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Boards and Commission AppointmentsVACANCIES AND APPLICATIONS FOR CITY OF DUBUQUE BOARDS AND COMMISSIONS For Council Meeting of Monday, February 6, 2012 6:30 p.m., Historic Federal Building, 350 W. 6th Street APPOINTMENTS TO THE FOLLOWING COMMISSIONS TO BE MADE AT THIS MEETING. Community Development Advisory Commission Three 3 -year terms: • One low /moderate - income area term (vacant term of Stubben) through February 15, 2015 • One low /moderate - income area term (vacant term of Craddieth) through February 15, 2014 • One at -large term (expired term of Wainwright) through February 15, 2015 Applicants: Abagail Smith, 1780 Central Avenue 2A (Low /Moderate - Income Area) Additional Applicant Adam Rathje, 299 Main St., Apt. #45 (Low /Moderate - Income Area) Additional Applicant Thomas Wainwright, 1788 Lori Street (At- Large) CITY OF DUBUQUE, IOWA - BOARDS AND COMMISSIONS * - Denotes Chairperson; For Information: 589 -4120 AIRPORT COMMISSION - 4 Yr. Term Meets 4th Monday 4 p.m. - Airport Amy Wagner Douglas Brotherton *Michael A. Santillo Charles Daoud Steven R. Accinelli 09 -14 -12 09 -14 -13 09 -14 -13 09 -14 -14 09 -14 -14 AIRPORT ZONING COMMISSION 6 Yr. Term - Apptd. 1996, Meets on Call *Steve Horsfield Linda Lucy Marianne Krause Tom Henschel Vacant (Term of Stiles) (By Board Vote) 01 -03 -02 (County) 12 -31 -02 (County) 12 -31 -08 (CityZAC) 01 -03 -14 (CityZAC) 01 -03 -14 AIRPORT ZONING BOARD OF ADJUSTMENT 5 Year Term, Meets on Call *Vacant Randall J. Klauer Michael A. Ruden Darlene Burds Ron Koppes (By Board Vote) (City ZBA) 02 -15 -11 (CityZBA) 02 -15 -11 (County) 02 -15 -11 (County) 02 -15 -11 ARTS AND CULTURAL AFFAIRS ADVISORY COMM. 3 Yr Term Meets 4th Tues., 4:30, Library Brd Rm. Ellen H Henkels Julie Steffen *Geri Shafer Louise Kames Marina O'Rourke Rosenow Susan Riedel Paul Hemmer (Bus /Prof) 06 -30 -12 (Bus /Prof Dist) 06 -30 -12 (At Large) 06 -30 -12 (Arts) 06 -30 -13 (Arts) 06 -30 -13 (Arts) 06 -30 -13 (Arts) 06 -30 -13 BOARD OF APPEALS - BUILDING CODE Appt. 3 Yr. Term, Meets on Call Vacant (Term of Anglese) (At Lrg) 08 -01 -11 Marla Cruise (ADA Rep) 08 -01 -12 Chuck Carr (Gen. Cont.) 08 -01 -12 Richard G. Luchsinger (At Lrg) 08 -01 -12 John Schwendinger (Jrny.Carp) 08 -01 -13 *F. James Kolf (Arch /Engr.) 08 -01 -13 I (ADA new position awaiting applicants) TBD CITY BOARD OF REVIEW (w /County) Appt. 6 Yr. Term, Meets May 1 -30 Ruth Ann Hanson John F. Ganshirt Donald Lochner Robert Schaub Greg Hutchinson (Realtor) 01 -01 -14 (Constr) 01 -01 -14 01 -01 -16 01 -01 -17 01 -01 -17 CIVIC CENTER ADV COMMISSION 3 Yr. Term - Meet 4:30 p.m. 4th Monday at Five Flags Cynthia A. Fuller *Bryce Parks Rod Bakke Vacant (Term of Field) Barb Kurt 06 -29 -12 06 -29 -12 06 -29 -13 06 -29 -13 06 -29 -13 CIVIL SERVICE COMMISSION 4 Yr. Term, Meets on Call Elizabeth Takes *Daniel White James Schilling 04 -06 -12 04 -06 -13 04 -06 -14 COMMUNITY DEVEL ADV. COMMISSION 3 Yr. Term, Meets 3rd Wednesday, 5:30 p.m. at Federal Bldg. /Housing Thomas Wainwright (At Large) 02 -15 -12 Vacant (Term of Stubben) (LowIM Inc A) 02 -15 -12 Paula Maloy, SVM (At Large) 02 -15 -13 Theresa Caldwell (Low /M Inc A) 02 -15 -13 Peter Koshakji (At Large) 02 -15 -13 Ricardo Woods (Housing Rep) 08 -15 -13 Ann Michalski (At- Large) 02 -15 -14 David Shaw (Low/M Inc Area) 02 -15 -14 Vacant (tlo Craddieth) (Low/M Inc Area) 02 -15 -14 ELECTRICAL CODE BOARD 3 Yr. Term; Meets Bi- Monthly Bob Schmidt Paul J. Uhlrich James Dixon Dan Hammel Ronald Mueller Elaine L. Reiss *Kevin Pfohl (Elec. Bkground) 05 -21 -12 (Elec. Bkground) 05 -21 -12 (Elec. Con.) 05 -21 -14 (JouriMaint) 05 -21 -14 (At Large) 05 -21 -14 (Elec. Engr.) 05 -21 -14 (JouriMaint) 05 -21 -14 ENTERPRISE ZONE COMMISSION 3 Year Term, Meets on Call *Rick Stein Dan LoBianco Doug Stillings Richard Van Iten Kelley Deutmeyer Dave Baker Peggy Murray Mike Van Milligen Daniel White (At Large) 2 -15 -12 (At Large) 2 -15 -12 (At Large) 2 -15 -12 (from LRP) 2 -15 -13 (IDED) 2 -15 -13 (Intl Labor) 2 -15 -13 (IA Workforce Dev) 2 -15 -14 (Council Rep) 2 -15 -14 (NICC) 2 -15 -14 ENVIRONMENTAL STEWARDSHIP ADVISORY COMMISSION - 3 Yr. Term Meets 15t Tues. 5 p.m. City Hall Annex Gayle Walter Aditi Sinha Vacant - Youth (Term of Miller) Michael J. Buelow Chad Oberdoerster Wayne Klostermann Stacey Splittstoesser 10 -01 -12 10 -01 -13 06 -01 -13 10 -01 -13 10 -01 -13 10 -01 -14 10 -01 -14 HISTORIC PRESERVATION COMM. Appt. 3 Yr. Term, Meets 3rd Thursday, 5:30 p.m., Federal Bldg D. Joseph Rapp (old Main Interim) 07 -01 -12 Mary Loney Bichell (At Large) 07 -01 -12 Vacant (Term of Knight) (At Large) 07 -01 -12 Christine Olson (At Large) 07 -01 -12 Robert McDoneli (Jackson Pk) 07 -01 -13 John E. Whalen, MD (mint]) 07 -01 -13 Christopher J. Wand (ArchlAt Lg) 07 -01 -14 *David Klavitter (Langworthy) 07 -01 -14 Mitzi Krey (Cathedral) 07 -01 -14 HOUSING COMMISSION 3 Yr. Term, 4th Tues. 4:00 p.m., Fed Bldg Amy Eudaley 08 -17 -11 Regine Ronek 08 -17 -11 *David J. Kapler 08 -17 -12 Dorothy Culbertson(Trust Fund Rep)08 -17 -12 Jim Holz (Trust Fund Rep)08 -17 -12 Lisa McAllister (Sec. 8 Area) 08 -17 -12 Judie Root 08 -17 -13 Dorothy Schwendinger, OSF 08 -17 -13 Ricardo Woods (CDAC Rep) 08 -17 -13 Mitzi Krey 08 -17 -14 HOUSING TRUST FUND ADVISORY COMMITTEE 3 Yr. Term, Meets 6x/Year *Jim Holz (From Hsg) 08 -17 -12 Dorothy Culbertson (From Hsg) 09 -08 -12 Doris M. Hingtgen (At Large) 09 -08 -12 Dorothy Schwendinger (From Hsg) 08 -17 -13 John V. Walsh (At Large) 09 -08 -13 HOUSING CODE APPEALS BOARD 3 Yr. Term, 3rd Tues. 4:00 p.m. Fed Bldg. Paul Newman *Robert Schaub Vacant (Term of Kinsella) Vacant (Term of Matheos) David Young Vacant (Term of Moore) Fred Miller 01 -11 -12 01 -11 -13 01 -11 -13 01 -11 -13 01 -11 -14 01 -11 -14 01 -11 -15 HUMAN RIGHTS COMMISSION 3 Yr. Term, Meets 2 "d Mon. 4:30 Annex Regine Ronek Mitzi Krey Judie Root Andrea Beacham Michael Elliot Miguel Jackson *Anthony Allen Kurt Hansen R.R.S. Stewart 01 -01 -13 01 -01 -13 01 -01 -13 01 -01 -14 01 -01 -14 01 -01 -14 01 -01 -15 01 -01 -15 01 -01 -15 As prepared for the 2/6/12 Council meeting INVESTMENT OVERSIGHT ADVISORY COMMISSION - 3 Yr. Term, Meets Qtrly; 4th Wednesday 3 p.m. City Hall "A" Brad Chalmers Ashlie Simonson *Gary Ruden Stephen V. Reisdort Paul Lassance 07 -01 -12 07 -01 -12 07 -01 -13 07 -01 -13 07 -01 -14 LIBRARY BOARD OF TRUSTEES 4 Yr Term, Meets 4th Thurs. 4 p. m. Library Paula Connors John Anderson - Bricker Mike Willis *Diann Guns Fred Miller David Hammer Jenny Leigh Harris 07 -01 -12 07 -01 -12 07 -01 -13 07 -01 -14 07 -01 -14 07 -01 -15 07 -01 -15 LONG RANGE PLAN'G ADV COMM. 3 Yr Term Meets 3rd Wed. 7p.m. Fed Bldg John Pregler Chad Darter Charles Winterwood, MD *James F. Prochaska Craig Beytien Richard Van Iten Alan Vincent 07 -01 -12 07 -01 -12 07 -01 -13 07 -01 -13 07 -01 -14 (Ent Zone Rep) 07 -01 -14 07 -01 -14 MECHANICAL CODE BOARD 3 Yr. Term - Meets Qrtly, City Hall Corey Valaskey David Grothe Michael P. Kelly Paul J. Papin Ronald Billmeyer Gary Hillard *Tom W. Giese 03 -16 -12 03 -16 -12 03 -16 -13 03 -16 -13 03 -16 -13 03 -16 -14 03 -16 -14 MEDIACOM CHARITABLE FOUNDATION 1 Yr. Term, On -Call, CC Appt'd Reps. Gail Chavenelle Connie Twining 12/31/12 12/31/12 MISSISSIPPI RIVER PARTNERSHIP Council Apptd. Rep - 3 Year Term Edward Cawley (Apptd Citizen Rep) 12 -31 -12 PARK AND RECREATION 3 Year Term Meets 2 "d Tues. 4:30 p.m ADV. COMM. . Bunker Hill Robert Blocker Karen C. Lyness David Schlueter Paul Hoffmann Chuck Harris Kenneth Klinge Evelyn Nadeau 06 -30 -12 06 -30 -13 06 -30 -13 06 -30 -13 06 -30 -14 06 -30 -14 06 -30 -14 PLUMBING CODE BOARD 3 Yr. Term, Meets Quarterly, City Hall Stanley G. Gonner (Master) 11 -02 -11 Vacant (Term of Swift) (At- Large) 11 -02 -12 Dan Harris (At Large) 11 -02 -12 Paul Papin (at will) (Journeyman) 11 -02 -12 *Harlan J. Willenborg (Master) 11 -02 -14 SAFE COMMUNITY ADVISORY CMTE 1 Yr Terms, Terms, Meets Quarterly Anthony Allen Mary Rae Bragg Diane Callahan Jonathan Cheatham Rachel Daack Ann Ernst Doug Stillings Susan Stork Amanda Elkins 12131111 12/31/11 12/31/11 12/31/11 12131111 12131111 12131111 12/31/11 12/31/11 SISTER CITY RELATIONSHIPS ADV CMS 3 Yr Terms, Meets Quarterly Kevin Lynch Joyce Connors Michael Coty Betty Phillips Louise Thurn Larissa Filimonenko Sheila Castenada Dick Landis Jill Connors Annalee Ward Jeffrey Jochum Phyllis Lee Pat McNamara (Council Rep) (Council Rep) 211113 2/1/13 2/1/13 2/1/14 2/1/14 2/1/14 2/1/14 2/1/14 2/1/15 2/1/15 211115 TRANSIT ADVISORY BOARD 3 yr. Term, Meet Monthly, 2 "d Thurs. Fed Bldg Matthew Esser Rhonda Knight R.R.S. Stewart George Enderson *Joel Lightcap 07 -30 -12 07 -30 -13 07 -30 -14 07 -30 -14 07 -30 -14 TV CABLE REGULATORY COMMISSION 3 Yr. Term, Meets 2 "d Wed OC. 5:30 Annex *Charlie Ellis Kevin R. Stevens Vacant (Term of Bellings) Ronald Tigges Walter Webster 06 -30 -12 06 -30 -13 06 -30 -13 06 -30 -14 06 -30 -14 TV CABLE COMMUNITY TELEPROGRAMMING COMMISSION 3 Yr. Term, Meets 1st Tues. 5:30 Annex Jennifer L. Tigges Alan Vincent Vacant (Term of McDonough) Vacant (Term of Everist) Pauline J. Maloney George P. Herrig Sr. Carol Hoverman 06 -30 -12 06 -30 -12 06 -30 -12 06 -30 -13 06 -30 -14 06 -30 -14 06 -30 -14 ZONING ADVISORY COMMISSION 3 Yr. Term, Meets 1st Wed. 6:30 Fed Bldg Charles Miller Stephen Hardie Patrick Norton Eugene Bird Jr. Martha E. Christ Thomas Henschel Ron Smith 07 -01 -12 07 -01 -12 07 -01 -13 (Airport ZC) 07 -01 -13 07 -01 -14 (Airport ZC) 07 -01 -14 07 -01 -14 ZONING BOARD OF ADJUSTMENT 5 Yr Term; Meets 4th Thurs. 4 pm Fed Bldg William J. Gibbs Jeff Cremer Heath Hutchinson Michael A. Ruden Randall J. Klauer 03 -25 -12 03 -25 -13 03 -25 -14 (Airport ZBA) 03 -25 -15 (Airport zBA) 03 -25 -16 ❑ = Indicates State - mandated board /commission subject to 2012 Gender Balance Law. ITY DEVELO MENU A DVVSO Y CO BSI 2 -6C -1: CONINIISSION CREATED; COMPOSITION: A. Creation: There is hereby created a community development advisory commission whose primary purpose shall be to provide for citizen participation in the development and evaluation of the city of Dubuque's community development block grant (CDBG) program. B. Membership: The commission shall comprise nine (9) members; four (4) members shall be residents of census tracts and block groups where at least fifty one percent (51%) of the residents are low /moderate income persons as determined by the United States department of commerce, bureau of the census; four (4) members shall be residents of the community at large; and one member shall be that member of the housing commission designated by the housing commission. (2007 Code § 15 -46) 2.5C -2: TERM; FILLING OF VACANCIES; COMPENSATION: A. Term: The term of office for a commission member shall be three (3) years. B. Removal Of Member: 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. C. Filling Vacancies: 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. D. Compensation: Members of the commission shall serve without compensation except for actual expenses, which shall be subject to approval by the city council. (2007 Code § 15 -48) 2 -5C-3: ORGANIZATION: The commission shall choose annually, at its first regular meeting of the fiscal year, one of its members to act as chairperson, and another of its members to act as vice chairperson, to perform all of the duties of the chairperson during the chairperson's absence or disability. The commission shall adopt such rules and regulations governing its organization and procedures as it may be deemed necessary, consistent with the following: A. Meetings: The commission shall meet as necessary to fulfill the purposes for which the commis ion was created. ..4,� - _.,e k(� -j i?t[,., t� r.es- - `- -.If =f.a - - -' �.a, l ._� =.F_A� Via• ,-[-��m..�sc tz�SK_.d.�cr— �ij,e 17Vie_r (_e r. .\ k B S�b4=,1'-, of the, _org9rd irr) .Fd�YH. r A 1„ 63 i�1n >1 {k krra ^.6- two-x_I i 0.A-' ii !i-.:t i � �:r:9 E vi ti < vi p 4 ,i to i Will 9. c.�,i ieE 8 :UI P "c.i t r_SiI I e �� s.12) [f /��� of � €�.��;s. f i t_�. [l tl,_,`, 3 t� . �:li ,, � sit -.86 -'d, `r, !!` 4 €- :R =��?`' - s_!c-h pr, �' cnbe d number of mer 'tuf(g`ro, ft'i9t °:i'k failure shall constitute grounds for the commission to recommend to the city council that said member be replaced. Attendance of all members shall be entered in the minutes. C. Minutes Filed With Clerk: The commission shall file with the city clerk a copy of the minutes of each regular and special meeting of the commission within ten (10) working days after such meeting. (2007 Code § 15 -51) 2 -5C-4: GENERAL DUTIES AND RESPONSIBILITIES: The commission shall have the following duties and responsibilities: A. To conduct public hearings in accordance with the minimum standards established in the CDBG program's citizen participation plan to ensure meaningful citizen input in the planning, implementation and assessment of the city's CDBG program; B. To provide for and encourage the participation of low and moderate income persons who reside in designated areas of slum and blight and residents of low and moderate income neighborhoods, as defined by the city council, in the planning, implementation and assessment of the CDBG program; C. To identify community development needs, particularly the needs of persons of low and moderate income; D. To serve in an advisory role upon the request of the city council in policy decisions regarding funding priorities and program development and implementation; E. To monitor and evaluate program activities to advise whether identified community development objectives have been met; F. To undertake public information efforts to educate the citizenry of the availability of CDBG funded programs and to provide for a greater understanding of the city's community development efforts; G. To assist in the preparation of the statement of community development objectives and projected use of funds, amendments thereto and required reports including, but not limited to, the annual grantee performance report (GPR) and the annual comprehensive housing assistance strategy (CHAS); H. To serve in an advisory role to the city manager in the review of complaints and grievances received in accordance with the procedures established in section 2-5C- 5 of this article; and To support, upon request, the shorts of the city council and other city commissions Ire the asses:'. ne:l it of the general development needs r The grievance procedure for the community development block grant program shall be as follows: A. Right To File: Any aggrieved person may file a grievance with the city manager. B. Contents: Grievances shall contain a concise statement of the grievance and an explanation of the action desired. C. Forwarding To Commission: The city manager shall forward the grievance to the commission within seven (7) working days of its receipt. D. Setting Date For Hearing; Notice To Complainant: The commission shall, within fifteen (15) working days of the receipt of the grievance, set a time for a hearing. The complainant shall be notified in writing of the time and place of the hearing. If a grievance is resolved prior to the date of the hearing, the aggrieved party shall request in writing that the grievance be withdrawn. E. Hearing Procedure: The commission shall conduct a hearing to review the grievance. The grievant may appear in person, by agent, or by attorney. All persons wishing to appear before the commission shall have an opportunity to be heard regarding the grievance. Minutes shall be kept of the proceedings of the hearing. F. Recommendations Of Commission: The commission shall forward its recommendation, in writing, to the city manager within ten (10) working days following the hearing. G. Action By City Manager: The city manager shall receive and review the recommendation of the commission and shall respond to the grievant within ten (10) working days of the receipt of the recommendation. The commission shall be advised of the action of the city manager. H. Compliance With Federal Regulations: The recommendations of the commission shall comply with the regulations established by the U.S. department of housing and urban development for the community development block grant program under title of the housing and community development act of 1974, as amended, and this code. I. Appeal To Council By Grievant: If the grievant is unsatisfied with the response of the city manager, an appeal may be made filed with the city clerk. The appeal shall be forwarded by the city clerk to the city council. The city council may, at its discretion, hold a hearing to consider the concerns of the grievant. Council Action; Appeal To HUD: Upon review of the appeal, the city council shall: 1) accept the response of the city manager; 2) modify the response of the city manager; or 3) return the grievance to the city manager for further review. If the outcome of such appeal is unsatisfactory the complainant may the _ written apnoal with gg �. p a e r �� hp 15-50) ) _zi ci va_r €op east ( _ ._!�. 2007 2-5C-6: PROCEDURES FOR OPERATIONS: The commission shall operate in accordance with the standards and procedures set forth in the city's community development block grant (CDBG) program's citizen participation plan. All administrative, personnel, accounting, budgetary and procurement policies of the city shall govern the commission in all its operations. (2007 Code § 15- 52) (1/30/2012) Kevin Firnstahl - Online Form Submittal: Board /Commission Page 1 From: "support @civicplus.com" < support @civicplus.com> To: <kfirnsta @cityofdubuque.org >, <atauke @cityofdubuque.org >, <dharris @cityo... Date: 1/30/2012 12:49 PM Subject: Online Form Submittal: Board /Commission Application Form The following form was submitted via your website: Board /Commission Application Form Select the Board, Commission, or Committee applying for:: Community Development Advisory Commission Name:: Abagail Smith Home Address:: 1780 Central Ave 2A Home Phone Number:: 563 -663 -3000 Business Name and Address:: Dubuque Bank & Trust 1398 Central Ave Dubuque, IA 52001 Business Phone Number:: 563 - 589 -2053 Occupation:: Assistant Director, Excursions Email Address:: asmith @dubuquebank.com Experience or education which qualifies you for this board or commission:: I am a young professional that works and has choosen to live in the downtown area for the past 5 years. I have experience within the buisiness community and have had the pleasure of serving on a Main Street Dubuque committiee for two years. I also have business experience and will be graduating in May with my Masters of Communication degree from the University of Dubuque. What contributions can you make or state reason for applying ?: As I have spent the past 5 years in the downtown area I believe that I can bring a young professional's perspective to the board. As a resident of downtown, I have a desire to help aid change and be an active member of the future of downtown. List two reference with names and addresses:: Hilary Stuben 1398 Central Ave Dubuque, IA 52001 563 -598 -2000 Steve Juergens 151 W 8th Street Dubuque, IA 52001 563 - 556 -4011 Are you currently serving on other Boards, Commissions, or Committees ?: No If yes, which ?: Select One Have you served on a Board, Commission, or Committee before ?: No If yes, which ?: Select One ign riur :: Abagail ft Smitii (1/30/2012) Kevin Firnstahl - Online Form Submittal: Board /Commission Page 2 Date:: 1/30/12 Additional Information: Form submitted on: 1/30/2012 12:49:00 PM Submitted from IP Address: 65.125.110.141 Referrer Page: No Referrer - Direct Link Form Address: http:// www. cityofdubuque .org /Forms.aspx ?FID =75 (1/26/2012) Kevin Firnstahl - Online Form Submittal: Board /Commission Page 1 From: "support @civicplus.com" <support @civicplus.com> To: <kfirnsta @cityofdubuque.org >, <atauke @cityofdubuque.org >, <dharris @cityo... Date: 1/26/2012 2:28 PM Subject: Online Form Submittal: Board /Commission Application Form The following form was submitted via your website: Board /Commission Application Form Select the Board, Commission, or Committee applying for:: Community Development Advisory Commission Name:: Adam J Rathje Home Address:: 299 Main St. Apt # 45 Home Phone Number:: 319 - 350 -3202 Business Name and Address:: Heartland Financial USA, Inc. 1398 Central Ave. Dubuque, IA 52001 Business Phone Number:: 563 - 587 -4232 Occupation:: Management Trainee - Operations Email Address:: arathje @htlf.com Experience or education which qualifies you for this board or commission:: I have been in living in Dubuque for 5 years now, beginning when I was a Freshman at Loras College. Throughout my time in Dubuque, I have lived in several areas and have been a part of the Dubuque community. I worked towards recieving a double major in IT Management in Business Management from Loras College in four years. I also was an intern at Heartland beginning my junior year at Loras working 25 -30 hours a week and going to school full time. What contributions can you make or state reason for applying ?: I can make many contributions to the community by bringing in my diverse background. I grew up on a farm outside of Cedar Rapids and have now been living in the City of Dubuque for 5 years. I can contribute knowledge from living in several areas of Dubuque and provide the commission with ideas that I have gained through work, school, and volunteer experiences. I was made aware of an open position through Hilary Stubben who is stepping down from the commission. List two reference with names and addresses:: Hilary Stubben 2433 Broadway Street Dubuque, IA 52001 Work - 563 -589 -1932 Cell - 563 - 451 -6960 Brian Fox 1682 Radford Road Apt. 6 Dubuque, IA 52002 Phone - 704 -905 -5888 Are you currently serving on other Boards, Commissions, or Committees ?: No If yes, which?: Select One Have )L! er a Huai( i'f�I�C;ICIii iliiee lJertOre (1/26/2012) Kevin Firnstahl - Online Form Submittal: Board/Commission Page 2 If yes, which?: Selec One Signature:: Adam Rathje —` `� Date:: 01/26/2012 / C.- �� z� Z] L..) - m �� .g) '� �' ;�- |Tl m Additional Information: cb �� �� r‘,.) . � Form submitted on: 1/26/2012 2:28:07 PM [ U cD m Submitted from |P Address: 65.125.110.141 Referrer Page: No Referrer - Direct Link FormAddnass:http:0wvmm.oityofdubuque.org/Forma.aapx?F|D=75 THE CITY OF Masterpiece on the Mississippi CITY •F DUI MUM, IOWA OA /COMMISSI • APPUCAT Dubuque Individuals serving on Boards and Commissions play an important role in advising the City Council on matters of interest to our community and its future. The City Clerk's Office, City Hall, 50 West 131h Street, Dubuque, IA accepts applications for any Board and /or Commission at any time, and the application stays active for one year from the date of receipt in the Clerk's Office. At the appropriate regularly scheduled 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 Board or Commission. Applicants will be advised when the application is being presented. Appointment to the Board or Commission will be made at a later meeting. Applicants will then be notified as to the outcome of the Council's action. If not appointed at that time, this application will be resubmitted, as needed, as long as the application is active (unless the applicant advises they are no longer interested). DATE: ADV!SORY BOARD /COMMISSION APPLYING FOR:= NAME: . P f M g ' I1 I !— ) C H r d j''—' f i r t. 'Li ii (Some boards /commissiohs require State of to ya Gender Balance compliance) ADDRESS: / _ _ ,__ BUSINESS: OCCUPATION:.` { ( _ HOME PHONE: ADDRESS: (City of Dubuque residency required) POSITION WITH COMPANY: BUSINESS PHONE: E -MAIL ADDRESS(ES): EXPERIENCE, EDUCATION WHICH QUALIFIES YOU FOR THIS BOARD /COMMISSION: WHAT CONTRIBUTIONS CAN YOU MAKE OR STATE REASON FOR APPLYING: LIST TWO REFERENCES: NAME: NAME: ADDRESS: / ADDRESS: Specific attention should be directed to possible conflict of interest. For further clarification, if a situation arises, contact the appropriate staff person or the City's legal staff. Are you currently serving on a City Board or Commission: Name: SIGNATURE: If qu-`stio nc coniva tlic I y Cler '. s Off `" City Hell, 50 W. 13' Si., Dub ugLl , I,F 5200 i Shone t,;(:32:/5&)-4120. 56::3/5{3U-0690, VvVVV,f.cIiyUiUUllrii.iL�i„UI�I well IIdIIIeb will lJ ; ll(UIJjJC.U_71VIII Llle, (Id; L c111i✓i we-yea' UUrIU(I.-