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03-753Council File # �3 �5� Green Sheet # JW�„ � Presented By Referred To 1 RESOLUTION OF SAINT PAUL, NIINNESOTA ! 'f Sherri Smith - term expires March 1, 2005 Kathy Wilken - term expires March 1, 2005 Mark Wolf - term expires March 1, 2005 i z 3 4 s 6 � s 9 10 11 12 Adoption Certified by Council Secretary � Approved by By: RESOLVED, that the Saint Paul City Council consents to and approves the appointments, made by the Mayor, of the following individuals to serve on the Joint County/City Health Services Advisory Committee. APPOINTMENTS � Committee: Date Requested by Department of: Form Approved by City Attorney By: Date �� Adopted by Council: Date Ap�rojby Mayor £or Submission to O� Council �3-�53 �reen Sheet Green Sheet Green Sheet Green Sheet Green Sheet Gr� Departme�rt/o�ce/cou Date initiated: � Mo �ayor's0ffice 73-AUG-03 Green Sheet N� 3004111 ConWct person & Phone: Deoartmen Sent To Person Initial/Date Kurt SChultz � 0 a or' Offce ASSIgn 1 avor• ice De ar[men[Direc[or Must Be on Council Agenda by (D Number 2 me For Routing 3 a or' Otfice Ma or/Assistant Order q o �;� 5 i CI k Ci Clerk Total # of Signature Pages (Clip Ail Locations for S Action Requested: Joint City/County Health Services Advisory Committee appoinhnents of Sherri Smith, Kathy Wilken, and Mazk Wolf �deosRppmeWmH�tO� Personal Service Contracts Must Answer the Following Quest _ PI�Ylbnolssloe LAasideP��frmeua�watetlioAeramahac[frethlstlel�OOm�C1 _CBl�enlailf� Yes Nu _ 19v1Srvh�Oamisal0o 2EaStliB�rwNflmBVa'6BBBatlhBO�InY�'P Yes Ib B.Oms llia P�/� �s a ska mt m+�lY I�ssad bY ary — o�7'eo[d[Ye�oyea7 — YB8 Ib _ Explain all yes answers on separate sheet and attach to gre Initiating Problem, Issues, Opportunity (Who, What, When, Where, Why) Advantages If Approved: Disadvantages If Approved: Disadvantages If Not Approved: Total Amount of Cost/Revenue Budget Transaction: Funding Source: Activity Number: Financial Information: � � PLEASE RETURN TO: TOM MARVER P.E.D.13 FLOOR 25 WEST FOURTH S'I'REET ✓ SAINT PAUL, MINNESOTA 55102 Phone: (651) 266.6610 FAX: (651) 228.3261 �:,..�� 1 �� Y�� ECEiv�o JUL 112001 Name: �5-, Pt� �Yh�-�-M M�tYOR' (1FFi�E Home Address: - r�3 ��P�nor 1�� a c e Street: csry: _ Sa � v�t-'Pa�� z� �5 � o y Telephone Number(s): (Inctude Area Codes) Planning District Council: Preferred Mailing Address: � What is your occupation? Place of Employment: Committee(s) Applied For: What sldlls, training or experience do you possess for the committee(s) for which you seek appointment? p�2QS2 �PP �r�PrY �pN- v�an (�1etfiam'�Qr �! City Council Ward: ' • . �� . i L_ •'!1 ' • [1 t . 6 .' The informarion included in this application is considered private data according to the Minnesota Government Data Pracrices Act. As a result, this informarion is not released to the general public. a3=1�3 PERSONAL REFERENCES [Reminder to Include Telephone Area Codes] Name: S'�P ��e•{ JOhr�C�rl C�if1P —�YP�'� ��ir �'� pQu �-I-n`��vPr �'ti On P'c�ec� Address: ISd9 MQCSItGII ��2hv2 � Sr P��{ i mn• 5sla� Phone: Name: �Iomel �Vork) 65I 645'��ay - � /��'ti ; . 'i� • - Address: a0�-I l 1eSt �fQn��in f4uE �t�ps mn � ss�.�. Phone: 1Homel �Vork) 6 �a� Name: FMn 1'ICl1JIl� X L�i�yrPl'JV�i'� Address Q�EY 2(?.u_f��.1�1 �`�'PaUf � iM SS�d� Phone: �fiome) �Vorkl �sl- qg�- laa3 Reasons for your interest in this particular committee: P1eQ�-e See a�c�ecQ �P�r Have you had previous contact with the committee for wluch you are maldng application? If so, when, and the circumstances? In an attempt to ensure that committee representation reflects the makeup of our community, please check the line applicable to you. This information is strictly voluntary. � White (Caucasian} Black (African American) American Indian or Alaskan Esldmo Date of Birth: � - a5 "�� Disabled: Yes No If special accommodarions are needed, please specify: Male Hispanic Asian or Pacifc Islander Female � How did you hear about this openine? ��_�'e�r n�'� S�- '•'� `•^" �� '4'�ing FAX N0. :651 Apr. 04 2002 01:37PM P2 ,� 03= t53 �too �g��. Application for Committee, Bo�rd, or Commission Please rccurn to Mark Engcbretson y�j Mayor's Office, Room 390 City Hali 15 West Keliogg Blvd., Saint Paul, MN 55702 Phone:651-266-8533 Fax:651-266-8513 The Minneaote Governmeat Deta Yraociees Ae[ (,Nirtneao�a S�ecutca Chap�er 13) govorns the City's ure ot the informa[ion coa[ained iu tni9 appliea[ion. Snme otchc informntiou sough[ in [hic application is pri�att dats under [he Act. The reques[ed ipforma[ion mi(1 be used by tha appolntiog anchori[y w carry out [he Ciry's official appviatmen� respnnsibili�ics. You arc no� requlted [o provide any information. flowev¢r, failure to aaswet tLc app)icatiop questionv may cauee the appointiag auchority eo rejtcz your application. 7he majoriiy of i[emx ceatained ia this applicai;on arc pubtic, includieg aeme, addross, employmcnt, skitle, �roining and experiea�e, uad aro tDereYoae availablo xo nayone rcqunsting ic. Tfic rcmaining i[ems nn cde spplieaciou form are etaasifled as privaee. Tbe privatc da�a ia available only to you and to oth r persons in [he City m�o, bccause of work ass�gnm�n[a, rcasonably rtquire aceess to the informu�ion. Name �i,�. ,_ I . � : 1 �� _ . T-Iomc address -- �,�y Telephones S'( - �•��f' - (��, ys-- PleuyelncluJcArea eQea pome wnrk —��(95�� E-mail address _ �y � � � � � � � C n t- � ----._.... ,� s.� — ��o Planni.qg District Council � b ____ _ City Council Ward�_ Prefcrred mailing address Occupation Place of cmploymcnt se �f Rf�lti Employmcnt address I 3 0 � _ � .y.o v�, ...-- Committce(s) applied for Tn; .., -1� f�.o � I-�-f_ Whst skiIls/training or experience do you possess for the committee(s) for which you seek appointment'? �n✓'inn .,.,.. : _I _ _� n, n � .,, . � . , V � r✓� ( P'r, i„ � ✓e d � �O 1 c � �� S. 11� � .-... , -. � ,� , � � W . � � S' , '`f�e � �0.s � (� / C ��a=L�. ..�J. t-o. j...c�S -�� -�' - � - � � � a 1^ c page 1 of2 ..a,.s,.. �.,;y �� l ��I � � � Apr. 04 2002 01:38PM P3 03-�53 � � (Y <�S N,' � G 0 O mQ �S �`i.✓ ' othrr 1N CO�.� � (�� /1 v .r5``'( other !s_rn-� ssy� Telepnones 6 ( � � 7 � — .d_g a � Please Include Area Codee 'fibms work o�her � rr;n Yu. :o�i Personal References Name ��Id�w �tllS � Address j � b�y �-� S Tclephone �QG/ — � t o 6 Please inelude prea Codca ItO�. Name � c.t G. 1n �n � �b� Address 1 .�.L Telephones .� ( � — �q 6 -- � Please Inelude Area Codea h`1R� Name_�� 7-�-��h'�-v7�L^ Address � � S �-(�Iti, ' C/ p � r`c� 7 "� Rcasons-f�r your interest in this pxrticular committee �{• �`� � � ��. �� . , ` t t( � ,t Gt� It1�V'L�Sf /tn �� ylt� ��c�t7`� �i'4�t�I�. �f'SC1�eC °C C.1C:g I7`'� \ t C 0� �S' ', l CS I' a� NC�i O!'o"�PS„� ,��Y .GSI_°1/'!� lS ��._� 1J �,� w �' �� l( r�Q �'7� �/> /' (1 �P U' � I P( 1� � P C l 1'c.. ( I V 2 6� Have yoa had previous contact with the committee for which you sre making applicationT If so, when, and under what cireumstances? in an atfcmpG to ensure that commictco toprescnlation reflocts the makcup of our cummunity, please check the boz applicable to you. Shis information is strictly volunta�y. � White (Caucasian) � Hispanic �Btack (African-Amcrican) � A+ian vr Pacific Islander � AmeTiean indian or Alaskan Eskimo � Male Pemale � Date of birth 1� "S (� Bisabled: � Yes No � If spccia( accommodations arc nceded, plcase specify }/� �' {�,...Q How did you hear about this opening? �. � S�� y . �� W e✓J '� page 2 of 2 � t� o 0 3g �17 Application for Committee, Board, or Commission Please return to Lucille Johnson p3 �� Citizen Service Office, Room 170 City Hall 15 West Keilogg Blvd., Saint Paul, MN 55102 Phone:651-266-8690 Fax:651-266-8689 The Minnesota Government Data Practices Act (Minnesota Statutes Chapter 13) goveras ihe City's use of the information contained in this application. Some of the information sought in this application is private data uader the Act. The requested information will be used by the appointing authority to carry out the City's oFficial appointment respoasibilities. You are aot required to provide any information. Aowever, failure to answer the applicatioa qu-�+��ns may cause the appointing authority to reject your applicatioa. The majority of items contained in this appl�^�tton are publiq including aame, address, employment, skills, training and experitnce, and are theiefore availabte to anyone requesting it. The xemaining items on the application form are classified as private. The prirate data i•+ available only to you and to other persons in the City who, because of woxk assignments, reasonably require access to the iaformation. Name /`7� r � (.✓ / � Home address `�� w ye%r.c !« l�.� 1t �°a-�j " /`�N J"S//7 stroet city statr zip Telephones � f � _ y� - y �,�, o ��.� ,� y � _� y � PlcaseiucludeAreaCodes home work tex E-mail addiess yy-� _ r wc /� � n rn vi i n t f - Planning District Council City Council Ward Preferredmailingaddress yg� �� NYb,"lJ�CA � � JP./',c,.i M.� ,tT!"!i7 street city stam zip Occupation�� ,�� T�e� oi�i � L.cw Jf Ae f . Place of employment Employmentaddress /�n� r� �� .r,f C�t 1,✓� J�,lt /�-A, tt P,E,,,/ Committee(s) applied for � f �o� 1 - s2� m.�� , l� �,.f Hc k if� .-� c,� , What skills/training or experience do you possess for the committee(s) for which you seek appointment? 1 L.i1 �JLC P � Y' � L�f f � /// / �'�.t o � � i i o �'or t� �..,r ai � � � � _k d � « iin�icf� •! I i ti/ .l d / / l�,c -r i�/ .! . .��.,,.,/r w f-� �f�� v�-� /F /- .r / ✓ // i i , i�.ii � /t i� � f�. -, —� - L,/ f` i page 1 of2 d3-�53 Personal References Name /-�/ y (rr�✓� ea nar �/a✓yu� — Address S�a (o ✓',� J s} z �t e / MN fc"/o y — Telephones � _ � � Pleaseinclude Area Codes home work other Name Address /0.2 3 / A Jf /� i r�✓✓ sr/o3 ___ Telephones � �� - y, _ Pleaseinclnde Area Codes Lome Name wo�k OiLex AdC1iCSS �jJ�� f�. r� r r A �c JV .�c✓c ✓, //c /`�lJV rr ii 3 Telephones � r � _ y� _ Pleaseiuclude Area Codes home work other Reasons £or your interest in this particular committee 1 u.r, ✓c � k.-. to _ a. _ �-i- - k L�.c /¢i -/� _ c- ff nr..�r�✓�.,.�l,,,f . a.'f G✓i// ✓`�ifi/.// c�r,.d Z f1.. �/..f �x...� ti�n�..t 1� �/� /�� jy� ffLC �J_ I� �a�liANYh I'I'�Y //J'I/'✓/�JE/]�i K/ / / / Have you had previous contact with the committee for which you are making application? If so, when, and under what circumstances? In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary. � White (Caucasian) � Hispanic � Black (African-American) � Asian or Pacific Islander � American Indian or Alaskan Eskimo � Male Female � Date of birth py _ o ,j _ �� Disabled: � Yes No � If special accommodations are needed, please specify Aow did you hear about this opening? page 2 of2 03-��'3 CITY OF SAINT PAUL Randy C. KeZly, Mayor To: 390 Cirv Ha[1 IS West Kellogg BouZevard Saint Pau1, MN 55102 Saint Paul City Councilmembers Council President Dan Bostrom Councilmember Jay Benanav Councilmember Jerry Blakey Councilmember Chris Coleman Councilmember Patrick Harris Councilmember Kathy Lantry Councilmember James Reiter From: Kurt Schultz Date: I' � August 13, 2003 Telephone.�651-266-8510 Facsimile: 65I -266-85I3 Joint County/City Health Services Advisory Committee Mayor Kelly has recommended the appointment of Sherri Smith, Kathy Wiiken and Mark Wolf to the Joint City/County Health Services Advisory Committee. Their terms shall each expire on Mazch 1, 2005. Attached is a copy of the resolution nominating these individuals as well as their applications for appointment. Please remember that certain information on the applications is classified as private and should not be released to the public. Feel free to contact me at 266-6590 if you have any question regarding these appointments. Attachments cc. Richard Ragan �