HomeMy WebLinkAbout2015-03-23 AppointmentsNOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
PLANNING AND ZONING COMMISSION
Two Vacancies — Five -Year Terms
May 1, 2015 — May 1, 2020
The duties of the Planning and Zoning Commission members include making (or causing to be made)
surveys, studies, maps, plans, or charts of the whole or any portion of the municipality and any land
outside which --in the opinion of the Commission --bears relation to a comprehensive plan; also include
recommending to the City Council from time -to -time amendments, supplements, changes, and
modifications to the Zoning Ordinance.
Iowa City -appointed members of boards and commissions must be eligible electors of the City of Iowa
City. This Commission conducts formal meetings the first and third Thursdays of each month at 7:30 p.m.
(Informal workshops are held the preceding Mondays at 7:30 p.m.)
Applications must be received by 5:00 p.m., Wednesday, March 18, 2015. 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 Planning and Zoning Commission should be directed to Robert Miklo,
Sr Urban Planner at 356-5240.
2/10/2015
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: 4
Council Announcement Date: Feb 9, 2015
Application Deadline: Wednesday, 5:00 p.m., March 18, 2015
Council Appointment Date: March 23, 2015
After 05/11/2015 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
PLANNING AND ZONING COMMISSION
Two vacancies — Five-year Term
May 1, 2013 — May 1, 2018
Term expires for John Thomas and Paula Swygard
Gender Balance Requirement: 2 Males
(M) Michael H. Hensch
815 Pepper Dr.
(M) John Thomas
509 Brown St.
(F) Erin Shane
3626 Foxana Dr.
(M) Max Parsons
1307 E. College St.
0
0(Currently serving an unexpired term)
❑D
❑x Denotes applicant completed the Confidential page of the application.
5
14a
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)
.$( 1
ales: 4
Council Announcement Date"
sd9, Fe 2015
Application Deadline: Wedne
ay, 00 p.m., March 18, 2015
Council Appointment Date: March 2 , 2015
After 05/11/2015 (3 mo from the annou cement date) Council y appoint any qualified
applicant without regard to gender.
PLANNING AND ZONING COMMISSION
One vacancy — Five-year Term
May 1, 2013 — May 1, 2018
Term expires for John Thomas and Paulawygard
Gender Balance Requirement: 2flales
(M) Michael H. Hensch / EI
815 Pepper Dr.
(M) John Thomas/ O(Currently servinAan unexpired term)
509 Brown St.
(F) Erin Shame rx-1
3626 F&ana Dr.
(M) Mq� Parsons rX_1
007 E. College St.
Denotes applicant completed the Confidential page of1he application.
City of Iowa City
Advisory Board/Commiss'0 ommittee #,
,pplication Form r �� � `' -�-�-
CITY OF IOWA CITY
�n i r r- r- rN vne)"�
(J B U 1
THIS APPLICATION IS A PUBLIC DOCUMENT AND A�.AIgHu CAN'�BE REPRODUCED_ DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MAf K, 0 i`40*jo.ENTIAL." THIS 'A It ;N,"YVILL BE CONSIDERED
S � � i a i
FOR THREE MONTHS ONLY AND AUTO MAT[ CALLk66N781b ' kI D FOR ANY VA AN @J G THAT TIME.
Advisory Board/Commission/Committee Name Planning and Zoning Commission Term 05/01/2015
NAME Michael H. Hensch HOME ADDRESS 815 Pepper Drive
Is your home address (listed above) within the corporate limits of Iowa City? 7 Yes ❑ No
How long have you been a resident of Iowa City? 25 years Gender: Male Pe FemaleEl
OCCUPATION Medical Examiner Administrator EMPLOYER Johnson County
PHONE NUMBER: HOME 319-331-0673 BUSINESS 319-339-6197
EMAIL ADDRESS:
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I have been a residential property owner in Iowa City for 25 years. I have a master of arts degree from the University
of Iowa in public affairs. I am an experienced and effective board member, e.g., 2 terms on the Johnson County
Veterans Affairs Commission, currently serving my 3rd term on the Iowa Association of County Medical Examiners
''oard of Directors, and I am serving my first term on the board of the Iowa Donor Network. I have worked in this
.)unty and city as a state trooper, department director at Mercy Hospital and a department director at Johnson
County. This experience has allowed me to become intimately familiar with the citizens and neighborhoods of our city
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
The role of the commission is to make recommendations to the city council and to assist in guiding the development
of the city in accordance with the city's code of ordinances. This includes developing and maintaining a
comprehensive plan; developing zoning ordinances and specific zoning districts; hearing matters related to zoning
regulations, such as re -zonings, use permits, development agreements, annexations, final planned developments, and
ordinance amendments; and to determine the consistency of proposed projects with the comprehensive plan.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
have made Iowa City my home and I hope to someday retire in this community. I think Iowa City is a great place
and I want to do my part to ensure that it remains a vibrant, healthy, safe and growing community for the next
generation. I am a highly organized and detail oriented person. I believe in teamwork and working to build consensus
and unity whenever possible. I always do my homework and am prepared for every meeting.
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? F✓ Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? nYes 7No
(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
February 2015 Page 2 of 7
BOARD, C I" N AND COMA ITV[Br�',
S
B gIESS LISTING,
30 E
Name of City
Board/Commission/Committee Plan nin ,and�Z rlf _commission
ta- ..r
Name Michael H. Hensch
� r
.wr®���
CITY OF IOWA CITY
Date 02/26/2015
J i
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of
a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached
(see page 7).
List all businesses in which you, or your spouse/domestic partner, have an ownership interest
(for example, sole proprietor, partner, 5% or more of corporation's stockholdings).
Please indicate if there are none.
BUSINESS NAME I BUSINESS ADDRESS
IN/A
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant Signature ' .
Address 815 Pepper Drive
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
February 2015 Page 3 of 7
City of Iowa City
Advisory Board/Commission/Committee'"'
%pplication Form -N-fiff
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 Planning and Zoning Commission Term 5/15 to 5/20
NAME John Thomas HOME ADDRESS 509 Brown Street
Is your home address (listed above) within the corporate limits of Iowa City? [7 Yes F� No
How long have you been a resident of Iowa City? 5+ years Gender: Male 0✓ FemaleE]
OCCUPATION Landscape Architect (retired) EMPLOYER Not Applicable
PHONE NUMBER: HOME 319-338-1841 BUSINESS
EMAIL ADDRESS: johnfredericthomas@gmah
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I have served on the Planning and Zoning Commision for over three years (December 2011 until the present). I have
an excellent understanding of the Comprehensive Plan, Zoning Code and commission procedure. I enjoy the work of
the Planning and Zoning Commission, and believe I serve the community well in this capacity.
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7r
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
I have an excellent knowledge of the documents that serve as the basis for the Planning and , 07yg C@mmi 4*`s
deliberations: the Comprehensive Plan (made up of numerous documents, including the 1997,-QQmpr&Kensiv"lan,
District Plans, Downtown/Riverfront Crossings Master Plan, and the Historic Preservation Plan}_;:Alontjlvith f4tt&w P&Z
commissioners, I have requested City staff to hold public hearings regarding road design and District k?ian updates. I
have spent many hours researching topics pertinent to urban planning, such as affordable housing str`at'egies.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I am applying so that I can continue to make contributions to the Planning and Zoning Commission's critical work of
determining the most appropriate course for land use policy in Iowa City.
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 FJNo
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.)
F
srepresentations 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
February 2015 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board/Commission/Committee Planning and Zoning Commission
Name John Thomas
� r
CITY OF IOWA CITY
Date 02/24/2015
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, or your spouse/domestic partner, 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 ADDRE S
None i 1:31
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant Signature,
Address 509 Brown
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
February 2015 Page 3 of 7
City of Iowa City r
J —. —
Advisory Board/Commission/Committee 1 4'th
1%pplication 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 Planning & Zoning Commission Term 5 year
NAME Erin Shane HOME ADDRESS 3626 Foxana Drive
Is your home address (listed above) within the corporate limits of Iowa City?
How long have you been a resident of Iowa City? 3 years
R]YesFJNo
Gender: Male ❑ Female❑✓
OCCUPATION Project Manager EMPLOYER University of Iowa
PHONE NUMBER: HOME 319-212-0213
EMAIL ADDRESS: eshane3@gmail.com
BUSINESS 319-384-4174
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
have been a certified planner for over 10 years. I also have over 15 years of planning and zoning experience
forking as a Planner for several municipalities and private firms.
f ? C-71
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ='i -T a_ j
follow the Board's activity in the local paper as well as occasionally reviewing the Board nline.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
As noted in my experience section above, I have worked in planning and zoning my entire career. I feel that I can
contibute my institutional knowledge to the Board.
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? FV- Yes [—] No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F]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 I
1 to answer all the questions, Council may not consider your application.
General Application
February 2015 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board/Commission/Committee Planning & Zoning Commission
Name Erin Shane
Xh
CITY OF IOWA CITY
Date 03/13/2015
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, or your spouse/domestic partner, 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 Signature
Address 3626 Foxana Drive
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
February 2015 Page 3 of 7
City of Iowa City r i
Advisory Board/Commission/Committee;'; 'TA
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 Planning and Zoning Term 5 years
NAME Max Parsons HOME ADDRESS 1307 E College Street
Is your home address (listed above) within the corporate limits of Iowa City? a Yes ❑ No
How long have you been a resident of Iowa City? 3 years Gender: Male Q Female
OCCUPATION Treasurer EMPLOYER Tallgrass Business Resources
PHONE NUMBER: HOME 319-430-7976 (cell) BUSINESS 319-338-7701
EMAIL ADDRESS: mparsons@tallgrassbiz.c(t
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
currently serve on the Iowa Clty Area Chamber of Commerce's Empowered Professionals of the Iowa City Area
;EPIC) leadership council. In this capacity, I am responsible for setting up social networking events, along with
costing professional speaker luncheons and participating in civic events across the Iowa City area for 100-150
I recently served as an Iowa City Area Chamber of Commerce Ambassador, welcoming new businesses in the Iowa
Citv area.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
I'm aware that the elected board studies and observes data from plans, maps, and charts of original zoning districts
within the City and in some cases the land nearby. The board considers many factors including current and
anticipated traffic levels, locations of business and residential districts, and the accommodation and safety of citizens
and property as it relates to future city planning. Members of the board then recommend any changes to the zoning
districts or modifications of the regulations to be enforced within those districts to the City Council.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I grew up and have spent the vast majority of my life in the Iowa City area. Now that I am a full time resident in the
City limits I am interested in serving and having a positive impact in helping shape what Iowa City looks like in the
future. I stay informed on City events, enjoy evaluating projects, and pay close attention to detail, and I want to take
that passion to the advisory board.
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? 0 Yes "No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F Yes 171No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
_... . _ _...- __.... ........ _w . .......
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
February 2015 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board/Commission/Committee Planning and Zoning
Name Max Parsons
�..=.�:.®4
x
CITY OF IOWA CITY
Date 03/16/2015
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, or your spouse/domestic partner, have an ownership interest
(for example, sole proprietor, partner, 5% or more of corporation's stockholdings).
Please indicate if there are none.
BUSINESS NAME I 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 7% �a-,�Pt
Address 1307 E College Street
Misrepresentations on this application &II constitute dust cause for removal of an appointee. If you fail
to answer all the questions, Council may noir q9p§[qgr your application.
General Application
February 2015 Page 3 of 7
14b
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 2, 2014, January 20, 2015, February 24,
2015, March 10, 2015
Application Deadline: Wednesday, 5:00 p.m., March 18, 2015
Council Appointment Date: March 23, 2015
After 03/02/2015 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
TELECOMMUNICATIONS COMMISSION
One Vacancy - Three-year Term
March 13, 2015 — March 13, 2018
Term expires for Matthew Butler
Gender Balance Requirement: 1 None
(M) Derek Ryan Johnk 0
1405 Keokuk St.
El Denotes applicant completed the Confidential page of the application.
r1r•1ick
f4�
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
TELECOMMUNICATIONS COMMISSION
One Vacancy — Three -Year Term
March 13, 2015 - March 13, 2018
The duties of the Telecommunications Commission include serving as a review board to resolve
disputes between any subscriber or potential subscriber and the cablevision company; reviewing and
auditing reports by the cablevision company to the City as required by the Cable Television Ordinance;
working with the public, the media, the City, and the cablevision company for the purpose of making
recommendations on various issues; engaging in other activities pursuant to the effective monitoring and
evaluation of the CATV system in the City.
Iowa City -appointed members of boards and commissions must be eligible electors of the City of Iowa
City. The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m.
Applications must be received by 5:00 p.m., Wednesday, March 18, 2015. 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 Ty Coleman,
Media Prod. Serv. Coord. at 356-5454.
3/10/2015
City of Iowa City r 1
Advisory Board/Commission/Committee; r
application Form -W-&--
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 2015-2018
NAME Derek Ryan Johnk HOME ADDRESS 1405 Keokuk Street, Iowa City, IA 52240
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? 1 year Gender: Male ❑✓ Female
OCCUPATION Information Technology Manager EMPLOYER Atos, Inc.
PHONE NUMBER: HOME 319-573-6451
EMAIL ADDRESS: derek.johnk@gmail.com
BUSINESS Same
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
8 years of IT Experience (End user support, IT Service Management, Process Analysis/Management)
Founding member of the Lucas Farms Neighborhood Association
Regular participant and presenter at Iowa City Neighborhood Council Meetings C^
Regular consumer advocate on the issue of Telecommunications`
— — .- -1 Im MMI-e1—kir ,uf% iennv onw C2 r%3 r-, X__ � 9
WIN IAI .V t VV.\ I..a-V V... ....v...-wvr. v. .. ..v w..v v... vv,.. ......
I am aware that the advisory board works regularly with telecom providers such as Mediac6ifft6 estab
agreement (rates, exclusivity, etc.) that benefits Iowa City. �-
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
I am very interested and motivated on the subject of internet access in our area. I have been very vocal on this issue
(meeting with city staff, neighbors, and lawmakers) already, and would like to advocate for affordable, fast data
access in our community. I believe that access to this utility is a way to empower economically stressed and aging
community members, and encourage independence.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
Member of Lucas Farms Neighborhood Association (past recipient of PIN grant)
Member of Iowa City Neighborhood Council (deciding body on past PIN grants)
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0✓ Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes WJNo
(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
February 2015 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board/Commission/Committee Telecommunications
Name Derek Ryan Johnk
� r
CITY OF IOWA CITY
Date 03/04/2015
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, or your spouse/domestic partner, 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
a
c
NOTE: A new form must be completed if the above informati
acquired in an additional business: -
Applicant Signature
Address 1405 Keokuk Street, Iowa C09, IA 52240
anges or an ownership interest is
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
February 2015 Page 3 of 7