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HomeMy WebLinkAbout10-30-2001 Revised Application for Appointment to City Advisory BoardSent By: BROIAIN,lO/ARD,SALZMANgwEISS,P.A.; 407 425 9596; Oct-30-01 3:37PM; BROWN, WARD, SALZMAN & WEISS, P.A. ATTORNEYS AT LAW Usher L. Brown' John H. Ward' Gate S. Salzman* Jeffrey S. Weiss Suzanne D'Agresta Anthony A. Garganese" Scott D. Danahy Alfred Truesdell Arthur R. "Randy" Brown, Jr.' Brett A. Marlowe Jeffrey P. Buak Kristine R. Kutz Joseph G. Cnlnmho Debra S. Babb Gregory A. Hass" Cheyenne R. Young Joseph E. Blitch ' Board CcrtiGed Civil Trial Lawyrr ° Board Certified Business Litigation Lawler Board Certified City, Canty S Uwal Govcinment I.aw• ' Board Ccrlificd Labor & EmPlnymcnt Law Octuber30, 2001 BY FACSIMILE 4(407) 327-4753 Ms. Andrea Lorenzo-Luaces City Clerk, City of Winter Springs 1126 East State Road 434 Winter Springs, Florida 32708 Dear Andrea: Page 1 Two Landmark Center 225 East Robinson Street, Suite 660 Post Office Boa 2873 Orlando, FL 32802-2873 (407) 425-9566 (407) 425-9596 FAX Email: agarganese@,orlandolaw.net Website: www.orlandolaw.net Enclosed for your review is the revised Application for Appointment to City Advisory Board or Committee which was approved by the City Commission at the October 29, 2001 meeting. If you have any questions or comments, please g. a call. i rely, Anthony A. Garganese City Attorney AAG:ss Enclosure ['\docs\C4 of Wintcr Springt\Gcncral\t'arrc:rrmdencc\CityClerk\andrea-appttcation 10-10-01 Sent By: BROWN,WARD,SALZMAN&WEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Pane 2 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. 2. 3. 4. 5. Name: Home Address: Home Telephone:_ Occupation: Business Telephone: 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? 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) 4b. If yes to 4a, please list each: nr-T-7P-- Pn' IZ':'1'a 11P17 11Dc g17ar_1 P AD Sent By:, BROt'N,INARD,SALZMAN&WEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 3/5 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 initials 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. INTERESTSIEXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: 2. Briefly state any prior experiences in serving on any governmental board or committee: 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 Trustees 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 BoardlLocal Planning Agency i. Tuscawilla Lighting and Beautification District Advisory Committee j. Other: *Please see attachment for description of the advisory board or committee. 2 r -- Sent By: BROIVN,tvARO,SALZMAN&INEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 4/5 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 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, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH 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 OCT-30-2001 15:49 407 425 9595 94'; P.©4 Sent By: BROWN,WARD,SALZMANSWEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 5/5 For Office Uso Only: Date Appointed: Board Appointed: Appointed by: Term Expires: F:IDOCS1City of Winter Springs\FonnsApplication for Appointment -Board Member H OCT-30-2001 15:49 407 425 9596 94< P.©5 Sent B;i: BR0WN,kA1ARD,SALZMAN0EISS,P.A.; 407 425 9596; Oct-30-01 3:37Ph1; r., BROWN, WARD, SALZMA.N & WEISS, P.A. ATTORNEYS AT LAW Usher L. Brown' John H. Ward' Gary S. Salzman° Jeffrey S. Weiss Suzanne D'Agresta Anthony A. Garganese" Scott D. Danahy Alfred Truesdell Arthur R. "Randy" Brown, Jr.' 8rctt A. Marlowe Jeffrey P. Buak Kristine R. Kutz Joseph G. Colomho Debra S. Babb Gregory A. Hass" Cheyenne R. Young Joseph E. Bliteh Board Certified Cwil Trial Lat%ycr ° Board Certified Business Ltugauott Law'Ycr Board Certified City, County & Lural G-c"111tenr Law ' Board Certified Labor & Employment Law Wuber30, 2001 BY FACSIMILE #(407) 327-4753 Ms. Andrea Lorenzo-Luaces City Clerk, City of Winter Springs 1126 East State Road 434 Winter Springs, Florida 32708 Dear Andrea: Page 1 Two Landmark Center 225 East Robinson Street, Suite 660 Post Office Box 2873 Orlando, FL 32802-2873 (407) 425-9566 (407) 425-9596 FAX Email: agarganese(a�orlandolaw.net Website: www.orlandolaw.net Enclosed for your review is the revised Application for Appointment to City Advisory Board or Committee which was approved by the City Commission at the October 29, 2001 meeting. if you have any questions or comments, please ga cal I. i rely, Anthony A. Garganese City Attorney AAG:ss Enclosure L•\does\City of winter SprintycUicncral\C artcarondcncc\City Clcrk\andrea-application 10-30-01 OCT-70-2001 15: 49 407 425 9595 3 4 " P.01 sent By:,, BROWN,WARD,SALZMAWNEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 2 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. 2. 3. 4. 5. Name: Home Address: Home Telephone:_ Occupation: Business Telephone: 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? 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) 4b. If yes to 4a, please list each: flr T-�f?-'?riCl� 1=.7 1Q .qr-7 n-iC rjc= C)-1" P O sent By:, BROIVN,kuARD,SALZMAN&WEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 3/5 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 initials 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. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: 2. Briefly state any prior experiences in serving on any governmental board or committee: 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 Trustees 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 i. Tuscawilla Lighting and Beautification District Advisory Committee j. Other: *Please see attachment for description of the advisory board or committee. 2 Sett B�: BR&NN ,VIARD,SALZMANUVEISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 4/5 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 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, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH 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 3 017-'170-2001 15:49 407 425 959n R4', P . 04 Sr-nt By: BROWN,WARD,SALZh1AN8V4EISS,P.A.; 407 425 9596; Oct-30-01 3:38PM; Page 5/5 F:\DOCS\City of Winter SpringstForM3Wpphca!lon for Appointment -Board Momber OCT-30-2001 15:49 407 425 9596 94'-: P.05