Loading...
HomeMy WebLinkAboutStaff Report 4.B Appointments Part 09 Technology 06/20/2011TECHNOLOGY ADVISORY COMMITTEE THREE VACANCIES FOR TWO -YEAR TERMS EXPIRING,JU.NE 30, 2013 iql Bruce Gould Petaluma, CA 94952. echnology 'and� Telecommunications ( Presenf Employer � �� °` SunWize Technologies, Inc. tiJOIJ Title � as 4 � f Director of Sales Prevtaus Governmental Bodies /Elective Offices you hive served' P /Office Heid and Dates None Civic or C:hantaEle Organtaatiotz fo avhich you trcave belonged Position /Uffice keld and Dates None What Special Interests /Skifls/Talents woulcl,you bring to this Soard Commission or Comittee'< Intimate knowledge of solar electricity (26 years in the industry). Knowledge of all methods of application of solar electric (photovoltaic) technology forresidential, cornmercial and industrial use. Electrical engineering degree. Page 2 of 4 ��a�3 btt aiiiiii hh' University of New ;Hampsh Hampshire, Class of 1977, School of EO'binee'ring and Physical. Sciences, B.S. Electrical Engineering I None 114 "T Y4V ++vl + vry a — I have a keen-interest in working on initiatives that would impact energy consumption through conservation measures and Would: increase the adoption.df solar energy in an effort to alleviate our use of traditional fossil - fueled energy. -IS your; application? ` Council Page 3 of 4 ILI`�I Revised August 12, 2008 Page 4 of 4 r Jlj h, r c.. j I' .. i.. Fir 6 t _. ,....,, - a City of Petaluma,. Cahornta ` City Board, Commission aril CommitFee Applic o a j85,_ r , Wt Instructions, : Use. fhis` form' to apply to serve on any of the City of Petaluma, Coliforn oards, Commissios, or Committees. ,Please fill out the form completely. If a question does not app write N/A in the space provided. When completed, please forward to the City Clerk's Office Pe;tdlumo, 1 1 English Street; Petaluma, CA 94952. All applications are reviewed by the City Council. , y ��� ��., pt Home Address;. Cit , State andIi 'Code Home Phone If a ointed, do y ou-want nurnber.to be availoble. to the°` blic? Work' Phone YES Iq✓ Y - n : E Mail If�a orateddo,ilyou�%antdthis`address to be J r availabletothe ublic a n Are youRa egi'stered'voter,,in Petaluma? - if '"' �so; for how�lo 44 , j . ,� �, „ .. ✓❑ YES ®NO Y &W 2 11 ,. 1 s W l, , Boar�d(s) Commission(s) =or Com ttee(s) of Interest* " ; ,53 g , p .vMd"b l/ *Note: To serve on'the Senior Advisory Committee you must be age 55 or above. Haveyou &attended a�meetingaof this r . �� 7'A; k�4 t�'Y:E" flit c x'"diDwu{ IdP4',pe ' d; ' 4 " d E > �mnriewed or appliedfor Have youservedon te ,, body F�� this ` bodypieviously�� � `�U y ® YES ❑ NO ❑ YES NO ? Harrigan, Thomas Technology Advisory Committee ,Preserit rEmploy,er . y s � _ ' �. � �, ►+ n ty 'AL 41 Job Title: Previous Governmentdl Bodies /Ele;cti�e Offices you have served;- Position %,Office °Heldand k Dates Civic or Chantable Organization to; which you have belonged, Position /Office Held and Dates �... �'i r s _ in -t��. a�n__ <r_ >rrs rt �onf.�G. w. •iarlt� �� ti.:_: h. e � ::. t .. a�.I&1 ,h 4rri� i .. What Special Interests %Skills /Talerifswould you b "ring;tothisBoard "Commission or Committee a���'�..,Ut � -^�` +& � 1 �'.� . u:: �'ia '116�k O r°�, .� n &..l J Page 2 of 4 �' Coll ege Professional ocatlOn Attended y ('Mafor ; Subfect, Dates, Degree %Date): Special Awartlsor Recognition Received x _ f u �� �Ple�a "se,st6te reasons why you�'want to become a momber of�this�, gdrd;��Corn`mission d,i; � Commute pecifc obfectives��You twoultlbe �working�toward��as`a ~me "tuber of thisadvisorypbodY m Is there anther information`that youfeel +would be usefulto�theCity y o Council in reviewing "` = s your application?.,, M Page 3 of 4 ) t3 A% re � deemed ,d ,. i 0 e� t i 6rf6 'a' p`p n't'e' d 4 6''1 this in pps i 6 n'' ? j YES I NO s,4 - D ib* b t If "Ie6as en 0� -C it p t vote on' matters , where ;there ''Aired appointed viso b6dy'membeftnotlt qlicy, ad ry, ppgi, 4 if -such q is s po en 6f, terest. Would be, -Willing,to,abstdiii,from ,Ou drises, ,conflict YES ❑ NO A did", �%h6dr, ­­ I �YQW , :Oppnm, ,qw 0 Ap plicant ' s Urp: f Date' ­,40 gg W ; Hk U Rev'ised August 12, 2008 Page 4 of 4 I t i � Special skills and interest I would bring to the Board. Since becoming the Programming Director at Petaluma Community Access in April, 2010, 1 have created: ® An online, accessible calendar of program scheduling through Google Calendars: http://pca.tv/pa-ge/pro-qramming / ® Astreamlined a consistent program of locally produced, shot and edited shorts and shows showcasing Petaluma and it's residents. ® The Petaluma Virtual Film Festival, airing shorts, features and animation showcasing Sonoma County on PCA ® Programmed Technology based interviews and conferences from O'Reilly Media. ® Implemented "Video on Demand ", a member service for archiving shows on InternetArc hive. org ® Implementing a show, "Taste of Petaluma" with hosts /interviewers ranging from high school to senior, male /female highlighting and interviewing established and maybe little know gems of Petaluma. ie: RO Shelling Grain and Feed, 3 Cooks Cafe, Angelo's Meats, Chinatown Restaurant, and more. Reason I want to be on the board. I have been involved in Film and TV since 1994 and have been involved in internet media since 1999. 1 feel I can bring my knowledge of media, social networking and showcasing what Petaluma has to offer beyond the borders of Petaluma. l S-o A LT ` _, a J I­ k qy 4 d d Y Wk, 7 a g , 4 r ` 7 �S Y • rA s �1{ fs to a i`�� • k ,a 4.e F d - 4 yr •r '2,0'i� Hof Petalu na R T arlii ®rna -- �w �� � �� u�� City, Board ,�Commassion � { � xand�CornmifiteeAp r ati - � � , a ,Instructions: Use this form to ,apply to serve on any of the, City of Petaluma, Cali -� Boards,, Commissions, or Committees Please fill out the form completely. If a does not o question yp write N/A in the space provided. When completed, please forward to the City Clerk's Offi Petaluma, I I English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. Name. e_­i'....r Edward (Ted) G Lombardi +8a "VDU € a e"1Yr + a s d"ll, Address; City, State Zip Code ;Home and ,. g AAA Petaluma, CA 94954 'hc 'S ' y - �S {, % ,y ^ - rk t.HomeryPhone (WaK? pointed do you want this K I � 4 th numbertobe available pubhc2J � �, ot_ ;, ( 4 r �Work,Phone 4 4 1 g, c c x`'� .C y r a5:.. s " r, . 'm?°A+ar''�-,.' ! 4r 1 , € ❑YES�k� sr� ...,zi .„ ( ( of Mail (Ifapporntect do this address to �.� � 9 ❑� J 7 �fjeaavailable� tothe public�J N0 „AYES ( _ NkT•. Are<ou'a re iste�etl voter uiria� } a s .x j �3"^d ' If f how "Io ?'�r � f� ; iri'"'P la y g! y so r o Cn g ' a y* ;y �.Y �µµ �, un 1$943*r.. .,.�rzmm'S. CJFet. .n 'w� . i'.,,x.✓"t.�i '.wa.� - -�1"a!v d._'3u3F�..V dvh;6+..... A.1�` .,9 >d ^ ,.�"9&e.i. ®✓ YES ® NO 15 on or - P $ ' Boards`;Commss s -,,i � est*�M ' � �� ( t �"� 1':. y , ,� $. �`�., i '�' , i Yy� D g-�A4" �.s4 *ah d� 3� w.rtv� a �9 � � ,v A' .a»i°�:hf�ux) a u — .5 ,, .. t , .� frfitu44F $ fr 1,✓,ppP d F {, "�4 � �o�� il�"IIJNR.- h _ ?s.W $ 0t Technology, & Telecommunications Advisory Committee *Note: To serve on the Sen Committee, you must be age 55 or above. y " 5 t ': ^a ' t + d #4l appliedfor ro Have ; you attendedameeting ofthi , Have you,servecJon;intenriewed; or P� xx", "^m is �. s„ d'ki body �d�x a� �� ��' thisbody�previously� `.. �a`,�._ �'si�u«M'. ✓❑ YES El No. ®✓ YES ❑ NO Lombardi, Edward (Ted) Technology Advisory Committee P5 I n' Kaiser Permanente ,� . 5 le; at Y s4 '1 C n` n r -fit.; P . skid df�Frx? �'E y.`',''�" } JobTitle r rou ® Program Manager a .�'.�£ ° �' r 'x i � e"'P. ,�d+5�^ Fi � v ._: :�:# � �� ka• '.. Previous�Governmental BodiesyElec #ive Offices youhave ser } ved, Position /Office Heldaand �- Petaluma Technology & Telecommunications Advisory Committee - 2008 - 2011. Chair 2010 o . J::c . N.. .u>. i JA A i ;...` v Cruic ,or ChdfItable,OrgamzatFon to�which4y hake belonged; Position /Office Held antl Dates 6t ga k d g m e5 1 ` a }�q& n r,a t�,x"( 4j . tiyr ,. v 3 °dti; .r ., b What Special Inter ests / Skills /ialentswouldyou�bnng�to'rthis Board.Comrnission or CornmitF'ee�' `�... 31 years of Information Technology (IT) & Telecommunications education, knowledge and experience. Certified Informatiorr I Systems Auditor (CISA) Certification , IT Service Management Information Technology Information Library (ITIL) v3 Certification Page 2 of 4 15'-- �s. w e dti yrczs r 5 �a y re b r a it n,W College�Prof�essional ,r�oca Attentled Subtect D�at / t University Phoenix - BS Information Systems - 200.1. , Heald Institute of Technology - AS Electronic Engineering Technology - 1989 = "'�"�f ,ko 0 u�ry m"Y.i'a x s 7a 0. .m 7 d"_ T ,ue a. `, �. av a�,,.:. s �� "dlk" s. `"�'�k �S.. f` aids" � �;(S'+ n �{� -�•a ��`'AW "C1 :'}�,` iK��f�� �. k. 0.y ^9' -, �'� Y �S� L ��i��k a i ad"� '.. 11" '. +�C '�l �( s Special Awards or Recognition; Receivetl s P t �, ��z.r�k;,. '. � � , := rm�v ��� ss.�"'_5.S� A '` .ra 3 -.� ..m�,v�'� �✓! `� '`a�ro.°� r ..�.,.faaf`� ��,4. »tz'. ,.,i. c , "+ Too many to list but here are a few U.S. Coast Guard Good Conduct Medal .U.S. Coast Guard Meritorious Unit Award U.S. Coast Guard Meritorious Service Award 2009 Above & Beyond Annual Award - Kais Permanente NFSBI organization . ar� was k� ' ... yt" " g f 4 4�, ";x: � w F' n.,1 ., .s......,✓" Please state reasons youVant to h become o o thIssi Boa ,'d Comm ssion or r Committee�ncludmgwhatspecific objec working toward asa memberof Having been a committee member for the past 3 years I would like: to continue the work that the committee has undertaken with a focus on promoting access to electronic information and community resources for all Petaluma citizens as well as supporting the new Economic Development Manager and the goals and objectives under the Economic Development strategy and continue to work to bring more high /clean /green technologies companies to Petaluma. W kll` "",, Age �i � &,� '$" b+?,�G .'�°` r °,"rru.._° �4 L' '.., axa �3 # i 9 �+ r d wup k4' - IT, d"Ra. �t +` t,v n e 'vvfr ;" a:4 ,7" alb " :p� s>+ " SAP ,»J Is T ere any other,inforrr atiornthat youryfeel,would be useful to the City Council to revs,,— your application, > .s Only that I really enjoy the committee role and the ability to serve my community in this small role Page 3 of 4 X53 303344 07:07:27 a.m. 06 -07 -2011 Revised August 12, 2008 Page 4 of 4 4/4 15`I � � `41iff rnitl� bll�dedLL�9 rs s ri fi . r - ' C� - C ®�4'lr1'11�On aAnd App� IBC�'tiOn - , ,,,,.. ,+ ;I3oard Instructions Use this form to apply to serve on any of the City of Petaluma, California's Boards; Commissions; or Committees Please fill out the form completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the C' Office City of Petaluma, 11 English Street, Petaluma, CA 94952. All applicationsare review uncil. iName ti Daniel Lyke ti C277 N p r rnRt rIy +✓rz ' .� -, .:., YV Home Address, City, tie and dip Code = ��'d Sa,. a . a ge ,v._ — f ti.n.: a r r` s� ZlZ02 Petaluma, CA 94952 me Plwrre (Ifappornfed do you wantths It�" " Q h Humberto be ava►lableytb the pub6c�) a �° _ r p r y .... 1 '' y K , 4r J iY Y A II tilt. f !II ➢ h n 'g �il rr ?qq"I 'J �'.'F,I,V l Fh/ , 10.N�;nl dY S n�.l I.x" ( , ;a- r 'w -:k. � � M�vi �, - - �IWaI I (Ifappornted'dlb.y wantthrsaddfessto ff� PY ' ° �'� I! ;. 'yh� r;s r �'�`�dhl' +n � . ��r r be available. -to the' ublic�� YES'` _ you a kregr5lered voter i Poetalluma� y f + if so fdr how g? ,Are + Ion ❑✓ YES NO since January 2008 r t arc!(s), Comoro on(s);ioe•C'omm�e'a(s)' of lrrrtierest" t ' Technology & Telecommunications Advisory Committee *Note: To serve on the SeniorAdvisory C ommfte, you must be age 55 or a bove. ' Have you'attended,a meet>ia-g oft is ' , Wive you+served on rnterviiewed; or" ppirecf for y 1 �� . . - ..�, t . Y1 body Os ! V I YES ❑ NO V✓ YES ® NO Lyke, Daniel Technology Advisory Committee 15S PreseritErn0joyem U�� "a A 'Self - Flutterby.net is my technology consulting c i i 'v "A. Mr IF W " . I 'V, 4 , ; - W 1� owner 0�.NL "-V '1 1 , 1 1 1 - i - i I 96 d id iV 66� Wie- - 0 f fic e 9 u have 96 ive''d Pb UdrV01 111 11 �gl.-- , � * , [ vious., ovemmett6l" Mc - Ild 'a si J Petaluma Technology & Telecommunications Advisory Committee July 2009 through June 2011 nizatiorild�Which 411k Fie M clivicibrc M46 belonged, Pbsffion/0, e ;a gi 4 Z Volunteer Coordinator for the Marin Cyclists Marin Century/Mt Tam Double, 2006-2007 COTS Family Connection participant 2009-2010 As an outgrowth of our Family Connection participation, my wife started and she and I run Family Build Night, a program to do crafts with families who've been through the COTS shelter system and are now in permanent housing. -Ma a1e drig', ti_ - -omm 1htere�WSIldills/T b n; or C A16e? Pj1hisBqard` 7 I've been deeply involved in technology at all levels for decades, from founding an Internet provider in the early '90s, to credits in Pixar films, to being a part of other projects and products you've used. More importantly, I've just started to see how we can guide the T&TAC to be a useful committee to the city, opening up a real dialog with the city council and providing better background and supporting information to help make our recommendations useful. Page 2 of 4 I 15 (0 N A k. College, Papies9onal, Vocational -ft 'irde­d`(MNJ i ift ft* erred AT e d j reasons w hy y dywahtAh"I hii be rof th is W aid C-b ' In ' In - hc 9 d In I -.. "' W',' It MIK f OMM 'as � MerjnOer,o 60 " Id be WIN id e;-, ,-,In �spet c. o jec, es wou e-,vvo In vwa Y ry "!this 4'd­­­ "bbd My term on the T&TaC thus far has been frustrating, but this spring I realized that the reason we're being ignored is that we're not providing enough of our insight into the reasons why we make those decisions. I'd like to open more of a dialog with the council and instill a culture into the T&TaC that provides more in-depth background to resolutions. I'd also like to continue trying to figure out how we can make city data more accessible and available for understanding by regular citizens, and hope evolve Petaluma0pen.com in order to add more features to do that. `Is there 'any o 11, nm on yquil e__ '16, 1 Wdu ft6tiitiit Council inrits-ft" Ica 71 In "i i . W J I settled in Petaluma with the hope that I'd never move again. My participation in the T&TaC is a continuing part of my attempt to set those roots deeply. Page 3 of 4 61 Revised August 12, 2008 Page 4 of 4 �� K 5 o l ❑ YES F✓ / NO aw � j ,,, '� , '. " UV Ile J ,� A�, - N _ - IL VP L; "4" f.iffyes�;p6ease Siam hamediur 'EM16rilitiploppenv 4 gany _, 11 W , l A 6, Z4 I dk6fft§4114i kMd"j`,d�i W YES ❑ NO k .......... U 1 ,,� Inisropenif . tabout ig f .Z t"N -A- TF Current member of the T&TaC U -11,1. ��v 4 t-5 - A0 "Jit � E l f . L M L Revised August 12, 2008 Page 4 of 4 �� K A ZT 'Y , u,� e 3 3 d d d K y k r �o- Al iK a$ ila a '�-� h` s,�E@ ,F' L; e • 3` d .3 .�+d to d` �• x f I'etaltt�rta,C'altf ®fin 3? U � } � 1+ � �� �` � � aJ � • �+� 8 yt '�tL F °� �,% Y� �� y, 19iRL Cmission2� Co i Cit B rnrnttee Ap a y oartl,I,orn and Uv^} v'**7 `' -y ",,p[�+sk p ` };� 1 T t�, •i a+se"u ] ��ri 1 >?� 't"'Y � 8 5 r ti Instructions: Use this form to apply to serve on any of the City of Petaluma, Cali s Boards, Commissions, or Committees. Please fill out the form completely. If a question does not a write N/A in the space provided. When completed, please forward to the City Clerk's Office of Petaluma, I I English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. 4+s': �'7Wd ,��. ,� c za`t w "c N. E n ex ++• kr+� .� k + J �^ r x �°' ''p 4]'-' r' t , Na � gyp@ � �._.�3�.�,n � �' L Y Qs �. "!"'�n... u ..M"•,�. .,J -°$i .fix . {�. �1�' °.w r ter. �.l Jaimey Walking Bear s".a ?.i c - - y. ;i t , m ,^aT �" as �fi f..• HomeA�ddres`s k Cit �S #ate p' Cotle n Y an'd�Zi �..9 �.. i laa. .� rC.x. � �r. a .> i• :,ar'S.� .� .. wlC"� n.. , � »�' � �3`1P nuFw„ i( Petaluma, CA 94952 'i .. as u + - aY"- aA d r " •+r`,r " dry„ Horne Phone (If;appomted do�you want th "is - o .1y R �, �9 ,„ys, ¢�,' via '# J'1- + + ; ". KA�Yx Lam a �t " +"n''„i7# T L e � number to be dyailable' o�the�pub6c?J' 4 e r C Work P +hone E Mail 4(If appomte6,46 "you wd 't -, this address to s ❑ be available to_ the public?J ;YES NO ,• _ a 4 �ia' Are you a registered Voter in;Petaluma� If so for how long? h , , — 71 �... _�.. .'�, ._ _ �i. s:+b `_ "a.r.� - ._.i. - rsu.`e. $,. ...s3..ffi. . -.r•.. ..-.5; .� - :_.... 4 a..a. ,- ., > <, ». �. -az 0 YES ® NO 16 years „ gY ,f5 -� + . •at: N�� �l•s�'' N s �' ! 4flf�9'�"� a91 ¢I;!. 4-n V •�L'�:%'cA � ' ", , ?'��*. p.�,J t.i r f • rx fl'v`. 13' rd(s) "Comm ssiori(s) orkCommittee(s) of Interest* Technology and Telecommunications Advisory Committee *Note: To serve on the Senior Advisory Committee, you must be age 55 or above. w, d e ' {. � � � Have you' attended a rneetmg of tFis, Have ou served on s`interviewed or a � lied fore J y pp 1 4 +�ro� y,� . h.. n �b �� 7� , � x •,� � � ,.�� �� ti� , � a � � this bosdy�previo`u'sly�~��;�� � +, ,-!� � a , •P � r �,.;��,z5»ay �r � �P L�.n, kmd(� � rr�,krt[a sk .� �i s� aj � � ! y IS 3 F s i �� n! < D YES ❑ NO [D YES ® NO Walking Bear, Jairmey Technology Advisory Committee 169 _ � �� e d ; PI z { = 4 R e~, s ¢ ` O'Reilly Media, Inc. sdy q k2ud A_� a t�r4g Wty t Aa 4 � �� , �ow N n Y_. ?9e x r Marketing Manager overn �, l F p- dies /Ele Precious ;Gme nta Bocti�e:Offices youhaveserwved rs Position /Office Held u Dafes d a 9. w City of Petaluma Technology and Telecommunications Advisory Committee 2009 - Present; Vice Chair 2010 - Present x , Civlcor Chartable Ogamzation to whichyou Ftiav e belonged , P /Office Held and , u. ra.R Recent Community Engagement includes: Board Member, Petaluma Music Festival, Inc. - 2010 - Present Advisor, Online and Social Media initiatives, Daily Acts - 2009 - Present Evangelist and Organizing Lead, Ignite Petaluma series - 2010 - Present Past President, Petaluma High Music Boosters, Inc. - 2006 - 2008 ar �, t 4, k.fwM What Special Interests /Skills %Talents would you'bring�to this- ,.B oroCommittee? 2 1/2 year service on the T &T Committee, Vice Chair for past 18 months. 10+ years marketing experience. Currently employed at one of the most respected technology companies in Sonoma County. In -depth knowledge of industry trends and emerging technologies, social platforms and other web based tools that the city can use to extend community engagement, while saving money. Access to growing network of technology professionals and public sector employees who are pioneering the use of new media tools in government. Evangelist for open government and open data initiatives. Page 2 of 4 U� �Colle a Professional ��ocationalxSchools Attended (LylatorxSubtect Dat s�Degree %Date) �- ag 3 "` " - u5.✓P_° ' . t :� S a rF .,+, , � . 4 An � S r+ r{ ° `,ytn r 2002 -03 Partial M.A.completed studies in Philosophy and Religion, Naropa University Oakland 1999 B.A. Environmental Studies and Planning, Sonoma State University 1994 A.A. Media Studies, Santa Rosa Junior College "'�`�`-� ��a ,� ;Special Awards:;orRecognition Received , r " VU =x , t dap`'' ro'Yk"`as "' f Please.state�reasons why you want$to becorne d of!this Boarda Cornrn scion or # w Committeesncludrngwhat specificobtectiues:y wouldbe,�w rkirigtoward asa mrernber of +r R thinadviso bod � Va I am currently Vice Chair of the committee and am reapplying for a seat on this body. My priority goals would include: -- Continuing work started on the committee to align our actions with the city's, in support of the Economic Strategic Development Plan, civic projects, and community organizations -- Continue efforts to promote and market Petaluma as a tech friendly community -- Provide recommendations about technology - related amenities and infrastructure needed to attract the tech businesses and professionals to live and work in Petaluma -- Support committee efforts in continued partnership with Petaluma's tech businesses -- Support open government and transparency efforts and standards -- Further city initiatives to use social media tools for community engagement and customer service � �,' + .; �, s s � �.- �• 't w ° a' r� r - t _ #� ' �� .yam s .� a " : c� Is "there any�otFer�mformotion thatsyou feel would be usefulto tI y Councilm�e�iewm ham Over the last two years, the committee has made great advances for the city, including: recommending city participation in the North Bay Hub, promoting open government and transparency through the use of the city web site and other web based tools, updating and improve the public's user experience of online resources, and promoting the city as a tech friendly destination. With the hiring of Ingrid Alverde, we are well positioned to continue some of our work in progress and support the city's key economic goals. It would be an honor to continue serving the community on this body. Page 3 of 4 101 'fi- � fi ., � �' X q'@ .} � � s� F §Y F y k' •41'�.J � H `Y�k � fb .�� S � .� � R IA 'x` {� � P l q l jp � i Are you�assoc�ated �Wrthjany�Organization /Emp oyment that miglif be?deemed a confl�ct�of , ° rd 'utieskif this,po �°� '���` interest�in�perForm�ngiyourd � �'����`���� �� � ��� � � §n ��- � '� � � S �i"' +4 "a4 �� •7 � � {�`ae P � �. "'_= �-'f � h� _.< .,� �'� �ap!� sF r h'�,. ?'�,*`� �''. � d� ;; '�l � ^�,'� A: !�� ® YES F] NO - a {' Wr • _ ^ } ' •�S t-{'2 4.` TY t J?�, Y 77:% 3 If yes please statename of Organaation /Employment, a� e"Max yf� J 5•w� 4'"If � City policy directssall appointed advisoryb�ody, <men,bersnot to vote on matters where�ther JR 2N ` - a f s� • "¢ d - "' yati E� §f ;,.2 k 4'h'<.i'" ,�k, rY'� 4 �^ k �' A'? d '3 Y. n.',.. : i +z5'�° es ,v�' 'w, 'f: k J �existsfaa conflict of mterest�fWould, oubekwilhn to»abstamfrorn votmgd�sueh a� Y.� g �'_F� r- � $� ,�„ a s -m ,,r � � s''�,. � ., u � why -�.'�' J � d"�"�.�r.�';'g`l'�r �t �r�� ' € �,����b �`� ' conflict ; arises = . z'°a y p 'o2" '(� X w : < fi.;S� , .a � a :. � K a z '+ r „it r ,3 r .ti, � iP~~' • r,�. r�. . YES NO V '� 'R s"af ' h 5 P"v s =7�• ..'€ � �'' � "�„�„ {"'�.,'"§ 'fit a „ 4 ,. �. `. Howdidyouheardabou .opening,7� ` Currently serve on the committee ,3 fn Date ApPhcant's Segnature� Y � � , j " 3" 4 U" �5 �I - F 4 r+".4"A A T,,, stJ'," §.i +, ..P'�".. �k;� Y^+P;, a A_ Z6 Revised August 12, 2008 Page 4 of 4