appeal Term 5 nears Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parentJguardian: ,JANE Stephen Buckman ~- ~. HOME ADDRESS 215 Amhurst Street Z~p.52245 ~~~_:, Is your home address (listed above) within the corporate limits of Iowa City? 0/ Yes ~ hlo ~ "~~ How long have you been a resident of Iowa Oity? 2s ~' ~ '~' ti OCCUPATION Architect EMPLOYER University of Iowa/FM/PDC PHONE NUMBER: HOME 319.354.5318 BUSINESS 319.335.1298 EXPERIENCE AND10R ACTIVITIES WHICH YOU FEEL QUALIFY YOt1 FOR TNIS POSITION: I am a licensed architect in the State of lowathat works with design professional to resolve code issues on University projects. I have attended code seminars as well as seminars sponsored by NFPA & FM Clobal. I whave worked with the ISU and UNI to recommend adopting the International Code Council documents to the Building Code Bureau. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer alf the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? To provide propority owners the opportunity to appeal the decision of an inspector with the City of Iowa City Building department and to make recommendations on adoptation of codes and amendments. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I have worn the hat of a designer, private business, and of an onwer, public institution, and understand the impact on life safety and cost of a decision. I have filled to Architecural position when that position became open do to a resignation. I have bee on the board since 2003. . i 5 t-° ~ ~:~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. ,n particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of afflictions must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certainimportantexceptions, a member of a city Board or Commissiton from having an interest in a city contract. A copy ofsecton 362.5 is attached (see page 6j. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theGode of Iowa, please contact the City Attorney's office at 356-5030. . Not aware of any conflect of interest. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 ~r BOARD, COMMISSION AND COMMITTEES ~ ~` '~~`~ BUSINESS LISTING ~•~as._ ~ CITY OF IaWA CITY Name of City Board/Commission/Committe~oard of Appeal Dat~1/17/2009 Nam~tephen Buckman Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS N _,, NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address 215 Amhurst Street Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2U08 Page 3 of 7 12-01-09 21h NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy -Three-year Term January 1, 2010 -January 1, 2013 One (1) Art/Design Professional 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 public 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. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Klingaman, Neighborhood Services Planner at 356-5237. Public Art Advisory Committee Wednesday, September 9, 2009 Page 4 of 4 Public Art Advisory Committee Attendance Record 2009 Name Term Ex fires 1/8 2/5 3/5 4/2 6/4 9/9 Annadora Khan O1/O1/11 X O/E x X X x Data ne Williamson 01/01/12 X X X X X x Jan Finla son O1/O1/11 X X X X X x Mark Seabold O 1 /01 / 10 X X X O/E X x Patrick Carne 01/01/12 O X X X X 0/E Rick Fosse X X O/E X X x Terr Robinson X X X X O/E O/E Key: X = Present O = Absent O/E = Absent/Excused Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 3 Council Announcement Date: September 15, 2009; November 2, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 PUBLIC ART ADVISORY COMMITTEE One Vacancy -Three Year Term One (1) Art or Design Professional January 1, 2010 -January 1, 2013 Term expires for Mark Seabold Mark Seabold ~ (Currently serving 2~d 3-yr term) 307 College Court ^D Denotes applicant completed the Confidential page of the application. City of Iowa City ~ ~ r j ~~.®~r `~ Advisory Board/Commission/Committee ~' ~~"',~"~'~~ ~-pplication Form -n-~-- CITY OF IOWA CITY __ Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory BoardJCommissionJCommittee Name Public Art Advisory Committee Term 2010- 2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: 'SAM E Mark Seabold HOME ADDRESS 307 College Court Iowa City, Iowa ZIP 52245 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? 16 years OCCUPATION architect EMPLOYER Shive-flattery PHONE NUMBER: HOME 319.338.5691 BUSINESS 319.354.3040 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITkON: joined the committee in 2003 and have been chair for the last 4 years. I feel that during this transitional times the Public Art Advisory Committee would benefit from my experience with implementing smaller scale projects as we11-'`° as being a constant for when Public Art funding discussions can begin again. , i'-.J Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. i General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? 6 years of experience. I have assissted on numerous selections, designed and fabricated a information kiosk for Arts -est 2004, and designed "glimpse" a walking tour map of Iowa City's Public Art collection. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I would like to reapply for an additional term to remain as a constant during our current economic situation. I believe I have had success on this committee in implementing both large but more importantly smaller neighborhood and school oriented projects. I feel that my experience will help the Public Art Committee spend our remaining budget wisely to incorporate art successfully in Iowa City. I also feel that I will continue to be an advocate for finding ways for Iowa City to expand it's collection and remain an advocate for reinstating Public Art funding when the time is appropriate. I also sit on the University of Iowa Museum of Art's Membership Council and have-connectic~'ns with many supporters of the arts in Iowa City. ,x ..~ _ POTENTIAL CONFLICTS OF INTEREST `A`' Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. i particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. I am an owner and one of Iowa's principals of Shive-Hattery Architecture- Engineering (I have less than 5% ownership). To date there have been no conflicts of interest during my time on the committee. If one should arrise I would expect to excuse myself for voting. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No {It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. if you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Public Art Advisory Committee Name Mark Seabold ~ r ~' ~'~~ '~®~~~ -~..._._ CITY OF IOWA CITY Dat~1 /28/2009 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Shive-Hattery 2834 Northgate Drive, Iowa City, Iowa 52245 ~4 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additions business. Applicant Signature, Signature of parent/guardian (Youth Advisory Commission only): Address 307 College Court, Iowa City Iowa Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 21i NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION Two Vacancies -Unexpired (+) Two-year Terms Effective Upon Appointment, ending December 31, 2011 Two (2) persons - At-Large The mission of the Youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. ZDOX n 3 m ° u 0 o nay ~ N W N ~D ~p ~ 7 '~ ,,,r ~'=rn ~ K ~ ~ C '+ ~ N ~D A~ c 0 26 ~ ~ ~ ~' c C ~ ~ ~ ~ ~ ~• ~ ~ = ~ G~ ~ ~. Z m c ~. ~-- ' v w w w w w w w w ~ ~ m ~ O O \_ \ \_ O O O (p CO O O O CO CO (D 3 i i i z ~ z -y z 3 z 3 A ~ m x x x x ~, Z ~ i ~ i ~ i Z 3 Z ~ Z ~ Z ~ N V Z 3 Z 3 Z 3 Z 3 Z 3 1` N x x x x x w x x X m x x N X X X X X X w x x x m x m w X X X m X X x x x X x m °; X ~ X X m ~ X V N X x m X X V w X x X x x N N X X X m X y .N x m x x x "~ C -Di 2 ~ D m v 3 mzv< n z O v o m ~ '' ~m0 V O ~_ ~ 3 v N O Z zOOX u 3 m n u zzan~ °Oayc~n N ~ ~D ~ ~ ~ ~ ~=m ~ K ~D ~ C O N ~D A ~- C O c 3 ~ ... ~ ~- n -. ~ ~ ~ ~ 2 ~ G~ ~ ~• Z m ..i ~ ~- m N w O N w O N w ~ N w -1 N w -~ N w O N w O N w O X ~ ~ CO C~ O O O CO CO CO X ~ X X ~ X N Q1 ~O X ~ X X X N V X ~ X X ~ ~ X o p X X X X o0 O m ~ ~ X X ~ ~ X iv ~ X X X X O C -D-I 2 ~' a mo 3 ~ p< m N ~ N ~ ~ m ~ °o ~ n o ~ m0 0 3 vN 0 z ~<° ~~c ~Q= ~ D ~ -' N (/~ O ~ c~O :iJ C7 0 ~_ O z Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 2 Council Announcement Date: July 6, 2009; August 18, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, S:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION Two Vacancies -Unexpired Term + Two-yr term Effective upon appointment -December 31, 2011 Two (2) persons - At-Large (Michelle Han, Patrick Diamitani resigned) Alexandra Tamerius D 2911 Eastwood Dr Gary Black D 419 South 7th Ave D Denotes applicant completed the Confidential page of the application. City ref Iowa City i r 1 advisory Board/Commission/Committee ~' ~"'~~~ application Form "~-'~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appoini~~nent is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name 'S Term 1~~ ~i0 - -~~3i Ii Youth Advisory Commission (shall not be more than 18 years of age at the time.of=application-~ Narne of Iowa City High School or high school equivalent: G-~ii M'~~' SG~^.r~ °~ . ~ a J ~ Signature of parent/guardian: ~.LC,I `~'' - "SAME ~ .~r~~ fi~ ~~~~.r~~.t s w, P f ~~~ HOME ADDRESS ~ ~ ! ~ Easy ~.~~~ ~~' /P. _ ZIP ~`'~+~.~- Is your hrome address (listed above) within the corporate limits of Iowa City? ~ Yes ~ No How long have you been a resident of Iowa City? `a ~1 e'~~'S OCCUPATION ~ EMPLOYER N~~ PHONE NUMBER: HOME ~ 319 ~~~ `~ ~.~ ~ BUSINESS ~l') EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~',,,, '~ l 0 ~ '~ ~ "n l" CF~a.,(~1 C'.I C1~ ~rQ ~~ "t'V~ Cry t `U''t ! ~. CcY C ~ }~1~c ~ ~-'.) %~ ~ ~ ~ ~ , ~. ~!' ~ ~ ~ ~ 5 ~ ~? F ~ t%i ; r~ V~ I V~ ~~~ ~`i ~ f E-~ ; 4. ~~ ,^ v1 '~, c`~ 5~~/~ i?I'~ `~, s7 ~., ~ u ~ -~, ~~.(,~~r:r`~ , ~~.~ (\ ( r ~.,~f(~ r = ~ /r~ ~ 1 ~ ~~ <vL r ~~- : ~:fl ~ < <'_. ~- :~ ~ {.lam ~ v',S ra ' JCS` .~ ~; Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT :S YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? `,. ~, ~~'~~ !~`.,~ r3' ` ,n ._ J S ~•~~ C, i'/O ~. e~ ~ .- ; ~'F ~E', C d/ S ; ~'~~ ~ ~1 7 ~ ~ ~ r` tt, WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE RFA~CIN F(~R APPLYINGI? .-. f i ~ ~ )~~y~ ~~e ~. ~~ ~ ~ ~ ~.o ~ ~ WW1 }~ , f ~ r-. ~ r~ ~ ~~ I , ~~ ~ ~~ ~ r~ v.`,r. .t7 t ~~~ ~ 1 ~~dQ." ~ t~~i 7f°. ~ Y "~, i ,~' 3 ..a POTENTIAL CONFLICTS OF INTEREST ~:' Please identify any potential conflicts between membership on the advisory board and ~t~ur personal interests,including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Caancil about the allocation of City funds, please list any present affiliations you have with agenciesthat apply fc;r funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types ol~ affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code oflowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6}. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to a~~swer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee ~~~t1~~~ ~~ Ji So ~~~ ~~MM~~ssi ~''~-- ~ ~ ~ ~- Name ~ ~ C. ~ ~~ r ~m~. '~ • ,wr®~~~ CITY OF IOWA CITY Date 1 ~ ~~ ~ ~ Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List ail businesses in which you, your spouse/domestic partner, or parent if Youth AdvisoN Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stock!~;oldings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS 5 f t E j. t w.., 7 NO'!'E: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~->~-- Signature of parent/guardian (Youth Ad Address ~L~ ~~ E~,S~,~,~l~n ~; ry Commission only):`TY1~c.~,~~c.~~~o~ ~.~^'°~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 11/09/2009 09:16 FAX a19 688 1049 CITY HIGH SCHOOL ` WHAT iS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ 002 ~- ~f he1,~ f ~~ ~~rnM~~;~~ 4tnt~ 5'c~~~s ~o S~ [v~ prdbl~M.s WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY 60ARD (OR STATE RFASCtN FOR APPLYINGI? h QlQ 8f9ana ~ ~.~d Sp2alz ~o r -~~ ~e~ pl e 9 ~-~ -~~ ~~~ ~ e ed ~~~P ~6Fiv 1N16S~ a~ ~G(N~ ~l~VI/ G/' L~r- ~oe~ i.~ vp C c~US~ ~ c~~Nn -~-'~Q .b ~~ ~i-s POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. . particular, ifyou are applying to be a member of a board or commission which makes recommendations tothe City Ce~~ncil about the allocation of City funds, please list any present affiliations you have with agenciesthat apply fc:r funding from the City. "Affiliation" includes being a board member or employee of the agency,Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 of the Code oflowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions ataout Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes ~"No fl; DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~No (lt has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. ~. General Application December 2008 Page 2 of 7 11/09/2009 09:17 FAX 319 688 1049 CITY HIGH SCHOOL ~ 003 1 ~~~ BOARD, COMMISSION ANp COMMITTEES ~- ~`~~~ p. y~t~+rq~ BUSINESS LISTING ..~~ CITY OF IOWA CITY Name of City /~ I Board/Commission/Committee .~-~~ L~ GJ-~'~ #tGYiSd( Date'~or'Z~`~ Name VOI~~ ~• ~j~Ot C~~ Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5. is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent iif Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stocKholdings). Please indicate if th®re are none. BUSINESS NAME BUSINESS ADDRESS l .a-<- L L.,¢v~! G ~C't G ~ ! 3 Z ~/Z, C, • ,/ 1-~F/ G 'r ow sT . .Tar `" - ..., _,, . .,~~ l-J NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature A~~t~y ~~1,(~/ Signature of parent/guardian (Youth Advisory Commission only): Address:. ~1 ~ S~ U~ ~~ ~V ~ Mis. epresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 21' NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High The mission of the Youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. 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: February 10, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High One 111 Tate High No applications as of Wednesday, 5:OOp.m., November 18, 2009 D Denotes applicant completed the Confidential page of the application. 21k NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2010 -December 31, 2011 One (1) person -Regina High The mission of the Youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, November 18, 2009. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. 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: September 15, 2009; November 2, 2009 Application Deadline: Wednesday, 5:OOp.m., November 18, 2009 Council Appointment Date: December 1, 2009 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term One (1) person -Regina High January 1, 2010 -December 31, 2011 Term expires for Hannah Green No applications as of Wednesday, 5:OOp.m., November 18, 2009 D Denotes applicant completed the Confidential page of the application.