SR-07-22-2014-3HdWA Y of i Council Report
Santa Monica
City Council Meeting: July 22, 2014
Agenda Item: 3.44
To: Mayor and City Council
From: Sarah Gorman, Director of Records & Elections
Subject: Revision of City Boards and Commissions Applications
Recommended Action
Staff recommends that the City Council authorize modifying City Boards and
Commissions applications to request more specialized questions for specific groups of
Boards and Commissions, and recommends that the Social Services Commission
applicants be City of Santa Monica residents.
Executive Summary
The City of Santa Monica has over 20 Board and Commissions. Volunteers serve as
Board Members and Commissioners. Members of the public apply for these positions
through an application provided by the City Clerk's office. Currently, one application is
used for all but two of the Boards and Commissions. Staff proposes to modify the
current application to provide more specialized questions for particular Boards and
Commissions. These applications would be required for new applicants, but not for
incumbents who currently hold a position on a Board or Commission.
Background
The City has a wide range of Boards and Commissions, covering topics such as
planning, the urban forest, and fire and life safety. The Boards and Commissions
provide guidance to the City Council on these varied topics. Commissions are advisory
to the City Council, established by the City Charter or by ordinance and involved in
programs and activities that advance the group's mission. In addition to their advisory
capacity, certain commissions (including Planning and Landmarks) have regulatory
functions. Boards (Architectural Review, Library, Personnel) also have an advisory role,
but are charged as well, by local or state law, with administrative, regulatory or review
1
authority. Task Forces are advisory bodies established by Council action, usually for a
given period of time, to take on a specified task or project.
Currently, only one application is used for the majority of the Boards and Commissions.
(The Pier Board and Civic Working Group use different applications.) The application
includes general questions and does not provide applicants with an adequate
opportunity to provide detailed responses that demonstrate their interest and experience
for each particular board. Staff proposes to implement more detailed questions on
applications that are more directly relevant to particular Boards and Commissions. This
would provide the individual applicant with an opportunity to demonstrate his or her
interest and experience under that board's purview.
Council has provided previous policy direction regarding Boards and Commissions. See
October 26. 2013 staff report.
The City Boards and Commissions have varying requirements, but the majority requires
that applicants be City residents. Currently, City residency is not required Social
Services Commission members. Staff recommends, however, that new applicants for
the Social Services Commission be required to be City residents. This would provide a
focus on Santa Monica needs within the Social Service community.
Discussion
Staff proposes dividing the Boards and Commissions into five groups for application
purposes. Each group would have questions specific to that group. The questions would
focus on common needs for each group. For example, questions for the Social Services
Group would focus on knowledge of social services, health care, supportive housing,
accessibility issues, education, and advocacy. Questions in the Planning and
Administration group would focus on experience with policy development, and
recognition of unique standards for the City, including geography, current zoning,
growth patterns, transportation challenges, and General and Specific Plans. Questions
in the Marketing Group would center on topics like strategic planning fundraising,
2
community outreach, event management, hospitality, and marketing. Questions in the
Arts, Library and Recreation Group would focus on knowledge of strategic planning,
training in the arts, local arts involvement, fundraising, library information and
community engagement. Questions in the Resources and Environmental Group would
focus on knowledge of financial matters, taxes, environmental concerns, and forestry
issues.
There would also be a common set of questions that would apply to all applications.
These questions would include questions like, "What is your vision for the Board or
Commission and the role it plays in Santa Monica and the region."
Use of these more specific questions should provide greater information to Council,
current Board and Commission members, and staff to assist in best analyzing
applications. Having this detailed information that relates to the particular Board or
Commission should provide Council with more data to analyze an applicant's
background or experience in the field.
These groups would be:
® Social Services Group (including the Social Services Commission, Disabilities
Commission, Commission for the Senior Community, and the Commission on
the Status of Women);
• Planning and Administration Group (including the Planning Commission,
Architectural Review Board, Landmarks Commission, Building and Fire -Life
Safety, the Housing Commission, the Airport Commission, and the Personnel
Board);
• the Marketing Group (including the Convention and Visitors Bureau, Downtown
Santa Monica, Inc., Santa Monica Pier Corporation, and Civic Working Group);
• Arts, Library and Recreation Group (including the Parks and Recreation
Commission and the Library Board); and
3
® Resource and Environmental Group (Clean Beaches and Ocean Parcel Tax,
Metropolitan Water District, LA County West Vector Control District, Task Force
on the Environment, and Urban Forest Task Force.)
Samples of applications including these new questions are attached to this staff report.
Financial Impacts & Budget Actions
There is no immediate financial impact or budget action necessary as a result of the
recommended action.
Prepared by: Sarah Gorman, Director of Records & Elections Services
Approved: Forwarded to Council:
Sarah Gorman Rod Gould
Director of Records and Elections City Manager
Services
Attachments: Proposed Revised Boards & Commissions Applications
N
Santa Monica Office of the City Clerk - Airport Commission Application Page 1 of 3
Airy wi ,u I,
RoA Size:
AddiHOral Conflar of int rest lnfi lrzya {lo: for applicants
Phone: (310) 458 -8211
Fax: (310)
1685 Main Street, et, Room 102.
Information to be Di la ed on the Internet:
P Y
PO Box 2200
Santa Monica, CA 90407
Prefix': — �.� I First Name`:
E -mail: clerl<C•?amo¢n_r
-- —
or to email Sarah P. Gorman,
-
City Clerk:
6 9
City Clerk Home
Public Address: -.
City Council Information
Airport Commission Application
City Council Homepage
Agendas, Minutes It Videos
Please read the following before completing an application:
Elected Representatives
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
Elections
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
Municipal Code B city charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards B Commissions
[)Alts ntI8IN2 rifOtli1nf 10n
Choose Civility
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, status,
Public Records Requests
national origin, ancestry, ry, sexual preference, or disability. Applicants shaft not, however, be under 18 years of age or serve rve on on more
City Forms a Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
with be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application wilt
become a public record and with be available for public inspection or duplication
Contact Us
AddiHOral Conflar of int rest lnfi lrzya {lo: for applicants
Phone: (310) 458 -8211
Fax: (310)
1685 Main Street, et, Room 102.
Information to be Di la ed on the Internet:
P Y
PO Box 2200
Santa Monica, CA 90407
Prefix': — �.� I First Name`:
E -mail: clerl<C•?amo¢n_r
-- —
or to email Sarah P. Gorman,
-
City Clerk:
Middle Name: Last Name:
sarah,gorlpa_r<asmggp, nc
Public Address: -.
.. City: State: Zip:
phone: Fax:
(xxx) xxx�xxxx fxxx) xxx -xxxx
E-math
Yes
Reside in Santa Monica? No
Number of years:`
Yes
Registered to vote in Santa Monica"
No
yes
Do you hold an elected position ?`
No
If yes, please specify:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
(;RY C=eiviceo
http:// www. smgov .net/depaitments /Clerkiboards /applications /airport.aspx 07/18/2014
Santa Monica Office of the City Clerk - Airport Commission Application Page 2 of 3
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Airport Commission .
Areas of Demonstrated Expertise: Check an that apply
Recognized interest, knowledge, and experience In the field of building safety, fire prevention, fire protection, disability access
regulations
Recognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
Policy development
Community outreach and involvement
Education
Strategic Planning
Federally- funded programs
l_'.. S Group
Please describe in detail your specific experience checked above:
What are your goats in serving on the Airport Commission?
What is your vision for the Airport Commission and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term Including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings.
Will you be able to commit the necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?'
No
Occupation':
Business name:
Business address:
City: State: Zip:
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx -xxIDC
City sorvieos
http: / /www.smgov. net /departments /Clerk/ boards /applications /aii-poit.aspx 07/18/2014
Santa Monica Office of the City Clerk - Airport Commission Application
For Confidential Use Only:
Residence address':
City':
Phone': (xxx)xxx -xxa
Cellular: (xxx)xxx -xxxx
State': Zip':
Page 3 of 3
ALL IRI ARMATIOil, FX( I PT FIJ ORMA l ON EN l l RGD IN TIll C ONNDENTIA( v (, NON, IS PUB I( AND AVAT A61 L [ OR HCWING Al rill
CITY(INtd, 01 FICF AND Oil fNE CITY'S WILD PAGE(EX0 i AS I.OI FD ABOVT),
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. if an
email address has been provided, an email confirmation xlll be sent. IF A CONFIRMATION 15 NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Clear Applicatim, Submit Apphcatlon,�
CItY of sTnin ffanlca a� 201 R
16P5 Atnn 51., SantA L'gnlr:,, CA'IOAnI (310) 45ft -6411 TT! (3101 4q -6626
Dislaimer PnrecY PoI1cY hcceasihility Policy Contact Us
City SeNiceS
http: / /www.smgov .net/departments /Clerk/boards /applications /airport.aspx 07/18/2014
Santa Monica Office of the City Cleric - Architectural Review Board Application
_ ty of Snta
r _
)t
City Council Information
City Council Homepage
Agendas, Minutes & Videos
Elected Representatives
Elections
Municipal Cade & City Charter
Passport Services
Boards & Commissions
Choose Civility
Public Records Requests
City Forms & Fees
Support services Division
Contact Us
Phone: (390) 458 -8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
E -mail: derkcl,s V,e_L
or to email Sarah P. Gorman,
City Clerk:
_a rah_s;erm anc±smgov,n c
City Cervices
Answer
.Architectural Review Board Application
Please read the following before completing an application:
Page 1 of 3
rext sf.,:
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City elected and appointed officials, including Council- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Oohs In4i Am information
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shat[ not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application wilt
become a public record and will be available for public inspection or duplication.
(dJ,f�on lC�nfitcx cf lore s; is[omta[ani r'c i�l_s
Information to be Displayed on the Internet
Prefix': — �_�)
First Name':
Middle Name:
Last Name':
Public Address: -
--
City:
State: Zip.
Phone:
Fax:
(xxx) xxx -xxxx
(xxx) xxx -xxxx
E -mail:
Yes
Are you a licensed architect ?'
No
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Architectural Review Board .
Areas of Demonstrated Expertise: Check all that apply
-1 Recognized interest, knowledge, and experience in the field of building safety, fire prevention, fire protection, disability access
regulations -
_.i Recognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
http: / /www.smgov. net / departments / Clerk /boards /applications /architectural review_board... 07/18/2014
Santa Monica Office of the City Clerk - Architectural Review Board Application
Policy development
Community outreach and involvement
Education
Strategic Planning
Federatty- funded programs
S Group
Please describe in detail your specific experience checked above:
What are your goals in serving on the Architectural Review Board?
What is your vision for the Architectural Review Board and the role it plays in Santa Monica and the region?
Page 2 of 3
Personal qualities identified in the criteria include leadership, creativity, and innovation as welt as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings.
Will you be able to commit the necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?"
No
Occupation`.
Business name:
Business address:
City: State: Zip:
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address':
City': State': Zip':
Phono: (xxx) xxx-xxxx _....... _.....
Cellular: (xxx)xxx -xxxx
City 8c, rice,
http:// www. smgov .netldepaitmentsICIerkiboards /applications /architectural review_ board... 07/18/2014
Santa Monica Office of the City Clerk - Architectural Review Board Application Page 3 of 3
ALL INI O MAHON, FX( P Ni 011MAI OF1 rN 'LtL`) IIfTI t 01PIDJ-Nri t •1 C110N, I> PUBI ( AND AVAiI AL'I F FIR ll_WING AY 1111
CITY( I FW S ORiCF AND( Al iilf_(A P Vol if PA6F (FX( FA NO HLOAOW)
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310)458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Cl-; , In Appllrailcn� f3.1onfiR P.ppl1 3on.�
atv or Santa em�nca c. �a1 n
1(05 NaLt St, 5lnta ).mnica, (A )0401 to 10) 4511 -a4t 1 I1 Y (110) ')1/ 66/6
01,o, W er I P,i,, ,, 11o11, I A...... Mot, Policy I ( ...M1ad t5
CITY JPI vies
http: / /www. smgov. net /departments /CIerklboards/ applications /architectural_review_board... 07/18/2014
Santa Monica Office of the City Clerk - Arts Commission Application
Page 1 of 3
LjCIty at "'at,I:.onica
real tI «:
�Go
City Clerk Home
City Council Information
Arts Commission Application
City Council Nomepage
Agendas, Minutes (E Videos
Please read the following before completing an application:
Elected Representatives
Elections
The Oaks Initiative, also known as the'Taxpayer Protection Act, "was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City- elected and appointed officials, including Council-appointed board and commission
Municipal Code @ City Charter
members. Related litigation on this matter recently concluded, and accordingly, the City is Implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards fl Commissions
0 @ks jnftip(iv_e IfLf_onhAtio_n
Choose Civility
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
Public Records Requests
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
City Forms 9 Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us
become a public record and will be available for public inspection or duplication.
Addlt o i I Co if =ct of raorest informmlon for npplicamts
Phone: (310)458 -8211
Fax: (310) 394 -2962
1685 Room 102
Street t, R
P Box t R
Information to be Displayed on the Internet:
Santa Monica, CA 90407
E-mail: co.tkOsmeov_net
i -
Prefix ": — L. First Name ':
or to email Sarah P. Gorman,
_
City Clerk:
- - - -
sar ail, got manosmog_v,noA
Middle Name: Last Name':
Public Address:
r re•
-
City: State: Lip:
Phone: Fax:
(xxx) xxx -xxxx (xxx) xxx -xxxx
E -mail:
Yes
Reside in Santa Monica?' No
Number of years:
Yes
Work in Santa Monica ? No
Number of years:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
- Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Arts Commission .
City riarvlces
http: / /www.smgov. net /departments /Clerk/boards/ applications /arts_ commission.aspx 07/18/2014
Santa Monica Office of the City Clerk - Arts Commission Application Page 2 of 3
Areas of Demonstrated Expertise: Check all that apply
'Strategic planning
Training in the arts
Local arts involvement
Fundraising
Community engagement
I Policy development
Background in park design, recreational programming, or a related field?
Program development
City parks If reueation activities
Please describe in detail your specific experience checked above:
What are your goals in serving on the Arts Commission ?
What is your vision for the Arts Commission and the rate it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Please describe how you see yourself working with staff and your fellow Commissioners to advance arts and /or recreation goals in a
broad way: '
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings.
Will you be able to commit the necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet?`
No
Occupation`:
Business name:
Business address:
City 3orvices
http: / /www.smgov. net /departments /Clerk/boards/ applications /arts_ commission.aspx 07/18/2014
Santa Monica Office of the City Clerk - Arts Commission Application
City: - State: Zip:
Phone: (xxx) x"-xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address': - - - -
City': State`. Zip':
Phone': (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx
Page 3 of 3
Al I INOWFANON, ['U I I'] MOIUM71014 El HEM ]J'Nai'CONI DI NHAL SI CT;OH, iS PUWI 1( AND AVAII Ait[ L 1 02 SHAVING AI IIIF
C i (I t R�S0, ICE AND ON IHNCIrYi li 6 Pl:,E(EgCt> r AS 110 TE) ABOVE;.
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation wilt be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458-8211.
Gleu Apph,ntion� Submit Application
aty of Momra 12011
1685 nlnin St., sama f.o31 fca, cA 9NO1 . (3fo) §se.oSn . 11 Y P1 ol'- w.6626
[)I ,I I Privacy Pan,, I A,-,, blllty Poll,, I C q-t Uz
City so cwf
http: / /www.smgov. net / departments /Clerk/boards/ applications /arts_ commission.aspx 07/18/2014
Santa Monica Office of the City Clerk - Building & Fire -Life Safety Commission Applica... Page 1 of 3
Lj< ty of s,ata,..,,e�rn
e.t ,Ill:
7
t,irlr
r r': fr,
.B
city Clerk Nome
City Coundfinformation
Building Et Fire -Life Safety Commission Application
City Council Homepage
Agendas, Minutes & Videos
Please read the following before completing an application:
Elected Representatives
Elections
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City - elected and appointed officials, Including Council- appointed board and commission
Municipal Code a City Charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards & Commissions
Oaks ini[iaitve Infonnatlo;,
Choose Civility
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, Sex, religion, marital status,
Public Records Requests
n
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
City Forms It Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
wit[ be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us
become a public record and wilt be available for public inspection or duplication.
dddipoml rc fl ct of lntc si in o_iiapon for.,pglayp
Phone: (340) 458 -8271
Fax: (310) 394 -2962
1685 Main Street, Room 102
PC) Box t R
Information to be Displayed on the Internet:
Santa Monica, CA 90407
E -mail: dericrosmeov.rct
Prefix': '— L. First Name`.
or to email Sarah P. Gorman,
City Clark:
-..... _.. -.....
=s hvoi ram =�mgov.ret
Middle Name: Last Nauru':
—._-
Public Address: -- - --
-- '-
City: State: Zip:
Phone: Fax:
(xxx) xxx -xxxx (xxx) xxx -xxxx
E -mail:
Yes
Do you hold an elected position?
No
If yes, please specify:
Yes
Are you a State of California registered architect?`
No
Yes
Are you a State of California registered civil or structural engineer ?'
No
Yes
Are you a State of Calfornia licensed building contractor?'
No
Yes
Are you a State of California Certified Access Specialist?
No
Yes
Are you a State of California Registered Fire Protection Engineer ?'
No
Specify current or prior service an City Boards /Commissions:
Gity Services
http: / /www.smgov. net / departments /Clerk/ boards / applications [building_and_safety.aspx 07/18/2014
Santa Monica Office of the City Clerk - Building & Fire -Life Safety Commission Applica... Page 2 of 3
List Community activities in which you are involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Building and Fire -Life Safety Commission .
Areas of Demonstrated Expertise: Check all that apply
Recognized interest, knowledge, and experience in the field of building safety, fire prevention, fire protection, disability access
regulations
iRecognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
Policy development
Community outreach and involvement
Education
I. Strategic Planning
Federally- funded programs
S Group
Please describe in detail your specific experience checked above:
What are your goals in serving on the Building and Fire -Life Safety Commission?
What is your vision for the Building and Fire Life Safety Commission and the role it plays in Santa Monica and the region?
Personal qualities identified In the criteria include leadership, creativity, and Innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the intemet?"
No
Occupation':
City Services Business name:
http: / /www.smgov .net/departments /Clerk/boards/ applications /building_and_safety.aspx 07/18/2014
Santa Monica Office of the City Clerk - Building & Fire -Life Safety Commission Applica... Page 3 of 3
Business address:
City:
Phone: (xxx)xxx -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address ":
City ":
Phone': (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx
State: zip:
State'; Zip':
AiJ_ INIOZMAI ON, EXO111 INF0Wk`,]1011 ENI 0) it IIT (.,N iDHII Ai AIATiCH, IS PUBLIC AP ID AVAILARI( 1 O VIEWING' I Ii;E
CI1 Y(1 rRK S'iRICL AND ON Ti h (;T S !f I? PAGE(IX(I PT AS HOD U AP.OVE),
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Glen Appblahon_ 8uNnutApplicafloti
City of Sapla I.bnica J 201H
1605 Liam SL, Santa h'onica, CA 911191 (310) 456 -9411 rY (310) 9t7 6626
nlslalnicr 1 Privacy Polly I AccesslbiRy Po11c11 I Contact Us
city 8arvlGe5
http: / /www.smgov .net/departments /Clerk/boards/ applications /building_ and_safety.aspx 07/18/2014
Santa Monica Office of the City Cleric - Clean Beaches & Ocean Parcel Tax Citizens Ove... Page I of 2
[LVty of SnNa A!onira
Text Sim:
�:, 2v5�1Xmm
v
s t
City Clerk Home
City Council Information
Clean Beaches &Ocean Parcel Tax Citizens Oversight Committee
City Council Homepage
Application
Agendas, Minutes a Videos
Elected Representatives
Please read the following before completing an application:
Elections
Municipal Code B City Charter
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
Passport Services
members, Related litigation on this matter recently concluded, and accordingly, the City is implementing the initiative. The City
Boards B Commissions
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Choose Civility
Wk n tiatly�fonm [ on
Public Records Requests
City Forms @ Fees
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shalt not, however, be under 18 years of age or serve on more
Support Services Division
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Coundlmembers at an open City Council meeting. Upon appointment, designated members
Contact Us
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and wilt be available for public inspection or duplication.
Phone: (310) 458-8211
Fax: (310) 394-2962
Adofbc, tC.fhct of l iesr �fomio(m to appti�ags
1685 Main Street, Roam 102
PO Box 2200
Santa Monica, CA 90407
E -mall: ciefPn,,,gov.ncl
Applicants must reside in Santa Monica
or to email Sarah P. Gorman,
City Clerk:
sar�h.aormanCNSTSnv. net
Information to be Displayed on the Internet:
Prefix : lTa First Name':
�.
. -»�•F!
Middle
Name: Last Name':
Public
Address:
City
Phone:
(xxx)
xxx-
xxxx
E-mafl
State: Zip:
Fax:
(xxx) xxx -xxxx
Yes
Reside in Santa Monica ?' No
Number of years:
Yes
Registered to vote in Santa Monica ?`
No
Yes
Do you hold an elected position?'
No
If yes, please specify:
Specify current or prior service on City BoardslCommfssions:
http:// www. smgov .net/depaitments /Clerk/boards /applications /measurev.aspx 07/18/2014
Santa Monica Office of the City Clerk - Clean Beaches & Ocean Parcel Tax Citizens Ove... Page 2 of 2
List Community activities in which you are involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Citizens Oversight Committee.
What are your goals in serving on the Citizens Oversight Committee?
Business Information
Yes
Okay to display on the Internet?'
No
Occupation':
Business name:
Business address:
City: State: Zip:
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address`:
City `: State`: Zip`:
Phone`. (xxx)xxx -xxxx
Cellular: Box)xxx -xxxx -
.ALI It111I.Ad1011,IX( CP r INPOPMATION ON fl SUD IN I HIL CONFIDI 11TIAL 9C1 ON, IS PUBLIC Ali) AVAR ABU I UR VI WING AT THE
CITY CILRk S (Y '!CE AS) ON ti =CITY 91 C PAC E(EXC ' I AS NO I I, A30VEj,
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OFTHIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Clem Apphcahon) Submit Allphciii., I -
City of sma popir, cam It
16!15 plop Sr., Sxnln 1V'j)1I1( a, CA 90901 (310) 458'0411 1 Y 1310) 917 66%
)Yd aiamr I Vrivzcy Policy I Acce1siblrity PIU, I Contact Us
CITY Servlcos
http: / /www.smgov. net /depaftments /Clerk/boards /applications /measurev,aspx 07/18/2014
Santa Monica Office of the City Clerk - Commission for the Senior Community Applicati... Page 1 of 3
�tv ersan� monr�
re:ASfz,:: a
Phone: (310) 458-8211
-
I IN
1685 Main Street Room 102
t ,
Information to be Displayed on the Internet:
P o Box
Pay
City Clerk Nome
City Council Information
Commission for the Senior Community Application
City Council Nomepage
E-mail: clerx.0smzov.net
Agendas, Minutes a Videos
Please read the following before completing an application:
Elected Representatives
-
The Oaks Initiative, also known as the'Taxpayer Protection Act,- was adopted by Santa Monica voters on November 2000, and amends
Elections
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
Municipal Code it City Charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Last Name`:
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport services
P
Santa Monica Board or Commission.
Boards it Commissions
Oaks information
'. Choose Civility
_igi[latfye
- -- -- -
City:
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
Public Records Requests
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
City Forms B: Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
pond xxx -xxxx
Appointment of members wilt be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us
become a public record and will be available for public inspection or duplication.
A d d itomro dctofl,[ i r s r 1 r fo i �,i atlm for agPf icon I
Phone: (310) 458-8211
-
Fax: (310) 394 -2962
1685 Main Street Room 102
t ,
Information to be Displayed on the Internet:
P o Box
Santa Monica, CA 90407
E-mail: clerx.0smzov.net
prefix`:
First Name':
or to email Samh P. Gorman,
-
City Clerk:
sash aormanr smao__eet
Middle Name:
Last Name`:
Public Address:
It IA L, I�i)i
�., _..
City:
State: Zip:
Phone:
Fax:
pond xxx -xxxx
(xxx) xxx -xxxx
E -mail:
Yes
Reside in Santa Monica?`. No
Number of years:'
Yes
Registered to vote in Santa MonicaT
No
Yes
Do you hold an elected position ?' No
If yes, please specify:
Yes
Are you applying for one of the seats reserved for those over the age of 60 ?`
No
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
City Services
http: / /www.smgov .net/departments /Clerk/boards /applications /senior community.aspx 07/18/2014
Santa Monica Office of the City Clerk - Commission for the Senior Community Applicati... Page 2 of 3
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Commission for the Senior Community .
Areas of Demonstrated Expertise: Check at( that apply
Knowledge of social services, healthcare and supportive housing
!Accessibility issues, including aging
Policy development
Community outreach and involvement
_'Education
Advocacy
Government or private funding
Please describe In detail your specific experience checked above:
What are your goals in serving on the Commission for the Senior Community?
What is your vision for the Commission for the Senior Community and the role it plays in Santa Monica and the region?
Personal qualities Identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively In a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet?'
No
Occupation':
Business name:
Business address:
City: _........ - State: _........ Zip:
Phone: (=) xxx -xxxx
City 3crvices
http: / /www.smgov .net/departments /Clerk/boards /applications /senior community.aspx 07/18/2014
Santa Monica Office of the City Clerk - Commission for the Senior Community Applicati... Page 3 of 3
Fax fxxx) xxx -x=
For Confidential Use Only:
Residence address
City': State': Zip
Phone': (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx
ALL INFORMATION, GX( P INYORMAYIONDC IIN- )IN'i'II(ONIIINIIAl SIX CI[ Of], IS PUBLIC /N) AVAILABLE I' OR Vil- WliGArriir
QIY CI FISK S 01 e ICE AND ON 1 N _ CITY S \,1r i PAAI (E X( P F AS 110710 ABOVE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Clear A>plk Attkmn Submit AVl h.don)
CA, al S-I,, Abnlc3 x12014
IGSIi!.lain St., Santa f,'unica, CA 90401 (310)455 -U4iI IIY(31p191/ -66)6
Ills, 'Am". 1911vncY PCilcy I Accesslbllity Policy I I azi Ile
City SnVvwes
http:// www.smgov.neVdepartmentsICIerkl boards / applications lsenior_community.aspx 07/18/2014
Santa Monica Office of the City Clerk - Convention & Visitors Bureau Application
City Clerk Home
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city Council Hemepoge
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Choose Civility
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Support services Division
Contact Us
Phone: (310)458 -8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
E -mail ¢,, WI,moov rat
or to email Sarah P. Gorman,
City Clerk:
s8rah nomsanCasttauv.ne[,
-� 1 t t,)i�!aii[t
City sel,iceo
Convention It Visitors Bureau Application
Please read the following before completing an application:
Page 1 of 3
The Oaks Initiative, also known as the Taxpayer Protection Act," was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City- elected and appointed officials, including Councit- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
O21a i"IdW ve Infmmatla
ALL persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, mantat status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and will be available for public inspection or duplication.
Adduicnal Conflict nt l ntcicst nf.,mariol in ap2hcants
Information to be Displayed on the Internet:
Prefix`: 1 -1 First Name'
Middle Name:
Last Name':
Public Address:
City:
State: Zip:
Phone:
Fax:
(xxx) xxx -xxxx
(xxx) xxx -xxxx
E -mail:
Reside in Santa Monica ?'
Work in Santa Monica ?'
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Yes
No
Number of years:
Yes
No
Number of years:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Convention and visitors Bureau .
http: / /www.smgov .net/departments /Clerk/boards /applications /convention and visitors b... 07/18/2014
Santa Monica Office of the City Clerk - Convention & Visitors Bureau Application Page 2 of 3
Areas of Demonstrated Expertise: Check all that apply
Strategic Planning
Performing arts production
Fundraising
Community outreach
Policy development
Performing arts operation
Event management
Hospitality
!. Fiduciary oversight
Beat estate development
''.Marketing
Knowledge of Santa Monica and the Civic /Pier /Arts
Knowledge of the field of public librarianship and of the Santa Monica Public Library
Please describe in detail your specific experience checked above:
What are your goals in serving on the Convention and Visitors Bureau?
What is your vision for the Convention and Visitors Bureau and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to Work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?`
No
Occupation':
Business name:
Business address:
City: State: Zip:
Phone: (xxx) xxx-xxxx
City smvirec
http: / /Www.smgov. netl depaitmentsI CIerldboards /applicationslconvention_ and visitors_b... 07/18/2014
Santa Monica Office of the City Clerk - Convention & Visitors Bureau Application
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address':
City`: State: Zip`.
Phone': (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx -
Page 3 of 3
At .L IIJ I OLMATION, EX( 1 [ IM JRhY,Ii0N t N rI R[D IN 410 CONH )LtlTIAt 1 < 1101 °, IS PUBI II AI ID AVAIIABU LO 1 VI-PIIRe AS 111t
ClYCI- RKo011KC AP)(1'11111 Cif, S VA- D PACI_(FX( t P I AS 101`I)MY)VE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. if an
email address has been provided, an email confirmation will be sent. IF CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Cleo Application Jubaut Apphcntlon
city of s,a1a .ar,m�a R, zmu
1665 Maln 5I, 11,to A'.onll, CA 9M01 (310)46& -6e,11 TTY 13 101 9 17 -6 676
0",1 ,t , I Pnrery Pnh,, I Accua,rt 111y Poticy I Contact Us
City gervires
http:// www. smgov .netldepartmentsICIerklboardsl applications leonvention_and_visitors_b... 07/18/2014
Santa Monica Office of the City Clerk - Disabilities Commission Application
o, ul Santa Rfnnica
City Clerk Home
City Council Information
City Council Homepage
Agendas, Minutes a Videos
Elected Representatives
Elections
Municipal Code R City Charter
Passport Services
Boards R Commissions
Choose Civility
Public Records Requests
City Forms R Fees
Support Services Division
Contact Us
Phone: (310) 458 -8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
E -mail: derpogmggv no[
or to email Sarah P. Gorman,
City Clerk:
�arzh.gortnar &gsmppv,net
t�
City Sorvices
Disabilities Commission Application
Please read the following before completing an application
Page 1 of 3
Text SZe:
The Oaks Initiative, also known as the 'Taxpayer Protection Act;' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Wkl initlative Information
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Counrilmembers at an open City Council meeting. Upon appointment, designated members
will he required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and will be available for public inspection or duplication.
Addtton il C< ifbcr of nterest ntormatwn frn�.pPd<ants
Information to be Displayed on the Internet:
Prefix':
Middle Name:
Public Address:
City: _....
Phone:
(xxx) xxx -xxxx
E -mach
Reside in Santa Monica?
Are you applying for one of the seats reserved for those with a disability?'
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
First Name':
Last Name':
State: Zip:
Fax:
(xxx) xxx�xxxx
Yes
No
Number of years:`
Yes
No
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
dirties of the DlsabiNtles Commission .
Areas of Demonstrated Expertise: Check all that apply
http:// www. smgov .net/departments /Clerk/boards /applications /disabilities.aspx 07/18/2014
Santa Monica Office of the City Clerk - Disabilities Commission Application
Clty Sorviceo
Knowledge of social services, healthcare and supportive housing
Accessibility issues, including aging
Policy development
Community outreach and involvement
!Education
Advocacy
Government or private funding
_.
Please describe in detail your specific experience checked above:
What are your goals in serving on the Disabilities Commission ?
What is your vision for the Disabilities Commission and the role it plays in Santa Monica and the region?
Page 2 of 3
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?`
No
Occupation':
Business name:
Business address:
City.
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address':
City':..
Phone`: (xxx) xxx -xxxx
Cellular.: (xxx)xxx -xxxx
State Eipi
State`: Zip':
http: / /www. smgov .net/departments /Clerk/boards /applications /disabilities.aspx
07/18/2014
Santa Monica Office of the City Clerk - Disabilities Commission Application Page 3 of 3
ALL INIORCIM Kill, EX(tPi iI IFGRMATRA! FAl(2D INTHt C04FIDENTIAI III F0,14, IEPUIIIlr All DAVAI I AM C FOR VIEWING AT TI IF
, I I Y CIA RKS OI190E AND OFF III'CIIYSWIB'AGE(I XCFP I AS HOTED ABOVE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
ClcarFlLP II_(ioi Submli Appht,ahon�
I
I It of Wnm t.'nnirn ,1011
I1W, Alvin fit,, $unto A'mr1, , CA 90601 (310) !M' 8111 ltY (AO) 91J 6616
0 sc1u mer I Pnvxcl' Po11cY I Arrcss lallitY Mfi,y I Gmtact Ui
Cify Sarvicoe
http: / /www.smgov .net/departments /Clerkiboards /applications /disabilities.aspx 07/18/2014
Santa Monica Office of the City Clerk - Downtown Santa Monica Inc. Application Page 1 of 3
City Clerk Home
City Council Information
City Council Homepage
Agendas, Minutes it Videos
Elected Representatives
Elections
Municipal Code a City Charter
Passport Services
Boards it Commissions
Choose Civility
Public Records Requests
City Forms a Fees
Support Services Division
Contact Us
Phone: (310)458 -8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
E-mail: derknr�smvov_get
or to email Samh P. Gorman,
City Clerk:
sniah. rsomanc� >smgcy. nct
(lily Services
I xtsi,e:
Downtown Santa Monica Inc. Application
Please read the following before completing an application
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City- elected and appointed officials, Including Councit- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Oats inkiative information
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, medial status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Counciimembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and will be available for public inspection or duplication.
Additm tCO[li- Iic(o(mtcies nfoimet,on u anpl wrtt5
Information to be Displayed on the Internet:
Prefix':
First Name
Middle Name:
Last Name':
Public Address:
City:
State: Zip
Phone:
Fax:
(xxx) xxx -xxxx
(xxx) xxx -xxxx
E -mail:
Yes
Reside in Santa Monica?'
No
Number of years:
Yes
Work in Santa Monica ?"
No
Number of years:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Downtown Santa Monica, Inc. ,
http:// www. smgov .netldepaitmentsICierldboards /applications /downtown santa_monica.a... 07/18/2014
Santa Monica Office of the City Clerk - Downtown Santa Monica Inc. Application Page 2 of 3
Areas of Demonstrated Expertise: Check all that apply
Strategic Planning
Performing arts production
Fundraising
Community outreach
Policy development
Performing arts operation
Event management
Hospitality
'Fiduciary oversight
Real estate development
Marketing
Knowledge of Santa Monica and the Civic /Pier /Arts
Knowledge of the field of public librarianship and of the Santa Monica Public Library
Please describe in detail your specific experience checked above:
What are your goals In serving on the Downtown Santa Monica, Inc. ?
What is your vision for the Downtown Santa Monica, Inc. and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term Including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Wilt you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?'
No
Occupation,:
Business name:
Business address:
City Services
http:// www.smgov.netldepartmentsICIerkl boards / applications ldowntown_santa_monica.a... 07/18/2014
Santa Monica Office of the City Clerk - Downtown Santa Monica Inc. Application
City: State: Zip
Phone: (xxx) xxx -xxax
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address': - --
City': - State': Zip':
Phone`: (xxx) xxxxxxx
Cellular: (xxx)xxx -xxxx
Page 3 of 3
A[ I III KIN, EX(. ItINORMAI (M t N f1 RIJ)I N l I i t( I IILNTiAIS r[WHl IS PUPIIf ANo AVAIL AN I I OR VN- WING Ai -fliE
CIiY(IiRR A`FICEA AND UA II S(HY'S ItRPA(d (IWIII Ati R01 E 1) ABOVE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. if an
email address has been provided, an email confirmation volt be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
CiefnAppilenflon SI IbIIit Application�
CK, of s,nm t.bnfca a zmn
ens m,�in ie, sanm Amnf�,, ca 9otm (no) nss -sa I f'lt Y (3m) 9n.eeie
ekdalnx, PrivazY Polley Ar <'.= sslbiNLVPolfcv I eontazt U„
Cftp S,rv,mis
http:// www. smgov .netldepaitmentsICIerklboards /applications /downtown santa_monica.a... 07/18/2014
Santa Monica Office of the City Clerk - Housing Commission Application Page I of 3
City Clerk Home
City Council information
Housing Commission Application
City Council Homepage
Information to be Displayed on the Internet:
Agendas, Minutes a videos
Please read the following before completing an application:
Elected Representatives
E -mail: ctel;; sniwy net
The Oaks Initiative, also known as the Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
Elections
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
Municipal Code it City Charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
sarah qo mane }Oreg_v,nxt
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards & Commissions
baps in =dative hs(orr.,atiar -
Choose Civility
Public Address: - - -- - -
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
Public Records Requests
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve an more
City Farms It Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact US
become a public record and will be available for public inspection or duplication.
Addi$ma[Confl;ct of )nteic bite i;Ranonf, roc ticamt
Phone: (310)458 -8211
Fax: (310) 394 -2962
7685 Main Street, Room 182
t R
Information to be Displayed on the Internet:
PO Box
-
Santa Monica, CA 90407
E -mail: ctel;; sniwy net
Prefix':
or to email Sarah P. Gorman,
City Clerk:
.... .. .. . ... .
sarah qo mane }Oreg_v,nxt
First Name`:
y ' (
Middle Name:
Lw-t
Last Name':
Public Address: - - -- - -
City: Santa Monica
Phone: -
(xxx)xxx -xxxx
Fax:
(xxx) xxx -xxxx
E -mail
Reside in Santa Monica?`
Do you hold an elected position?"
Are you applying for the seat reserved
for a Housing Authority Section 8
Program participant ?'
Are you applying for the seat reserved
for a Housing Authority Section 8
Program participant, who is over the
age of 62 ?'
State: Zip:
Yes No
If yes, indicate number of years:''
Yes No
If yes, please specify:
Yes
No
Yes
No
Specify current or prior service on City Boards /Commissions:
CRY :i ewiceo List Community activities in which you are involved;
http: / /www.smgov. net /departments /Clerk/ boards / applications /housing_ commission.aspx 07/18/2014
Santa Monica Office of the City Clerk - Housing Commission Application Page 2 of 3
Describe your qualifications, experience, and educat ion, and list any technical or professional requirements you have relative to the
duties of the Housing Commission .
Areas of Demonstrated Expertise: Check all that apply
_.I Recognized interest, knowledge, and experience in the field of building safety, fire prevention, fire protection, disability access
regulations
Recognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
Policy development
Community outreach and involvement
Education
Strategic Planning
Federally- funded programs
S Group
Please describe in detmt your specific experience checked above;
What are your goats in serving on the Housing Commission ?
What is your vision for the Housing Commission and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as Well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of the Board meetings.
Will you be able to commit the necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Intemet?`
No
Occupation:
Business name:
Business address:
Oi¢y S•arvices
http: / /www.smgov. net /departments /CIerkiboards/ applications /housing_commission.aspx . 07/18/2014
Santa Monica Office of the City Cleric - Housing Commission Application
City: State: Zip:
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx-xxxx
For Confidential Use Only:
Residence address':
CRY`: State`: Zip':
Phone`: (xxx) xxxxxxx
Cellular: (xxx)xxx -xxxx
Page 3 of 3
ALi W1 OWAAf K)N, EXC' i 1 N101i1ddT10N 1,14TI R1011lIHCOIJ'IDIN,AlSICION, IS PURI IC AND. AVAIL AM t 1OR VIE \41NGnITHC
CI T' Ai RK S011 ('EF4D(,N lI1ECITA VXB 1A (IXCkP1 A511011- D ABOVE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211
Cledl Applicetlon Submit Application
, ,, of sank, r.oin� a v 2014
1685 MNn SL., Ssnta Lbnica, CA 90401 QW) 45G 9,11 l TTY (310) 917 -6626
D,d,,,e, N,R, Poh,I I Accussiblfll Ponry I Contact Us
( %i(V Gowi Ce s
http:// www. smgov .net/departments /Clerk/boards/ applications /housing_ commission.aspx 07/18/2014
Santa Monica Office of the City Clerk - Landmarks Commission Application
Page 1 of 3
City Clerk Home
City council Information
Landmarks Commission Application
City Council Homepage
Agendas, Minutes B voices
Please read the following before completing an application;
Elected Representatives
The Oaks Initiative, also known as tbe'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
Elections
the City Charter. Its requirements affect all City - elected and appointed officials, including Council-appointed board and commission
Municipal Code a City Charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards B Commissions
Oaks im,_"t m. Into; maeon
Choose Civility
All Persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
Public Records Requests
national origin, ancestry, sexual preference, or disability. Applicants shalt not, however, be under 18 years of age or serve on more
City Forms tt Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special quagfications and requirements.
Appointment of members will be made by Councilmembees at an open City Council meeting. Upon appointment, designated members
Support Services Division
wilt be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us
become a public record and w It be available for public inspection or duplication.
nddltbra(COr f },ct os,yotciest,mfyM, , o zpp`,icants
Phone: (310) 458-8211
Fax: (310) 394 -2962
1685 Main Street, Roam 102
t,
la
Information to Infi be Displayed on the Internet:
P Box 2200
P Y
Santa Monica, CA 90407
E -mail: cled¢ssm¢ov. net
Prefix First Name':
or to emait Sarah P. Gorman,
City Clerk:
_...
,eiah.ecrma ..... M,.net
Middle Name: Last Name':
.._
Public Address;
•�,< .:'
City: State: Zip:
Phone: Fax:
(xxx) xxx -xxxx (xxx) xxx -xxxx
E -mail: _.
Yes
Reside in Santa Monica ? No
Number of years:`
Yes
Are you a registered architect ?"
No
Yes
Are you a local historian ?`
No
Yes
Are you an architect historian ?'
No
Yes
Are you a California real estate licensee ?'
No
Specify current or prior service on City Boards /Commissions:
GRy services List Community activities in which you are involved:
http: / /www.smgov. net / departments /Clerk[boards /applications /landmarks.aspx 07/18/2014
Santa Monica Office of the City Clerk - Landmarks Commission Application Page 2 of 3
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Landmarks Commission .
Areas of Demonstrated Expertise: Check all that apply
Recognized interest, knowledge, and experience in the field of building safety, fire prevention, fire protection, disability access
regulations
Recognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
`i Policy development
Community outreach and involvement
Education
'Strategic Planning
..I Federally- funded programs
S Group
Please describe in detail your specific experience checked above:
What are your goals in serving on the Landmarks Commission?
What is your vision for the Landmarks Commission and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Okay to display on the Internet ?'
Occupation`:
Business name:
Business address:
City Smvices
Yes
No
http: / /www.smgov .net/departments /Clerk[boards /applications /landmarks.aspx 07/18/2014
Santa Monica Office of the City Clerk - Landmarks Commission Application Page 3 of 3
City: ............... State: Zip: _....
Phone: (xxx) xxx -lo=
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address
City,: State': Zip
Phone`. (xxx) xxxxxxx
Cellular: fxxx)xxx -xxxx
AL, iNi OW,1,Ai OH, EK( U' f Lill ORA1A110 t l N1011) ltd ii ii MINI IO1N HAT. V CIION, IS PUM C AND AVAIlAM 1 1012 `AEW816 Al I 11E
CITYCI J R(S 011'ICE AM OMIT i GAY'S VI B PAbi'(EXU UP II LOIEO AbVr),
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent, IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211,
Cloor Application Suhmlt Applicoiion j
Clly o[ Sanln L'onlca 131014
I6IIi Mstn SL, Sxnta A'onica. 6,90401 (310),59f4 T!'(1310)9i) -6626
Otx1e(o,er 1 P,i", ild", I ACCCSI billy Poky I C,,"I ,I Oz
City "'wire"
http:// www. smgov .net/depaitments /Clerk/boards /applications /landmarks.aspx 07/18/2014
Santa Monica Office of the City Cleric - Library Board Application
Page 1 of 3
{tyni5antaf.lnnic�
Tertsl,e:
i
ds ,
D
mow
City Clerk Home
City Council Information
Library Board Application
City Council Homepage
Agendas, Minutes a Videos
Please read the following before completing an application:
Elected Representatives
The Oaks Initiative, also known Protection Act,' was adopted by Santa Monica voters November and amends
Elections
is affect all City of and
the Lily Charter. Its requirements affect all City - elected and appointed officials, including Council - appointed board and commission
Municipal Code B City charter
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative, The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you If you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards a Commissions
Oaks ln4fative lrfonratiun
Choose Civility
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, or marital status,
Public Records Requests
age
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
y,
City Forms B Fees
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members wilt be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us
become a public record and wit[ be available for public inspection or duplication.
'AddltiO,,M C.Mri1Ct Of to A �Il[0[Yla --i 41 lal 1.pp) k Iltl
Phone: (310) 458-8211
Fax: (310) 394 -2962
1605 Main Street, Room 102
PO Box t, R
Information to be Displayed on the Internet:
Santa Monica, CA 90407
_
E -mail t1E,k4,,w,cvno[
Prefix`. First Name ":
or to email Sarah P. Gorman,
-
City Clerk:
Sarah gormvlcj,5�3gyLet
Middle Name: Last Name
Public Address:
1.
-
City; State: Zip:
Phone: Fax:
(xxx) xxx.xxxx (xxx) xxx -xxxx
E-mail:
Yes
Reside in Santa Monica ? No
Number of years:"
Yes
Registered to vote in Santa Monica ?"
No
Yes
Do you hold an elected position?'
No
If yes, please specify:
Specify current or prior service on City Boards /Commissions;
List Community activities in which you are involved:
City Sandces
http:// www. smgov .net/depaitments /Clerk/boards /applications /libraly.aspx 07/18/2014
Santa Monica Office of the City Clerk - Library Board Application Page 2 of 3
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Santa Monica Library Board .
Areas of Demonstrated Expertise: Check all that apply
Strategic Planning
Performing arts production
Fundraising
Community outreach
Policy development
Performing arts operation
Event management
Hospitality
Fiduciary oversight
Real estate development
Marketing
Knowledge of Santa Monica and the Civic /Pier /Arts
Knowledge of the field of public Librarianship and of the Santa Monica Public Library
Please describe in detail your specific experience checked above:
What are your goals in serving on the Santa Monica Library Board ?
What is your vision for the Santa Monica Library Board and the role it plays in Santa Monica and the region?
Personal qualities identified In the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet?'
No
Occupation`.
Business name:
','try Bervicos Business address:
http: / /www.smgov. net / departments /Clerkiboards /applications /library.aspx 07/18/2014
Santa Monica Office of the City Clerk - Library Board Application
City: State: Zip:
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Residence address:
City': State: Zip':
Phone': (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx
Page 3 of 3
ALL INIO<b,TIaN, EXCi IT I IM ORMATION LN N RED IN fti Call[ It)[ HTIAL YI( TIGN, IS PUBiY AND AVAIL AN 17 F OR VIiNINi; AI i HL
(A I'S 11 RS0I1 ILI AI) ON I H L CRY, \YI B PAOI NV P I AY N101 ED A80VE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
Glefar APIA cation 9lbmit FlpplicafPon_1
CIL, of Santa MonIC3 , 2019
fees Ala1n St., Santa non[ca, (A OMOi (310) q5A -&ll 1 . TTY ]in) 9f) -6626
n6dnlmcr I Pdyacy Policy 1 ucces9 ,W, Policy I Contact lie
Cry Soiv IfeS
http: / /www.smgov .net/departments /Cleikiboards /applications /libraiT.aspx 07/18/2014
Santa Monica Office of the City Cleric - LA County West Vector Control District Applica... Page 1 of 2
�ity of Santa Atonlcv
fe
City Clerk Home
City Council Information
City Cwncit Homepage
Agendas, Minutes B Videos
Elected Representatives
Elections
Municipal Code & City Charter
Passport Services
Boards @ Commissions
Choose Civility
Public Records Requests
City Forms B Fees
Support Servkes Division
rent tae:
IlEt"wo va��
a
LA County West Vector Control District Application
Please read the following before completing an application
The Oaks Initiative, also known as the Taxpayer Protection Act;' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City elected and appointed officials, including Council- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Oak, Initiabve Information
Ali persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve an more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us become a public record and will be available for public inspection or duplication.
hddinonelConttl_et of l ntue,st,ln(pnnabon fo Ppbca
Phone: (310) 458-8211
Fax: (310) 394 -2962 Member must be a registered voter in Santa Monica.
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
Information to be Displayed on the Internet:
E -mail: Oed,(,smgov.nct
or to emait Sarah P. Gorman,
City Clerk:
Prefix': — (..�.� First Name`:
sarah ,arman6P cv,net
Middle Last Name':
Name:
�! tf I- i,v,
Publfc
t1 yU
Address:
City: State: Zip
Phone:
(xxx) Fax:
xxx- DOCK)xxx -xxxx
xxxx
E -mail
Yes
Reside in Santa Monica ? No
Number of years:"
Yes
Registered to vote in Santa Monica ?`
No
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Describe your quat fications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the IA County West Vector Control District.
City sarvleee
http: / /www.smgov.net/departments /Clerk /boards /applications /vector.aspx 07/18/2014
Santa Monica Office of the City Clerk - LA County West Vector Control District Applica... Page 2 of 2
What are your goals in serving on the LA County West Vector Control District?
Business Information
Yes
Okay to display on the Internet?'
No
Occupation':
Business name:
Business address:
City: State:
Phone: (xxx)= -xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
Zip
Residence address':
City `: State': Zip
Phone`: pxx) xxx -xxxx
Cellular. (xxx)xxx -xxxx
ALL ILIUfhhI ION, I XCi 113 Ou Rt AATI01( 41 tR[) It! IHIC0N'Ii,ENTIA( SL( IION, IS PUBLIC AND AVAIIABI I fOR .IV00 A] 111
Cit'(( i}P.R S(`I I C E MID 0H I9C Q1 I 6 PAGI (EX(I PT As NOILD ABOPF),
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 -8211.
time Submit Application
C;IV (jT Santa M)III(a c 2014
1665 Alain 51., Santa l.'e)nl<a, (A 90;01 (310) 15a -8411 T Y (110) 917 6626
(III, iukr I Privaq. Polley I Aaesslbillty Jo6cY I Cant -1 Uz
http: / /www.smgov. net /depaitments /Clerk/ boards /applications /vector.aspx 07/18/2014
Santa Monica Office of the City Clerk - Metropolitan Water District Board of Directors A... Page 1 of 2
City Clerk Home
City Council Information
City Council Homepage
Agendas, Minutes B Videos
Elected Representatives
Elections
Municipal Code it City Charter
Passport Services
Boards a Commissions
Choose Civility
Public Records Requests
City Forms It Fees
Support Services Division
r1,
Metropolitan Water District hoard of Directors Application
Please read the following before completing an application:
The Oaks Initiative, also known as the'Taxpayer Protection ACT," was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City - elected and appointed officials, including Council- appointed board and commission
members, Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Oaks initiative Infc,niWon
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
Contact Us become a public record and will be available for public inspection or duplication.
Additicnal Con'uct of l rhi Alycn_nat ion napphcants
Phone: (310) 458 -8211
Fax: (310) 394 -2962
R
1685 Main Street Room 102
t ,
la
Information to be Displayed on the Internet:
rm
P Box
P Y
Santa Monica, CA 90407
E -mail: clerfa�fLgov n7,et
Prefix': -- �_�� First Name':
or to email Sarah P. Gorman,
City Clerk
Middle
saal_i ,o man v,ngpy_I)e(
- --
Name, Last Name':
_.._
Public
Address:
City: State: Zip:
Phone
(xxx) Fax:
xxx- (xxx) xxx -xxxx
xXNX
E-mail:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Metropolitan Water District Board of Directors.
What are your goals in serving on the Metropolitan Water District Board of Directors?
City Servic,,
http: / /www.smgov. net / departments /Clerk/boards /applications /mwd.aspx 07/18/2014
Santa Monica Office of the City Clerk - Metropolitan Water District Board of Directors A... Page 2 of 2
Business Information
Yes
Okay to display on the Internet ?'
No
Occupation':
Business name:
Business address:
City: State: Zip
Phone: (xxx) xxx -xxxx
Fax: (xxx) xxa -xxxx
For Confidential Use Only:
Residence address':
City': State': Zip':
Phone`. (xxx) xxx -xxxx
Cellular: (xxx)xxx -xxxx
AT NfO RLWI0N, EXC Pf HT ORMATI011 f NR RED IN 111L CONI D! NTIAI A CT!OM, IS PUh R ANDAMrAb— FOR. JC`NING AT THE
CITY CI rRh S OP LICE AND 44111E CITYS V,'Hl PAGL(E XCI-Pr AS N07ED AOOVE),
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING 1310) 45B-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. I F A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 458 - 81I211.
`Glen All Ill l,CTunn SuhimL4plrlw1tio
Cey or 5:mm Atndo -, 7014
1666 Alalu Sl, Sanla 1.'e�nleq CA 90SO1 1310) 4588411 TTY 131(1) 91]66]6
r Y' n=r PIiV= y I ry Acroszil 61y P�IIC/ Conlxi 1J5
Ciy Services
http: / /www.smgov.net/depai tments /Clerk /boards /applications /mwd.aspx 07/18/2014
Santa Monica Office of the City Clerk - Personnel Board Application
�c¢v otsnnril kanica
City Clerk Home
City Council Information
City Council Homepage
Agendas, Minutes ft Videos
Elected Representatives
Elections
Municipal Code h City Charter
Passport Services
Boards a Commissions
Choose Civility
Public Records Requests
City Farms a Fees
Support Services Division
Contact Us
Phone: (310) 458 -8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
PO Box 2200
Santa Monica, CA 90407
E—mail:IeiN4?sn?
or to email Sarah P. Gorman,
City Clerk:
I s;+ah_gonn_n(�singrr ✓.nrt
c
Trxl
Personnel Board Application
Please read the following before completing an application
Page 1 of 3
The Oaks Initiative, also known as the'Taxpayer Protection Act,' was adopted by Santa Monica voters on November 2000, and amends
the City Charter. Its requirements affect all City-elected and appointed officials, including Council- appointed board and commission
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Attorney and City Clerk's Office prepared the following information about the Initiative that may affect you if you are appointed to a
Santa Monica Board or Commission.
Oahu 11111aWv, lofonnadly,
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and will be available for public inspection or duplication.
Addiponsl Confflct ,ufitei 'It 41 r.,M I H.n ter 1plHI1tt1
Information to be Displayed on the Internet:
Prefix':
Middle Name:
Public Address:
City:
Phone:
(xxx) xxx -xxxx
E -mail:
First Name':
Last Name':
State: Zip:
Fax:
(xxx) xxx -xxxx
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Cif iree Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
y' xery duties of the Personnel Board.
http: / /www.smgov .net/departments /Clerk/boards /applications /personnel.aspx 07/18/2014
Yes
Reside in Santa Monica ?`
No
Number of years:'
Yes
Registered to vote in Santa MonicaY
No
Yes
Do you hold an elected position ?`
No
If yes, please specify:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are involved:
Cif iree Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
y' xery duties of the Personnel Board.
http: / /www.smgov .net/departments /Clerk/boards /applications /personnel.aspx 07/18/2014
Santa Monica Office of the City Cleric - Personnel Board Application
Page 2 of 3
Areas of Demonstrated Expertise: Check all that apply
Recognized Interest, knowledge; and experience in the field of building safety; fire prevention, fire protection, disability access
regulations
Recognition of unique standards for the City of Santa Monica, including geography, current zoning, growth pattern, transportation
challenges, and General and Specific Plans
Policy development
Community outreach and involvement
Education
Strategic Planning
_'. Federally-funded programs
S Group
Please describe in detail your specific experience checked above:
What are your goals in serving on the Personnel Board?
What is your vision for the Personnel Board and the rote it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as well as the ability to work effectively in a
group setting and an ability to balance competing needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term Including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings, Witt you be able to commit the
necessary time to perform your duties If appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?'
No
Occupation':
Business name:
Business address:
City: State: Zip:
Phone: (xxx) xxx-xxxx
Fax: (xxx) xxx -xxxx
For Confidential Use Only:
City su�vwes Residence address':
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Santa Monica Office of the City Clerk - Personnel Board Application
City':
Phone (xxx)xxx-xxxx
Cellular; (xxx)xxx -xxxx
State': Zip':
Page 3 of 3
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CItyCII M',OI 1 ICI AM 011 IIF 0TYSVA B PIGI (FX(I I1 /S tIOi ED ABOVE).
DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-
8211
After an application has been submitted, a confirmation page will be displayed; please print or save that page for your records. If an
email address has been provided, an email confirmation will be sent. IF A CONFIRMATION IS NOT DISPLAYED, PLEASE RESUBMIT OR
CONTACT THE CITY CLERK'S OFFICE AT (310) 45 &8211.
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City Servicoc
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Santa Monica Office of the City Clerk - Santa Monica Pier Corporation Application Page 1 of 3
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City Clerk Home
Santa Monica Pier Corporation Application
City Council information
City Council Homepage
Agendas, Minutes a Videos
Please read the following before completing an application:
Elected Representatives
The Oaks also known er Act," was adopted by Santa Monica voters November and amends
Elections
is affect all C eectetl an
o and
the City Charter. Its requirements affect ail City - elected and appointed officials, including Council -appointed board and commission
Charter. It
members. Related litigation on this matter recently concluded, and accordingly, the City is implementing the Initiative. The City
Municipal Code a City charter
Attorney and City Clerk's Office prepared the following information about the initiative that may affect you if you are appointed to a
Passport Services
Santa Monica Board or Commission.
Boards it Commissions
Ohs 6ulirtrve Infonn,tinn
Choose Civility
All persons are invited to apply for membership on City Boards and Commissions regardless of race, age, sex, religion, marital status,
Public Records Requests
national origin, ancestry, sexual preference, or disability. Applicants shall not, however, be under 18 years of age or serve on more
than one Board, Commission or Corporation. Some Boards and Commissions do require special qualifications and requirements.
Cif Forms a Fees
City
Appointment of members will be made by Councilmembers at an open City Council meeting. Upon appointment, designated members
Support Services Division
will be required to file a Conflict of Interest disclosure statement. Please answer all questions on this application. This application will
become a public record and will be available for public inspection or duplication.
Contact Us
Addition,( Conlict of Innem t I,f nra cn for upFbcants
Phone: (310) 458-8211
Fax: (310) 394 -2962
1685 Main Street, Room 102
Information to be Displayed on the Internet:
PO Box 2200
Santa Monica, CA 90407
E -mail derkosm¢ov. net
Prefix': First Name,:
or to email Sarah P. Gorman,
City Clerk:
sash o mam n�mw, let
Middle Name: Last Name':
Public Address:
C J-1 J
./k
City: State: Zip:
Phone: Fax:
(xxx) xxx -xxxx (xxx) xxx -xxxx
E -mail:
Yes
Reside in Santa Mmdca ?` No
Number of years:
Yes
Work in Santa Monica ?" No
Number of years:
Specify current or prior service on City Boards /Commissions:
List Community activities in which you are Involved:
Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the
duties of the Santa Monica Pier Corporation .
( GUY 8ervicoa
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Santa Monica Office of the City Clerk - Santa Monica Pier Corporation Application Page 2 of 3
Areas of Demonstrated Expertise: Check all that apply
Strategic Planning
Performing arts production
Fundraising
Community outreach
l Policy development
Performing arts operation
.._i Event management
Hospitality
Fiduciary oversight
Real estate development
Marketing
Knowledge of Santa Monica and the Civic /Pier /Arts
Knowledge of the field of public librarianship and of the Santa Monica Public Library
Please describe in detail your specific experience checked above:
What are your goals in serving on the Santa Monica Pier Corporation ?
What is your vision for the Santa Monica Pier Corporation and the role it plays in Santa Monica and the region?
Personal qualities identified in the criteria include leadership, creativity, and innovation as wail as the ability to work effectively in a
group setting and an ability to balance competfng needs. Provide examples of how you have demonstrated those qualities:
Participation on the Board requires a significant commitment over the length of the term including attendance at approximately two
scheduled meetings per month, and possibly other tasks and meetings outside of Board meetings. Will you be able to commit the
necessary time to perform your duties if appointed to the Board?
Yes No
Business Information
Yes
Okay to display on the Internet ?`
No
Occupation`:
Business name:
Business address:
CRY ServlcRZ
http: / /www.smgov. net /departments /Clerk /boards /applications /prc.aspx 07/18/2014