5.1. SR 10-12-2009REQUEST FOR ACTION
To Item Number
Ci Council 5.1.
Agenda Section Meeting Date Prepared by
Administration October 12, 2009 Jessica Miller, Executive
Secreta /De u Ci Clerk
Item Description Reviewed by
Interview Heritage Preservation Commission Applicant Tina Allard, Ci Clerk
Reviewed by
Lori ohnson, Ci Administrator
Action Requested
Interview Mark Konietzko for consideration as a Heritage Preservation Commissioner. If appointed,
term expiration would be February 28, 2012.
Background/Discussion
There is one vacancy on the Heritage Preservation Commission. Mx. Konietzko will be in attendance at
the October 12, 2009 meeting.
Financial Impact
N/A
Attachments
^ Application
Action Motion by Second by Vote
FOllow Up
S:\Administration\Council RCA\Boards\2009\HPC Appt.doc
APPLICATION FOR APPOINTMENT TO RECEIV ED SEP 2'~ 2~~9
CITY BOARD/COMMISSION
EDA, HRA, AND LIBRARY BOARD , REC' ~. ~~ ~--~'
E3;rt9 asr:.aser l'srl ~i-
Terms beginning in January
'T'hank you for your interest in serving your community! Please indicate in order of preference on
which of the following boards and commissions you are interested in serving with 1 indicating pour
first choice, 2 your second choice, and 3 your third choice.
' Economic Development Authority
The EDA is composed of four Councilmembers and three citizens. The length of term for the
Councilmembers coincides with the term of office for Council The length of term for the citizen-
members is six years.
2 Housing and Redevelopment Authority
The HRA consists of five Commissioners composed of one City Councilmember and four citizens at
lar .The term of~office is five years.
_ Libraryoard
The Library Board consists of five members. The term of office is three years.
See the specific board and commission description for additional information.
APPLICANT INFORMATION
Name:
City of Residence: ~l~ ~I~1" AA
Occupation: ~~i~IS.Sr ~~ll,Lt' L~.Zlt.~ Employer:
oard/commission for which you are submi this applica ~on. _ _ ~~~~
Education/Professional Experience: Describe your educational and professional experience or
sCkeills that qualify you to ser/1ve on this board/commission.
Statement of Interest: Please state briefly why you are interested in serving on this
Relevant Personal/Yroiessional >/xpenence: Please descnbe your protessionat, civic, or
community participatio which may be relevant in serving on this board/commission. ^
Attendance: Are your aware of the importance of regular meeting attendance including the time
commitment involved in preparing for meetings, and do you feel you have the time available to be
an active participant? ~ Yes ^ No
Comments:
Conflict of Interest is defined as the participation in any activity, recommended action, or decision
from which the individual has or could have the potential to receive personal gain, whether it be
direct or indirect. (See attached "Conflict of Interest" Ordinance)
In accordance with this definition, do you have any legal or equitable interest in any business,
however organized, which could be construed as a conflict of interest? ^ Yes ~ No
If yes, provide details on a se crate iece of a er.
20 Q
pplicant Signa e Date
Questions may be directed to the Administration Department at 763.635.1000.
OFFICE USE ONLY
The Applicant is: ^ New Applicant ^ Applying fox Reappointment
Council Action: ^ Not Appointed
Appointed to: _
Date Appointed:
Term Expires: _