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HomeMy WebLinkAbout2012-02-21 AppointmentM 25a :I NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF ADJUSTMENT One vacancy — Unexpired Term Effective Upon Appointment— Ending January 1, 2014 Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and intent of the ordinance and in accordance with general or specific rules contained therein. The Board may grant variances to the Zoning Chapter only 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. The Board may also hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by a City official in the enforcement of the Zoning Chapter. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m. Applications must be received by 5:00 p.m., Wednesday, February 15, 2012. 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 Board of Adjustment Commission should be directed to Sarah Walz, Associate Planner at 356 -5239. 7 m zoox u r. m u u Z 11 > -U 0 Q N W (D CD 9(D (D CD C 3 x QCO 0 CD z 0 m Q- 0 3 0D:*Woo zz 0) c:L 3 ��C -0Q' m CD CD T� G) v �m cc �. mM�'`� to 0 CD 00O0o m 1 N N -A N -A N -A N m 55 M 00000 -A -A -A m 3 W NCJ7�� N x ; xxx =' xxxxx o xxxxx L W xxxxx xx�xm w m x x x x x A Dca >O D zo DN O Z m` �c m Cl) O3 �m vz -I Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child, aunt, or uncle. (Resolution 85 -354) Males: 3 Females: Council Announcement Date: January 10, 2012 Application Deadline: Wednesday, 5:OOp.m., February 15, 2012 Council Appointment Date: February 21, 2012 After 04/09/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. BOARD OF ADJUSTMENT One vacancy — Unexpired Term Effective Upon Appointment — January 14, 2014 Barbara Eckstein resigned Gender Balance Requirement: 1 Female (M) Adam Plagge Fx1 414 Brown St, Apt 4 El Denotes applicant completed the Confidential page of the application. City of Iowa City _ I r , Advisory Board /Commission /Committee pnplieation Form -n-�- CITY OF IOWA CITY 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 /Committee Name Board of Adjustment 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: NAME Adam Plagge HOME ADDRESS 414 Brown St Apt 4 Iowa City IA 52245 Is your home address (listed above) within the corporate limits of Iowa City? 0✓ Yes R No How long have you been a resident of Iowa City? 1.5 years Gender: Male 0✓ Female F] OCCUPATION Student EMPLOYER University of Iowa PHONE NUMBER: HOME 515 - 343 -7424 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I - viously served as a board member and am currently a masters candidate in University of Iowa's Urban Planning a. OBA programs. C s e —eo! a n i o -;011 -f o- a ti "(Op r l e4ed i e+k, ) WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Having served previously and taken course work geared towards quasi judicial bodies I feel I have a solid understanding of the role the BOA plays in city governance. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING ? The ability to contribute in making equitable and judicially sound decisions.; rte; LIST POTENTIAL CONFLICTS OF INTEREST: See naae 1 for information renardina Congi�i of Irif�rPCt j Previously a consultant for Prestige Properties. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes r-1-No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes QNo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) 9isrepresentations on this application will constitute just cause for removal of an appointee. If you fail co answer all the questions, Council may not consider your application. General Application June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Board of Adjustment Name Adam Plagge I r 1 Mqp. CITY OF IOWA CITY Date 12/22/2011 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, 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 r E -1J d NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature b441111 Signature of parent /guardian (Youth ry Commission only): Address 414 Brown St Apt 4 Iowa City IA 52245 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. General Application June 2010 Page 3 of 8 L02-21-1 25b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy— Five -Year Term January 1, 2012 - December 31, 2016 One (1) Mechanical or Building Design Professional Or A qualified trade representative, (if after 3 months no professional applies or is appointed) It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the International Building Code, International Residential Code, Uniform Plumbing Code, National Electric Code, International Mechanical Code, International Fire 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 4:00 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, February 15, 2012. 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. XI ZO'OXTs KC)Cn�D'C ii n mj ii n o �I� :3 u nlvv cl—:3 X = col° z °�'z3 a) N m ,� C) � v 1Q �z m°' 3 N CD 330=4a0 - -0 7 N O N' D s O a! ICD -- CD cD O °'� n ='' o m v m m- OL m I W N W,W W N W 1,111, m N O N''N N O O O N O X cnW�NN m __ co z 3 T TI Z CD I s j z ju 1 Z I I i i Z� X O x X X ca I I II 1 D 0 X > c X ca N y i I zD s i 4O I — I -' 1 T jZ 0 v CD rMIL \V O W /0 -h m D ;u 'a cD mO n CD o M �' 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: November 1, 2011; January 10, 2012 Application Deadline: Wednesday, 5:00 p.m., February 15, 2012 Council Appointment Date: February 21, 2012 After 01/30/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. BOARD OF APPEALS One vacancy - Five -year Term January 1, 2012 — December 31, 2016 Term expires for Scott McDonough Gender Balance Requirement: 1 Female Mechanical or Building Design Professional; Or a qualified trade representative, if after 3 months no professional applies or is appointed Scott McDonough Fx1 10 Bella Vista PI 0 Denotes applicant completed the Confidential page of the application. Advisory Board /Commission /Committee; A% sewn 0 Anplication Form CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLI, 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 /Committee Name board of appeals Term 2012 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Scott McDonough HOME ADDRESS 10 Bella Vista PI Is your home address (listed above) within the corporate limits of Iowa City? a Yes F] No How long have you been a resident of Iowa City ? 2s 1fs Gender: Male 0 Female OCCUPATION contractor EMPLOYER McDonough Structures PHONE NUMBER: HOME 319- 631 -0405 BUSINESS s1 a- s» -s4Ai N G7 EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POTION: am a current member of this board = eT co 65 r'ko-*� U WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am a current member of this board CD WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? I'm a very practicle person LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest none IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [V Yes F No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? RYes ✓QNo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) .Asrepresentations 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 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee board of appeals Name Scott McDonough ®�%i:�( CITY OF IOWA CITY Date 12 -8 -11 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, 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 McDonough Structures 340 Highland Ave. I C, IA 52240 CD NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address 10 Bella Vista PI "Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail _i answer all the questions, Council may not consider your application. General Application M1 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HISTORIC PRESERVATION COMMISSION Four Vacancies — Three Year Terms March 29, 2012 - March 29, 2015 (1) At Large Representative (1) Woodlawn Representative (1) College Green Representative (1) East College Representative Duties of the Historic Preservation Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions; furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. This Commission meets the second Thursday of each month at 5:30 p.m and, if necessary, the fourth Thursday of each month at 5:30 p.m. Iowa City appointed members of the boards and commissions must be eligible electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, February 15, 2012. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Historic Preservation Commission should be directed to Christina Kuecker, Associate Planner at 356 -5243. 1/26/2012 1 zo u ox 119-11 m z 11 u D °0cr CD CD �m :3 CD CD C-- 3 m SR 0 z C: O N (D 0a c 0 2 3 0 D 3 m n D = 0 z D D N D c m 3 m v 9 0 & = z D 0 r p z D z m O z 0 r D m m m cn m X D v m O n m O z rn z D m cn --I CA) w w w w w w w w w w m N CO N N C0 w N t0 N (0 N N CD N N GO N CD N (0 w N (0 N N CO � N t0 W X x m x m x x o m x x m x x w x x O O O x x O x x x o x x x x x x x x x w a x x x x x x x x x x x m° x x x x x x x cn ° m x° m x x m x x m x° m °' co x x m x x° x x x x x x m x x x x x x x co x x x x x x° x x M CO x x m x m m x x x x w x x x x x x x °° x x x x x x° x x x x x x 0 D m z v Nz on �m X m n v cn O X n X m cn m D 0 z n 3 cn N 0 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: 5 Females: 2 Council Announcement Date: December 6, 2011; January 24, 2012 Application Deadline: Wednesday, 5:OOp.m., February 15, 2012 Council Appointment Date: February 21, 2012 After 03/05/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. HISTORIC PRESERVATION COMMISSION Four vacancies — Three -Year Terms (1) At -Large Representative (1) Woodlawn Representative (1) College Green Representative (1) East College Representative March 29, 2012 — March 29, 2015 Term expires for Frank Wagner, Ginalie Swaim, Pam Michaud, Esther Baker Gender Balance Requirement: 3 Females, 1 None (1) College Green Representative (F) Pam Michaud El 109 S Johnson St (1) At -Large Representative (M) Frank Wagner 0 1724 Muscatine Ave (1) East College St Representative (F) Esther Baker El 1022 E College St (1) Woodlawn Representative (Currently serving 1 st three -yr term) (Currently serving 1 st three -yr term) (Currently serving 2nd three -yr term) (F) Ginalie Swaim El (Currently serving 1 st three -yr term) 1024 Woodlawn El Denotes applicant completed the Confidential page of the application. City of Iowa City I Akz r Advisory Board /Commission /Committee k s lm�ft t -)plication Form CITY OF OF IOWA CITY 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. /� f C-o-% Advisory Board /Commission /Committee Name � x ,ri'� Pi^�SUtrUetlqr1 (&'h /SS ce�Term -� en Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Ilo en // I I /l.I /\ CLU--ty HOME ADDRESS /0V =? X16 Is your home address (listed above) within the corporate limits of Iowa City? I Yes r] No How long have you been a resident of Iowa City? 3 e4rS Gender: Male Female OCCUPATION la-11 EMPLOYER.,SL/ T" PHONE NUMBER: HOME = /� 7 /a y / BUSINESS P Us in EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: qs fd Lt% D / �3� t� ✓l Ca ern ltl'Lt.l'G%S Xj(/1 7 mA WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? GQ .tea S WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FORAPPLYING ? 1c�0i ��.v ✓t /,,e ul jc�r7�v��+viS3� C9' �C�oSI �n�f/ .� 'e- 'a (c a�-( �v� ((T r��{ G� e c—r� 0r, i nU i ✓ GC�s7�7'!i `' C� ra. /1 0 �q 1P�e.�2i( �a� c �.L21U✓Y, C�IQ.I / ` �J LIST POTENTIAL CONFLICTS OF INTEREST: See paqe 1 for information reqardinq Conflict;6f 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---- 4 No (It has been Council policy not to permit an individual to serve on two Boards or Commissions-at the ,u ame time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. General Application January 2012 Page 2 of 8 � r BOARD, COMMISSION AND COMMITTEES,,"`1 °� BUSINESS LISTING CITY OF IOWA CITY Name of City � n It J") S— /) Board /Commission /Committee 7 /' lCr- ri -25� V,';u y Date Name /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 7). 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 O 2 S- - - r ' 1 GO U 0 =N NOTE: A new form must be completed if the above information changes or an owhershiplinterest is acquired in an additional business. Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address /0 i � J o n n -ST; 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 January 2012 Page 3 of 8 City of Iowa City _ r Advisory Board /Commission /Committee 4k cwh Application Form -� -�--- CITY OF IOWA CITY 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 /Committee Name Historic Preservation Commission Term 3 years Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Frank F. Wagner HOME ADDRESS 1724 Muscatine Ave. 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? 35 + years Gender: Male a Female OCCUPATION Contractor EMPLOYER Self - employed PHONE NUMBER: HOME 319.321.7910 BUSINESS -jig.-121 7n1n EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have been a life -long supporter of the many dimensions of Historic Preservation. Specifically I am a contractor who specializes in the restoration and historically- appropriate repair and renovation of older homes. I have completed ojects in such historically sensitive neighborhoods as St. Louis' Central West End, Georgetown, Alexandria VA not Lo mention throughout Iowa City. I have a solid knowledge of historic materials and construction techiques. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have a firm understanding of both the work and importance of the Historic Preservation Commision in its stated mission to protect and enhance both structures and districts with historic, architectural and /or cultural value. I am currently a member of the HPC WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING)? As a contractor who specializes in the restoration and historically- appropriate repair and renovatio'r -'of older homes using appropriate materials and techniques, I believe I can advise the commision in this sR-qcific Via. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflic#Fei Interest '.,. j �.- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 7 Yes F-1 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FYes PlfNo (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. aneral Application June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Historic Preservation Commission Name Frank F. Wagner I r 1 �-..z.z4 M m tt ' '"y' ®'� CITY OF IOWA CITY Date 01/27/2012 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, 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 Wagner Bros LLC 1724 Muscatine Ave., Iowa City Iowa 52240 NOTE: A new form acquired in an addi Applicant Signature r Signature of parent/gua Address 1724 Muscatine pk$e fKythe above information changes or an ownership interest is Gl/c n (Youth Advisory Commission only): 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. aneral Application June 2010 Page 3 of 8 City of �Gvva CRY CITY OF IOWA CITY 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. Aovisory Board /Commission /Committee Name Historic Preservation Commission Term 2012 -2015 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 rdiar� v _ NAME Esthe Ba' er- u - - HOME ADDRESS 1022 E_ Golleg tr ..t. lows-- City, A 52240 Is your home address (listed above) within the corporate limits of Iowa City? ✓0 Yes F-1 No How long have you been a resident of Iowa City? nine years Gender: Male ❑ Female W] OCCUPATION consultant EMPLOYER self - employed PHONE NUMBER: HOME 319 - 354 -1483 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I ve served two terms as a representative of the East College Historic District on the Hi�tpric Priervation Commission. I have lived in /owned several historic homes of various eras over the past tw7oxdec s, aTfd ave an appreciation for and understanding of the importance of preserving this important aspect �1?a-iorfiunityc' J istory. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -T, have served two terms on the Historic Preservation Commission and have assisted in grar riti for tffc) Commission. r�z WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? I have a deep appreciation for and understanding of the importance of preserving the buildings that are such an important part of a community's heritage. I am committed to the preservation and conservation of historic structures, while being mindful of the needs of today's home and business owners, contemporary usage, changes in regulations, and the availability of new technology and materials that may be used for repairs and preservation of historic homes. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest None IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 7 Yes F] No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? . ❑Yes W]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 June 2010 Page 2 of 8 Name of City Board /Commission /Committee Historic Preservation Commission Name Esther M. Baker S I CITY OF IOWA CITY Date 01/30/2012 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a; cEty B.oardF:or. Commission from having an. interest ,in. a. city contract,: A.copy,of S$p lion: .362.5 is. attac —• -•• -- •�-� ....�� y.,u, rvu� oNvuu�iwvii�eoen. Na�u�ci� vi, JJ aIU1IL.II I VUUI7.1UV1•JUly.UUIIIIIII„IUII 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 ,A/,3 A J C -- In-a I a� -M o _ r �^� NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additio (business. Applicant Signature C Signature of parent/guardian (Youth Advisory Commission only): Address 1022 E. College Street, Iowa City, IA 52240 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail .o answer all the questions, Council may not consider your application. General Application June 2010 Page 3 of 8 city of Iowa city I r 1 Advisory Board /Commission /Committee 4.;­'III Application Form -^�-�- CITY OF IOWA CITY THIa 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 /Committee Name Historic Preservation Commission Term 3 yrs /2012 -15 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Ginalie Swaim HOME ADDRESS 1024 Woodl awn, Tnwn City, TA 59945 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? 38 yrs Gender: Male F] Female OCCUPATION Histnri ral P�1; rnr EMPLOYER: State Historical society of Iow. PHONE NUMBER: HOME 337 -9828 BUSINESS 335 -3932 EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Previous :terms on Historic Preservation-Commission. 28 years editing -Iowa history magazine --ith stories on preservation and historic properties. Owner of home in historic district and ive experienced design- review process by commission for our home. Prepared and presented tours of historic neighborhoods. Repairing historic home after tornado of 2006. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I understand the commission's mission and mandate and its role in approving applications from property owners. The commission also educates the public;. encourages stewardship, and upholds the Secretary of Interior's design standards. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYIAG)? I believe that I maintain an open mind to the interests and needs -of'.ti apro rty °ner as well as those of the community, neighborhood, and future Iowa City �e�s .dents w1JQ yyill value our historic neighborhoods. I recognize the economic value and qulity-of liming aspects of prservation. I know there's a delicate balance between preservation'-F��nd c�liange —, , LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflicf `ilnterest U �s None. c� IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑ Yes R No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? RYes FqNo (It has been Council policy not to permit an individual to serve on two Boards. or Commissions at the same time.) .srepresentations on this application will constitute just cause for removal of an appointee. If you fail w answer all the questions, Council may not consider your application. General Application January 2012 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Historic Preservation Commission Name Ginalie Swaim 1 r i T CITY OF IOWA CITY Date February 9, 201 e Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, your spouse /domestic partner; or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NONE c a NOTE: A new form must be completed if the above information changes or are ownership interest is acquired in an additional busjPess) Applicant Signature Signature of parent/guardian (YoutWVisi Address 1024 Woodlawn, Iowa City IA 52245 Commission only): Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. General Application January 2012 Page 3 of 8 25d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION One Vacancy — Unexpired Term Effective Upon Appointment - March 13, 2014 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 15, 2012. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Telecommunications Commission should be directed to Bob Hardy, Cable Television Administrator at 356 -5047. 1/11/2012 M 25e 3 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION Two Vacancies — Three -Year Terms March 13, 2012 - March 13, 2015 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 15, 2012. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Telecommunications Commission should be directed to Bob Hardy, Cable Television Administrator at 356 -5047. 1/26/2012 Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child, aunt, or uncle. (Resolution 85 -354) Males: 2 Females: 2 Council Announcement Date: December 6, 2011; January 24, 2012 Application Deadline: Wednesday, 5:OOp.m., February 15, 2012 Council Appointment Date: February 21, 2012 After 03/05/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. TELECOMMUNICATIONS COMMISSION Two vacancies — Three -Year Terms March 13, 2012 — March 13, 2015 Term expires for Saul Mekies, Laura Bergus Gender Balance Requirement: None (M) Matthew Butler 1371 2602 Friendship St (M) Nicholas Kilburg 0 915 Oakcrest St #19 (F) Laura Bergus 0 2231 California Ave (Currently serving 1St three -year term) 0 Denotes applicant completed the Confidential page of the application. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child, aunt, or uncle. (Resolution 85 -354) Males: 2 Females: 2 Council Announcement Date: November 1, 2011; January 10, 2012 Application Deadline: Wednesday, 5:00 p.m., February 15, 2012 Council Appointment Date: February 21, 2012 After 01/30/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. TELECOMMUNICATIONS COMMISSION One vacancy - Unexpired Term Effective upon appointment — March 13, 2014 Nolan Klouda resigned Gender Balance Requirement: None (M) (M) (F) Matthew Butler 0 2602 Friendship St Nicholas Kilburg 0 915 Oakcrest St #19 Laura Bergus 0 (Currently serving 1St three -year term) 2231 California Ave El . Denotes applicant completed the Confidential page of the application. City of Iowa City i r 1 Advisory Board /Commission /Committee`�� "nplication Form -�-� CITY OF IOWA CITY 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. fV Advisory Board /Commission /Committee Name Iowa City Telecommunications Commission, Tefa Youth Advisory Commission (shall not be more than 18 years of age at the time of ap,plica#iog) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: "mA NAME Matthew Butler HOME ADDRESS 2602 Friendshin:St. 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? 15 years Gender: Male 7 Female F1 OCCUPATION Multimedia Consultant EMPLOYER University of Iowa PHONE NUMBER: HOME 319 - 936 -1339 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: For seven years, from 2005 -2011, 1 was the AV Specialist for the Iowa City Public Library responsible for the ( -to -day operations of the Library Channel. I was intimately familiar with the technical, logistical, and political aopects of running a local access television channel. I often reported our activity to the ICTC. I am also a contributing producer for PATV and have offered consultation to other local channels in Iowa City. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? As someone who recently had their salary come out of Iowa City's cable franchise fees, I became interested in the workings of this board and how cable rights were negotiated in Iowa City. While I am not familiar with the inner workings, I understand how the board relates to the city council and the public. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? Operations level knowledge of local access television production. A balanced perspective concerning the needs of the municipality, Iowa City citizens, local television channels, and businesses. A life -long committment to cable needs' in Iowa City. Historical knowledge met with forward- looking goals. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict 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? F]Yes P/1No (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 January 2012 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Iowa City Telecommunications Commission Name Matthew Butler �,MWPMNN5X= CITY OF IOWA CITY Date 01/26/2012 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, 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 interest is acquired in an additional business. Applicant Signature , v % Signature of parent/guardian (Youth Advisory Commission only): Address 2602 Friendship St. 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 January 2012 Page 3 of 8 City of Iowa City r i Ott Advisory Board /Commission /Committee #;;,� VIII + ruylrmr .pplication Form -�-&& CITY OF IOWA CITY 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 /Committee Nam�j � ►� �� 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: NAME �s K�� HOME ADDRESS�t��c2.�sT�.�`� Is your home address (listed above) within the corporate limits of Iowa City? ffYes F1 No How long have you been a resident of Iowa City? 5'IEgQ5 Gender: Male V Female OCCUPATION TT`dx-jsE' EMPLOYER�tccC� PHONE NUMBER: HOME S11 -9q1-3q2-1 6-60 BUSINESS 31 i. 3000Q- '� CP EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: —� +ZtcN p°lA �.K�- f 4^3Sa.,.,5 flaSE� uT� C.�r- �Bz�.►•q+��s,�S OF LOO 44rP1.vCArJte f'4CgS WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? zSec�s v,,ar�ss�s Z►' ,�Eb.o:Tfrrza ux>7{/ �Fttaa f�S� 1; V5 W�Va lzrip, ,we, t �g� y C wcl cahk (; �D� 1 car�P+w4— S�ascxrA�'� o��L -rE'S, FictDS PUg�ie Ha- WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR- APPLYINIG ? LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest T 'Da 4-.-7- i �-T�v� -.3--7 mkvE Ar5 Ct.JPt =cr% bF v.a'r'W(Lfflf -r- ,'e— T� 12.1��. F--F3, 34 u W=ur a*-, &'1-- .PL6.7 -V v0 -e1 ,tor c.RRRtrr'tZy �lRy.t° A.� C�sL� s..K'oI-7V�"L -1-zI%. �.�-, eF �1—awo C_ /�a9 'Q c+ •V .�'w -M Q4U4 P.*k SQ ZL0 S Rvz�G �Il` IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ZYes 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 January 2012 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City /" C__vHAI � Board /Commission /Committee l�c�c�r- i►�u,� f Name i- �.=G�sz. 1 • te='`30`� 10 ft CITY OF IOWA CITY Date f • 2Ce.12_ Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, 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 iJv ti)� 7:9 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. �^ Applicant Sig Signature of parent /guardian (Youth 6;Kvisory Commissio only): Address `��� 0.+9<,Y45 rr` 0 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 January 2012 Page 3 of 8 City of Iowa City Advisory Board /Commission /Committee 1k h ..m p + rywaor� application Form -�-� CITY OF IOWA CITY 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 /Committee Name Telecommunications Term 2012- Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Laura Bergus HOME ADDRESS 2231 California Ave. Is your home address (listed above) within the corporate limits of Iowa City? n Yes F] No How long have you been a resident of Iowa City? 31 years Gender: Male n Female OCCUPATION Attorney EMPLOYER Hayek, Brown, Moreland & Smith, LLP PHONE NUMBER: HOME (319) 541 -9677 BUSINESS (31g) 33m6n6 EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Prior term on the commission. Professional cable franchise oversight for 10 years (City of North Liberty). Good )rking relationship with Mediacom. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Current member, since 2009. - WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING)? Continue facilitating communication with cable franchisee and public regarding cable service. Provide guidance in franchise oversight, enforcement, and negotiation. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest None. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes R No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? nYes ❑✓ 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 January 2012 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Telecommunications Name Laura Bergus CITY OF IOWA CITY Date 02/10/2012 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, your spouse /domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None. NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature_ JV Signature of parent/guardian (Youth Address 2231 California Ave. Commission only): 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 January 2012 Page 3 of 8 M] NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy — 2 -Yr Term January 1, 2012 - December 31, 2013 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, February 15, 2012. 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 Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356 -5041. x m ZQOx u u m u u D O O a y N tD cD =m 3 x c CO C O y CD A CL O c 3 O c �D m v mDDcn �0X Nm-< 0 0 !C m 0!C ic vy 0 z rn i:�:. n W N W W GJ W W W i) W C.) N w N m� X V N x x m x x Co O c �D m v mDDcn �0X Nm-< 0 0 !C m 0!C ic vy 0 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: 3 Females: 2 Council Announcement Date: September 20, 2011; November 1, 2011; December 6, 2011; January 24, 2011 Application Deadline: Wednesday, 5:OOp.m., February 15, 2012 Council Appointment Date: February 21, 2012 (Recommendations to be made by Council liaison) After 12/19/11 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. YOUTH ADVISORY COMMISSION One Vacancy — Two Year Term January 1, 2012 — December 31, 2013 Term expires for Alexandra Tamerius Gender Balance Requirement: 1 Female (M) Edgar Thornton 0 631 Scott Park Dr 0 Denotes applicant completed the Confidential page of the application. City of Iowa City r Advisory Board /Commission /Committee' Tat- Qnplication Form wiiiiii I. CITY OF IOWA CITY 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 /Committee Name Youth Advisory Commission Term Youth Advisory Commission (shall not be more than 18 years of age at the time of a plic tion) Name of Iowa City High School or hi school equ%i �alent: ' L S Signature of parent/guardian: ,�G NAME Edgar T. Thornton, IV HOME ADDRESS 631 Scott Park Drive, Iowa City, 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? Since 2003 Gender`galel Ferrale� OCCUPATION Sophomore at City High EMPLOYER PHONE NUMBER: HOME 319 - 338 -5579 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSIi•ION: I an active member of Boy Scout Troop 250, and participate in many civic and cultural activities with the Troop, ii .ding Scouting for Food. I am also an active member of Trinity Episcopal Church, participating with the youth group and serving as an acolyte. At City High school I participate in the Band, Tennis and other activities. In these roles I see the issues and needs of my friends and others, on both the east and west sides of town. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Youth Advisory Commission, unfortunately, has limited visibility within the general high school community. Most people don't know what they do. I understand they make recommendations on a limited amount of funding directed to young people, and consider /make recommendations on issues affecting youth. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? As a Boy Scout I have received training in leadership - including public speaking and group decision making. I would like to use these skills in helping the Commission become more visible and offering new and innovative suggestions to address youth issues. As a mixed race, African- American/White, young man I am in a unique position to work pro - actively @ to help us have a more important role and better image in the Iowa City community. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest None. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? n✓ Yes F-] No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? [:]Yes W]No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) - lisrepresentations, on this application will constitute just cause for removal of an appointee. If you fail co answer all the I questions, Council may not consider your a pp lication. General Application January 2012 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Youth Advisory Commission Name Edgar T. Thornton, IV � r + wir ®im� CITY OF IOWA CITY Date 01/25/2012 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, your spouse /domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Sig natureV4X'/iG',' Signature of parent/guardian (Youth Advisory Commission only): Address 631 Scott Park Drive, Iowa City, 52245 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. General Application January 2012 Page 3 of 8 25 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy - Two -Year Term January 1, 2011 - December 31, 2012 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, February 15, 2012. 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 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: 3 Females: 2 Council Announcement Date: October 26, 2010; December 7, 2010; January 10, 2011; February 15, 2011; March 22, 2011; May 3, 2011; June 7, 2011; August 2, 2011; September 6, 2011; October 4, 2011; November 1, 2011; December 6, 2012; January 24, 2012 Application Deadline: Wednesday, 5:OOp.m., February 15, 2012 Council Appointment Date: February 21, 2012 (Recommendations to be made by Council liaison) After 01/24/11 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. YOUTH ADVISORY COMMISSION One Vacancy — Two Year Term January 1, 2011 — December 31, 2012 One (1) person — Tate High Gender Balance Requirement: 1 Female No applications as of Wednesday, 5:OOp.m., February 15, 2012 121 Denotes applicant completed the Confidential page of the application.