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Boards and CommissionsVACANCIES AND APPLICATIONS FOR CITY OF DUBUQUE BOARDS AND COMMISSIONS For Council Meeting of Monday, December 3, 2001 6:30 P.M., Public Library Auditorium APPLICANTS ARE INVITED TO ADDRESS THE COUNCIL ON THEIR POSSIBLE APPOINTMENT ENVIRONMENTAL STEWARDSHIP ADVISORY COMMISSION 1 Unexpired Three year term which will expire 10-01-04 (Term of Bennett) 1 VACANCY APPLICANT: John Nemmers, 1011 Melrose Terrace APPOINTMENT TO THIS COMMISSION TO BE MADE AT THIS MEETING COMMUNITY DEVELOPMENT ADVISORY COMMISSION 1 Unexpired 3-Year term which will expire 2-15-04 for Census Tract 3 (Vacant) 1 VACANCY APPLICANT: (Census Tract 3) Richard J. Sullivan, 817 Garfield CITY OF DUBUQUE BOARDS AND COMMISSIONS * Denotes Chairperson For Information: 589-4120 REVISED 11 20 01 AIRPORT COMMISSION -4 Yr. Term Meet 3rd Monday 4:00 p.m - Airport John Markham (Council Member) 01-15-02 Rick C. Goodin 09-14-02 Teri Goodmann 09-14-04 *Douglas Brotherton 09-14-05 Jim O'Neill 09-14-05 AIRPORT ZONING COMMISSION 6 Yr. Term - Apptd. 1996 Steve Horsfield (Appt) 01-03-02 Jeffery S. Gaber (City) 01-03-02 Linda Lucy (County) 01-03-02 Janet Reiss (County) 01-03-02 Jeff Stiles (City) 01-03-02 AIRPORT ZONING BOARD OF ADJUSTMENT 5 Year Term - Meet on Call (Apptd.) James Bauerly (City) 02-15-01 Vicki Bechen (City) 02-15-01 Darlene Burds (County) 02-15-01 Ron Koppes (County) 02-15-01 BOARD OF APPEALS - BUILDING CODE Appt. 3 Yr. Term - Meet on Call Ronald D. Jahns (Jrny. Carp.) 08-01-01 F. James Kolf (Arch/Engr.) 08-01-01 Steven J. Gudenkauf (At Large) 08-01-02 Chuck Carr (Gen. Cont.) 08-01-03 Richard G. Luchsinqer (At Large) 08-01-03 BOARD OF REVIEW Appt. 6 Yr. Term - Meet May 1-30 John F. Ganshirt 01-01-02 Ruth Ann Hanson 01-01-02 Donald Lochner 01-01-04 Robert Schaub 01-01-05 Greg Hutchinson 01-01-05 CIVIC CENTER COMMISSION Appt. 3 Yr. Term - Meet 4:30 p.m. 3rd Monday at Five Flags Gary P. Dolphin Cynthia A. Fuller Mark M. Nauman *Michael Brannon Rod Bakke 06-29-03 06-29-03 06-29-04 06-29-04 06-29-04 CIVIL SERVICE COMMISSION Appt. 4 Yr. Term - Meet on Call Loras Kluesner 04-06-02 Richard Wertzberger 04-06-04 * Merle J. Duehr, Jr. 04-06-05 COMMUNITY DEVELOPMENT ADVISORY COMMISSION Meet 3rd Tues. Library 6:00 Harry Neustadt (Housing) 02-15-02 *Michael J. Kelley (C. Tr. 2) 02-15-02 Dan Shireman (C. Tr. 5) 02-15-02 Walter Pregler (At. Large) 02-15-02 Charles Isenhart (Cs. Tr. 1) 02-15-03 Thomas Wainwright (At Large) 02-15-03 Jim Giesen (At Large) 02-15-04 (C. Tr. 3) 02-15-04 Paula Maloy SVM (C. Tr. 10) 02-15-04 ELECTRICAL CODE BOARD 3 Year Term; Meet Every 3 Months *James Dixon (Elec. Con.) 05-21-02 Dan Hammel (Jour/Maint) 05-21-02 Kevin Pfohl (Jour/Main) 05-21-02 David A. Pregler (At Lg) 05-21-02 Elaine L. Reiss (Elec. Engr.) 05-21-02 ENTERPRISE ZONE COMMISSION 3 Year Term Meet On Call Bill Baum (IDED) 2-15-02 Daniel White (NICC) 2-15-02 Mike Van Milligen (Council Rep) 2-15-02 Doug Buswell (At Large) 2-15-03 Dan LoBianco (At Large) 2-15-03 Doug Stillings (At Large) 2-15-03 Charlotte Kamm (Workforce Ctr.) 2-15-04 * Rick Stein (Long Range Comm) 2-15-04 Dave Baker (Int'l Labor) 2-15-04 ENVIRONMENTAL STEWARDSHIP ADVISORY COMMISSION - 3 Yr. Term Meet 1st Tues. 4:00 p.m. City Hall Annex Briana Tully (Youth) 06-01-02 William L. Niemann 10-01-02 Art Sunleaf 10-01-02 Leslee Spraggins 10-01-03 David B. Czarnecki 10-01-03 *Michael J. Buelow 10-01-04 John S. Bennett 10-01-04 HISTORIC PRESERVATION COMMISSION Appt. 3 Yr. Term, Meet 1st & 3rd Thursday, 5:00 p.m., Library Audrey Henson (Old Main) 07-01-02 *Terry L. Mozena (Langworthy) 07-01-02 Christopher J. Wand (Arch/At Lge) 07-01-02 Kenneth C. Kringle (Cathedral) 07-01-03 Jim Gibbs (At Large) 07-01-03 Pamela Bradford (W. 11th) 07-01-04 Suzanne M. Guinn (Jackson Pk) 07-01-04 HOUSING COMMISSION 3 Yr. Term, Meet 2nd Tues. 4:30 p.m. 1805 Central Harry Neustadt 08-17-02 Paula Stenlund 08-17-02 Thomas P. Swift II 08-17-02 Danise R. Miller (Sec. 8) 08-17-03 Dorothy Culbertson 08-17-03 * Jim Holz 08-17-03 John J. Plein 08-17-03 Char Eddy 08-17-04 John L. Henning 08-17-04 David J. Kapler 08-17-04 HOUSING ADVISORY TRUST FUND LCOMM TTEE - 3 Yr. Term - Meet 6x a Year Harry Neustadt (Frm Hsg.) 09-08-02 Doris M. Hingtgen (At Large) 09-08-03 John V. Walsh (At Large) 09-08-04 John Henning (Frm. Hsg.) 09-08-04 * Jim Holz (Frm. Hsg.) 09-08-04 HOUSING CODE APPEALS BOARD 3 Yr. Term - Meets 3rd Tuesday Thomas A. Hannan 01-11-02 Robert L. Sampson 01-11-02 David Althaus 01-11-03 Thomas G. Swift 01-11-03 * Robert Schaub 01-11-04 William J. Kinsella 01-11-04 Edward A. Swift 01-11-04 HUMAN RIGHTS COMMISSION 3 Yr. Term, Meets 2nd Mon. 4:15 Annex Kathy Blau 01-01-02 *Thomas Determan 01-01-02 Ruby Sutton 01-01-02 Marty O'Shea 01-01-03 Charles F. Ryan 01-01-03 Katherine V. Stevens 01-01-03 Raydora Drummer 01-01-04 Judith Haley Giesen 01-01-04 Evelyn E. Jackson 01-01-04 INVESTMENT OVERSIGHT ADVISORY COMM SS ON - 3 Yr. Term - Meet Quarter y Charles Spielman 07-01-02 *Paul Lassance 07-01-03 Hiram Melendez 07-01-03 Gary Ruden 07-01-04 Stephen V. Reisdorf 07-01-04 LIBRARY BOARD OF TRUSTEES 4 Yr. Term, Meets 4th Thurs. 4:00 - Library Sue Lindsay 07-01-03 Kevin Lynch 07-01-03 J. L. Felderman 07-01-05 Michael Shubatt 07-01-05 * Kristen L. Smith 07-01-05 Mary L. Strom 07-01-05 Thomas A. Tully 07-01-05 4/7/95 Dock Bd. Deleted LONG RANGE PLANNING ADVISORY COMMISSION, Meets 3rd Wed., 7 p.m., Lib. Roy D. Buol (Council Member) Terry Duggan (Alt. C. Member) Michael E. Portzen David Rusk Richard Stein *Mary Lynn Neumeister Floyd Schneider Charles Winterwood, MD 07-01-02 07-01-02 07-01-02 07-01-02 07-01-03 07-01-03 07-01-04 07-01-04 MECHANICAL CODE BOARD 3 Yr. Term - Meet on Call Harlan J. Willenborg (Pipefitter) Paul Brashaw (Refrig. Con.) Robert K. Bush (Refrig. Wkr.) (Engr.) *David W. Grothe (Sht. Metal Wkr.) Tom W. Giese (Sht. Metal Wkr.) Todd Geisler (Pipefitter) PARK AND RECREATION ADVISORY COMMISSION 3 Yr. Term - Meets 2nd Tues. 4:30 03-16-00 03-16-01 03-16-01 03-16-01 03-16-02 03-16-02 03-16-03 Library Tom Blocklinger *Thomas J. Schrobilgen Kim Daykin Chuck Duggan Karen C. Lyness Gary L. Harjehausen Paul Hoffmann, D.D.S. PLUMBING BOARD 3 Yr. Term - Meet on Call 06-30-02 06-30-02 06-30-03 06-30-03 06-30-04 06-30-04 06-30-04 Paul Papin (Jrnyman) 11-02-00 (B.S.Degree) 11-02-01 Stanley G. Gonner (Master) 11-02-02 Harlan J. Willenborg (Master) 11-02-02 Dan Harris (At Large) 11-02-03 TRANSIT BOARD OF TRUSTEES, 3 Yr. Term, Meet B month y, 2nd Thurs. L brary. George T. Enderson 07-30-02 Joel Lightcap 07-30-02 Michael W. Sand 07-30-02 *H. J. Bemis 07-30-03 Don Stedman 07-30-04 TV CABLE REGULATORY COMMISSION 3 Yr. Term, Meets 2nd Wed. 5:30 Annex Ronald Tigges 06-30-02 Walter Webster 06-30-02 *Charlie Ellis 06-30-03 06-30-04 Michael W. Pratt 06-30-04 TV CABLE COMMUNITY TELEPROGRAMMING COMMISSION 3 Yr. Term, Meet 1st Tues. 5:30 Annex Anthony Allen 06-30-02 David A. Wanamaker 06-30-02 Sr. Carol Hoverman 06-30-02 06-30-03 06-30-03 Jennifer L. Tigges 06-30-03 Paul R. Kohl 06-30-04 ZONING ADVISORY COMMISSION Yr. Term, Meets 1st Wed. 6:30 Library Martha E. Christ 07-01-02 Richard J. Schiltz 07-01-02 Ron Smith 07-01-02 Stephen Hardie 07-01-03 Ben Roush 07-01-03 Eugene J. Bird, Jr. 07-01-04 *Jeff Stiles 07-01-04 ZONING BOARD OF ADJUSTMENT 5 Yr. Term; Meet 4th Thurs. Library Frederick R. Beeler Jim Urell William M. Gasper *Michael A. Ruden Randall J. Klauer 03-25-02 03-25-03 03-25-04 03-25-05 03-25-06 NOTE: On 2/6/98 Mary mentioned that with the new state Code re: Civil Service Comm. that I should show them all expiring on 3/31/98. Then the appointments will be for a I yr, 2 yr, & 3 yr. NOTE: Mary asked to check @ the liaison staff person from Zoning to Long Range; Kay said in 12/97 it should now be Bob Nagle. 2/99 Mary said that we have to include the Enterprise Zone Comm. so I added that. 4/7/99 With the resignation of K. Eipperle on Hist. Pres. & the need for Architect, we switched that to D. Plisek who is also an architect, thus opening up an At large position. Going to present Al Smemo's app at the 4/19 Cuoncil Meeting. 4/12/99 in March Council adopted an ORD. re: having one new Housing Comm. from Sec. 8. That would be a 10th one. Today Mayor said to make it a 3 yr. term expiriing 8-17-03. 9/5/00 Deleted I space on Long Range Planning - Zoning Liaison, supposedly for I year then review; 5/30/01 Talked to Rick Engelken (Assessor's Office). He stated that Board of Review terms of Ganshirt & Hanson should be I 01 02 rather than 01. 7/16/01 Council declared Teply's seat vacant in Housing Comm.- only attended one meeting. 8/6/01 Council changed Long Range Planning Comm. - deleted I 3 Yr. term which would have expired 7 I 02 (term of Chris Curfman who only attended 2 or 3 meetings; also Council appointed Floyd Schneider & Charles Winterwood MD to 3 yr terms (replaced G. Mills & vacant seat of Cooper), The Council Member & Alt. terms were updated to 7 I 02 per JFS. 8/01 Merrill Crawford said that Craig Schaefer had moved out of town & his term expired so we do a Certificate of Apprec. and his position is vacant; also Mike Pratt has only attended a couple of meetings and his term is also ending. Will declare it vacant too. Merrill had sent them both a letter @ renewal etc. 8/01 - Per Itr from David Harris re: Housing Trust Fund Committee: Harry Neustadt selected to fill unexpired term of B. Bisenius expiring 9/8/02 Jim Holz & John Henning from Housing selected for new 3 yr. terms expiring 9/8/04 CITY OF DUBUQUE, IOWA BOARD/COMMISSION APPLICATION FORM Individuals serving on Soards and Commissions play an important role in advising t~ ~un~[ on matters of interest to our community and its future. The City Clerk's Office, City Hall, accepts applications for any Board and/or Comml~Eon at ~y tE ~r~, and that application stays active for one year from the date of receipt in the Clerk's Off[ce.~, At the appropriate regularly scheduled council meeting, applications will be submitted t~the City Council for their review and applicants are encouraged to address the Council stating their reasons for wanting to serve on this particular commission. Applicants will be advised when the application is being presented. Appointment(s) will be made at a later meeting. Applicants will be notified as to the outcome of the Council's action. If not appointed at that time, this application will continue to be resubmitted, as needed, as long as the application is active (unless the applicant advises they are no longer interested). DATE: ~ ~,,~'1' ~t~P-~ ADVISORY BOARD/COMMISSION APPLYING FOR: ~-'l~v[lrOt~-~/ ~'~-~]~> ~t/~r0r~ ~--ow~. NAME: ~'lO//t u~ ~/~ ~--~ BUSINESS: OCCUPATION: HOME PHONE: ~' ADDRESS: IO1( HC~i~o_c~ ADDRESS: 'Z-7~7.- POSITIO. WITH COMPA.Y: BUSINESS PHONE: EXPERIENCE, EDUCATION AND TRAINING WHICH, YOU FEF, L QUALIFY YOU FOR THIS BOARD/ COMMISSION: ~t, J~ I WHAT CONTRIBUTIONS D~ YOU FEEL ~OU CAN MAKE TO ~H~S ADVISORY BOARD (OR STATE LIST TWO REFERENCES: NAME: ADDRESS: NAME: F ADDRESS: Specific attention should be directed to possible conflict of interest. arises, contact the appropriate Staff personnel or Legal Staff. Are you currently serving on a City Board or Commission: ~o For further clarification, if a situation If questions, contact the City Clerk's Office, City Hall, 13th & Central, Dubuque, iA 52001 Phone: 589-4120; ALL NAMES WILL BE DROPPED FROM THE LIST AFTER A ONE YEAR PERIOD. SIGNATURE ENVIRONMENT § 15,8-24 .~RTICLE I. IN GENEI~L Secs. ]$.5-1-18.5-20. (Reserved) ARTICLE ~I. ENVIRONM]E1N~TAL STEW- ARDSHIP ADVISORY COt~IISSION Sec, 1/3,5-21. Created; Composition: There is hereby created an Environmental Stewardship Ad~dsory Commission, which shall consist of seven (7) members, who shall all be residen~ of the City, and shall include a mem- ber representing those who will inherit /.he environment (a person between the ages of 16 and 20 at time of appointment), and six (6)' members who shall include representation from diverse segments of the City's population. It is desirable to select some members who may have helpful backgrounds with environmen- talfoiological science, health care, busi- ness'industry, and environmentaUcivic groups. (Ord. 64-93, § 1, 12-6-1993; Ord. 93-95, § 1. 12-1g-1995, elf. t-1-1996) Sec. 18.5-22. Application And Appoint- merit Process: The appointment process to the Commission by the City Council shall include at least the following: (1) Am application form requesting basic information on the education, training, experience, expecLafions and other qua]i- fications of the applicant; (2) Notice to and an opportunity for the general public to comment in writing on the qualifications of each applicant; and (8) A formal interview by the City Council to determine the applicant's qualifications and ability to effectively serve on the Coramission. (Ord. 84-93, § 1, 12-6-1993) See. 18.5-23. Term; Term Limits; Filling Of Vacancies; Compensa- tion: The term of office for a member of the Com- mission, other than the youth representative, shall be three (3) years, or until a successor is duly appointed. However, two (2) of the initial terms shall be for a term of one year; two (2) of the initial te~rn~ shall be for two (2) years; and two (2) of the initial terms shall be for three (3) years. The youth representative shall be for a term of one year, expiring on June 1 of the following yea.r; the initial term shah expire June 1, 1994. A Commission member may be removed at anytime with or without cause by a vote of two- thirds (:/3) of all members of the City Council. A vacancy on the Commission caused by res- ignation or otherwise shall be filled by appoint- ment by the City Council for the remainder of the unexpired berm. Members of the Corem/solon shall serve w/th- cut compensation except for actual expenses, which shall be subject to approval by the City Council. The tenn of office of a member appointed aRer January 1, 1996, shall erpire October 1. (Ord. 64-93, § 1, 12-6-1993; Ord. 93-95, § 2, 12-18-1995) Sec. 18,5-24. Duties; The duties of Cae Commission shall be as follows: (1) To develop, articulate and propose goals, objectives and policies for the steward- ship cf the Citfs environment and it's eceloo~cal systems for present and future generations. An initial report to City Coundl shcu]d be completed within a year and thenceforth periodically. It shall also include sections on the current condition of the City's natural environ- ments and on the progress being made in Supp. No, 29 1197 City Clerk's Office City t-lall 50 West 13th Street Dubuque, Iowa 52001-4864 (563) 589-4120 office (563) 58%0890 ~ax ctyclerk@cityofdubuque.org October 16, 2001 John Nemmers 1011 Melrose Terrace Dubuque, IA 52001 Dear Mr. Nemmers: I am sorry to inform you that you were not appointed to the Environmental Stewardship Advisory Commission at last night's City Council meeting. Your application will stay on file for one year and if there should be another vacancy during that time it will again be submitted to the Council for their review. The Council and staff are appreciative of your interest in serving the City. Thank you for the time and effort involved n makin.q yourself available. kmc Sincerely, Jeanne F. Schneider City Clerk Service People Integrity Responsibility I~movation Teamwork COMMUNITY DEVELOPMENT § 15-48 corporation counsel whenever it is determined that such waiver would be in the best public interest. (1976 Code, § 111/~-127) Seca. 15-38-15-45. (Reserved) ARTICLE IV. COMMUNITY DEVELOP. MENT ADVISORY COMMISSION Sec. 15-46. Croat;d; Composition: There is hereby created a Community Devel- opment Advisory Commission whose primary purpose shall be to provide for citizen participa- tion in the development and evaluation of the City cf Dubuque's Community Development Block Grant CCDBG") program. The Commission shall consist of nine (9) members; five (5) of which shall be residents of one of each of the five (5) census tracts with the lowest median household incdme as determined by the U.S. Department of Commerce, Bureau of tho Census; three (3) of which shall be resi- dents of the community at large; and one of which shall be a member of the Housing Com- mission designated by the Housing Commission. (Ord. 83-92, 11-2-1992; Ord. 88-95, §5, 12-18-1995, elf. 1-1-1996) Sec. 15-47. Application And Appointment Process: The process of appointment to the Commis- sion by the City Council shall include at least the following elements: (1) Submission of an application form con- taining the requested information on the qualifications and expectations of the applicant; and (2) Notice to and an opportunity for the general public to comment, in writing, on the qualifications of each applicant; and (3) A formal interview by the City Council to determine the applicant's qualifications and ability to serve effectively on the Commission. Individuals who, by their professional or personal experience or interest, are knowledge- able of the development needs of the community at large and of low and moderate income per- sons in particular shall be considered qualified to serve on the Commission, subject to City Council review and consideration of other appli- cable information. (Ord. 83-92, 11-2-1992) Sec. 15.48. Term; Filling Of Vacancies; Compensation; The term of office for a Commission member shall be three (3) years except as set forth be- low, The initial terms of the Commission shall be as follows: (1) For each of the five (5) residents of the /lye (5) census tracts with the lowest median household income as determined by the U.S. Department of Commerce, Bureau of the Census; one shall be ap- pointed for an initial term of one year, two (2) shall be appointed for an initial term of two (2) years; two (2) shall be appointed for an initial term of three (3) years. (2) For the three (3) community at large residents; one shall be appointed for an initial term of one year, one shall be appointed for an initial term of two (2) years, and one shall be appointed for an initial term of three (3) years. (3) For the one member of the Housing Com- mission designated by the Housing Com- mission, the initial term shall be one year. A Commission member may be removed at any time with or without cause by a vote of two- thirds (2/3) of all members of the City Council. Supp. No. 29 941 § 15-48 DUBUQUE CODE A vacancy occurring on the Commission caused by resignation or otherwise, shall be filled by appointment of the City Council for the remainder of the unexpired term. Members of the Commission shall serve with- out compensation except for actual expenses, which shall be subject to approval by the City Council. (Ord~ 83-92, 11-2-1992) Sec, 15-49. Duties And Responsibilities; General: The Commission shall have the following duties and responsibilities: (1) To conduct public hearings in accordance with the minimum standards established in the CDBG program's citizen partic]pa- tion plan to ensure meaningful citizen input in the planning, implementation and assessment of the City's CDBG pro- (2) To provide for and encourage the partici- pation of low and moderate income per- sons who reside in designated areas of slum and blight and residents of low and moderate income neighborhoods, as de- fined by the City Council, in the plan- ning, implementation and assessment of the CDBG program; (3) To identify community development needs, particularly the needs of persons of low and moderate income; (4) To serve in an advisory role upon the request of the City Council in policy decisions regarding funding priorities and program development and implemen- tation; (5) To monitor and evaluate program activi- ties to advise whether identified commu- nity development objectives have been met; (6) To undertake public information efforts to educate the citizenry of the availabili- (7) ty of CDBG funded programs and to provide for a greater understanding of the City's community development ef- forts; and To assist in the preparation of the state- ment of community development objec- tlves and projected use of funds, amend- ments thereto and required reports cluding, but not limited to, the annual grantee performance report (GPR) and the annual comprehensive housing assis- tance strategy (CHAS); (8) To serve in an ad~sory role to the City Manager in the review of complaints and grievances received in accordance with the procedures established herein in Section 15-52; (9) To support, upon request, the efforts of the City Council and other City commis- sions in the assessment of the general development needs of the community. The City Council shall have the authority to establish or revise the priorities of the Commis- sion. (Ord. 83-92, 11-2-1992) Sec. 15-50. Duties And Responsibilities; Grievance Procedure~ Review Standards; Appeal Process: The Commission shall participate in the fol- lowing described grievance procedure estab- lished by the City Council for the community development block grant program. (1) All complaints regarding the community development block grant (CDBG) pro- gram shall be handled in accordance with the following described grievance procedure. Any aggrieved person shall file a grievance with the City Manager. Grievances shall be filed in a timely manner and must be received by the City Manager within one year of the alleged occurrence. Supp. I%, 29 942 CITY OF DUBUQUE, IOWA BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards and Commissions play an important role in advising on matters of interest to our community and its future. The City Clerk's Office, City Hall, accepts applications for any Board and/or Commission at any time, and that application stays active for one year from the date of receipt in the Clerk's Office. At the appropriate regularly scheduled council meeting, applications will be submitted to the City Council for their review and applicants are encouraged to address the Council stating their reasons for wanting to serve on this particular commission. Applicants will be advised when the application is being presented. Appointment(s) will be made at a later meeting. Applicants will be notified as to the outcome of the Council's action. If not appointed at that time, this application will continue to be resubmitted, as needed, as long as the application is active (unless the applicant advises they are no longer interested). ADVISORY B.O~ARD/COMMISSION APPLYING BUSINESS: OCCUPATION: HOME PHONE: ~3, ADDRESS: POSITION WITH COMPANY: BUSINESS PHONE: EXPERIENCE, EDUCATION AND TRAINING ,WHICH YOU FEEL QUALIFY YOU FOR THIS BOABD/ , WHAT CONTRIBUTIONS DO.~_YOU FEEL YOU CAN MAKE T.O THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING) :,~ ,~--~ ~,~ ~,~ ~c~,~ ?~/-~ /~ --~'-~ ,~'TZ~ ~' ' LIST TWO REFERENCES: · NAME: £ ADDRESS: Specific atten{~ion should be directed to possible conflict of interest. For fu~her clarification, if a situation arises, contact the appropriate Staff personnel or Legal Staff. Are you currently serving on a City Board or Commission: ' ~ If questions, contact the City Clerk's Office, City Hall, 13th & Central, Dubuque, IA 52001 Phone: 589-4120~ ALL.N~MES W~ BE DROPPED FROM THE LIST A~ER A ONE YEAR PERIOD. SIGNATURE