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HomeMy WebLinkAbout2018-09-18 AppointmentItem Number: 15.a. I r , CITY OF IOWA CITY UNESCO CITY OF LITERATURE September 18, 2018 Community Police Review Board - One vacancy to fill an unexpired term, Upon appointment - June 30, 2021. (Royceann Porter resigned) ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Adams, Adil -Application Canady, Laurie -Application Eastham, Charles -Application Ferdig, Jessica -Application Goldsmith, Zachary -Application McDaniel. Latisha -Application Olmstead, Harry -Application Taha, Mohamed Ahmed EI Mandi -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: COMMUNITY POLICE REVIEW BOARD One Vacancy: Unexpired Term Upon Appointment — June 30, 2021 Duties of the Community Police Review Board include: • Reviewing Police Department investigations into allegations of misconduct lodged against police officers; conducting further investigation of the complaint when the Board deems it necessary, and issuing a public report which explains why and the extent to which the complaint is sustained or not sustained; • Maintaining a central registry of complaints against sworn police officers and issuing annual reports regarding the disposition of the complaints to the City Council; • Reviewing police policies and practices from time -to -time and recommending changes to the City Council when the Board deems it appropriate. • Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. An application can be completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the Clerk's office. Vacancy open until filled. Questions about the Iowa City Community Review Board should be directed to Chris Olney City Clerk's Office at 356-5043. Board/Commission Application Cover Board/Commission: Community Police Review Board (CPRB) One Vacancy to fill unexpired term Upon appointment - 6/30/2021 It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council Announcement Date: 7/3/2018 Application Deadline: Open until filled Council Appointment Date: 9/18/2018 Date of Non -Gender Appointment: 10/4/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 -Female Current Gender Balance: Female: 1 Male: 3 Gender Name and Address Male Adams, Adil 2532 Bartelt Rd #1C Female Canady, Laurie 64 Arbury Drive Male Eastham, Charles 953 Canton St Female Ferdig, Jessica 18 Dunuggan Court Male Goldsmith, Zachary 721 Kimball Rd Female McDaniel, Latisha 331 Willow Wind Place Male Olmstead, Harry 1259 Shannon Dr. Apt #102 Male Taha, Mohamed Ahmed EI Mandi 2532 Bartelt Rd #2C Community Police Review Board - Current members # years as Name Term ending resident of IC Occupation Gender Age* Countryof Sexual Orgin* Orientation* Gender Religion* Disability* Ethnicity* Identity* Race* Unique Identifiers* Donald.. King 6/30/2019 -1st term _ 15 Security officer M Monique Green 6/30/2020-lstterm 10 F 0 M, If 11 e Townsend _ 6/30/2020 -lstterm 53 M David Semler 6/30/2021-Sstterm 4 lawyer Vacant 6/30/2021 -Unexpired M 38 ---- USA Male ------ Unitarian No Caucasian No - — ---- No No Please note: The information provided is the information provided on the application at the time of submission. * Information is voluntary i 1" ------ - --- COMMUNITY POLICE REVIEW BOARD ATTENDANCE RECORD YEAR 2017-2018 (MeetingDate KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member TERM 8/29 9/12 10/10 11/14 12/7 1/9/18 2/13/18 3/19/18 4/17/18 4/23/18 5/8/18 6/12/18 7/23/18 NAME EXP. Mazahir 7/1/21 X X X X O/E --- --- ---- ---- ------ ----- ------- ------- Salih Donald 7/1/19 X X X X X O X X X X X X X King Monique 7/1/20 X X X X X X X X X X X X X Green Orville 7/1/20 X X X X X X X X X X X X X Townsend Royceann 7/1/21 ---- ---- ---- ---- ---- ---- X O/E X O/E X O/E— Porter David 7/1/21 X O X O/E X X X X X X X X X Selmer KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member r Advisory Board/Commission/Committee Application This application is a public document and as such can be reproduced and distributed for CITY OF IOWA CITY the public. This application will be considered for twelve months only and automatically UNESCO CITY OF LITERATURE considered for any vacancy during that time. NOTE: Must be 18 years of Age and live within city limits of Iowa City to apply Date of Application Which Board or Commission are you interested in P-. is ✓y1 A"n JQ � -t Applicant Information: First Name t4 01 L Last Name lD ell Home Address Z 5 3 2'�G'i Y-,�-� pz� -,&/ ` C City. C State j JA Zip Code 4 Contact phone number ?2 �1 .6 Zmail Address _ OLd 61, 0 P Cf 1. Is your home address (listed above) within the corporate limits of Iowa City? YES__�./NO 2. How long have you been a resident of Iowa City? V-> 3. Occupation: t!> t,\ -: c-3 ....... 4. Gender* VNN W""'"' This question is mandatory in order for the City to comply with the State's gender balancer tMmea which treats gender as binary "Gender Identity" may be provided in the demographics section of the 44 atidMelow Male �� y'I. €) cn ❑ Female 5. Experiences and/or activities which you feel qualify you for this position: �. �G/1 93 e-1 0. what is your present knowledge of each advisory board you are interested in? 7 '1 Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflict of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision—making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, agreement with respect to the proceeds of the federally—assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of Iowa generally prohibits, with certain important exceo-41a, a embeeM a city Board or Commission from having an interest in a city contract. Section 362.5 City Council Resolution #15-300 established a policy that the following persons slfgT,, t b-eligil or appointments to Boards and Commissions.- cn A council member's spouse, domestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in- law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, poster child, persons who are parents of the same child, and persons whom the employee is in an intimate relationship. Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. ............................................................................................................................., 7. Do you currently have a conflict of interest? YES NO P,"� Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer/ 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). List potential conflicts of interest (See above for information regarding conflict of interest) Please indicate if there are none. ,,., :6 BUSINESS NAME BUSINESS ADDRESS Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 8. Do you currently serve on another Iowa City board or commission? YES / NO If yes, which one do you prefer? _JC u I�ha V.— RA5 [�u , �w The City Council values all types of diversity on its boards and commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the board and commission is representative of the community and the groups(s) which it serves, please provide your information for the following: Demographic Information• 9. Age 10. Country of Origin �y0 11. Sexual Orientation v,(\ 02NI-0—" 12. Religion 4t,� 1 ✓V7 13. Do you have a disability? YES NO ca 14. Ethnicity ,1 C"" 15. Race 16. Gender Identity A.. -�, +ki Note: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise finance and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Contact information is attached. (rev. 5/8/18) �I ._.aAdvisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CIN OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/25/2018 First Name Laurie Last Name Canady Home Address 64 Arbury Drive, Iowa (IA) City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number# 3193304587 Email Address* lauriecanady@gmail.com Boards & Commissions Select a Board or Commission you are interested in-* Community Police Review Board (CPRB) 2. How long have you been a resident of Iowa City? 30 years not including undergrad 3. Occupation: Homemaker 4. Gender` 'This question is rrandatory in order for the Qty to corrply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray be provided in the Damgraphics sectional' the application below. r Male PF Female 5. Experience and/or activities which you feel qualify you for this position:* ICCSD volunteer 1996-2017 Iowa City Road Races board member 2000-2012, Race Director Citizen for many years as well as parent in the community. HAM Radio Operator KCOWLO Various other boards 6. What is your present knowledge of each advisory board you are interested in?* In talking with others and reading about this Board, I feel I would be a good fit in terms of what is happening on the streets of Iowa City. I am eager to learn more about this board and serve-- other than what I have read online. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 60 10. Country of Origin United States of America 11. Sexual Orientation Straight 12. Religion Protestant 13. Do you have a disability? No 14. Ethnicity Caucasian 15. Race White 16. Gender identity Female *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant` Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down r Advisory Board/Commission Application Form 7,,r� This application is a public document and as such can be reproduced and distributed for ,%NN- � the public This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 1!3!2018 First Name Charles Last Name Eastham Home Address* 953 Canton St City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number 319 541-3972 Email Address eastham@outlook.com Boards & Commissions Select a Board or Commission You are int erested in:* Community Police Review Board (CPRB) 2. How long have you been a resident of Iowa City? 45 years 3. Occupation: Retired 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* I am currently actively participating in the following organizations and groups. My involvement with these groups requires analyzing racial and ethnic disparities in numerous outcomes and developing strategies for reducing those disparities. Iowa City Community School District Equity Advisory Committee Center for Worker Justice Board of Directors Black Voices Project Coalition for Racial Justice 6. What is your present knowledge of each advisory board you are interested in?* Currently, the Iowa City Community Police Review Board (CPRB) may review police policies, procedures, and practices, and recommend modifications to them as appropriate. The CPRB also provides a complaint process for claims of misconduct by individual police officers. At its April 18, 2017 Work Session the Council supported proposals by Police Chief Jody Matherly to aggressively address the Iowa City Police Department's disproportionate minority contact issues over the next five years by, among other measures, increasing the role of the CPRB in reviewing police policies. At the April 18, Work Session the Council also discussed a number of strategies proposed by Council Member Kingsley Botchway to address racial disparities in ICPD policing outcomes. Those strategies include restructuring the CPRB so that the Board: • Focuses on policies and procedures and whether these policies and procedures align with community expectations; • Focuses on use of force data and whether patterns align with community expectations; • Reviews key areas of disproportionality and reports improvement; • Requires independent investigation of any police misconduct as determined by the CPRB. If appointed, I am looking forward to working with other members of the CPRB, the police department and the Council to substantially reduce disproportionate minority contact by the ICPD and to conducting fair, thorough, and accurate investigations of misconduct complaints brought against individual officers. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest- The nterest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* Yes Board current serving on* Housing and Community Development Commission(HCDC) If Yes, preference on first choice Community Police Review Board Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 76 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion None 13. Do you have a disability? No 14. Ethnicity White *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant's Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down ,_, Advisory Board/Commission Application Form ,� ��+� This application is a public document and as such can be reproduced and distributed for ZZ .,j,W, the public This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/31/2018 First Name Jessica Last Name Ferdig Home Address* 18 Dunuggan Ct City IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 3199300811 Email Address jessferdig@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) 2. How long have you been a resident of Iowa City?* 8 3. Occupation: * Research Associate 4. Gender* 'This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray be provided in the Derrographics sectionof the application below r- Male 17 Female 5. Experience and/or activities which you feel qualify you for this position:* Lifelong resident of Johnson County Master in Public Health within Community and Behavioral Health Bilingual English/Spanish Experience in immigration processes and legal system (assisted 2 family members in IR -2 visas) Interest in law and politics Experience in working with underserved populations Experience with confidential information protection (HIPPA) Experience working with large data sets Experience with publication writing 6. What is your present knowledge of each advisory board you are interested in? Review of community complaints made about police officers Vetting of community complaints through procedures set forth by City Council Keep data and create statistics regarding community complaints Host annual community forum for public opinions and transparency Attend meetings ever second Tuesday of each month at 5:30pm Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission? * Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 26 10. Country of Origin 11. Sexual Orientation 12. Religion 13. Do you have a disability? 14. Ethnicity 15. Race 16. Gender identity "NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down lr^„� Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/10/2018 First Name Zachary Last Name Goldsmith Home Address* 721 Kimball Road City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319-383-6832 Email Address* zachgoldsmith95@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 39 years 3. Occupation:* Teacher 4. Gender* *This question is rrandatory in order for the City to con* with the State's gender balance requirenent, which treats gender as binary. "Gender Identity" nay be provided in the DDrrographics sectionof the application below. 17 Male r Female 5. Experience and/or activities which you feel qualify you for this position: I feel that I bring a wealth of knowledge about Iowa City to the table. I've have spent my whole life here, and have many connections throughout the community. For the Police Commission I would bring a unique perspective, and would hope to make sure that there is justice being served for populations that feel underrepresented. In terms of wanting to be a part of the Senior Center Commission, I have always felt a great connection to the Senior and Elder population in my life. Time spent with them is time well spent, and if I can help to make their lives a little bit better then I would like to work to do that. 6. What is your present knowledge of each advisory board you are interested in? I know that the Police Commission was set up after the untimely death of Eric Shaw. I would believe that the Senior Center Commission helps with the running of the Senior Center after reading some of the past meeting notes. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to sere. Council policy is not to permit an individual to sere on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 42 10. Country of Origin United Stated of America 11. Sexual Orientation Straight 12. Religion Jewish 13. Do you have a disability? No 14. Ethnicity Jewish 15. Race White 16. Gender identity *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. l`1-0 I -4 Advisory Board/Commission Application Form � �"°1A �� This application is a public document and as such can be reproduced and distributed for ®'moi the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/30/2018 First Name Latisha Last Name McDaniel Home Address* 331 Willow Wind PI City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 2146823014 Email Address brufanegra@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) 2. How long have you been a resident of Iowa City? 6 years 3. Occupation: * Research Associate 4. Gender* 'This question is mandatory in order for the City to comply w ith the State's gender balance requirement, which treats gender as binary. "Gender Identity" rrey be provided in the Derrographics sectionof the application below r Male Pf Female 5. Experience and/or activities which you feel qualify you for this position:* I have been an activist and community organizer for over 10 years starting in Dallas, Texas with issues dealing with the LGBTQ community, hate crimes, and immigration. I have been organizing in Iowa City around issues of police brutality/accountability, immigration, campus sexual assault, LGBTQ community, workers rights, water protection and women's rights. I am currently a co-chair of the UI LGBTQ Staff and Faculty Association. I am affiliated with Black Voices Project, Center for Worker Justice, Women's Resource and Action Center, Indigenous Iowa and Transformative Healing. 6. What is your present knowledge of each advisory board you are interested in?* I have attended a few meetings of the Community Police Review Board. I am acquainted with current and former members. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 40 10. Country of Origin United States 11. Sexual Orientation Bisexual 12. Religion Agnostic 13. Do you have a disability? No 14. Ethnicity 15. Race Black 16. Gender identity cisgender *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down 'r a — Advisory Board/Commission Application Form lr�W� This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/14/2018 First Name Harry Last Name Olmstead Home Address * 1259 Shannon Drive, Apartment 102 City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-855-2666 Email Address* Harry03@aol.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Library, Board of Trustees Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation: * Retired Teacher 4. Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. °Gender klentity" Trey provided in the DErrographiccs sectmof the application below. R Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of Masters. Teach for America 1991 - 1974 Special Education LD & BD. I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2 years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun - committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa Olmstead Consumer Task Force 5 years (11 year as vice -chair & 2 years co-chair of Medicaid Privatization sub- committee. 6. What is your present knowledge of each advisory board you are interested in?* Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens and City Council. I have given a presentation to the Iowa City Senior Center Col mission also I've attended 3 years of the annual report and public forum of the Iowa City Police Review Board. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission? No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 68 10. Country of Origin United States of America 11. Sexual Orientation Straight 12. Religion Quaker 13. Do you have a disability? Yes Please explain: I'm a person with a right above the knee and and use a power wheelchair for mobility. 14. Ethnicity United States of America 15. Race White 16. Gender identity Male *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) I Signature of Applicant* Qlat-y1 ter? 04&4ulre Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down � r CITY OF IOWA CITY UNESCO CITY OF LITERATURE Advisory Board/Commission/Committee Application Form C?P)s This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. Advisory Board/Commission/Committee Name Liee kd-v Date of Application Name Home Address 25 32, Ba kl& � w.* 4.?,� t,0" Contact phone number ,3d 542— 4733 Email Address A4d& - fes, Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa -;+ 9 Y 1!t%S Occupation: ,S'1/(�fJj rC11)Gender: Male Female _� M Experiences and/or activities which you feel qualify you for this position .. pD �Geyi�ad�l What is your present knowledge of this advisory board? /1 `7 d -/L' Mjkph AUAC%^ 51�I.t�rDHsl OA m edlIj aft a,/j V/ Z,-, s -T6 i U�%e C 4�1J` ��' a N &,u Vjje lee ej Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Potential Conflict of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision–making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, agreement with respect to the proceeds of the federally–assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, member of a city Board or Commission from having an interest in a city contract. Section 362.5 City Council Resolution #15-300 established a policy that the following persons shall not be eligible for appointments to Boards and Commissions. A council member's spouse, domestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, poster child, persons who are parents of the same child, and persons whom the employee is in an intimate relationship. Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissi*©js at the same time. You will be asked to resign from one if appointed to another. =-7 Do you currently have a conflict of interest? YES NO -�N... List potential conflicts of interest (See last page for information regarding conflict.gfnteftst) Please indicate if there are none. ca r"a Do you currently serve on another Iowa City board or commission? YES__ NO—Z If so which one do you prefer? The City Council values all types of diversity on its boards and commissions. Your responses on this page provide valuable infonnation to the Council in achieving that goal. In order to ensure that the board and commission is representative of the community and the groups(s) which it serves, please provide your information for the following: Age 52 Country of Origin 1511 DI y, Sexual Orientation r1A e Religion Do you have a disability? YES NO t -- Race, Color or Ethnic Group����_� *Note: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise finance and one person who receives rental assistance. (Resolution) Signature of Applicant* 4d— Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Contact information is attached. ! L Item Number: 15.b. I r , CITY OF IOWA CITY UNESCO CITY OF LITERATURE September 18, 2018 Senior Center Commission - One vacancy to fill an unexpired plus a three- year term, Upon appointment - December 31, 2021. (Kathy Mitchell resigned) ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Crawford, Kathleen -Application Goldsmith, Zachary -Application Olmstead, Harry -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION One Vacancy: Unexpired plus a three-year term Upon appointment - December 31, 2021 The duties of members of the Senior Center Commission are to: • Serve in an advisory role to the City Council with regard to needs of the Senior Center; • make recommendations with regard to policies and programs at the Senior Center; • join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center; • encourage full participation by senior citizens in the programs of the Senior Center; • ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens; • serves in an advocacy role with regard to the needs of senior citizens in Iowa City. • The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, September 11, 2018. An application can be completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the City Clerk's office. Questions about the Iowa City Senior Center Commission should be directed to LaTasha Deloach Senior Center Coordinator at 356-5225. Board/Commission Application Cover Board/Commission: Senior Center Commission One vacancy to fill an unexpired term plus a three- year term Upon appointment -12/31/2021 It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council Announcement Date: 8/07/2018 Application Deadline: 9/11/2018 Council Appointment Date: 9/18/2018 Date of Non -Gender Appointment: 11/7/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: None Current Gender Balance: Female:3 Male: 3 Gender Name and Address Female Crawford, Kathleen 401 Hawkridge Dr. Male Goldsmith, Zachary 721 Kimball Rd Male Olmstead, Harry 1259 Shannon Dr. Apt #102 Senior Center Commission - Current members Name Term ending 7tyearsa, resident of IC Occupation Gender Age* Countryof Orgin* Sexual Orientation* Religion* Disability* Ethnicity* Gender Identity* Race* Unique Identifiers* Lorraine T. Dorfman 12/31/2018 -Unexpired.. 48 Professor F 81 USA Heterosexual Jewish Caucasian Margaret Reese'JC Rep 12/31/2018 F Vacant Unexpired + 12/31/2021 Kenneth Bowen 12/31/2019 -Unexpired 3 Retired Telephone Co. M 66 USA Heterosexual Western European - White Hiram R Webber 12/31/2019 -1st Term 40 Retired M 71 USA Chronic Sciatica CheryllClamon 12/31/2020 -2nd Term 41 Retired F 72 USA Heterosexual Caucasian Robert Finlayson 12/31/2020 -1st Term 24 Attorney M 47 USA Heterosexual Christian Caucasian Please note: The information provided is the information provided on the application at the time of submission. * Information is voluntary Preliminary Minutes June 21, 2018 Senior Center Commission Attendance Record Year 2017 Name Term Expires 8/17/17 9/21/17 10/26/17 11/16/17 12/14/17 1/18/18 2/16/18 3115/18 4119/18 5/17/18 6/21/18 7/19/18 Kenn Bowen 12/31/20 X X X NM X X X NIM X X X X Cheryll Clamon 12/31/18 X X X NM X X O/E N/M X X O/E X Lorraine Dorfman 12/31/19 O/E X X NM X X X N/M X X X X Robert (Scott) Finlayson 12/31/20 - - -- -- - -- - -- X X O/E X Mark Holbrook 12/31/18 X O/E X NM X Kathy Mitchell 12/31/19 X X X NM X X X N/M X X X -- Margaret Reese 12/31/17 X X X NM O/E X X NIM X X X X Hiram (Rick) Weber 12/31/20 X X X NM X O/E X N/M X X X X Key: X = Present O = Absent O/E = Absent/Excused NM= No meeting — = Not a member __4 Advisory Board/Commission Application Form .2 ! p 7a�It+� This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 2/18/2018 First Name Kathleen Last Name Crawford Home Address* 401 Hawkridge Dr City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-594-1123 Email Address karhyuiowa25@gmail.com Boards & Commissions Select a Board or Commission you are interested in-* Library, Board of Trustees Select a Bo u are interested in: Senior Center Commission Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City? 10 3. Occupation: * Health Professional 4. Gender* *This question is rrandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" nay be provided in the Dern:)graphics sectionof the application below. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* I have worked with many diverse groups through graduate school and the community. I have organized student academic fairs: graded assignments via ICON; and lead biology discussions. In addition, I have organized a health professional organization, where I solicited speakers, gained funding for a office, and mentored students. I have worked with various technologies and advised about policies and procedures. 6. What is your present knowledge of each advisory board you are interested in?* I believe that the University libraries and public libraries are outstanding offering a plethora of services for citizens. I hope that it can accomplish as much as possible for the next generation. The senior center I am aware of some of its activities in technology and social events. In addition, the human rights board, I have seen events that deal with atrocities in the country. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. t.;lty c;ouncll Kesolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest? * ini 8. Do you currently serve on another Iowa City board or commission? No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 10. Country of Origin 11. Sexual Orientation 12. Religion 13. Do you have a disability? 14. Ethnicity 15. Race 16. Gender identity *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. 2'1 CITY OF IOWA CITY UNESCO CITY OF LITERATURE Date of Application 8/10/2018 First Name Zachary Last Name Goldsmith Home Address* 721 Kimball Road City IOWA CITY State IA Zip Code 52245 Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for the public This application will be considered for twelve months only and automatically considered for any vacancy during that time. NOTE: Must be 18 years of age and live Wthin city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319-383-6832 Email Address* zachgoldsmith95@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) "Select a Board or Commission you are interested in: (/ Senior Center CommISSIO 2. How long have you been a resident of Iowa City?* 39 years 3. Occupation: Teacher 4. Gender* "ibis question is mandatory in order for the (Ity to comply with the State's gender balance requirement, which treats gender as binary. "Crider Identity" rray be provided in the larrographics sectionof the application below. 17 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I feel that I bring a wealth of knowledge about Iowa City to the table. I've have spent my whole life here, and have many connections throughout the community. For the Police Commission I would bring a unique perspective, and would hope to make sure that there is justice being served for populations that feel underrepresented. In terms of wanting to be a part of the Senior Center Commission, I have always felt a great connection to the Senior and Elder population in my life. Time spent with them is time well spent, and if I can help to make their lives a little bit better then I would like to work to do that. 6. What is your present knowledge of each advisory board you are interested in? I know that the Police Commission was set up after the untimely death of Eric Shaw. I would believe that the Senior Center Commission helps with the running of the Senior Center after reading some of the past meeting notes. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federallyassisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 42 10. Country of Origin United Stated of America 11. Sexual Orientation Straight 12. Religion Jewish 13. Do you have a disability? No 14. Ethnicity Jewish 15. Race White 16. Gender identity *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* ryfa,•t�l e,.'CC` d >rrn-0 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. q' 4. :. li� f��'�+t Advisory Board/Corrinvssion Application Form This application is document a public and as such can be reproduced and distributed for the This public. application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live Wthin city limits of Iowa City to apply Date of Application 8/14/2018 First Name Harry Last Name Olmstead Home Address* 1259 Shannon Drive, Apartment 102 City IOWA CITY State IA Zip Code 52246 I. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-855-2666 Email Address* Harry03@aol.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Library, Board of Trustees Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation: Retired Teacher 4. Gender* `This question is rrandatory in order for the City to corrply with the State's gender balance requirement, which treats gender as binary_ "C ender Identity" may be provided in the Demographics sectionof the application below. 67 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of Masters. Teach for America 1991 - 1974 Special Education LD & BD. I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2 years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun - committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa Olmstead Consumer Task Force 5 years (/year as vice -chair & 2 years co-chair of Medicaid Privatization sub- committee. 6. What is your present knowledge of each advisory board you are interested in?* Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens and City Council. I have given a presentation to the Iowa City Senior Center Co!mission also I've attended 3 years of the annual report and public forum of the Iowa City Police Review Board. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibilit)4 mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 68 10. Country of Origin United States of America 11. Sexual Orientation Straight 12. Religion Quaker 13. Do you have a disability? Yes Please explain: I'm a person with a right above the knee and and use a power wheelchair for mobility. 14. Ethnicity United States of America 15. Race White 16. Gender identity Male *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* t � ej;? 04wdaze Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down