Loading...
HomeMy WebLinkAbout2010-03-02 AppointmentI 29a NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION One Vacancy -Four Year Term March 1, 2010 -March 1, 2014 (Note new expiration date) Duties: To exercise all the powers granted to cities and towns under Chapter 330 of the Code of Iowa, except the power to sell said airport. To annually certify the amount of taxes within the limitations of the Statutes of the State of Iowa to be levied for Airport purposes. All funds derived from taxation or otherwise for airport purposes shall be under the full and absolute control of the Airport Commission, deposited with the City Treasurer, and disbursed only on the written warrants or order of the Airport Commission. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Airport Commission meets the second Thursday of each month at 5:45 p.m. Applications must be received by 5:00 p.m., Wednesday, February 17, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Airport Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION One Vacancy -Six Year Term March 1, 2010 -March 1, 2016 Duties: To exercise all the po ers granted to cities and towns under apter 330 of the Code of Iowa, except the power to sell said airpo To annually certify the amount oft es within the limitations of the Statutes of the State of Iowa to be I vied for Airport purposes. All fu ds derived from taxation or otherwise for airport purposes shall be un er the full and absolute contr of the Airport Commission, deposited with the City Treasurer, and disb rsed only on the written w rrants or order of the Airport Commission. Iowa City-appointed members of boards nd commissions mu be eligible electors of the City of Iowa City. The Airport Commission meets the sec d Thursday of ea month at 5:45 p.m. Applications must be received by 5:00 p.m., Wednesday, F bruary 17, 2010. The City of Iowa City encourages diversity in the appointment of citize to boards nd commissions. Persons interested in being considered should contact the City Clerk at ity Hall, 10 E. Washington Street. Application forms are available from the Clerk's office upon request o on th City website at www.icgov.org. Questions about the Iowa City Airport Commissio s uld be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Aif$Ct , • u u . •.~ January 21, 2010 A~E~RQRT ~~#MMISfJ~N ATTENDANCE RECORD YEAR 2010 NAME TERM EXP. 1/21 2/18 Greg Farris 3/1/13 X Minnetta Gardinier 3/1/15 X Howard Horan 3/1/14 X Janelle Rettig 3/1/12 X John Staley 3/1 /10 X NAME TERM EXP. Greg Farris 3/1/13 Minnetta Gardinier 3/1 /15 Howard Horan 3/1/14 Janelle Rettig 3/1 /12 John Staley 3/1/10 KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member 2 December 7, 2009 aIIRRI<'31~tT GE~i>~ANItE~lf~~1 ATTENDANCE RECORD YEAR 2009 5/6 5/21 6/18 7/10 NAME TERM EXP. 1/8 2/5 2/12 3/12 4/2 4/14 4/16 X X X X Greg Farris 3/1/13 X X X X X X X O/E O/E O/E X Minnetta Gardinier 3/1/15 --- --- --- X X X X X X X X Howard Horan 3/1/14 X X X X O/E O!E X X X X X Janelle Rettig 3/1/12 X O/E X X X X X X X X John Staley 3/1/10 X O/E X X O/E OIE X X NAME TERM 7116 8/20 9/17 10/15 11/19 1217 12/17 EXP. Greg Farris 3/1/13 X X X X X X Minnetta Gardinier 3/1/15 X X O/E O/E X O/E Howard Horan 3/1 /14 X X X X X X Janelle Rettig 3/1/12 X X X X X X John Staley 3/1/10 O/E O/E X X X X KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member 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: January 12, 2010 Application Deadline: Wednesday, 5:00 p.m., February 17, 2010 Council Appointment Date: March 2, 2010 AIRPORT COMMISSION One Vacancy -Four Year Term March 1, 2010 -March 1, 2014 Term expires for John Staley Jose Assouline ~ 814 Camp Cardinal Rd Steve Crane ~ 765 Kennedy Parkway Nolan Klouda ~ 309 Finkbine Ln Apt 9 ODenotes applicant completed the Confidential page of the application. City of Iowa City _ ~ r _,~iy ^ ' • ~ '~~`~r P rM Advisory Board/Commission/Committee ~,,-~ .;~'~~ '' oplication Form ~-"-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name AsEe~rl+r~e--- /~+' r-po r-t- t~rnrv.; s ~ or Term 6 years Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: c~ Signature of parent/guardian: ~'z ~- "°`~'~ G,..~ ~ ~-.~ ~„ C7 ~ N NAME Assouline a ~vs~, -=-~~-y N s+- HOME ADDRESS 814 Camp Cardinal Rd ~~P ~246~ aTr-~T- e~- Isyour home address (listed above) within the corporate limits of Iowa City? ~ des c~ No How long have you been a resident of Iowa City? 32 years OCCUPATION Professor of Engineering/Scientist EMPLOYER Uof I PHONE NUMBER: HOME 319 338 7423 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: As a professor and engineer I have experience in the administration of technical entities. I have been involved in a number of committees on the welfare of the University. I have also been involved in city and state issues. I am currently the president of a couple of condominium associations and the Iowa City Jewish Federation. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I believe that the Airport is an important element in our community both in terms of economy in commercial opportunities. As a result members of this committee ought to be knowledgeable in public affairs and have some +r~hnical knowledge. I think 1 fulfill both criteria. I have been peripherally in this airport during my involvement eriment on the flight simulator and in collaboration with Prof. Tom Schnell. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I think I could participate positively in discussions concerning the airport's financial and public reports. I might be able to understand the technical aspect of the demands/needs of the airports day-to-day activities. I will always try to 'provide a fair and balance opinion. In addtion, because of my interest in the community and the well beefing of the economy of our city, I have been involved in various aspects of the city's activities. At the Univers~', I am usually recongnized as a good adminstrator. ca ° ,,,~ c' ,~. :t> r~ ~ ...... n -~ env ~~ ~' -" ~~: cn POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. ' articular, if you are applying to be a member of a board or commission which makes recommendations tothe 1,,,~/ Council about the allocation. of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING ~~~®~ CITY OF IOWA CITY Name of City /~- , Board/Commission/CommittseAsse~-e- ~:1 f i~cr~ ~c rr. nti-- ~S; c r~ Date Nam~ssouline T~X„C.- Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Jose and Susan Rental Inc. 814 Camp Cardinal Rd, Iowa City 52246 ECG Academy Inc POB 2976 Iowa City, IA 52244 N Q au~~ rv -' 1~ c, . ~. .. cn NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. ~ _ Applicant Signature Signature of parent/guardian (Youth Address 814 Camp Cardinal Rd fission only): Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 City of Iowa City + r i Advisory Board/Commission/Committee #;~r ; ~'~~ ~~ '.pplication Form -~-~-- C1TY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY. VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Airport Commission Term 3/1/10-3/1/14 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Steve Crane HOME ADDRESS 765 Kennedy Parkway ZIP 52246 Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes ~ No How long have you been a resident of Iowa City? 16 years OCCUPATION Bank market president EMPLOYER First American Bank PHONE NUMBER: HOME 319-331-9306 BUSINESS 319-688-9300 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: In my current profession as well as non profits I have served on, one of the larger responsibilities Ihave been assigned is balancing the budget(s) and allocating funds responsibly to meet that goal. When I was on the Iowa City Housing Commission I was an active participant in the allocation process. N d ~ O ~ ~ -*, ~ ~ ~ .... -=t c ~ -- ~~ r~s ~° ~o Misrepresentations on this application will constitute just cause for removal of ara appoir~'t'~e. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My knowledge of the advisory board is they are responsible to make decisions on how the appropriate funds which have been allocated for the airport are to be distributed. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I feel my experience as a banker would help when reviewing the financials to see if there are additional efficiencies or revenue sources that could be considered. As an air force veteran and as a neighboring business to the airport I have an interest in the longevity of the airport and would be an active participant. I understand the neighborhood as we are located across the airport on Highway 1. I interact with. many of the other business owners in the neighborhood and I feel having a active, nearby business person on the commission would be helpful. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe _~ry Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. o A c~ -~ _. =-~ c-~ -- f---. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~® (~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION?~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) ', Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Airport Commission Name Steve Crane Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached {see page 6). NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional busi Applicant Signature G,~.,,,~-ems Signature of parent/guardian (Youth Advisory Commission only): Address 765 Kennedy Parkway ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer atl the questions, Council. may not consider your application. ~~~.®~i1 ~t ~i(I~~~`S -•-~a.a~ CITY OF IOWA CITY Date 02/10/2010 General Application January 2010 Page 3 of List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner; 5% or more of corporation's stockholdings). Please indicate if there are none. r~ t '~a ~ ~. ~.a ~~~ ~ ._~ Individuals serving on SoardslCommissionslCOr??mittees play ar3 important role in advisirZq the Cou~?ci! on t?'iatteY~ ~~ Is?~~fEx~~ i~ ~~~i` i:C~?`~it~tk~li~~ ~~'~ its ~~#t,~r~?. ,L?L~i#~ c~~+® ~tibl5~ !~:a,d~ ~tl 'z~tttlc~ +~:pt~. ~-r t`-~~$P.." vaE,~!;C~# a~ ~ieei? ~~fiol.i#?~'~t~, ~~':*~` t.'")Is:r'Ci3 #'P~lej~~i~ III %~pp',4~:ai(~?rls d't r.i?~ t~~ Vv~rF4 se~.s=on. ? ~P c?~#.i~~st`~~F_~li~'nt i ~ ~ ,,~ "#~ ?1f?;~~ ~c.:+;`ti't~[ - t.'t.ii~ ii 3~i't~~t~?`#C: r-;~=t?%}#;:~~~~s `~.f~tr:~ 3~ 1~~5~c~Ii1 vC7![#fi~i--~-i~, T ~?iS +Ca~s`jl wt ~'~ ?alli..U LJVt ~il"E±#4-S G(9!Y {~~4~{~.?~ `k3 +".~°"--.~ ~3 ~,I~°„E~S'! .t?t~ tJ~3t+. Ip#.3 C.}Y 4fi ~4LG~, ~~1 ~.s'`S..il`iJrtiL.~a$#~tt e~}L~1 j`- ri~."`~. i.d ril t$IC~., iF^41 ~' fGyy f e~~~~r6:uC~t€~~~~'~~ v1~SY ~rle~i<.~ Y:. L:° E. v~t~°~#~#~iiAi.~Ji~ ~!.., I~bva L.s r~y~. if..3"~-+~. THIS AI'PLICATIC~Iv IS A PI~I3LIC i~~CIsMEIvT ANi~ AS St_1CH C;AN 13E REPR~GUCEu ANu UiSTRISi~TE#U F~i~ TtiE PI.iBLIC. WITH THE EXCEPTIGN fir= THE LAST !AGE MARKED "CQNt=ti7ENTdAL.`' THIS APPLICATION Wll_L_ Fil<i";C!t~ISIUI=R~I~ FAR THREE Iv~)I~THS cu?I~L~` A,l'~L) A= sT~~1i#AT ICKi I:~' ~ ~~}~IS11~3~REC~ Fi.JF~ ANY VAt:,ANCY Dk_)RIN~~?`HAT TIME. p .^+~\/: J':: #~• SJ~C~"~~af~L''#~t'~I~.~,;:i#~'?il~..•d~J #~'i??#;_tF`~ "4 ~ti?~ _ _ ~_ _-. ~o~&tr~'1 At~l~~fi v` C~iTil~~lt3~ (,~l?c#l ~ ~;~t ~~ I??Cj' l`iei~ # ~ ~ ~~~f5 t.,~ aC~ ~I the i3t?"i2 C)~ a~IlGail~~3) tilu` +;?t~° ruf i~~§~c"5 %.'#~ y~ Hip#? ~?°I?.~~o! t°?C r;i{~6,3 •s :r`~?~s'~# ~.t~i,?s.`s~!~'~'~~ a®,,.,~..~_.®~.~~.. _.._.._. ~T1 D -~ ~ -~ - -. - _-~- ____. _~_ __~- - '~i ~ y ~~ N,t3I`y~ E ~ , ~--, . _._,_. _s__.v_._ ..___..,, _ . _- _...__v_r..,_. ---~-, IS ?ir~~#?- I'IOri`~ ~d(~f~?~c {I;fitE'd a~G'4~p) `;~J#tlli-~ '~~~ ,:~~rr~±:~raie Iii(?3IS ~~ It~4~~~i a;t~j i `ft~y I-Io•d~r Ior;g Dave yo~# I~eei? a reside#?~ of lo~a City r - ______~_ __ C: ~;~.. u r~AT 1 G N .~ j ~' ~~: ~-'T` _.~.~ ____ E l1/! P L~'Y E F~ ~+-t^NE N1.11i11BEF': `y~~v~E _~ __~__ .cam--, ~_~ ~! o EXh ERIENGE ANDiC~R ACTIVITIES \NHICt-I ~'(.:~iJ FEES C~~ALIf=Y ~`~U FAR THIS P~SITI~N: ry c~ ,~ ~}r t , s~ ~' ~ >_ _ r _e t,. - r7 e ,!C_e r (~ ~.~i'ir3~ .r tit.~t rr 4, ui.. '3 eTi,-.. ~i ~`'_~~ ,CS ~~ _ _ at_c e`i.. ~ .. _ __ --_ i ~ r .. a ,.... esS_--i -°. . ."R!t_ F t['t "?.i oe L ti--3`- € 3 ~ --.~ - ,.~ _ rl. r-.- ...- 1- ~ _~ .. . _ _.. . e ~ ... .. - ~. . ._ _ ~ v ,6 _, -. ,.~ r - _ , a - - .. . _, - ._. a a ° h ~ t r ~ n s re ~ ,y ~ ~ { ;^rr, t-, ;.^• ;f ~ I J! ai`i c`~'~` #•` v 4 i :'- .. ~ ~ ~` is L~ ~ ~ i i~iFc?`Z{p1~~vr':t~cit+~,?v ~~+ ~:i!~i al,,ps~.at#+., J~;a `..~~:' a.i_3t~. Fu~_ .c Uft3~ v' 4.t+~_. Nr= 4Zs ~; tyS~~,>„~~e ~?( ;~: _. ~~.p=..ii..ctii;#?~. ~„~;t;?`"•i ;?"` 14 t;'h `,:a•~`;~r' .~ ., ';'~l~i" ~~~3[C;ti~J~#. -~ . i~~,~A 14 ~`Ct,~l~ Pl~z ~.®~~ ~ (.';~~~,v`l~i ~~; ~.~ ~, ; ~;~ ~., t' ~;4~, ~ ~r~".~=.s, ~ 4cnc],~, :gip !~ts!la.f~f`'s~mn,sC~;#nC? eX,? rtc~C ~#~~s,rn~J~ aa_Er~,d,ris~~ n~ ~. -~-~ fr~`~s~ ~ ~~ qtr:r,~~~~i s=,a`~n ~!~ ~?-i~KC deCiSii;,S fr;t~af::lr?~ tfi~ s's-{f'rdIIC~`rl o Ts~3ii~~. UVHAT CCNTRIBLT°~~JS Dt3 ~'~J ~-~EIe ~~~U CA1`~ ~rt~AK~ T{? THIS ,~;1/ViSt~RY" BC,G~D (C)~? STATi= I h~V~ ttft[71N~et~~e ni ~+€~, e~i~?a~'i~'s~~~ irs, tec8~ g~ refrirt~~}?i ac'~r~i~?IStC~sE~~n th~fi I cep ~~e~nl ~I~}~1f1 n c~isi~~ts~iarls. I I ~oi;tteve I can ptavEde ~ ?resn pets~;ei,t.~e us ,~e,i. Alin ~;~~~ ; ~~~:~ s~isl~, nva~r tc' ;rye liar ~ uit~ area, , Itsre ;-tear the airport u~: ° ~ ur' uc `'a ii itYV `hn ~}?~^ma a *ti; I ' a `=ff::Ui I°-v" r-`r'f r +h~ ry r't~.i~.^ # rc 4 lr; " r "': iui: itu ! r<et - E .~ rule tl'v'".. St ~~' i - :~~: ~i,,,.,Ci~~~. ~?., IVi; .~.t ~~' ~~ t, Y..r :.~,s.: !['i-.; ..5. u ~z.t, cst b "~'v~,u~y t I trfi~~fSt~,r ?~C~t~ro #~i~ :~~~:r-~r~Str~t!`~~~° ~~ pCis~ ~~ ~,i FiaS Cq ?S=~e4- N O C3 ~, =<~ -~ ~~ ~. ____ - - -_-c:~ -~~- i PC3TENTIAL CCt~l~l_iC ~ ~ ~~ I~T~I~~sT ~ w Please idenfiify a-~y potential conflicts bet~nreen n~er~bership on the advisory board ar~~ your personal ~nteres?;~ytncludsna tt~sanc~al inte,e~ts ~r~a ;t~ui du~!es to a;; er?~~~oyer. !o ir'ttCUlar, if you are ar,oiytng to Erc a rrr~:mr?er Cpl a ~oari7 ar carnrn~sstan wrrit~tl C2`laKeS r~car~~rrlen~lat~arrS tCthe C,. Council about tl~e allocation of City Bands, Tease list any present affiliations you have with agenciesthat apply far t+.rnUint~ ifCvt41 u~..e vity. fir:+~da I~3:'l" rli:.uCles ~'J~Iri~ c~',-ward r~eE1i~~ ~€'r~~g~al~*' at site r3~Bn~:~.SJ~tiei types of affiliations must be examined on a case by case oasis by the Cit-y;~tiorney's office. ~'(au shauld also know that Section 362,5 afthe Code of laws t~erreraiiy prohibits, with certain irraportantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6'r. 1f you are uncertain whettaer a potential carafiict of interes exists or i`ra~~e t~uestions about Section .362.5 of theCode of fovea, please contact the City Attorneys office at 356-503i~, ~T r ~, `'.. i h ~ ~ ~~ Y',~'~4..1 APB ~.=s'~ ~:^..i==.~. ~ E~. ~~:~ Y~_}~.~ ~'Vr~~I i TC ~3~ s ~ '~T'~=I~~; ~'_ ~~ ~ ~1; 1 t ~~~~ ~{~~,,.~ ~i~;'*.~i"~ ~' ~ ~!°".~I~ ,°.h~ r ~ i j`,."`~ ~^, ~/ fj:1)^ ~ 3 1' =~j~l~,~'~j ~~~~~-•' ,~ ~i','i1v1~ .r-_.(e,l~a ? _ ~~ ~ ; 1~;0 ,_..~ ~ f:_ t.'r tom: a~ -- .L, o st., v ,~:-1 i, f ~It S,~v' ~e~}t iC-.'Urty p.+.r,v +}{ i?VL ti: N~~f'.li~i ~~ ~.6kE .~ll~i~l v4 ~pti~Y GY .,r .a t i L..v,~ ~}~ V .. ._ 3if ,~.."iaJ,v~~v sri ~~ ,.., v4~n!.~~ t~f~,?~.~ f! ~-_ __ ~__ . _ - r._ ._ r _ ~~ T 1 y =st [- {! ~v y `^ rr_ ~ ;r S F .: t -.ice f' t .. -5 <'= ,=.r ... gf r~3' ~ ~~ ~ 1 ~~~ ti=,l..kr~-"sl. ...a i C. r~~I..t i .~tE ~, 4 ~tl i"1~CS ~._ J, a„ ~/ v ? ..;,~:.,a V. ~3. f,r~.,.. .,. ~.G. ~`.t ,Ct. ~' # " ~' "' i.; s,i -E``. r,,,,i~i '~~,°j E"3t. ~ ...,,i,~!(" -, ,It: ~., -~ i .~,_r~#.:i !~~ -_--~ Ge~~reral A~ipl€c~~t€i'~' _ Name of City BoarciiComrr~ission;'~`o;~rnittee Airport E:.Or?'irztissiort Name =~~:a~z ;^=;~u~ date Section 3t~2.5 of the Code of lourva generally prohibits, with pertain important exceptions, a member of a city Board or Commission from haying an interest in a city contract. A copy of Section X62.5 is attached see page 6j. ~IC)T~: A new form must be completed if the above information chances or an ®wnership interesti5 ac:luired in ar? additional businAss. Applicant Signature, Signature of parent;'guardia,~ ~`~outh ,advisor}j Co~r~rr~issic~n only). Address 3C?9 l=in~hine ! n. ,A~t, g ~----_______~__a.__ ______--- i ~,I 1~~lisrepresentations on 'this applicatiot ~ ~~viil constitute ust cause for ren~~aval of an appointee. if you fail j . tt~ a~?swer all the rauest~ons, Cour;cil may €~ct consider yt~ur application. _~ General A.pplicatie~r? ~anuar~r ~~~~ ~a,~e .;, ~f ~' List all bi;sinesses in which you, your spouseidomestic partner, or parent if'~'outh Advisory Commission app{icant, have an ownership interest for example, sole proprietor, partner, 5~1~ or more of corporation's stockholdings;. Please Indicate if there are nave, Page 1 of 1 2~~., Marian Karr From: Jay Murray [jaymurray123@gmail.com] Sent: Friday, February 26, 2010 10:36 AM To: Michael Tharp Subject: Recommendation Mike, I would like to recommend Steve Crane for a seat on the airport commission. Thanks, Jay A. Murray 319-551-2151 Cell Iowa City 3/1/2010 Page 1 of 1 ~~ Marian Karr From: dgordoniow@aol.com Sent: Friday, February 26, 2010 12:22 PM To: Council Subject: Airport Commission Seat To the Iowa City Council. Please accept my recommendation for Steve Crane for the seat on the Airport Commission. I have known Mr Crane for several years as businessman in our Community and I believe he will be an excellent commissionor. Best Regards, Dennis Gordon Gordon Aircraft, Inc Iowa City, IA 52240 319-351-8659 2/26/2010 29b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Unexpired + 5-yr Term Effective Upon Appointment, ending December 31, 2011 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 0 Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:OOp.m., February 24, 2010 l~Denotes applicant completed the Confidential page of the application. 03-02-10 29c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Five-Year Term January 1, 2009 -December 31, 2013 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 0 Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Five-Year Term January 1, 2009 -December 31, 2013 Term expires for Dennis Keitel No applications as of Wednesday, 5:OOp.m., February 24, 2010 ~ Denotes applicant completed the Confidential page of the application. 2sa NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-Year Term January 1, 2006 -December 31, 2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the Ciry of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www. icgov. org. Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: September 20, 2005; November 1, 2005; December 13, 2005; January 23, 2006; February 28, 2006; March 21, 2006; April 18, 2006; June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2006 -December 31, 2011 Term expires for Mark Anderson No applications as of Wednesday, 5:OOp.m., February 24, 2010 ~ Denotes applicant completed the Confidential page of the application. 29e NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-yr Term January 1, 2010 -December 31, 2015 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www. icgov. org. Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: September 15, 2009; November 2, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2010 -December 31, 2015 Term expires for Brian Sponcil No applications as of Wednesday, 5:OOp.m., February 24, 2010 ~ Denotes applicant completed the Confidential page of the application. 29f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Five-Year Term January 1, 2009 -December 31, 2013 One (1) Mechanical Professional It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 5 Females: Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 BOARD OF APPEALS One vacancy -Five-Year Term (1) One Mechanical Professional January 1, 2009 -December 31, 2013 Term expires for Tim Fehr (Mechanical Professional) No applications as of Wednesday, 5:OOp.m., February 24, 2010 ~ Denotes applicant completed the Confidential page of the application. 29 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: CIVIL SERVICE COMMISSION One Vacancy -Four-year Term April 5, 2010 -April 7, 2014 Duties: Approve all entrance and promotional examinations used by the City of Iowa City; holds hearings involving employee discharge or reduction in rank or compensation and ascertains to the best of its ability the facts of the case. After weighing all evidence, takes action as provided in Chapter 400 of the Code of Iowa. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. Members of the Civil Service Commission must be residents of the City of Iowa City preceding their appointment. The Commission meets when deemed necessary. Applications must be received by 5:00 p.m., Wednesday, February 17, 2010. 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 Civil Service Commission should be directed to Karen Jennings, Personnel Administrator at 356-5025. BoardlCommission: ~~l Seti~~ Commission ATTENDANCE RECORD YEAR 2009 (Meeting Date) NAME TERM EXPIRES 7/07/09 10/22/09 11/13!2009 L ra Dickerson 4/5/10 X X X Bill Cook 411/13 X X X Elizabeth Cummins 4/4112 X X X KEY: X = Present O = Absent O/E = AbsentlExcused NM = No Meeting ._. = Not a Member Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 1 Council Announcement Date: January 12, 2010 Application Deadline: Wednesday, 5:00 p.m., February 17, 2010 Council Appointment Date: March 2, 2010 CIVIL SERVICE COMMISSION One Vacancy -Four-Year Term April 5, 2010 -April 7, 2014 Term expires for Lyra Dickerson Lyra Dickerson ~ (Currently serving 4th term) 324 Post Rd ~ Denotes applicant completed the Confidential page of the application. City of Iowa City ~ ? 1 ~~.®~x Adviso Board/Commission/Committee ~~~"',~``~~ rY ~` nplication Form "'`-"~ CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Lyra W Dickerson Term 4/5/10 - 4/7/14 Youth Advisory Commission (shall not be more than 18 years of age at the time of appNication) Name of Iowa City High School or high school equivalent: °- Signature of parent/guardian: ~~''~ '~ ~~ ~ ~~ NAME Lyra W. Dickerson r C~ 545 HOME ADDRESS 324 Post Rd. Iowa City - ~ 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? 41 years OCCUPATION Sr Asst Director, University Human Resources EMPLOYER University of Iowa PHONE NUMBER: HOME 351-7567 BUSINESS 335-2721 EXPERIENCE AND/OR ACTIVITIES WHICH YOU .FEEL QUALIFY YOU FOR THIS POSITION: I have served on the Iowa City Civil Service Commission since April 1990; am currently serving as chairperson. I have 35 years of Personnel/Human Resources experience with The University of Iowa and two years of HR experience with Iowa Work Force development. My primary duties in my current position include the interpretation and application of the Regents merit rules and the collective bargaining agreement between AFSCME and the State of Iowa/Iowa Board of Regents. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am currently serving as the chairperson of the Iowa City Civil Service Commission. I understand the testing and selection processes for both the Iowa City Fire Department and the Iowa City Police Department. I have chaired peal hearings stemming from disciplinary actions taken by each of these departments. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE o~ocnni ~nR APPI YINC;h My knowledge and experience with the application of EEOC regulations, federal and state employment laws, the labor contract between AFSCME and the State of Iowa/ Iowa Board of Regents allow me to bring professional expertise to the matters that are presented to the Commission. I am well organized and have a record of conducting focused, productive meetings and hearings. ~ ~ ~ ~~ ~ c~.~~ c~ ...- ~ ~ ~ ~ vQ 0 ._. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. articular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. None of which I am aware. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committe~~a W. Dickerson ~~~.®~J CITY OF IOWA CITY Date pIaSI~ Nam~yra W. Dickerson Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None r.~ c~ c~ ° ~ ~ ~ ..~.. ~ N !"° ~ 1 -~~ '~ Q ~ -~ -- U~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature c~ Signature of parent/gua an (Youth Advisory Commission only): Address 324 Post Rd. Iowa Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 29h NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HISTORIC PRESERVATION COMMISSION Three Vacancies -Three Year Terms March 29, 2010 -March 29, 2013 (1) At Large Representative (1) Summit St Representative (1) Brown St Representative Duties of the Historic Preservation Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions; furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. This Commission meets the second Thursday of each month at 5:30 p.m and, if necessary, the fourth Thursday of each month at 5:30 p.m. Iowa City appointed members of the boards and commissions must be eligible electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, February 17, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Historic Preservation Commission should be directed to Christina Kuecker, Associate Planner at 356-5243. 1 /14!2010 HISTORIC PRESERVATION COMMISSION ATTENDANCE RECORD 2010 NAME TERM EXP. 1114 BALDRIDGE, THOMAS 3/29/11 O/E BAKER, ESTHER 3/29/12 X DOWNING, WILL 3/29/10 X EUBANKS, LINDSAY 3/29/11 X McMAHON, DAVID 3/29/11 X MICHAUD, PAM 3/29/12 O/E PONTO, JAMES 3/29/10 X SWAIM, GINALIE 3/29/12 X THOMANN, DANA 3/29/11 X TRIMBLE, ALICIA 3/29/10 X WAGNER, FRANK 3/29/12 X KEY: X =Present O =Absent O/E = Absent/Excused NM = No meeting/No Quorum -- = Not a Member ~ zoox n ~ m u n Z ° u D ~ ~ p ? N y ~~ ~ m ~ ~ ,'~ ~~m coo cn cx, ~Zc o ~ Aa c 0 2 ~ z m ~ m ~ -~ o30 r m ~ n D -~ 3 D z v z D cn 3 - v D m ~ p - `~ D cmn 3 D c v D 3 3 ~ z v ~ v = c3 = n ? D ~ c z ~ cn r v D ~ °o z z ~ ~ ~ D ~ ~ = ~ D ~ v ~ m _ 3 D a m N W (N`D N W CN`D O C` ~ -- ~ -~ N ~ ~ ~ O ~ O ~ N ~ tN`D ~ -~ ~ ~ ~ --' N ~ ~ -~ N C`O ~ O w N (`D -~ N w N t~D ~ ~ .~ m m ~ ~ 3 x x x x x ' x x x x o ~ x x x x x ~ x x x x w X X ~ X X ~ ; O m X X X X w N x x ° x x ~ x x x ~ m x A w x x ~ x x x x x x x O m X ~ X X O m ~ ; X X X X N °° x x ~ 'm ~ m ~ m ~ ° s x x x x °' O m x = x x m x x x O m x ~ ~ x x x x x x x ~ x x w x x ', x x x x x x ° x c x m x m x O x x ~ x x x ~ x ~ x x O s x m x x N -~ D~ ~~ m~ z r^ vN Dm z~ c°o m .D.~ m~ nz o~ 0 v3 0 z .~ >( ~ X X X X O ; ~ X X X c Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 5 Council Announcement Date: January 12, 2010 Application Deadline: Wednesday, 5:00 p.m., February 17, 2010 Council Appointment Date: March 2, 2010 HISTORIC PRESERVATION COMMISSION Three Vacancies -Three Year Terms March 29, 2010 -March 29, 2013 (1)At-Large Representative Term expires for Alicia Trimble James (Jim) Ponto 618 Brown St Kent Ackerson O 617 Brown St William Downing 411 S Summit St Alicia Trimble ~ 2232 California Ave Nolan Klouda 309 Finkbine Ln, Apt 9 (Currently serving 1 St three-year term) (1 )Summit St District Representative Term expires for William Downing William Downing ~ (Currently serving 1St three-year term) 411 S Summit St (1)Brown St District Representative Term expires for James Ponto James (Jim) Ponto D 618 Brown St Kent Ackerson ~ 617 Brown St D (Currently serving 3~d three-year term) ~ (Currently serving 1St three-year term) (Currently serving 3~d three-year term) D Denotes applicant completed the Confidential page of the application. City of Iowa City _ I, r 1 . t~`rj r p"1~ Advisory Board/Commission/Committee ~,~~'~~ , ,~plication Form ~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Historic Preservation Comission Term 2010-2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: a © ° Signature of parent/guardian: ~~ ~ ~ r ~t -~- ~'"ME James (Jim) Ponto HOME ADDRESS 618 Brown St Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? since 1978 OCCUPATION nuclear pharmacist/professor EMPLOYER University of Iowa PHONE NUMBER: HOME 338-5802 BUSINESS 356-2741 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I am completing three 3-year terms on the Iowa City Historic Preservation Commission, representing the Brown St. Historic Distict. Although I do not have a background in art history/architecture, I have learned a lot during service on the HPC over the past 9 years. I love living in a historic house in a historic district, and I am a strong advocate of historic preservation. On the other hand, I understand and appreciate limitations and restrictions that historic renovation can involve. Hence, I am a proponent of HPC, especially through its publishing guidelines and personal interactions with city HPC staff, providing education and consultation to property owners early in the planning process. 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. :-~ -- ~- =~ ~ u' ~ ~m x~ Yep` ~ No General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am completing my third 3-year term on the HPC. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I love living in a historic house in a historic district, and I am a strong advocate of historic preservation. I strongly believe that historic and conservation districts are aloes-cost mechanism to stablize, and often improve, neighborhoods and individual property values. On the other hand, I understand and appreciate limitations and restrictions that historic renovation can involve. Hence, I am a proponent of HPC, especially through its publishing guidelines and personal interactions with city HPC staff, providing education and consultation to property owners early in the planning process. ,,,, a o ° ~~ ~ ~ ---~ ~ ,.~ -~ c~ cn :~'~ ~. ~1 ~' ~ ~~' POTENTIAL CONFLICTS OF INTEREST ~ ^' 0 Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. ' articular, if you are applying to be a member of a board or commission which makes recommendations tothe Cary Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. no conflicts of interest IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Historic Preservation Comission ~ r ,~w,~'~ -+t.ai~ CITY OF IOWA CITY Dat@1 /14/2010 Name James (Jim) Ponto Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS none N c o ..~-- Z" ---4 ~ cn ~ r°' ~~ .~; Q NOTE: A new form must be completec~.if`th~bove information changes or an ownership interestis acquired in an additior}al~usiness,~( Applicant Signature- Signature of parent/gu Address 618 Brown St (Youth Advisory Commission only): Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 City of Iowa City ~ r i Advisory Board/Commission/Committee ~' ~--"';~"~'~~ ~` oplication Form -~-~- CITY OF IOUVA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Historic Preservation Commission Term 2010-2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Q c~ o Signature of parent/guardian: ~~~' w y~~~ C'? -' : 1 ~...~ NAME Kent L. Ackerson --ate ~ ~ ~'-' rn A HOME ADDRESS 617 Brown Street ~~p X245 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? 47 years OCCUPATION Physicist (semi-retired) EMPLOYER University of Iowa PHONE NUMBER: HOME 319 337 9021 BUSINESS 319 621 3735 (cell) EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: My wife and I have lived at 617 Brown Street for 36 years. We take pride in our neighborhood and enjoy older houses. We have maintained and improved our home over the years with an eye to retaining the character of the Brown Street neighborhood. We were both born in Iowa (she in Iowa City). My 90-year-old mother still lives on a Century farm in southwestern Iowa (Red Oak). I have a deep and abiding interest in preserving our heritage and passing it along to those who follow. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My neighbor, Jim Ponto, is completing a term on the Historic Preservation Commission. Work on our house was reviewed and approved by the Commission. I have reviewed the "Duties of the Historic Preservation Commission" on the website of the City of Iowa City. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I have a strong interest in preserving the character of the Brown Street neighborhood and of the City of Iowa City. I have ample time to devote to the work of this Commission. This town has provided for my family for many years and it is time for me to do my part toward keeping Iowa City an attractive and pleasant town. N d -r'1 ~~ ~ ~_~ ~ ~ r ~~ ~ -sue POTENTIAL CONFLICTS OF INTEREST ~, Please identify any potential conflicts between membership on the advisory board aid your personal interests,including financial interests and your duties to an employer. I~ articular, ifyou are applying to be a member of a board or commission which makes recommendations tothe C,..,~ Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. I have no known potential conflicts of interest. My son, Kristopher Ackerson, is an Assistant Transportation Planner with JCCOG. I do not see this as a potential conflict of interest, but mention it in the spirit of full disclosure. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~/ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Historic Preservation Commission Name Kent L. Ackerson ~ r -~a.a4_ CITY OF IOWA CITY D at@2/04/2010 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Ackerson Consulting, LLC (sole proprietor) 617 Brown Street, Iowa City N d `t? r'*~ wr (~ °~`t. ...} t" ~ ~ ~ .~r.A c.D NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additiona~usiness. Applicant Signature. Signature of parent/guardian (Youth Advisory Commission only): Address 617 Brown Street Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 City of Iowa City ~ r 1 ~~.®~r Advisory Board/Commission/Committee ~~,--"',~'~~ "nplication Form -~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Historic Preservation Commission Term 2010-201 Youth Advisory Commission (shall not be more than 18 years of age at the time of a~ication) Name of Iowa City High School or high school equivalent: °~~, -; Signature of parent/guardian: c~-~ - ~ -s rn NAME William T Down HOME ADDRESS 411 S Summit Street ~~ ca ?~ ~'LI P Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes How long have you been a resident of Iowa City? 32 years OCCUPATION Architect -o ~ ~ ! 5340 No EMPLOYER Rohrbach Associates PC PHONE NUMBER: HOME 358-9949 BUSINESS 338-9311 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have served one full term on the comission previously. I am an architect and I am an owner/occupant of a home within a historic district of Iowa City. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application December 2008 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am a current member of the Historic Preservation Commission WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As a I am a resident of one of the Historic overlay districts and an architect I feel I have knowledge and experience that will be pertinent to discussions of this commission. N O 0 ;~ O r'r~ ~ --3 p .~ C? -~ -~ ~ -~ Oti i~ i ~ r~+ "a g ~~ I ~ `t7 a ~ ~ r p~ 'a.~.~ ~/ ~' N .~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. I articular, if you are applying to be a member of a board or commission which makes recommendations tothe C,~.y Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 of the Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail +o answer all the questions, Council may not consider your application. General Application December 2008 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Historic Preservation Commission Name William T Downi -+t.a.._ CITY OF IOWA CITY Date ~~~~ -~U Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. s-- Applicant Signature ~ ' ~ Signature of parent/guardian (Youth Advisory Commission only): Address 411 S Summit Street Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail +o answer all the questions, Council may not consider your application. General Application December 2008 Page 3 of 7 List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. 02/17/2010 WED 11:39 FAX 319 364 2994 Rep, Da~rid I,oebsack X002/005 City of Iowa City ~ r 1 ~~~~ ^dvisory Board/Commission/Committee ~'~~"';~~ ~-pplication Form "~--- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important rote in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers_ This form may be filled out manually (please use a~ black ink pen), typewritten, or electronically (PDI=). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory BoardlCommission/Committee Name Historic Preservation Commission -At Larat~ Term 3/10-3/13 Youth Advisory Commission (shalt not be more than 18 years of age at the time of ap~cation) Name of Iowa City High School or high school equivalent: o -` r' ~; Signature of parent/guardian: ~~=`r w NAME Alicia Trimble .,~~ g-,"; a" nJMEADDRESS 2232 California Ave, Iowa City, IA ~~~ 540 Is your home address (listed above) within the corporate limits of Iowa City? 0/ lies ©No How long have you been a resident of Iowa City? 5 years, 7 months OCCUPATION Congressional Aide EMPLOYER Congressman LoebsacklFederal Goverment PHONE NUMBER: HOME (3331-5113 BUSINESS (319)364-2288 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION' 1 currently serve on the Historic Preservation Commission. I also sit on the board of Friends of Historic Preservation and am a member of the Iowa Historic Preservation Alliance. Previous to my present career I studied archaeology and was a teaching assistant for the 2004 excavation of Plum Grove and an intern in the White Mountain Apache Historic Preservation Office in 2000. My employment has allowed me to be versed in federal, state, and local laws regulating historic preservation, proposed historic preservation legislation in both the U.S. House of Representatives and Senate, historic tax credits, and disaster recovery involving. historic structures. I am also currently completing a masters of public administration where I am currently working on a thesis which examines the effect of historic preservation and local zoning on the recovering and rebuilding in Cedar Rapids, IA 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. neral Application uecember 2008 Page 1 of 7 02/17/2010 WED 11:39 FAX 319 364 2994 Rep. David Loebsack WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? 1003/005 t currently sit on the Historic Preservation Commission and have a good understanding of its duties and ponsibilities. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I currently serve on the Historic Preservation Commission where 1 have participated in a number of activities, including the preparation of grant proposals, training opportunfties, and preparation for the Historic Preservation Awards. I have enjoyed those opportunities and look forward to similar opportunities in the future. ~..~ 0 0 0 ~ -~ D ~~ ~ .~.. t-s -d' ~.~ ~. ~~ i~ ~ ~.=. .~ N POTENTIAL CONFLICTS OF INTEREST Please identify any potential con#licts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. tiarticular, if you are applying to be a member of a board or commission which makes recommendations tothe _y Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation"'includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attomey's office at 356-5030. I am a federal employee and may have to recuse myself from any votes involving direct federal funding. I have held my current job since the beginning of the term I am can-entty serving and thus far there have not been any issues IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMM1SSlON? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on iwo 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. neral Application December 2008 Page 2 of 7 02/17/2010 WED 11:39 FAY 319 364 2994 Rep, David I,oebsack BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Historic Preservation Commission -At Larae ~J 004/005 ~~®~ .w.®~~~ ..~..~ CI~IY OF IOWA CITY Dat®2/17/2010 Name Alicia Trimble Section 362.5 of the Code of lawa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. Applicant Signatu Signature of parent/guardian (Youth Advisory Commission only): Address 2232 California Ave, Iowa City, IA 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- neral Application December 2008 Page 3 of 7 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Indlvld{.gals ser~ring on BoardslCommisslor?s,%~`omrr~lttees pla~J an important role !n adVlsing the ~ouncll ors r~~atte~s at interest to our corr~munity ar~d its ;afore. Applicants must t~eside irs Iowa City. After a Lr~3~'ancy has bee-; ann~-uhce~, tl`?e C ~~u!~cil reviews all applications c~u~~it~g the work session. The appc~intrrent is rracle at the next #orn"ia! ,ouncil meeting. Appoi!stees serve as ~~rRpaid volunteers. This #orn~ may be #illei out manually please use a black ink per;, typewritten, or electronically (PL;Fj. return the application to :,ity Clerk, 41 Cs E. l'~~ashingtor St., lo~va City, Iowa. THIS AF'PI_ICATION IS A PUL~t.IC DQCUMENT AND AS SUCH CAN EiE REPRC~DtJCED AND DISTRIBt.JTED EQR THE PIJBLly. 'JUIT'-? THE EXCE°TlON :~F TI-'E ! ,AST pd,GE ;VlAP.KE'D "rQNFIC?ENTl~tL." THIS APPLICATION 1/\/11_.l„ REC;C3NS1(~lERED Er~R THREE ~/I(~UTHS nNl Y ANC ,A f. ITC~I~IIs~,TICAI_IY f~(,~'•N~In~RFC1 ~f~R ARIY \jA(~A_N(,Y DURIP~G THAT TI~;1E. 5-F ~~~;cr~ nn !"';_l lartit_s ~~.~ ~t_,C({1~1~lJiij{!.IsCi(jsa'?~L•fi lei f!ltteC "v.i{j"t t- rii~.i:-:i i~iYa,W: ureiii:e; _. V: {~a r-_. ! i_ T~.~~l f-; _ wn~`nwn Mouth Advis®ry ~c~rarr~issian {shall not. be more than ~ ~ years of age: at the time of pplicaticn) i~al~le of Iowa City High School or hig'i=, s{1~1+001 equivalent: ~ _ -_ a ____ Signature of parent,~c~uardian; ~?~. ~ ~< NAI~~ ~ioiun (~i4una i-ii~ME 1!~L'RESS 309 Finkbirte Ln Is your home address {listed above] within the corporate limits of Iowa City % l~'Yes ~ No ~iow long have you been a resident of Iowa City? ~ r;~c=~i~t s7 __._- OCCtSP'.ATlC3N Customer Service A en _ Ten~r ora Ei~1PL®YER A~= ~ . +~~~~ ~~G~l~ "V"~3ER: l-l~"J'~ - - -~v tic I`v~t1e : ~ ~ !~ - BUSINESS EXPERIEN%~E AItIL?1t~R R.CTI~`ITIES WHICH v'C~IJ !=EEL ~`t.IALIEY'~'C~U EuP~. THIS POSITIC)-~: i have a BA in History #rom Gustavus Adolphus College in St. Peter, MN. In addition, l have worked in the field of historic preservation: l spent a summer as an intern ~rrorking on the National Register a# Historic Places with the National Park Service, and I served for one year as the coordinator an oral history project in Fairbanks, AK. I have an ongoing interest in history and historic preservation, as well as interest in local government administration. The tivork of this commission represents an intersection between these interests. l also have a k~aster's degree in Public Administration, with an empl-lasis on Local government management. Fi ~israpresentatir~ns on this application kvill constit;.~te just cal.lse #ar rernravai of an appointee, if you tail I; - I to answer all the gaestions. Council may r~:;i consider your application. , __~ ------ ~er!er'al ,Al~~licati+~r? .Jan~~a~; 1gii~ Page ~ o` 7 9 ,~. ~~ -r ~~ ~-- ~~I P-v~~~ t g. rT -.~ - ~ ~ 3--ii l ~r ; ~. ~'_~- isti. r~s~ ~~°tr i - The Historic Preservation Carramission conduc?s studies concerning sites of historic interest. It is dedicated to preserving properties with historic value, and conducting the necessary research. Vv`Flt?T Ct:~~dTR13CT14;l~iS P;C; Y~tJ FEEL Y~tJ CAIN l~~Al<E TCi TI~iS A~~yiSC~RY B~P,R~ ~C}R STAT E ~i=a~~N PAR r~PPf_`ylf~t~i~ 1 have excellent research skills, and will be able to make substantial contributions to studies on historical sites. I am ;well pos'stioned to evaluate the research of others, and provide a fresh perspective. As a person with loos! 'government administration experience; I understand the administrative perspective as well as the preservationist 'mindset. I hope to serve the Iowa City community in this capacity; and play a small part in preserving someN~f the town's Iheritage. ~~ m °~~ -~ w ~® ! ~ -~ ~ ---a c'a :~~ -~ _,.. ~~ ~.L F"~LlT~l~~l k lAL lr+J143"L_I~ i ~ l1!" 11`~TE.I~~S~I 'lease identify any potential conflicts bet~~~eer n,en?bershi{? or? tl?e ad1ris~?ry board and your persona! i ritedsis,!i~vEL4 (.i eti~ a~n C"d e~i~tr~i Sn~~Gr~siJ ono y~vi.3r U\a Lis lL3 gee i~~:vy a.i= In ~rticular, if you are applying to be a member of a board or commission which makes recommendations tothe C._ :,ouncil about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the aaency.Other types of off=.liaitons must he examined or! a case by case basis by the City Attorney's office. You shauid also knowthat Section 362.5 of the Code of Iowa generally prohibits. with certain importantexceptions, a memb,,er of a city Board or Commission from having an interest in a cit}J contract. A copy ofSection 362.5 is attache:.3 ~C4vP ~anR] ~~ If you are uncemain whether a potential conflict of interest exists or have questions about Section 362.5 of +i,Q('nde of laws. alease contact the City A.ttarney's office at 356-503rD. 1F Yt~l~ ARE r.1~T SELECTED, D+C 1' std `~JA1~4T r ~ BE ~`•llO~i"It=1ED % ~ 1''es ~ Uo C~~ `~'t~U Ct.IRREN~i<Y SER~!E Ol~l Al~1CTHEf? l~`a~A CITY 13~ARD OR C01~11i'~11SSIC~N? ~ Yes 0 No (it has been Council policy not to pertrit an individual ?ij serve Ln tw~c ~oa~~ds or Ccrt~rr~issit~ns at the same tune.} ~ c~ ~ `~ 'l ~1 iAC ~'t Cfet i 44 t f Yc,r ~ n i f t ~, 1!1tis.epr~s~,nta~~orss d~~ this application :;ill c.,n.,~~~ute Luc. cause ,or .~..rav~l of an ap~,ointee. a. you fa.l ;I i t~, ans~~aer ail the q!~esticns, Council ma not consider yo~.~r application. I~ i~ ~Jer~eral A~;~licatio: Jar;uarv 2: 0 F'aae 2 of 7 r, .,_ ~, _ ,_ _ _ ~ ., . _, _F . ~'~~ _ ~_ ~ .., ~ - ~ , _ _ .~ _ _.... ~~ t~ _ ~ ~ ~ _ ~ _ _ . ,..N_,. ...__.-_.. .. LL..._ ._ _._._.~ a-, ..,~.... .. .._ _. .. ..~ ~ .- sq. .. s ___-_. __-.. ~ e.~~~ e~~~...~~~__._ bi. h.~. r"aC i-.f,P' :it Y'rr'r~ dl na .: ~~..~ ,. {~F~~ ,. ~~f., ~ ry}~ r^ F T °,js-~ {"'?'^.': ~.3~~!~~ };-,F^' ~~1'..~ ..CST^r~x^~~,. c.. .r.. ~ ... ... ~ _..., _. _.. ,..,. ._J..~ : ,.~ ...~ .:. - - r- 1. ~... ... ~... _. _-_~-___.~.____,~....~._._.._~__~.___»._..~..._.~_..__.. ..~ ~ l .> ?_3 ~... ~'?-l~,=a~}~?.J~i Lli PSbi .. _.__..~... -.._..,.._.. _,.,~. ..._..-___..._.... ~<~?°~rC~Ft'.',.'v.~?~i•~~ii..,..~'_ i:~' t.,`..`' e~Lr:°~,.~x~'-.1#~ ~J~J~tI ~.~5s~t?itl~~j~l,"~~'. r3 aL.^:v,° 't_3! ~Y,'.ry. iy.e? _F± t:~.;i C'~4.f~~ifli.~.C' ':1 ~V~1'-_1 ~:~ff to ct}?~`sf+fE°!' c~°si {1 i~' !"`•,t i~~~x~i ~S. ~~Ju~; ~i~ s~r..3.~~% r~.~~ v~ t iS9C7?( VrJ~i~" ~~"~:?~~r.~~€O~ . 03-02-7 0 29i NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: POLICE CITIZENS' REVIEW BOARD One Vacancy -Unexpired Terms Effective Upon Appointment -September 1, 2012 Duties of the Police Citizens' 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 eligible electors of the City of Iowa City. However, the City Council reserves the right to waive the residency requirement for good cause shown. The City Council also reserves the right, for good cause shown, to waive the requirement that-the Board include one current or former "peace officer" as that term is defined by State law. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. 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 Police Citizens' Review Board should be directed to Marian Karr or Kellie Tuttle at 356-5041. 1!26/2010 ~~OyC zz~~ro o ay-~ ~, ~ ~ ~ ~ ~~°°° ~ = ~ c °~' ~ ' a ~ ;~ _. =~ ~ ~ o~ ~ ~ w a ~ ° , a ~ ~ ~ ' - k~ ro~z~ (.,) W w N y ~l O ~ ~ ~ ' ~ 3 3 3 ~ ~t ~ ~ ~ w 1 1 1 1 y _ ~ ~ ~d ~ ~Y ~• ^Z l l Q ~/ O ~d O n y r l J 1y~ J O !C 7~O~C zz~y~ ~ ~-~~ ~ = ~ ~ ~ ~ ~D to "'! ~D C o G ~ o Q ~ ~ ~ ~ ~ ~ t o , i y ~ y < °• z ~ ~ ~ a s ~ a' ~ o va o o ~ ~ b 7~ w w N ~C ~O N ~ ~ ~ ~ ~ w N ~ ~ ~ ~ ~ ~ C W i i ~ ~ ~ X 1 1 z 2 Zz 2 2z A i ~ 7 ~ r~ y ~y ra y ri y y a y a _ A i i ~ ~ X X X i i '~ '~ '~ '~ ~ 00 1 z z z z z i ~ ~, ~ 3 3 ~~ 00 X X k ~ ~ I~ O ~ ~ j j O 1 I ~ ~ 0 W \ N F~+ \_l z z z 1 1 z z N 3 3 3 ~ ~ 3 3 ~ ~ ~ i ~ ~ H t~ ~ "~ d ~ ~Y ~• z M~ M `/O~ ` J v ~~ O 0 r I^~I l 1 ^~ l l y r~ r l J fN ~~y W O U Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-.law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Female: Council Announcement Date: January 25, 2010 Application Deadline: Wednesday, 5:00 p.m., February 24, 2010 Council Appointment Date: March 2, 2010 ** Appointments to the Board shall include one current or former "peace officer" as that term is defined by State law. The City Council reserves the right, for good cause shown, to waive the requirement that the Board include one current or former peace officer. ** The City Council also reserves the right to waive the residency requirement for good cause shown. POLICE CITIZENS' REVIEW BOARD One Vacancy -Unexpired Term Effective Upon Appointment -September 1, 2012 Abigail Yoder resigned Peter Jochimsen D 1010 Woodlawn Ave Daniel Talton ~ 320 S. Gilbert St Royceann Porter D 136 Appanoose Ct D Denotes applicant completed the Confidential page of the application. City of Iowa City ~ r 1 ~~=~ Advisory Board/Commission/Committee ~' -"'~"~'~~, i ~~1~~ Application Form -~-~- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Retum the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/CommissionlCommittee Name Police Citizen Review Board Term ends 9-1-2012 Youth Advisory Commisslon (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Peter R. Jochimsen 7ME ADDRESS 1010 Woodlawn Ave. ZIP 52245 Is your home address (listed above) within the corporate limits of Iowa City? ©Yes ~ No How long have you been a resident of Iowa City? 35 years OCCUPATION Suroeon EMPLOYER Retired/Self employed consultant PHONE NUMBER: HOME 319-351-6649 BUSINESS Medical leoal consultant EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Along career at the University of Iowa, and Chief of Surgical Services at the VA, as well asvice-chairman of the Department of Surgery for a time, provided me with ample opportunity to partidpate in and lead numerous committee meetings, often with multiple contentious points of view and equally strong willed persons all convinced of the rightness of their position. This was certainly true, as an example, of the Iowa City Deer Task Force. Twenty two and more years as an active Naval Reservist, as a Senior Captain, gave me the opportunity to participate in Captain's Mast, a judicial hearing involving an accused and a legal authority. My civil trial work as both a plaintiff and defendant's medical expert witness has given me great experience in trial work and in appreciation of fact gathering and of testimony. o d Misrepresentations on this application will constitute just cause for removal of anoir}~e. If fail to answer all the questions, Council may not consider your application. n,"! CQ neral Application ~, ~ ~ ~ uanuary 2010 Page 1 of 7 ~' -= w WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Knowledge is based primarily on newspaper reports and other Haw's outlets detailing the activities of the Board and interactions with citizens of Iowa City and surrounding areas. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As 1 am now retired from my University career as Director of Surgical Oncology and as Professor Emeritus in the Department of Surgery, I have the ability to devote more of my time to civic duties. I have served in the past on the Historic Preservation Commiisslon and, as well, the Deer Task Force. I am familiar with the operations of Advisory Boards, Commissions, and Committees. I appreciate that the opportunity to serve is a privilege. With recent issues raised concerning and dealing with the Police Department, and other law inforcement agencies, within the community, interacting with the members of the community, a great need exists to enhance and encourage the 'dialogue occurring between the two, to reach a better and more comprehensive appreciation of the difFculty (,experienced by the people and law inforcement. The very long time I spent acquiring credentials to practice surgery, 'a small rural college, medical school in Milwaukee, and more than seven years in Minneapolis for my residency, have; provided me with a good understanding of the issues related to students and many of the difficulties that seem to exist in a University environ. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. In particular, if you are applying to be a memberof a board orcommission which makes recommendations tothe amity Council about the allocation of City funds, please list any present affiliations you have with agenciesthat ply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). N If you are uncertain whether a potential conflict of interest exists or have questions abo~Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. °~~, rn ~ I know of no conflicts of interest. c7-C - ~--- -=~ c~ ° :<r ~• f~l ~ ~ o ~ _ t"°') IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ©Yes ~ N~.' DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer ail the questions, Council may not consider your application. neral Application ,lanuary 2010 Page 2 of 7 ~ r ~ ~~= ~ BOARD, COMMISSION AND COMMITTEES ~-*`1°~~~ BUSINESS LISTING ..,..~_ CITY OF IOWA CITY Name of City Board/Commission/Committee Police Citizen Review Board Date 02/10/2010 Name Peter R. Jochimsen Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please Indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None r ~ ~ ~yim. ~~ .r.` r ~`` NOTE: A new form m acquired in an adyt+fr6 Applicant Signatures Signature of parent/gua plated if the above information changes or an ownership interestis Commission only): Address 1010 Woodlawn Ave. 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. neral Application January 2010 Page 3 of 7 City of Iowa City ~ r i r- - Adviso Board/Commission/Committee ~' =' ~''~~ rY ~®~~~ Application Form ~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/CommissionlCommittee Name Police Citizen Review Board Term Youth Advisory Commission (shall not be more than 18 years of age at the time of pplication) Name of Iowa City High School or high school equivalent: ° ~ '*1 Signature of parent/guardian: apt ~ i NAME Daniel James Tallon HG. ;ADDRESS 320 S. Gilbert Street -, . . :<~ m ~ o~~ ~ ~1 P ~L240 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? 3 1/2 Years OCCUPATION Soldier /Server PHONE NUMBER: HOME 563 271 9747 EMPLOYER Iowa National Guard/ Atlas l Jimmy Jack's Rib Shack BUSINESS N/A EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: My biggest life experience is my nearly Four years service in the Iowa Army National Guard. Although I have a long career ahead of me, I have learned many lessons in that time, the formost being professionalism, integrity, and service. I served as a member of my Church Vestry for several years and represented my church at our diocesan convention. I donate much of my time to the political party that I am a member, and donate my time to the Central Committee. I also rely on my life experiences to from a majority of my opinions and perspectives, these expereiences include growing up in a very diverse lower income household, which has become the backbone of my view on life, and the sole reason I so often search for ways to serve. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail t~ answer all the questions, Council may not consider your application. General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The PCRB is charged with reviewing Iowa City police policies as well as complaints against officers employed by the city. The PCRB recommends action the City Council. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I believe that I would be an excellent choice for this position because, I would carry out my duties in a professional manner and contribute my personal experiences to the board. I very likely differ from other choices in age, Socioeconomic status, and life experiences, but those difference would be my biggest contribution. N ~_ O ~ ~~ N ---t =G ~ ~ ~~ ~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City ~uncil about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowfhat Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail t~ answer all the questions, Council may not consider your application. General Application January 2010 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Police Citizen Review Board Name Daniel James Tallon ~r i ~;~~~`~ -n.as__ CITY OF IOWA CITY Date Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor; partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS -- O ..~, ~ -'` `'~ ~~~~ ti b .~,' ~- ij .~ y (~ ~`C.) NOTE: A new form must be completed if the above information changes or an owragrshii erestis acquired in an additional business. ~` ;, Applicant Signature ~'~~ ~ --..._~ za~ Signature of parent/guardian (Youth Advisory Commission only): Address 320 S. Gilbert Street Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail +~ answer all the questions, Council may not consider your application. General Application January 2010 Page 3 of 7 Page 1 of 1 Marian Karr From: Mark McCallum [mccallum_mark@hotmail.com] Sent: Tuesday, February 23, 2010 3:01 PM To: Council; Mark Subject: Police Citizens Review Board Candidate ,Dan Tallen Council Members: Dan Tallen will be making an application for a position on the Iowa City Police Citizens Review Board. I met Dan last fall during my candidacy for council and while our "World Views" are somewhat at odds. I found Dan to be very bright, alert and very capable. The characteristic that stands -out in my mind about Dan , is that he is a man of his word. Whenever Dan tells you he is going to do something, he does. I think this is one of the most important things an individual can have in our society today. Dan exhibits compassion for his fellow man , is a critical thinker and it is without reservation that I recommend him for a position on the Citizen Review Board. You will find Dan of the highest integrity-conscientious, truthful, and loyal. If I can be of any further help or assistance, please do not hesitate to call. Sincerely, Mark McCallum 932 East College Street, Iowa City, Iowa 52240 Cell 1-319-430-1461 Hotmail: Powerful Free email with security by Microsoft. Get it now. 2/23/2010 City of Iowa City ~ ? j Advisory Board/Commission/Committee ~' -~"'~'''~~ ,. ww®~~ . pplication Form ~- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name I ~ ~~ Term Youth Advisory Commission (shall not be more than 18 years of age at the time of app~ation) Name of Iowa City High School or high school equivalent: ~~-~~-~,~~ c~ Signature of parent/guardian: ~-- ~ -t _.~ r"~ "' 4ME Royceann Porter ~ „° HOME ADDRESS 136 Appanoose Court ~1P Is your home address (listed above) within the corporate limits of Iowa City? /^ Yes How long have you been a resident of Iowa City? 19 years OCCUPATION Community Liasion EMPLOYER Four Oaks PHONE NUMBER: HOME (319) 354-8633 BUSINESS (319) 721-8915 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Because I work on a daily basis, experiences that I have had, some negative, some positive, many resolved in a effective way. I believe that my experiences in helping disputing parties come to consensus when in conflict. I feel competent and confident in my ability to work with people in resolving conflict. Many of my activities related to my position as Community Liasion have provided me with the opportunity to be involved in the lives of children and .families in a positive manner. I feel that my job as Community Liasion gives me access to conflict resolution whereas I have sat in interviews with youth and parents with the Iowa City Police Department and I have also had the opportunity to sit in mediations with families who are housed with the Iowa City Housing Authority. 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. r~ -~ 520 No General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My present knowledge of the Advisory Board is that they will be listening to concerns of citizens regarding the Advisory Board that attempts to build relationships between the police department and the community. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? My contributions would come in a way of being knowledgeable about the Iowa City community, being able to add to the Advisory Board some skills and abilities to work with all people and that I believe that I do have strong communication skills that will enable me to help the Advisory Board with the decision making process. N O O i "~ -p-{ ~_ :~ ~.- -~ r ~. N ~`+ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe ~~cy Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions; Council may not consider your application. General Application January 2010 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City ~C~2 Board/Commission/Committee ~~~®~1 j~Ra1{0~ CITY OF IOWA CITY Date 02/24/2010 Name Royceann Porter Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS .~ N f~ .~-- ~' -o w z°a -~, rv I°_' ~~ ~ ;~: .. NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an adnal business. Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address 136 Appanoose Court Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 3 of 7 29' NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION One Vacancy -Three Year Terms March 13, 2010 -March 13, 2013 The duties of the Telecommunications Commission include serving as a review board to resolve disputes between any subscriber or potential subscriber and the cablevision company; reviewing and auditing reports by the cablevision company to the City as required by the Cable Television Ordinance; working with the public, the media, the City, and the cablevision company for the purpose of making recommendations on various issues; engaging in other activities pursuant to the effective monitoring and evaluation of the CATV system in the City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m. Applications must be received by 5:00 p.m., Wednesday, February 17, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Telecommunications Commission should be directed to Bob Hardy, Cable Television Administrator at 356-5047. 1 /14/2010 _ ~ ,, ,, ~ ~e~~', COMMISSION 12 MONTH ATTENDANCE RECORD July 2008 to CURRENT d G Ga Ha en Meetin Date Hoerschelman Saul Meikes Bob Kem on or 7/28/08 X X X X X 8/25/08 X X X o/c X 9/23/08 x x x X x o/c X X 10.27/08 X X 11/24/08 Did not meet 12/15/08 X X X X X 1 /26/09 X X X X o/c 2/243/09 X' x olc o/c X Laura Ber us 4/27/09 X X X X X 6/1/09 x x x vacant X 6/22/09 X X X X Mekies 7/27/09 X X X o/c x X 8/24/09 X X X X X X X 9/28/09 X X o/c 10/24/09 x x xx 11 /23/09 x x o/c x x (X) =Present (O) =Absent (OIC) = Absent/Called (Excused) Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 1 Council Announcement Date: January 12, 2010 Application Deadline: Wednesday, 5:00 p.m., February 17, 2010 Council Appointment Date: March 2, 2010 TELECOMMUNICATIONS COMMISSION One Vacancy -Three-year Term March 13, 2010 -March 13, 2013 Term expires for Hans Hoerschelman Hans Hoerschelman ~ (Currently serving 1St 3-yr term) 731 Michael St #20 Dawn Doering-Suter ~ 609 Brown St ~ .Denotes applicant completed the Confidential page of the application. City of Iowa City ~ r 1 Advisory Board/Commission/Committee ~,",~~~~~~ *',wr®~~'~' ~ ~plication Form -.~...._ CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Telecommunications Commission Term 3/10 - 3/13 Youth Advisory Commission (shall not be more than 18 years of age at the time_of appd~¢ation) Name of Iowa City High School or high school equivalent: ~ ° n ~ ago Signature of parent/guardian: ~„~ _ --- NAME Hans Hoerschelman °~ ~~ ~ ~~ ~ HOME ADDRESS 731 Michael St #20 Iowa City, IA `'~ 5 46 SIP 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? 10 years OCCUPATION Application Designer EMPLOYER The University of Iowa PHONE NUMBER: HOME 319-466-1640 BUSINESS 319-335-0132 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have served for almost 3 years on the Telecommunications Commission, during which time I have held the positions of Vice Chair and Chair, whereby I have worked closely with City staff and local Access entities to ensure that community concerns and opinions were understood and expressed to the proper entity. As Chair, I have kept watch on issues relating to the Iowa City cable franchise, the Access channels, and the general telecommunications landscape. Previous to joining the ICTC, I served on the Board of Directors of Public Access TV in Iowa City, as well as a volunteer producer and organizer. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Commission is made of 5 members who internally elect a Chair and Vice-Chair to head meetings. The Commission digests information relating to the City's cable franchise agreement, hears community input, and r -sees the communties 7 access entities. The commission works with City staff to research legislation and other ~. alopments that may impact telecommunications in Iowa City and presents reccommendatsions to the City Council WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I wish to continue on the Commission in order to keep alive those initiatives begun while in my previous term. These include facilitating communication and collaboration between access entities, completion of the Triannual Review of the cable franchisee, development of a 'production community group' for the School's channel content, and continuing to push for changes to Iowa's state video franchising law that bring sensibility to its implementation as well as protection to municipalities against abuse of its intention. It has been a pleasure to serve for the last. 2+ years and I would greatly appreciate the opportunity to continue. N 4 ~ C ~n rn --t n ~' ~~ ~~ POTENTIAL CONFLICTS OF INTEREST ~~ :' '"' Please identify any potential conflicts between membership on the advisory boa d anr`r~your personal interests,including financial interests and your duties to an employer. I articular, if you are applying to be a member of a board or commission which makes recommendations tothe (,..y Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply .for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also knowthat Section 362.5 of the Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy ofSection 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Telecommunications Commission Name Hans Hoerschelman Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS 460 Website Design 308 E. Burlington St #188 Iowa City, IA 52240 N O O '~ ~,,,~ ~ n r- _~ ~ .. NOTE: A new form must be comp) acquired in an additional bu~fi' ass Applicant Signature e above information changes or an ownership interestis Signature of parent/g~rdian (Ybuth Advisory Commission only): Address 731 Michael St #20 Iowa City, I Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. ~~ ,try.--.. p wir®~~i- -~...__ CITY OF IOWA CITY Date General Application January 2010 Page 3 of 7 City of Iowa City i r i~~~ P Adviso Board/Commission/Committee ~;~ ~~'~~ '~ ~®IiO~ pplication Form -~-~-- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL RECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name _ ~ ~ C'v:~~~~~.,,~~ c ~:.hu n 5 `C~n~~ 5 S ~~.~ Term ~J ©lU Youth Advisory Commission (shall not be more than 18 years of age at the tir~~f a ~icat Name of Iowa City High School or high school equivalent: ~=; c~~ n -- ~.... Signature of parent/guardian: ~~ ~`' ~,~,, NAME HOME ADDRESS esi.:~ . ,~- aft ZIP `'J a ~f~ Is your home address (listed above) within the corporate limits of Iowa City? Yes How long have you beenn a resident of Iowa City? , ~~ tr e~rLS OCCUPATION -1 C~~ EMPLOYER `-"'~ PHONE NUMBER: HOME,..~I ~ ~ j ~~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~.~ I~lc-+~- a ~ck~i~~,'~ ~~1 ~-h~c~fi~,r Cvr}'lmwn~~~1-~'~~S• ~ ~~~v~ l~~k~~% ~~~h ~-s-- l~:c~.l ,~~kX~c. ,-~cJ~uc~fi~n C~.~ci ~r~cy..~er~~-e'lf` ~~Ci~-/~S C'~5 C'c~~- F~c.E (,~~~, ~ Ilc.t~~ I.eXY~~~f W~~h ~l~ -k~~-'~ ~'~~ ~tt~lc.i CU-c.~lv~'~Le (~l~d~~rt~~ Ci~n~ f !~ : / lJ~ C~i ~ ~'tCc/~~Ze.IJ • fc3 ~<<~ Cc/'l cl ~~(r.~c<<~~ a ~ f ~c.~: ~ _~ ! ~~l ~t~ ~ Ct~r7 ~~t~~~l y Cyr o~~-~l ~ f ~"~ j ~% ~~r~~ t~l t ( ~c~~, f<~.. ~ f ~(~=e r'l-t~~e., . .-F r"G~ u t (~ -~(.~~ ~{~ ~,~ nr2.() ~'i~CY~t c.,LA ~ l it i~~t l ~c s.~.~ G t ~iJ ~ c sz.. ~i~)~ Ciy~ C J~Yci ~ ~` 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. No General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? l ~ c-t ri ~.# LcJdi~2 r ~ h ~~ /~-max=~ / rt I'i.~~~ G'r t~ C. L.~~:J.. •~= ~1 w~(~" :~,,~y ~ `, t.~-~. CZ ~C!;,~~ ~~ c ~. I~r~c~Q,f~Sft/1c.(crly~ c~ {~ ~L,-e (`c~'1'idr~i .5~ ~ cn`~ ~c:~ C_~. $ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? `7in ci~~~ y ~ ~ ~~ ~~~~ ~ ~~t ~~, (~ ~l1~ ~~ i rt ~f~ C~,~~.n ~ i ~" ~~c j c~r~. r~tv~~1 u~~1O ~- i L ' / ,~~:c~1.5~ ir1 !'~'i rl~C~rn~~y ~vl i~°1 fUii~c.~ G, ~~ z~..~r~, c~n~ Ce Cur~~'yt~~~'/ n ~ c; I cs-E~ 1 <) t ~ i,S,..sl L-~.~ ~~~ f ~~~~~-~ ~1 ~ ~ C~!'1 r~L~~e~ i ~ ~ ~"1 ~-~- C~ ~l ~ncEn, ~f r~ e> ~~-[~~r-c,.~-art ~ ('~~~~~C~~ c~.Y~i ~ ~ ~~ a ~' ~~,~ ~» ~~.~r; ~ ~.~ , ~ {<~, 1. ~~~ ~~;~ ~~' ~'~~~-~~~- l~yuu~~~ , ~'-~,5-I~c~~,~./ ~~~~ {=~- ~=f ~ ,~2c~~l~i /,cJ r~~ ~GI C' ~t~. l ~~ J ~~ lC~~, ~-~. ~{ .~Yt~ ll~ ~'/c~~Ctic ~x~- ~/~ ~ ~n~~.~f' ~ ~- ~~->(s,~t ~ f rcf~:-~~~ ~ ~~1~ ~l ~~~c.t ~~~ ~yc; j~ 1~rr`~ POTENTIAL CONFLICTS OF INTEREST ~a~',~tT~-c~ f i:~,~ Please identify any potential conflicts between membership on the advisory board and your p`er~sonal interests,including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recon~endations tothe ~~ry Council about the allocation of City funds, please list any present affiliations you.have~ith agenciesthat apply for funding from the City. "Affiliation" includes being a board member or empt~ilae of~e agcy.Other types of affiliations must be examined on a case by case basis by the City Attorney'~ces~o ,,,~,~ c-~ -< - Youshould also knowthatSection 362.5 ofthe Code of Iowa generally prohibits, with ce ~timportan eptions, a member of a city Board or Commission from having an interest in a city contract. ~y r~, .Sec 362.5 is attached (see page 6). ©~ ~ If you are uncertain whether a potential conflict of interest exists or have questions~abou~ection 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. Ol,~)~rz-1 .ln f~ id1~.~if ~~ ~l( ~4~e1~~5~.u~e.: ~ ~-+''~ ~ 1~d~s~ r'j~~~:~c.( GAF tc.~.%v lam`-,`-l ~~-~ -V/~~-1~t7 ~~'1 v ~'ch.~lc:~ ~,re.~~ c~~(~ ~/' /~f"h~~-~c~ C: }v~ t~%k~lt~1~ ~ %GC.. ~-~ ~ ~c.~ c.~- ~~,;ti.e.,,-~ t/c;i~..r> CAS cTohn,~.,-~ ~'~~~ eLntq ~tt'Ycnl~Iltul /~.(~~,c~ ~;~, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~'es ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes ~. (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City ___- Board/Commission/Committee \i~lc?.COr~~~i~tiu.n~c~~~c;Y~ ~ Li;}1d1'l~s>~~n Name ~~ )~~~ ~ ~~C~Y' i r~ =~ - ~ JiA ~ r i ~iu1~' ~ wir®~~~ ~....._ CITY OF IOWA CITY Date ~~ ~~J,~C:~l Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS 0 0 .~ -,, -.i t-° -v o~ _" ~ .. 0 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature Signature of parent/guardian (Youth Advisory'Commission only): Address d (~~( I'~~o~..~~ ._~ `~~~.~.:c~ C~t~l ~ i~ ~~ ~d4 ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 3 of 7 29k NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High The mission of the Youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7j members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shalt not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 2 Council Announcement Date: February 10, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High No applications as of Wednesday, S:OOp.m., February 24, 2010 D Denotes applicant completed the Confidential page of the application. 291 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2010 -December 31, 2011 One (1) person -Regina High The mission of the Youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, February 24, 2010. 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 C-erk's office upon request or on the City website at www.icgov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 2 Council Announcement Date: September 15, 2009; November 2, 2009; December 1, 2009; January 25, 2010 Application Deadline: Wednesday, 5:OOp.m., February 24, 2010 Council Appointment Date: March 2, 2010 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term One (1) person -Regina High January 1, 2010 -December 31, 2011 Term expires for Hannah Green No applications as of Wednesday, 5:OOp.m., February 24, 2010 O Denotes applicant completed the Confidential page of the application.