Loading...
HomeMy WebLinkAbout2008 12 08 Regular 604 Appointments to Board of TrusteesDate: December 8, 2008 This Agenda Item was not discussed during the December 8, 2008 City Commission Regular Meeting. COMMISSION AGENDA ITEM 604 December 8. 2008 Regular Meeting REQUEST: Informational Consent Public Hearings Regular X Mgr. / t. Authorization The City Clerk is requesting the City Commission to review the information in this Agenda Item regarding upcoming Appointments/ Reappointments to the Board of Trustees, for Seat One, Seat Two, Seat Three, Seat Four, and Seat Five. Each Seat is scheduled to expire in January of the year 2009; and if possible, the City Commission is being requested to make Appointments/Reappointments to this Advisory Board at this City Commission Meeting. PURPOSE: The purpose of this Agenda Item is for the City Commission to make Appointments/Reappointments to the Board of Trustees for Seat One, Seat Two, Seat Three, Seat Four, and Seat Five. CONSIDERATIONS: Section 14-52. of the Code of Ordinances of the City of Winter Springs, established "A board of trustees consisting of five (5) members who shall be appointed by resolution of the City Commission." CITY OF WINTER SPRINGS, FLORIDA CITY COMMISSION REGULAR MEETING -DECEMBER 8, 2008 REGULAR AGENDA ITEM "604" PAGE 2 OF 2 Section 14-52. also states that "Each commissioner shall have one (1) appointment to the board. Vacancies in the board shall be filled by the city commission member whose seat number corresponds with the vacant board seat subject to commission ratification, for the unexpired term of such vacancy. If any commissioner fails to appoint a member within two (2) regularly scheduled commission meetings after a vacancy occurs or a term expires, that seat will be filled by the mayor, subject to the ratification by the city commission." All Seats on the Board of Trustees are currently scheduled to expire in January 2009; and all Terms of Office are for three (3) years. All current Advisory Board Members have been notified that their Terms of Office are expiring in January 2009. Appointments/Reappointments to the Board of Trustees should be made no later than early January 2009. The next "Regular" Meeting of the Board of Trustees is scheduled for Tuesday, January 27, 2009. Once Appointments/Reappointments have been made for all five (5) Seats, Staff will bring back a Resolution for ratification by the City Commission, as stipulated by the Code of Ordinances. ATTACHMENTS: A. Copy of the current Board of Trustees Member List. B. Advisory Board Applications/Information received from the current Board of Trustees Members (in Seat order). C. Advisory Board Applications (in alphabetical order) recently received this year regarding possible Appointment to one of the City's Advisory Boards/Committees. D. Attendance Information from 2006 through November 2008 for the Board of Trustees. RECOMMENDATION: The City Commission is requested to make Appointments/Reappointments to the Board of Trustees. COMMISSION ACTION: ATTACHMENT "A" CITY OF WINTER SPRINGS, FLORIDA 1126 EAST STATE ROAD 434 WINTER SPRINGS, FLORIDA 32708-2799 TELEPHONE: (407) 327-1800 FACSIMILE: (407) 327-4753 WEBSITE: www.winterspringsfl.org BOARD OF TRUSTEES MEMBERS: Seat One: Mr. Michael S. Blake, Vice Chairman 711 Canadice Lane Winter Springs, Florida 32708 Telephone: (407) 365-7051 [Personal] email: Michael_Blake@ajg.com Term Expires: January 2009 Seat Two: Mr. A. Mark Sardo, Chairman 997 Sequoia Court Winter Springs, Florida 32708 Telephone: (407) 695-0229 [Residence] email: amsardo@cfl.rr.com Term Expires: January 2009 Seat Three: Mr. David W. McLeod 645 Dunmar Circle Winter Springs, Florida 32708 Telephone: (407) 695-1604 [Residence] Telephone: (407) 832-9187 [Mobile] email: dmcleod@cfl.rr.com Term Expires: January 2009 Seat Four: Mr. Vernon Rozelle 648 Redwood Drive Winter Springs, Florida 32708 Telephone: (407) 718-2190 [Mobile] email: shealund53@yahoo.com Term Expires: January 2009 Seat Five: Ms. Maria N. Fair 1207 Trotwood Boulevard Winter Springs, Florida 32708 Telephone: (407) 695-1069 [Residence] Term Expires: January 2009 LOCATION: City Of Winter Springs Municipal Building (City Hall) 1126 East State Road 434, Winter Springs, Florida 32708 Commission Chambers MEETING DATES: Regular Meetings Are Held On The Last Tuesday Of Each Quarter MEETING TIME: 6:30 p.m. 2008 REGULAR MEETING SCHEDULE: January 29, 2008 Apri129, 2008 July 29, 2008 October 28, 2008 STAFF REPRESENTATIVES: Mr. Ronald W. McLemore, City Manager Ms. Michelle Greco, Director, Finance Department Mr. Kevin Smith, Director, General Services Department TERM OF SER VICE: 3 Years DOCS/advisoryboardsandcommittees/boardoftrustees/al ll/meetings/2008memberlist.xls Revised 07/23/08 ATTACHMENT «B„ Andrea Lorenzo-luaces From: Michael_Blake@ajg.com Sent: Thursday, November 20, 2008 2:52 PM To: Andrea Lorenzo-luaces Subject: Board of Trustees Andrea, Thanks you for the informational packet regarding the appointment process for the City of Winter Springs Board of Trustees. It has been my pleasure and a privilege to serve the citizens and employees of Winter Springs in this capacity over the last two years. Due to pressing personal and professional obligations during this coming year, I respectfully request to not be re-appointed at this time. Michael S. Blake, Sr. CFP Area Vice President Gallagher Benefit Services, Inc. 541 East Mitchell Hammock Road, Suite 300, Oviedo, FL 32765 U.S. Mail: P.O. Box 622467, Oviedo, FL 32762 (407)977-0077 • (800) 540-8755 • Fax (407) 977-0027 www.gallagherbenefits.com This message, including attachments, is forthe named person's exclusive use only. It may contain confidential, proprietary, or legally privileged information. If you received this message in error, no confidentiality or privilege is waived or lost. Please delete it and all copies from your system, destroy any hard copies, and notify the sender immediately. If you are not the intended recipient, or his or her authorized agent, you are hereby notified that any dissemination, distribution or copying of this email is strictly prohibited. GBS reserves the right to monitor all email communications through its networks. Any views or opinions expressed in this message are solely those of the individual sender. Securities are offered through NFP Securities, Inc. A Registered Broker/Dealer & Investment Advisor Member NASD, SIPC Page 1 of 1 Danielle Harker From: Mark Sardo [msardo@pfginc.com] Sent: Wednesday, November 05, 2008 11:50 AM To: Danielle Harker Subject: BOT Reappointment Importance: High Sensitivity: Private Please note, it is my full intention to serve on the City of Winter Springs BOT until January 2009. Mark S. P~r~r~syiv~n~a FI~AN~Cf,A~L Gi~oUt~ Integrity /Vision /Performance Mark Sardo Financial Consultant 997 Sequoia Ct Winter Springs, FL 32708 407-695-0229 office 407-695-8386 fax email: msardo@pfginc.com website: www.pfgws.com Please note, securities orders cannot be honored when communicating by email. Securities offered through WalnutStreet Securities Inc, Member FINRA, SIPC / Advisory Services through PFG Financial Advisors /PFG is not a subsidiary or control affiliate of WSS. The following annotation was made by the Broker Dealer email server on 11/05/08, 11:50:09 ------------------------------------------------------------------------------ The information contained in this message may be CONFIDENTIAL and is for the intended addressee only. Any unauthorized use, dissemination of the information, or copying of this message is prohibited. If you are not the intended addressee, please notify the sender immediately and delete this message. 11/5/2008 ~~~~~~~ October 31, 2008 N0~/ 0 ~ 2008 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Andrea Lorenzo-Luaces Office of the City Clerk 1126 East State Road 434 Winter Springs, FL 32708 Dear Ms. Lorenzo-Luaces, Please consider this letter as my indication of preference. I do not wish to be considered for Reappointment. Sincerely, Mark Sardo 997 Se~uo':a Ct Winter Springs, FI 32708 ~~~® November 3, 2008 City of Winter Springs, Fl. 1126 East State Road 434 Winter Springs,.Florida 32708 Attn. Andrea Lorenzo-Luaces City Clerk Dear Andrea: NO V 0 7 2008 CITY OF WIN'~F_R SPRINGS OFFICE OF THE CITY CLERK Please inform the Mayor and Commission, that at this time, I must decline from being reappointed to the Winter Springs' Board of Trustees. It was a great opportunity and privilege to serve on the board with knowledgeable people that understood that there j ob was to advise the City Commission on how to protect the City employees retirement, along with what is the best investment for the times. ~~r Mcleod ~~~~~ Nov. 07, 2008 Andrea Lorenzo-Luaces City Clerk City of Winter Springs Dear Andrea, Lvov 13 zooo CITY pF {ryINTF!-~ SPRINGS OFFICE OF THE CITY CLERK Please consider this letter of intent to continue on The Board Of Trustees For the next term, if appointment is approved by my Commissioner. Attached is my 3 page signed application . Regards, Vernon Rozelle , Jr. Via Fax on Nov 7,2008 to 407-327-4753 ~X_ c Lam- y~S 3 /0~-3 ~~, ~~ CITY OF WINTER SPRINGS APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony_ Please complete the following in the space provided: A. GENERAL ------ 1. Name: ~ i 2. Home Address: CC/ ~y~ - ~~~ ~~/%~v"~._.~ 3. Home Telephone: ~~ ~ ~' ~ ~~ 4. Occupation: ~~"'~~~-~ ~ 5. Business Telephone: ~ Z ~Z ~ ~--- ~ B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County 2a. Do you live within the City limits of Winter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of polo contenders (no contasi) shaii be considered a conviction for purposes of this question. 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? ~(M ~N)- ~~~7f (~ N~ (Y) (N)'~ 4b. If yes to 4a, please list each: 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a standard background check being performed on you by ~ itials the City of Winter Springs? (Y) (N) 6a. Are you related to a City of Winter Springs Commission ' member by blood, adoption or marriage? (Y) (N) 6b. If yes to 6a, please provide relation: C. INTERESTSlEXPERIENCE 1. Briefly state yo r int~e~r~est in serving on a City advisory board or committee: 2. Briefly state ~~yJ! prio experiences in serving on any g committee: ~C/~~ --/,~(i'~,..D~.[.~(,2~ ~iJ~ <.- In numerical sequence (1 -most interested), please rank wh committee you wish to serve:` mental oar or ~ ~~ ~~~ advisory board or a. Board of Adjustment b- ~_ Board of Trustees c. Beautification of Winter Springs Board d. Charter Review Committee e- Code Enforcement Board f. Districting Commission g. Oak Forest Wall and Beautifcation District Advisory Committee h. Planning and Zoning Board/Local Planning Agency ~. Tuscawilla Lighting and Beautification District Advisory Committee j. Other: `Please see attach ment for description of the advisory board or committee. 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American ~ Male _. Asian-American Hispanic-American Native American _~~ Caucasian Not Known Female Not Known DISABILITY Physically disabled YOU HEREBY REPRESENTTO THE CITYOF WINTER SPRINGS, UNDER PENALTIES OF PERJURY. THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA~STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APP ED TO A CITY ADVISORY BOARD OR COMMITTEE, AND I APPOINTED, I I OUR SOLE OBLIGATION AND DUTY TO COMPLY WITH S ~ LAWS_ ~ /"-~ Signature: Date Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 "$~~~;-~• Shall a,~ am pecsoa living within th~ity limits at all times whllo setving on ' ~~~¢ or committee. and at least six f61 mostths p~jof„to beiag nomitta_t~ elated or • Kjtf4inted to the board or committee. (gl Qequ~rementsofboardat,Ld.committeemembers.Anypersopnominated.electedorappoinbed to serve on a board or committee of (Ste city shall satisfy the following~cquirynents exceot as otherwise provided by,~tate or federal law: U, Complete a board or committee application as prescribul by the city commission: ~ (~ Consent to a standard criminal background check' ~" `lam ~ iie duly registered to vote in Seminole County ~ - ~'~~ [41 13e a resident as defined in this section• and ~ j~ .- ~2~ -~--{,,5 -~ -1-Ias-rre conv~c _or foun Qu- tv. roeardlesYs of adiudicatic ptuvoses of this paraaraah intment and' removal of members. (Jnless otherwise reouireil by sate or federal {aw. or gpecif tally provided otherwise in the Code ali persons shall fie appointed to and removed firm city boards and committees by majoritx vote of the ett~ mmission ~ Board and ' committee members shall serve at the pleasure of the ci corrL ission and may be summariiv t~noved at any time with or without cause A board or committee appointment shad not•be •~ttstrued as creative or conferring, upon a uerson any rig tt or jntere~t in serving on a board or.committee including but not limited to acontract liberty propcr~yfi or vested right • ~J ~~ A(I board and committee members shall be appointed to serve three-year terms and t • may _bc reappointed by the city commission for subsequent three year terms without 1-~- limitation. if a member is removed or vacatcs•their appointment far any reason i cln uding J ~~l death. excessive absences or resignation ptjor to the expiration of their term the City ~k~ S.Qtnmission may at its discretion appoint the first alternate member described below or C,~ ether avalified individual whom shall serve rho remainingportion of the unexpired term ~r aoscnccs wttntn a twelve-month period from any regttlarivscheduiedme~tina shad be deattted auWmatically *ern^vcd from the respective board or committ~~ in which rho -ba stnces aye oacun ~fiairmanships_ Each_board and committee shall be responsible to elect, by majority voteof the~the next meeting held A{I newly established boards and committees shall make such i~puty-chairperson. ~Iterttate members. At the discretion of the citycommission two t2) alternate members may ~eanpointedtveachCitvofWinterSpringsboardorcommission unlessotherwiseprovided City of Winter Springs ~ Ordinance No. 2001-49 - ,, - Page 3 of 5 . • . RECE1'v~o' NOV ~ ~ 2~~ CITY OF WINTER SPRINGS of yrINTER SPRtNCi6 APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITI"iceo~Ta+E~'T"c~ERK City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL 1. Name: ~C:triGt ~ ~ ~~f+2 2. Home Address: ~7-+~'l 1 rc~-u.~pyd ~ ~ Vcj ~ f,(,) tn~l-c~b7'i~ si ~~- ~~'~n~ 3. Home Telephone: ~Or) -~q5 ~' lob9 4. Occupation: F na nc ~c-~1 ~~ 50~ 5. Business Telephone: ~Q~- q`1r-~~~`~ B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (`n~ (N) 2a. Do you live within the City limits of Winter Springs: (Y)J,~ (N) 2b. If yes to 2a, how long have you been a resident? r5 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of polo contenders (no contest) shall be considered a conviction for purposes of this question. m (N)_~ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y) / (N) 4b. If yes to 4a, please list each: ~a~~ p~ Trus+'~c-S 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a ~n~_. standard background check being performed on you by initial' the City of Winter Springs? (~')_~ (N) 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y) (N) t/ 6b. If yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: l&s ~ ~~ oa.ile>z an~ dn~eres~ Cr fi ~ Cage- e~e.a. a..6 ou-f- my Cornrnun ~ ~-.~t (~vr ~q~ 7rtrt ~- ~ ~ r? a r--1- f3-F' t~e.n i ~ ~ Ltn~ r1"Y,~-L i ~cf ; a ~e_ 9~cr p lac ~ ~ '. ~, work a.-td P 1 2. Briefly state any prior experiences in serving on any governmental board or committee: ("t~l c, ~ n {orce rr2Q of ,~~ar7->f lYl ~m loer' fors r~ o f' T~s~-S ~ ~Qar-C1 p ~ "D ireC~272 1~i hSc~tcta~ U P of me~nbQr~h~n 0v~e~o -I,vi~~r SPr-~SCHa~rbe~, pooctrd oF7Jir<~ar lUi+'~'- ~} G~f Far Tc_ac!-,in9 plan,~cl Gi v~n~ L~Dmm: (-. °C:< . 3. In numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:` a. ,3 _Board of Ad'ustment _ >b. 1 Board of Trustees Gu-~~-r'~~ Se.r~~ti~ G~ c. '/ Beautification of Winter Springs Board d. a Charter Review Committee e. ~o Code Enforcement board f. ~}' Districting Commission g. `~ Oak Forest Wall and Beautification District Advisory Committee h. ~ Planning and Zoning Board/Local Planning Agency i. ~_ Tuscawilla Lighting and Beautification District Advisory Committee j. /~ Other: `Please see attachment for description of the advisory board or committee. r ash t1 c F C~a~ua~e- 5~ud ~ ¢s ~ ~~ru r~~p L~-~ f 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American _~ Female Hispanic-American Not Known Native American _~ Caucasian DISABILITY Not Known Physically disabled YOU HEREBY REPRESENTTO THECITYOF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS .TRUE ANO ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS (SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA~STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. Signature. ~ "Y~ . Date: I ~ ~ ~ ~ bR Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 ~Lrnt" s mean any txrsop living withia th~ty, ligt~• at at,~,t times while s~rvir-g oa >l~~zoard ar committee. and at least six (61 months or to bei g nomit~. elected or allptt4inled to the board or comtt+itirt (cj $equ_j,~ementsofboardandcommitteemembtrs Anypecsanpominated electodorappointed ~q~servo on a board or court mittu of 4he eity~hal(sadsfy the following,Jequinernents except as otherwise provided by state or federal law u Complete a board or committee application as gceseribed by the city commission: ~Jl_. ft~ N , ~ t~ ~ Consent to a standard criminal backgr,Qitnd check ~ . ``1~-~l ~ l3e duly reeistered to vote in Seminole unto' , ~ . - ~'~ u He a resident as defined in this section and . ~q, .~~~. ~ ~'`~ --- --~-- -~laszte convtc or foun gut t~gardless of adjudication of a felony in ~ . ~n_~'iusisdiction any plea of Hole conte~tdere shall be considered a conviction fo_r purposes of this aaraeraoh t Antx>intment and removal of members Unless otherwise rwuired by state or federal law or stxcif calls orovided otherwise itt the Code all p~oc~.c shall 6e appointed to and removed 1~toveii at anytime with or without cause Aboard or committee appointment shall not be ~~nstrued as creative or conferring upon apcrson any t~'ght4r interest in serving on a board Qe.cx~tnmittee ineludine but not limited to acontraet lihecty property or vested right Tezm. Alt board and committee members shall be appointed to serve three-year terms and e ~` may be reaaoointed by the city commission for subsequent t_hsee-veer terms without ` ~^-'~-- limltat'son If a member ~s removed or vacates•thelr appointment for any reason including ~ ~"~ ~ Beath exccsstv~e absetmcs or resignation. p.~gr ~ the expiration of their term -the City ~ ~ ~ommtssion may at its discretion aoooint the first altetnate member &seribed below or ~~ Qther qualified individual whom shall sctvc the romainin~portion of ttte; unexpieod term .. .~~ ' ~- Q.,~~.~..~ w««<^- a ~wcevc-monist acnoa mom a++v ~,r~,tanyscheduted meeting shall, ~ _ ~errttted automatically rr;noved from the resnecdve board or committee .n which rho ~ ~ - _ _ ., `tlbSenCCS~IaVC.O,C1CUtTe~ ' _Gfiairmanshias. Each Board and committee shall be responsible to etect_ by majority votcof _ the members of each board or committee a chairperson and vice-chairperson. The elcotion ~ ' ~lt_la l occur annually at the first meeting held inJanuary unless there is two I,anuary meeting, ~ _~ e next meettne held All newly established boards-and committees shall make.such electrons at their reeulariv held meetine and then annually as stated above, Alternate ; nt me _bers fas arovided bdowl shall not bc~ elected to positions of chairperson or deputy-chaitperson Alternatetnembets Atthediscretionofthccitycommissian two(2)alternatemembersmav beaaaotntcdtoeachCitvofWinterSarinasboardorcotnmission unless otherwise rovided City of Winter Springs Ordinance No. 2001-49 Page 3 of S . •~ ~ ~ . ATTACHMENT «C„ `~ ~ ~~ CITY OF WINTER SPRINGS OFF E OF~TF-fE CITY CL RK APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL 1. Name: J /~' Lt. C",, /.JKU(-t,~/ 1~ ~~8 50 ~~- ~l~r~C~. . 2. Home Address: A _ 3. Home Telephone: ~~7~ ~/~-®70~~ 4. Occupation:~r~~~/I~ ~~~/2 r. 5. Business Telephone: ~~~o' ~Q~ "7~ ~~~~ $ ~~"~~~,,..~fGt B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y)_~ (N) 2a. Do you live within the City limits ofiNinter Springs: (Y) ~{N) 2b. If yes to 2a, how long have you been a resident? ~~ ?9~ 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Arty plea of polo contenders {no contest) shall be considered a conviction for purposes of this question. (~ {N) C/ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y) (~ ~ 4b. If yes to 4a, please (ist each: ~~~ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a standard background check being performed on you by iniC Is the City of Winter Springs? (Y) (N)~__ 6a. Are you related tv a City of Winter Springs Commission / member by blood, adoption or marriage? (~ {N) f~ 6b. If yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. Briet1y state your interest in serving on a City advisory board or committee: ~ f`Cv~~ t1fJ ~' j ,~ 3~' s , tvv~-~es~' !s ~!!~r>:y - ~e~ 1 a 2. Briefly state any prior exp eriences in ,serving on any governmental board or committee:l~~{ ~Oo 6'oy~~sNi~,~,~ EX~~r~.~rr/, ,~~ ,S~~,L~ o.r~ r S£rs~e,~ ~i ~S /~.~~~cA>es/~ ~i~/l~i~~ 3. In numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:` a. ~ Board of Adjustment b. - ~ ~ Board~of TTUStees " "' '~' ~~ c. 3 Beautification of Winter Springs Board .. d. Charter Review Committee e. Code Enforcement Board f. ~_ Districting Commission g. Oak Forest WaN and Beautification District Advisory Committee h. __~,__ Planning and Zoning Board/Local Planning Agency i. Tuscawilla Lighting and Beautification District Advisory Committee j. Other: 'Please see attachment for description of the advisory board or committee. ~.. O. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the Ciry annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American _,~ Male Asian-American Hispanic-American Native American _ / Caucasian Not Known Female Not Known DISABILITY Physiglly disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, lT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. Signature: 6' 4 Date: 03/o~y lUff - Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 ~~~ ~~~ _ "~sident" sha1~ mean any person living within the oily limits at all ~tj,~s w~'~ servln¢ on ~ .. ~ ._.:... . or committee. end at least six f61 months ~C to being nomit~, elocted oc ~ : • ;~~ted to the board or committee. • Requiroments of board and committee members. Anxpersop nominated, eleetod orappointed • tQaesve on a board or committee of the city~s~ta!(satis the following~equlr+ements. except as otherwise pJovided by state or federal law: ~ • ~I ] Complete a board or committee application as prescribed by the city commission: ~-~~ j~ Consent to a standard criminal background check. ~ • ' ~~ ~ Be duly reeistered to vote in Seminole (igunty~ ~, ~ J-{-~ Ae a resident as defined in this section. and ~r~,r ~,~ , -.~-~ ----{~j-- -was-rtayorb~onvrcted or loon gut regardless of adjudication of a felony in ~ _ ~~ J an_~LrisdictIon. anv plea of polo contenders shall be considered a conviction for proposes of thi_,par~araoh. Appointment and removal of members Unless otherwise rewired by state or federal !aw or specifcally provided otherwise in the Code al! persons shall 6e appointed to and removed itxnoved at anv time with or without cause A board or committee appointment shall not be ~~t>sstnred as creative or confecrinQ upon a person any right orinterest in serving on a board Qrsommittee including but not limited to acontract liberty, property or vested rieht term. All board and committee members shall be appointed to servo three-year terms and ~ ~• may _be rcaooointed by the city commission. for subsequent three-year term§ without ~ "''-t-~-- Lmitation. if a member is removed or vacates .their appointment for anv reason including J ~a~i death. excessive absences or reel nation prior to thcexpIration of their term -the City k,•,~,` ~mtsston may at its discretion appoint the first alternate member described below or C,~ 9ther qualified individual whom shall serve the remaining portion of the unexpired term .~ ~ avscncw vvrurrn a zrvave-monar penoa from anv mautarly scheduled meeting shat! be - • der~tned automatically rernovul from the rest7cctive board or committ~ . in which _thr senses ~ave.oGCUrred, ;~fiairmanships. Each board and committee shall be responsible to elect, by majority voteof he members of each board or committee a chairperson and vice-chairperson, The election hall. occur annually at the first meeting held in January unless there is no January meeting, `xrt the next meetine held All newly established boards and committees shall make such duty-chaimerson. Itcrnate members, At the discretion of the citycommission two (2) alternate members may ~nomtedtoeachCitvofWinterSprin¢sboardoccommission unless otherwise provided City of Winter Springs _ Ordinance No. 2001-~9 Page 3 of 5 ..... - r IR~~E~'V''ED SEP 2 3 2D08 CITY OF vVINTER SPRINGS ot~c OF THE C TY C~L,ERK APPUCAT(ON FOR APPOINTMENT TO CITY ADVISORY GUARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL 1. Name: _ 1 ~_11~ AN _~ F-\NI~C-s A N L A L 2. Home Address: 35 5 i t.J E L- y c_ OAKS a4Z is I >`I ~'L~ SPK I N 6 S~ F C 3 -2~o g 3. Nome Telephone: ~ ~ 1 3~ 7 3 S 11 4. Occupation: ~ti,s t N t ss O lJ rJ E-i2 G - 5. Business Telephone:, 0 7 9 ~. g 9~ Z~ B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County. 2a. Do you live within the City limits ofiAfanter Sptfrtgs: 2b. If yes to 2a, how bng have yvu been a resident? 3. Have you ever been oomicted ar found guilty. regardless of adjudication, of a felony ~ any jurfsdicaon? Any plea of nob contendere (no contest) shaA be considered a conviction far purposes of this question. e}a. Qo y~ presently serve on any other City of Vtifinter Springs advtsory board or committee (~ t~ (N) (~ ~ (N) . 6 DH~ (~ (~ !~ (Y} ((~ ~ 4b. tf yes to 4a, please list each: e f I , 5. City ordinance requires that a!! persons applyirsg for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Oo you voluntarily consent to having a ~~~ standard background check being performed on you by ~niGal--- the City of Winter Springs? (Yj ~/ (N)~__ 8a. Are yov related to a Ciry of Winter Springs Commission member by blood, adoption or marriage? (~ ~N) r/ ou_ ii yes to fie, please provide rela#ion: >-:. tNTF~tESTS1F~(P~RIENr~ 1. S t3riefty stets your interest ai serving on a City advisory board or c~mrt't~tee: ~^ave. ~ive~ ~~.. W~..~tec SPt•:~a ~'~oc ovee 6 ye_o.cs a~~ ~r^r. '~ rt waiffs, J _ ~QH~ fl bJ~ -Fo o~..~dl ~a~t:c:Pa'Et ~... '1~t g~o,,~'4~. yK t.J'.,,,~-et 5 ~. S . ?. ~. ie."!}• state ary p,:or eXp2fi2;'~te~ iri she v~rg ut i dciy governrflentai oaatci or `~ fornmittee: ~ o+.,,.. a.~. c.'1ta c ~.. J.v~•Q a\.,,..o~f~ p ~,,~5~ t ~ i a~c.et i ~- 4 co~v,~-~ e~ . ~' ~ \~.o,ve -~ouHd~.~ a ~'~+~ 3 b~s;,,.ess~ . ~' L,.•,,e Sert~ 0 c.,c c c...~ l o ~ : a tt~. - vc-F~•• ~tp.~~,.~~~ a `'fie o AN a S a~..-~ ~. In ni1rt~enca! sefiuenaa ~~ - rraost !nt?resta~}`," ale .~a?~;' .~h~s~ adv,sa ; ~r orb '~ i s..l.; ~ i'~i e s . committee you wish to serve:` a. Board of Adjustment b. ~_ . Baar+d~of Trustees - c. Beautification of Winter Springs Board d. Charter Review Committee e. Code Enforoernent Board f. districting Commission g. Oak Forest Wall and 8eaudficatian District Advisory Comm~tee h. ~_ Planning and Zoning BoardlLocal Planning Agency i. Tuscawiila t.ighting and Beautfication District Advisory Committee j. Other. 'Please see attachment for desdiption of the advisory t~osrd Or committee. 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annuafly submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate twxes: RACE GENDER African-American ~ Male L/' Asian-American Female Hispanic-American Not Known Native American Caucasian DISABU.ITY iv®t ~r~iUwrr i=hysicatty disabled YOU HEREBY REPRESENT TO THE CITY OP WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROYIDEO HEREIN IS TRUE ANO ACCURATE TO THE BEST OF YOUR IQ~104tILEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HER: BY ACI=.NQ~1'LFDtiE TUE 1=~STENGE CiF TH€ c;OJDE OF ETHICS FCItZ PUBt-IC c7FFICERS [SEC`ftO~IS 1iZ.311-.326. FLORtDb STATUTES] ANS) THE FLORIt~A "SUNSI';l!`3E LAt{Y`' LSEC i lvr~f ~86.~ F ;, F= ORiC.A S . f`_tTES~~ ~~~ -` ~~=< PERTAIN TO YOU IF YOU ARE APPOINTEC~ TO A C1T`t< ADilFSC?RY BC)Pti~i[7 fiK 4..i.is~-iTflf7 # 2 ~~, ; ~3`fil 3° ~[i`F^`liiti i iii, t s 1~ .~ `z =~ ~ i= ~=s~zss~ i ed=ate ~+~i.s ~v i ii E i.F CDIYIPLY WITH SUCH LAWS. Signature: ' ~~ _ late: ~ ~ ~ ~ _ ~ r,r____ a_. r~ i~wr.,.a...c...;...... riCdS~ tCitii++ !v. ~.ily u! rruuci .~,~~~~ The Office of the Ciry Clerk ! 1 GU Cdl! a7laiG i;ra.; -~r.°i-ter Winter Springs. Florida 32708-2799 3 :. ~ (~~ C ~-~K~? ~'~ Mkt,. " ~idc~nt" sltali mean any nctson living witttltt the oily limits at all times while saving on said b,~ard or c~tti_mittsr and al leAst six fbl months or in nomlttAt~ elected or anointed to the board or committee. Lc] $e~a~ementsofboardandcommitteomambcrs An~ersonngmina electedorappointed ',,, ~~r~~on a board or committee of rho cittr shalt satisfy the foilowinc~quirrtnonts except ~.s otherwise provided by state or federal law: (l] Co~lete a board or committee~paiication as prescribed by the city commission: c~' ~ .~ i~"' (Z.~ Consent to a standard criminal background check; ~, , j~1 l3e duty registered to vote in Seminole County; ~ '- ?`~ u ~e a resident as defined in this section; and c~1 ,/ ~vJ . - `j+~ ---- 3{.j-- -Dias-ere conv~c or four g-a u-Tty regarcSlessCoFadjudication~of a felony,,,jn gn~ju~isdietion anyplea of polo contendere shall be considered a conviction for ~ '~J purposes of this aar~~rsah. intment and removal of members. Unless otherwise reouireif by state or federal (aw_ , or snecif rally vrovided otherwise in the Code. al{„persons shall be appointed to. and removed mitt oily boacda and committees by majority vote of the city commission. ~ Board .and ~nmittee members shall serve at.the pleasure of the citycommission and may bo summarily t+entoyed at any time with or without cause. A board or committee~ppoititment.shall not ~be •construed as creating or conferring. upon aperson, any right.or interest in serving on a board Qr.committce including, but not limited. to acontract.1i1~. property or vested rieht. ~.tm. Ali board and committee members. shah be avpointed to serve three-year terms .and r Ig}4Y b~ reappointed by the city commission. for subsequent three Year terms without ~ ''"'~-~- ~1~tation. If a member ~s removed. or vacates ~thcir appointment for gny reason. including' ~,.(, ~t . death. excessive absences, or rest nag Lion. prior to the expiration of their germ. the City k,~ sg~mission may at its discretion appoint the first alternate member described bclow,•pr ~,~ ~. qualified individual. whom shalt serve the rcmain{ngportion of thcunexpired term. Absencxs. Any board or committee member incurring three (3~ consecutive absences. or five ~ ~ . ~ . ~} absences within atwelve-month vetted. from any re ug_Iarly scheduled mettin¢. shal!_ be ed u mafical! m eyed f m the re ectiv board or ces aye o c iemansLii~~_Each board and committee sha{I be trsaons'rble to elect. by maiority voteof tha members of each board or committee. a chairperson and vice-chairperson. The elcotion mill. occur annualiy at the first meetin hg eld in January. unig~s there is no January meeting, tit the next meeting hcid. Aii newly established baards=and committees sail make.such t~ections at their re ug_ laxly held meting and then annual as stated aboveL itematc e~bcrs~as_nnrQVided _bolowl shalt. not bi~ eketed to positions of chairoerson or ufy-chaigsccson Alternate members. At the discretion ofthe citycommission. two f2] alternate members may e~appointed to each City of WinterSprings board orcommission,unless otherwise provided City of Winter Springs Ordinance No. 2001.49 Page 3 of 5 - ~. CITY OF WINTER SPRINGS APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL 1. Name: ~ ~ ~y ~ ~ d N ~~S 2. Home Add 3. Home Tele ~ ~ ~ G ~ q 4. Occupatior 5. Business T B. ELIG161LITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. nt C i l i S o (Y) J (N) 1. ou y: em no e n Are you duly registered to vote ri S -/ {N) Y 2a. ngs: p Do you live within the City limits of-Winter ( ) 2b. If yes to 2a, how long have you been a resident? d ~ 3 ~~ 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of polo contendere (no contest) shall be considered a / ~ convic+ion for purposes of this q~,egtion. (Y) fN) ` 4a. Do you presently serve on any other City of Winter / (N) / Y Springs advisory board or commiriee? ) ( 4b. If yes to 4a, please list each: •-~ ~- 5. City ordinance requires that alt persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Oo you voluntarily consent to having a standard background check being performed on you by i 'ats the City of Winter Springs? (~() {N)---__ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (1~ {N) 6b. If yes to 6a, please provide relation: ~~ Briefly state any committee:_ °~ 3. In numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:` a. Board of Adjustment b. ~ ' Baard~of Trustees ~" "" " '"' ~~ c. _~____ Beautification of Winter Springs Board ~ .. d. Charter Review Committee e. Code Enforcement Soard f, ni-striding Commission g. Oak Forest Wall and Beautification District Advisory Committee h. Planning and Zoning eoard/Loca1 Planning Agency i. ~ Tuscawilla Lighting d Be tification Di trict Advisory Committee j. ~ ~, Other:~M ~ ~ ~~ ~~~~ ~COIYI O~YY1 1 2e 'Please see attachment for descr~tion of the advisory board oldcommittee. C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: p, STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American ~ Female Hispanic-American Native American Caucasian Not Known Not Known DISABILITY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE ANO ACCURATE TO THE BEST OF YOUR KNOWLEDGE. AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WI' Signature: Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 Office: 407.366.7033 • Direct: 407.461.0699 • Fax: 407.359.5704 Lidya@KumbaRealty.com 890 Northern Way Suite D-2 • Winter Springs, Florida 32708 1~" "-~~ ~` `~' & PROPERTY MANAGEMENT November 12, 2008 City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, FL 32708 To the Advisory Board: ~~~~~~~ Sir:' 1 5 2008 CITY OF V/iNTER SARiNGS OFFICE OF THE CITY CLERK I am requesting that you consider my application for a voluntary board position. I have been a proud resident of Tuscawilla for over 13 yrs and have served on the HOA board for my subdivision for several years. We have moved to the older area where there is no HOA but I am an avid gardener. My home was picked for this years "Garden Walk" by the Master Gardeners program for Seminole County. I am also a member of the garden club. Apart from my love of design and gardening I am also a business woman. I have always been in business in one way or another and presently own Kumba Realty and Property Management. My office is in Winter Springs also. I have some great ideas as to how we can improve our great community and would love a chance to share and implement. They have a saying "if you want something done ask a busy person" and that applies to me. I work very hard b»t a1_ways have time for the projects that I am involved in. I would be grateful if you would give me the opportunity to be of service to Winter Springs. Si c rely, . om ao~~ Lidya G n age ",F,~tidcnt" si1Al11 m~a4,y~xrsoa livi_n~~wikhin the wily l;mits at all tunas 'i~ o on ald~l~ or c~mrrtittrr and at ieA.st six l61 months or to be[n¢ namig~a ~¢,_. eltctod ar ~p~tp~ed to the I:aard or committee. [c1 j~equj~ements ofboard gnd committee members AnXpersoanominated electedora ~glnted S4~eave on a board or committee of the city shalt satisfy the~'~llowin¢ reauirCments except as otherwise provided bxstate or federal law: U Complete a board or committee application as prescribed by the city commission; t`)~~- [~ Consent to a standard criminal baet~round check: 5 , - J-~ ~ 13e dullregistered to vote in Seminole Countx; ,'t " -~-~ 13e a resident as defined in this section: and .~. ,~~ . - `'~~ --- --- 3~-- -Iias~ nvic or Dun g--3-ut t~Tv, ccfardless ofadjudieation. ofa felony~n any ~jurisdietlon. env Dice o.f nolo-contendere shall be considcrrd a conviction for 3 ~ ~ ~~~ purposes of this par~;,raph. intment and removal of members. Unless otherwisE reauiretl by state or federal law. or specifeally provided otherwise in the Code. all_per~ons shall 6e a~nofnted to. and removed from city boards and committees by majority vote of the clay comrnlssion Board .and ~Qmmittee members shall servo atthe pleasureofthe city commiss(onand maybe summacjiy tr~rtoved at any Limo with or without cause. A board or committee appointment shall not be t~strued as creating or conferring, upon a person env rlght4r interest in serving_on a board Qr.committee including but not limited to acontract liberty property or vested ri¢ht M8Y b liml r`~~l nth. exeessiv+e absences. or rest nag Lion. prior to the expiraEion of their term. the City k~ ~mmission may at its discretion appoint the first alternate member described below or C,~ 9ther quat[fied individual whom shat[ serve the remainin[r portion of the unexpired term Absences. Any board or committee member incurring thrx {3~ conse,~trtivcabsences or five ~ . ~ - (,~} absences within a twelve-mon~,iperiod from any neguiar[y schuiuled mcttin~ shal[~ - ~ . ed utoma 'cat removed from the res t[v board or ' ces ave.o urr Chairmanships. Each board and committee she{[ be responsible to elect. bx_maiority vote of Lhemembers of each board or committee a chairperson and vice-ohairpotson. The election eta 1 occur annually at the first meeting held in January unless there is no Ianuary meeting depu -chairperson. Alternate members. At the disccetion ofthe c'styeommission two (2 alternate members max beappointeti to each City of WinterSprin¢s boardorcomm[ssion unless otherwise provided All board and committee members snail be appointed to serve tiu+ee-veer terns and ~ ~' c reappointed by the city commission far subsequent threw year terms without f` "'i1-~-- tation. If a member is removed or vacates their appointment for env reason includin¢ 1 ~`~~ City of Winter Springs . Ordina~icc No. 244 I -49 Page3of 5 ~~-- - __ _ REGIEIV6E® - JAId 1 0 2008 _ ' ~.. CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CITY OF WINTER SPRINGS APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person hsls been convicted of a felony. Please complete the following in the space provided: A. GENERAL ~M1 1. Name: ~ ~•tt+.. ~~ ~ L 2. Home Address: ~fl~ 'SAh~ tr: ~ ~ CT 3. Home Telephone: ~~ O T ~ 3 2~ - W ~ 0 3 4. Occupation: _ ~Ie.a~ I ~L, Ct~t.F 13 ~+5~ k P 5 S r ' 5. Business Telephone: y U? 3 D3 -.7~~~ B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y)~ (N) 2a. Do you live within the City limits of-Winter Springs: (Y)~ (N) 2b. If yes to 2a, how long have you been a resident? ~Q ~ 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y) (N)~ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y) " (N)~C 4b. If yes to 4a, please list each: ••i 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a 1~ G~-~ standard background check being performed on you by initiars -- the City of Winter Springs? ~.)~ (N)___ 6a. Are you related to a City of >~nter Springs Commission member by blood, adoption or marriage? (y) (N)~ 6b. If yes to 6a, please provide relation: C~ ~-t2~C N 2. Briefly state any prior experiences in serving on any gove nmental bo~rd 1 t-~tl lv<tw~f' . ~n committee: I c t i S ~~t1.:..c I s aso~ i~ tMt'tltid u,,, c~,,.,/ w~ _____~' Cc~~~~: car a $- l.c~.l Rc~. ~,! 3. In numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:` a. 3 Board of Adjustment b. -~ ~ Board~ofTTUStees " "' "''~ c. Beautification of Winter Springs Board ,. d. Charter Review Committee e. Code Enforcement Board f. Districting Commission g. Oak Forest Wall and Beautification District Advisory Committee h. ~_ Planning and Zoning Board/Local Planning Agency ommittee sory C i. Tuscawilla Lighting and Beautification District Advi s A j. ~ Other: 17~e(VA {~ T0.k Qt.~v"^" ~l~T+~~-.a/~ .Se~ ~.In~w-t~'t~,e "Please see attachment for description of the advisory board or committee. 4 W~~ Sp~~s~ °~~ Sp~~ a~t;v7 S~ ~~ (~.e~r C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENbER African-American ~ Male Asian-American Hispanic-American Native American Caucasian Not Known Female Not Known DISAI3lLITY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE ANO ACCURATE TO THE BEST OF YOUR KNOWLEDGE. ANO .THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. I Signature: Date: ~ - g- 0 ~ Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 _`Rrsidet~t" shalLmea~ env oe n liyjg¢ withia the city 'mats at ai~~}es while serving on ~i~t~atd or committee. and at leas~jx f61 months or to 6eiag nometxed or • • senQinled to the board or committee. . Requ}~ements ofboard~nd committee members. Anypersopnominated. electedorappoj_nted W serve on a board or committee of~he city shall satisfy the fo[lowtng,feyuiranents.oxcept ~s otherwise p or yidrd by state or fedora{ law: L] Complete a board or committee application as prescribed by the city commission: ~ ~L (~ Consent to a standard criminal baekpround check• ~ ^ ~~ j~1 13e duly reeistered to vote in Seminole County; ~ . - ~.9~j l:,.1 J3e a resident as defined in this scction• and ~~,~ ~ • ---~-- --K-as-~teym' nvic or Foun gut tY, regardless of adjudication of a felony in ~n~•~usisdiction. any plea of polo contenders shall be considered a conviction for ~ ~ . ''~~ purposes of this aarggca~h. Aaaointment and removal of members Unless otherwise req ireii by state or federal law ar speciEieally provided otherwise ip the Code altpersons shall 6e appointed to and removed firm city boards and committees by maiority vote of the city commission ~ Board .and ' ~mmittce members shat l serve at the p l easure of the citt• commission and may be summariix ct~toved at any Hme with or without cause Aboard or committee appointment shall notbc •~tt~ied as creative or confen•ing, upon a person any ri~ht4r interest in serving on a board Qcsommittee includine, but not limited to a contract l~borty property or vested rieht ~'erttt, All board and committee me~bers shall be appointed to serve there-year tetms.and ` • ~' ~~~ 1ti~ Ca.~ .. r• ^., ~ aoscnccs vrnuun a rvveive-monm pcrtoa ttom any re ug lartyseheduled meetingL¢hall be ~ecttted automatically removed from the respective board or committer in which ~~ ~ • - •- a severs aye oceucred ~ ' ~Iiairmanshias. Each board and committee shall be responsible to elect, by majority voteof he members of each board or committee a chairpuson and vice-chairperson. The eltction Mall. occur annually at the first meetinl+held in January unless there is no 7anutu~ meeting, hit the next meetine held All newly established boards'and committees shall make such . _ - - - duty-chairperson. itetnate members. At the discretion of the city commission two f21 alternate members may pointed to each City of WinterSprinas board orcommission unless otherwise provided Cily of Winter Springs Ordinance No. 2001-49 ~~ Page) of 5 ..-- . ..- s=ommtsston may ac tts atscrotion appoint the first alternate member described below or 43her qualified individual whom shall serve the remaininn portion of the unexpired term ` NQV d 7 2008 CITY OF WINTER SPRINGS CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL ,~~ ~ ~J~ ,~j 1. Name: ~L/y /~( ~/~1~~~~ 2. Home Address: ~J ~i 2 ZGtq~~ /1/~5~ [~i/L~i~l~ 3. Nome 7elephone:T7 3~_~~ ~~ 9f 4. Occupation: ~~ ~t/ZGJ /~ti ~~ (~/~'~l~S ~C~G(I~ t 5. Business Telephone: L,~/~ 7 v?Jl~T s j_~J`~~ B. ELIG161LITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1 ~ 1. Are you duly registered to vote in Seminole County: r7 ( N) i i S Y ~ N - ~ - -- - 2a. ngs pr nter Do you live within the City limitsof-1N ) ( ( ) 2b. If yes to 2a, how long have you been aresident? ~~ -- 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of noio contenders (no COnteSt) shall be considered s conviction for purposes of this question. (Y) (N) 4a. Oo you presently serve on any other City of Winter Springs advisory board or committee? (Y) (M 4b. If yes to 4a, please Gst each: ~~~ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Oo you voluntarily consent to having a standard background check being performed on you by ,c;~`"^ the City of Winter Springs? 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (~ (N) tib. If yes to 6a, please provide relation: C. INTERESTS/EXPERfENCE ' 1. Briefly state your interest in serving on a City advisory board or committee: ~~,~,~ ~~ in serving on any governmental board or ,~A , 3. In numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:` a. Board of Adjustment b. l - . ... Baard~of T=rustees -......... _ ...._ .._ ........ ....... _ ................ _ ......., c. Beautification of Winter Springs Board ,. d. Charter Review Committee . e. Code Enforcement Board f. Districting Commission g. Oak Forest Wall and Beautification District Advisary Committee h. Planning and Zoning Board/Local Planning Agency i. Tuscawilla lighting and Beautification District Advisory Committee j. Other: 'Please see attachment for description of the advisory board or committee. 2 ...~...-....-.,~,.,~,t . 2. riefly state any prior experiences ~- O. STATE REPORTING REQUIREMENTS. Section T60.80, Florida Statutes, requires that the City annually submit a report t0 the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GE~ African-American Male Asian-American Hispanic-American Native American Caucasian Not Known Female Not Known DISABILITY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.32ti, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTESj, WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF OINTED, IT !S YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH S WS. ^ /J ~ ~ Signature: Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 venter Springs, Florida 32708-2799 3 For Office Use Only: Oate Appointed: Appointed by: Board Appointed: Term Expires: F:1DOt;Slt:ity of INwtler SprirgstFortnsVlppdution fo! /lppoinhnent-Boats MemEer ~I 4 CITY OF WIl~TER SPRINGS, FLORIDA ADVISORY BOARDS AND COMMITTEES Ad Hoc Winter Springs Citizen Property Tax Reform Mitigation Study Committee: This eighteen to twenty-one (18-21) Member (Ad Hoc) Committee will "become thoroughly familiar with proposed and adopted Property Tax Legislation, and municipal service programs effected by proposed and adopted Legislation, and strategies for mitigating the impacts." Meetings began in early 2007. Ad Hoc Winter Springs Open Space Advisory Study Committee: This seven (7) Member Ad Hoc Committee will "identify green space and conservation lands for possible acquisition by the City which would add to the City's inventory of open spaces set aside in perpetuity for recreational and conservation uses thus adding value to the quality of life of Winter Springs residents and mitigating the undesirable impacts of growth on the City's natural resources." Meetings began in late November 2006. Beautification Of Winter Springs Board (B.O.W.S.): This seven (7) Member Advisory Board is "empowered and directed to consider and study the entire field of beautification in the city." Regular Meetings are held on the second Wednesday of each month. Board Of Adjustment: This is a five (5) Member Advisory Board which "shall make recommendations to the city commission to grant any variance or special exception." Currently, Regular Meetings are held "as needed " - on the first Thursday of each month. Board Of Trustees: This is a five (5) Member Advisory Board which "shall administer the city's pension plan pursuant to the provisions contained therein as adopted by the city commission." Regular Meetings are held quarterly, on the last Tuesday of January, April, July, and October. Code Enforcement Board: This Board holds Hearings complete with testimony. With discussion on "findings of fact, based on evidence of record, and conclusions of law and shall issue an order affording the proper relief consistent with powers granted herein." The Code Enforcement Board is comprised of seven (7) Regular Members and two (2) Alternate Members. Regular Meetings are held on the third Tuesday of each month. Districting Commission: This five (5) Member Advisory Commission files a report containing a recommended plan for establishment or adjustment of the district boundaries. By City Ordinance, this Advisory Commission meets every three (3) years. Regular Meetings will be held when designated. The next Districting Commission will be selected in early 2010. Oak Forest Wall And Beautifcation District Advisory Committee: This five (5) Member Advisory Committee "shall review and discuss issues related to the foregoing and other directly related matters of interest to the owners of property within" the Oak Forest community. Regular Meetings are held on the second Thursday of each month. Planning And Zoning Board/Local Planning Agency: This five (5) Member Advisory Board recommends to the City Commission "the boundaries of the various original zoning districts and appropriate regulations to be enforced therein and any proposed amendments" along with dealing with traffic circulation elements, and the Comprehensive Plan. Regular Meetings are held on the first Wednesday of each month. Tuscawilla Lighting And Beaatification District Advisory Committee: This five (5) Member Advisory Committee "shall review and discuss issues related to the foregoing and other directly related matters of interest to the owners of property within" the Tuscawilla community. Regular Meetings are held on the third Wednesday of each month. Revised 10/29/07 "F,t=sidcnt" shaii~, n t nreso Ini_v_ing withia the oity~~m~ts at all i~~,s while servl_na on "d boaa+! Or c~rt~-~itt~t and at (Asst six {~ mop for to ina nominated. Cl-octed or K,jn4inted to the board or committee. ~ $eguiromentsofboardandcommitteomembess Anxpersonnominated electedorant~ointed ~crve onon a board or committee of the city shall satisfy~l e,~'ollowtne ttiayirements exct~t as otherwise prov'sded_y state or federal law: X11 Complete a board or committee application as prescribed by the city commission: p~ (,~ Consent to a standard criminal background check. j .- `~-~.~ {~ f3e duly registered to vote in Seminole Cqunty' ~ - Vj~ L4.1 )3e a resident as defined in this section:-and ~q , /~,(j , ------~}- --Has ire convto or faun gui ty. regardlests of adjudication. of a felotty~n '~ andjurisdiction. anv plea c.f polo contendero shall be considered a conviction for proposes of this paracraoh. intment and removal of members.-(lnlcss otherwise required by stateor federal law, or gpecitieally provided otherwise in the Code all persons shall 6e anpyjntcd to and removal- fmm-city boards and committees by majority voce of the city comryissjon ~ Board .and pQjrrmittee members shall serve at the pleasure of the city corrLmission and may be summarily tr,;rtoved at anv time with or without cause A board or commi~~gppointment shall notbe ~nstrued as creating or confecrin~ upon agerson. any right.or interest in serving on a board flr.cotnmittee including, but not limited. to acontract liberty property or vested rieht .. .~ •. _~ Tenn. Ali board and committee members shall be appointed to serve three-year terms and r~, •~' may be reappointed by the city commission for subsequent three year tctm~ without ~ ~'~"""'t-`-- - linrltation Cf a member is removed or vacates~their appointment for any trason,jncluding 1 ~~~i death. cxcess'rve absetrccs or resi nag lion. prior to the expiration of their terns -the City k~ ~mntission spay at its discretion appoint the first alternate member described below or ~~ -. - Qthexqualified individual. whom shall serve the rcmainin~portion of the unexpired tam - - @(rsenccs Any board or committee member incurringthree {~ consecutive absences o ve ~ • . ~ . f5} absences within atwelve-month pa~iod from any~egulady scheduled meettn~ shall be d~.~red automati~~y reMtavcd from the resoeetiyo board or com ittee in ~ ' a senses eve occu ------- - --- - . airmanships. Each board and committee shall be respo_nsibl_e to elect, by majority voteof ~~ members- of each board or comt~ittce a chairperson and,yce-chairp~tson. The eleokion shall. occur annually at the first meetingheld in January unless there is no January meeting ~f1 tl1G next meeting held Ali newly established boards~and committees shad makesuch t~loetions at their ce ularly -held meeting and then arlnually~s stated above Alternate ; ~inbers (as provided belowl shall not b~ elected to positions of chairperson or depu -chairperson. Alternate members. At the discretion of the citycommission two (21 alternate members may lzeapnointcdtocachCityofWinierSpringsboardoreommi slop unlessotherwiseprovided Cily of Winter Springs Ordirrancc No. 2001.49 Page3o(5.~--_ _~- E ~ G ~ Ru., c.:,7 -- DEC 0 ~ ~~~,~ CITY OF WINTER 5PFiiNGiB GITY OF WINTER SPRINGS OFFICE OF TNF ~~TV ~, ~~w APPLICATION FOR APPOINTMENT TO CITY ADVISORY GUARD OR COMMIT'fgE City Code requires prospective and existing board members to fill out an application. City Code also prohbits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the fogowing in the space provided a. GENERAe. 1. Name: /l`"~,a x /~ ,~,,,~„ ~ ~~ 2. Home Address: 7f ~ ,~>>, ~,,¢ ; /coo-y, o 3. Home Telephone: ~f o '~ ~ z 1 7 ~ 3,~ 4. Occupation: /~~ ~n ~~/ -- G 5. Business Telephone: rtJ//g B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are elig~le to serve on a City advisory board or committee. i. Are you duly negisMred to vote in Seminole County: (lr7 ~ (td) 2a. Do you live within the City runits of-Winter Springs: ~ (lr) • ~. (N) 2b. If yes to 2a, how bng have you been a resident? ~ ~T~rrS 3. Have you ever been vonvicted or found guilty, regarclless of adjudication. of a febny ~ any jurisdiction? Any plea of polo contendere (no contest) shah be considered a - conviction for purposes of this question- (Y) (N) ~ 4a. Do you pn~ently serve on any other City of venter Springs advisory board or oanmittee? {1t7 (N) ~ 4b. If yes to 4a, please list each: •-i 5. City ordinance requires that all persons applying for a City advisory board or comm~tee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Oo you voluntary consent to having a 1yt kr! standard background check being performed on you by ,n-~s"-~ the City of Winter Springs? (y~ l~ ~M 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y) ~N~ 1/ 6b. ff yes to 6a, please provide relation: C. INTERESTS/EXPERlENCE 1. briefly state your ineerest in serving on a City advisory board or commatee: ~e~ 3. In numerical sequence (1 -most interested), please rank which advisory board or corrxnittee you wish to serve:' a. Boats of Adjustment b. ~ l3oard~of 1'rustee~ -... _ _.. _. _ ... _ ---..... ... _ ..... _ .... .. . .. ..... . . _ ......., c. Beautification of Witter SPA ~ _ d. Charter Review Committee e. Code Enforcement Board f. Districting Corrtmission g. Oak Forest Wall and t3eautification Cistrid Advisory Committee h. Planning and Zoning Boardllocal Planning Agency i. TuscawiNa lighting and Beautiftcatiori District Advisory Committee j. Other: `Please see attachment for description of the advisory board or committee.. . 2 2. Briefly state any prior experiences in serving on any governmental board or committee: rAx ~ , ~'~ ~~~ ~'~~, ~~ ~. STATE REPORTING REQUIREMENTS. Section 764.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of hoard and committee members. Please check the appropriate boxes: RACE EG NOER African,Arnerican '~ / Male Asian-American Hispanic-American Native American ~ Caucasian Not Known Female Not Known ~?ISABlLITY Physi~Ity disallled YOU HEREBY REPRESENT TO THECtTY Of WINTER SPRINt3S, UNDER PENALTIES OF PERJURY, THAT THE INFORlIAAT10N PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR Kt+tOWLEDGE, ANp THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE t=XISTENCE OF THE CC1DE OF ETHfGS FOR PUBLIC OFFICERS (SECTIONS 112.3ii :326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAVV" jSECTtON Z86.dtt~ l=LORtDA STATUTESj, WHICH itlfAY PERTAIN 70 YOU tF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, tT !S YOUR SOLE OBUGATlON AND DUTY TO COMPLY WITH SUCH LAWS. Signature: ____1~'~ Date: r ~~~~Sr Please return to: City of Winter Sprittgs The Office of the City Clerk 1126 East State Road 434 Winter Springs, F[orida 32748-2789 3 ~d nt" ' A f,Lr~ean env oerson living withia~he city limits ataL 1~$§ wftilc na on std ~gi-,~or cotti_mittr-~ and at IeAst stx t61 months p~joE to 6eiag nomi~e~. elcrxed ar _ ' gppQjtiled to the board or committee. [cj Rcauircmentsofboardandcommitteemembers Anypersonnominat~ed elected orappo~,nted ~ e on a board or committee ofjtte citychall satisfy the followin¢ reouircmcnts except ~s otherwise provided by state or federal law: L1,1 Complete a board or committee application as prescribed by the city commission~~ ~] Consent to a standard criminal background chock: J ` ~~ j~1 fie duly re istered to vote in Seminole Gounty'~~~ - (41 lie a rosident as defined in this section: and~?r~, ~ ~~'J • ~- ~~ -----{3j- --~iaszte convt or foun g--3 uiity, regardless of adjudicatiodt. of a felony in any •ju,~isdiction. any plea of polo contondere shall be considered a conviction for '~ ' p~uposcs of this~_gcaph. intment and removal of_mEmbers. Unless otherwise rwuireil by state or federal law. or spscif calls provided otherwise in the Code allpersons shall 6c appointed to and removed fmm city boards and committees by maiority vote of the eity commission-Board .and potztmittec members ahal f serve at the pl ensure of the city commission and~rtav be summariiY roved at anytime with or without cause. A board or committer-gppoiatment shalt notbe gonstrued as creative or conferring, upon a person any tighter interest in serving on a board Qr.committee includnnt~ but not limited to a contract llbertyLpronery or vested right ~~ All board and com mittee members shall be a ppointed to serve three-year forms and `' ~'~ ~` ' ~y bo reappointed by a city commission for subsequent three-year tentts without c~^*`'.":tl,,t- jt~tation Tf s member;is removed or vaeates•thcir ap~ojn ant for ~rtyleason including ~.~t~l Beath. oxeessiv~e absettec s or resignatioa,prior to the expiration of their term. the City tk-`I'mo. emission may at its discretion appoint the first alternate member dcseribed below or V~-c . 9titer qualified individual whom shall serve the trm ainingportion of ttrd unexpired term _ Afisenccs. Any board or committee member incurring wee (3) consecutive absenoes or five ' . ~ . {,sj absences within a twelve-month period from l~y..!'~+tlarl_Y scheduled mcetinp shall be ed utomaticall rttnoved from the res eetiv board or ' ave. ore S:fiairmanships. Each board and committee shall be responsible to elect, by maiority voteof deputy-chairperson. Alternate tnembers. At the discretion of the citescommission two t"21 alternate members may ~eapaointedtoeachCityofWintcrSprinasboardorcotnmission unlessotherwiscprovided Cilyof WintcrSprings Ordinance No. 2001.49 _ Page3of 5 -..-. .- ~~t 29 08 05:21p BRRBRRR WRTKIIYS 407 365 7549 p.l NOV 12 20(1 .. CITY OF 1q/1NTER SPtiIN6~ OFFICE OF THE CITY CL€Rit CITY OF WINTER SPRINGS APPI_1CA7'ION FOR APPOINTMENT TO CITY ADVISORY BOARD OR CQMMITTEE City Cade requires prospective and existing hoard members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERA!. /' ~i~ ~ 2. Home Address:_ ~ ~~~ ~y~c r ~ ~ ~~~? I ~Y~~~S 3. Home7elephone:_ -U7 y~l~s ~ ~~~J 4. Occupation: ~ ~ ~ ~ ' 5. Business Telephone: `'?'G 7 ~~`~ I ~° ~ ~ e. >±>_IGIBtUTY The i nformation provided in this section is for purposes of determ ining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: M x (N) 2a. Do you live within the City limits of-11V'inter Springs: {~') ~~ {N) 2b. If yes to 2a, how long have you been a resident? U~Q /~ 3 Have you ever been convicted ar found guilty, regardless . of adjudication, of a felony in arty jurisdiction? Any plea of nab contendere Ina contest) shall be considered a {Y) {N) corvic+ion tar purposes o! this question. 4a. Oa you presently serve on any other City of VVnter m (M Springs advisory board or committee? 4b. tt yes to 4a, please list each: Dct 29 08 05:22p BRRBRRR WRTKINS 407 365 7549 p~, 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a ~„ ~- board or committee. Oo you voluntarily consent to having a standard background check being performed on you by ini~iats the City of Winter Springs? (Y} ,X (N)i__ 6a. Are you related to a City of Winter Springs Commission ~i member by blood, adoption or marriage? (Y} (N) ~ 6b. [f yes to 6a, please provide relation: C i._ 2. Briefly state any prior experiences in serving on any governmental board or committee:_ T S'Ci /vrP~ .CUr ,~ . ~ /z-1,~ P~'fsS O,rt ~~..~--_ ~i,,,,~ ,1,~ .~?25~~ ~rJ~e U~ ~fI 's ~~ ~'a~ ~ Yuri o>rs a /n~~'r~ 3. to numerical sequence (1 -most interested), please rank which advisory board or committee you wish to serve:' a, Board of Adjustment b. ~; . Barard~of TTUStees -.... - ri'~~-j- ~ • a ~-~-~--. ' ~~ ~.....~i~i-ociJt~-y.~ c. Beautification of Winter Springs Board ~ .. O~ d. Charter Review Committee e. Code Enforcement Board f, Districting Commission g, Oak Forest Wafl and Beautification District Advisory Committee h. Planning and Zoning Boardll_oca) Planning Agency i, ~-- Tuscawilla lighting and t3eautification District Advisory Committee j. Other: 'Please see attachment far description of the advisory board or committee. C_ tNTERE5TSlEXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: ^ct 29 08 05:21p BRRBRRR WRTKIIVS - 407 365 7549 . ~ ~~ D. STATE REPORTING REQUfREMENTS. Section 760.8A, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of hoard and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American _ x Female Hispanic-American Not Known Native American '~ Caucasian Not Known 131SAHtLITY Physically disabled YOU HEREBY REPRESt:kT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE. AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU Hi=REBY ACt<N©WI~DGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.32ti, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE lAW'~ [5>:CTtON 28s.a11, FLORIDA STATUTESj, WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTS!?, 17 tS YOUR SOLE OBLIGAT{ON AND DUTY TO COMPLY W17H SUCH LAWS. Signature: ~ .(,'1 LY.,'1.~'~~~. Date: f ~ i a-='t i -u ~ Please return to: City of Winter Springs The Office of the City Cleric 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 P~ "Rssidcttt"shah mean aay aeasot:Jivina within the city limits at all times wltilasetvin¢ on 'std bo~n1 or c-om_-r+iit« and at least six l61 men or to being nominated. alxted or K}pointed to the board9r committee. (c1 j~equirementsofboardandcommitteemembtrs Anypersopnominated electedoraQgo~nted ~, enre on a board or committee of ~hc eittr shall satisfy the fo(lowina~uimments except ps otherwise arovided by state or federal law: ~~ ~~~~ L~l Complete a board or committee application as prescribed by the city commission; L7~-~--- ~ Consent to_a standard criminal background check; "J : - `~'~ ~ ~e duly registered to vote in Seminole County; ~ ~ J ~' u Ae a resident as defined in this section: and ~~ f ~ ~~ -----{ j5 -- -bias-rte .con i o`r~'oun gui ty. regardlesl s of adjudication. of a felonyjn _y~'~, ~n~jucisdiction. an~plea of nolo come t~dere shall be considered a conviction for ~ • ,"~" purposes of this pac~araoh. intment and removal of msmbers._Unloss otherwise requireif by state or federal law, or ~pecif ealiv provided otherwise in the Code alipersons shall 6c appointed to and removed from city boards and committees by majority vote of the city eommis~ion ~ Board ,and • sotnmittee members shall~,ervc at the pleasure afthe city commission and may be sumrpari,_}i ~ttoved at any time with or without cause A board or committee appointment shall notbe -~nstrued as creating or conferrigg, upon a person any right.or interest in serving_on a board or.cotnmittee includinge, but not limited to a contract liberty ~roner~ or vested cig_ht T__s~ Alt board and committee members shall be appointed to serve three-year terms and ~~, •~' ~gy o reappoytted by the city commission for subsequent three-year tenrt~ with,Qut ~ ~'~`~^'~-- limltation If a member is removed or vacates•their appointment for any reason including J ~~~ i death. excessive absences or resignation. prior to the expiration of their term the Citv k.~ S:ommission may at its discrodon appoint the first alternate member described below or ~~ Other qualified individual whom shall serve the remaining portion of the unoxei ,red term .. ~l;~sences Any board or committee member incturi~tg three (~) consecutiyeabsences or five ~ ~ . ~ . - . ~ absences within a twelvemonth period from any regular(vscheduled meeting shall he ~ ~ . u ma 'call r~rttoved from the es ectiv board or '_ a senses ave.occun: ~ ~ ~ ~ . sirmanships. Each board and committee shall be resaonsibls to elect, by majority vote of !~ mcm bets o f each boazd or committee a chairperson and vice-ehairprrson. The election shall occurannually at the first meeting held inlanuary unless there islto January meeting, ~t the next mectine held. Atl newly established boasds~and committees shall makesuch elections at their regularly -hold meeting and then annualt~as stand aboy~e Alternate ; »_betrs Jas provided bclowl shall not b~ elected to _positions of chairperson or deputy-chaimcrson. Alternate members. At the discretion ofthe city commission two (21 alternate members may iyeapnointedtoeachCityofWinterSpringsboardorcommission unlessothetwiscnrovided City of Winter Springs , Qrdinancc No. 2001-~9 _ Page 3 of 5 . •. - ATTACHMENT "D" C[TY OF W[NTER SPRINGS, FLORIDA BOARD OF TRUSTEES ATTENDANCE - 2006 11/16/06 11/16/06 CITY NAME OF 09/27/06 REGULAR COMMISSION ADVISORY BOARD 01/31/06 04/25/06 05/24/06 07/25/06 08/16/06 08/31/06 CITY COMMISSION POSTPONED FROM WORKSHOP MEMBER REGULAR REGULAR SPECIAL REGULAR SPECIAL SPECIAL WORKSHOP (PENSION) 10/31/06 (PENSION) GIANNONI, VINCENT Did Not Want Zo Be Reappointed... GILTZ, BYRON PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PESUT, GUY ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ____ ROBERT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT ABSENT ABSENT Resigned... QUEEN, MARK No( Reappointed... SARDQ A. MARK PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT ROZELLE, VERNON PRESF,NT PRESENT PRESENT ABSENT PRESENT ABSENT PRESENT PRESENT PRESENT REVISED 12/20/06 CITY OF WINTER SPRINGS, FLORIDA BOARD OF TRUSTEES ATTENDANCE - 2007 (/31/07 8/22/07 NAME OF REGULAR REGULAR ADVISORY BOARD 01/04/07 RESCHEDULED 02/21/07 03/08/07 03/29/07 04/24/07 RESCHEDULED FROM 10/30/07 MEMBER SPECIAL FROM 1/30/07 SPECIAL SPECIAL SPECIAL REGULAR 7/31/07 REGULAR BYRON PRESENT, PRESENT Resigned... McLEOD, DAVID W. PRESENT PRESENT DeMAIO, GUY PRESENT PRESENT ABSENT ABSENT ABSENT PRESENT PRESENT ABSENT Removed From Board ForA6sencec... BLAKE, MICHAEL S. PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT SARDO, A. MARK PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT ROZELLE, VERNON PRESENT' PRESENT PRESENT PRESENT PRESENT ABSENT PRESENT PRESENT REVISED 11/14/07 CITY OF WINTER SPRINGS, FLORIDA BOARD OF TRUSTEES ATTENDANCE - 2008 07/22/08 NAME OF REGULAR ADVISORY BOARD 01/29/08 04/29/08 (RESCHEDULED U7/29/O8 09!17/08 IO/01!08 10/28/08 MEMBER REGULAR REGULAR FROM 07/29/08) SPECIAL SPECIAL SPECIAL REGULAR PRESENT PRESENT McLEOD, VIA VIA DAVID W. PRESENT ABSEA~T PRESENT TELEPHONE PRESENT PRESENT TELEPHONE PRESENT ~ PRESENT N. PRESENT ~ PRESENT ~ PRESENT ~ PRESENT ~ PRESENT BLAKE, MICHAEL S. PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT SARDO, A. MARK PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT ROZELLE, VERNON PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT PRESENT REVISED 10/29/08