HomeMy WebLinkAbout03/05/1991, C-3 - AWARD CONTRACT FOR ""MITCHELL PARK WELL IMPROVEMENTS"" TO NICK E. POKRAJAC, INC. IN THE AMOUNT OF $8871.00." 4IIN�I�IIIBIIIIII�f IJII � � - MEEnNG OATS:
°TUI Cl Sdn WIS OBISPO March s 1991
MiGn COUNCIL AGENDA REPORT ITEM NUMBER
:�f�
FROM: (�-�'
William T. Hetland, Utilities Directoxkl-
Gary W. Henderson, Utilities Engineer,::�7•-,;'�'
SUBJECT:
Award Contract for "Mitchell Park Well Improvements" to Nick E.
Pokrajac, Inc. in the Amount of $8,871. 00.
CAO RECOMMENDATION:
Waive the Architectural Review Commission's earlier requirement that
a Master Plan for Mitchell Park be approved prior to consideration of
a "Mitchell Park Well Improvements Project", and authorize the CAO to
proceed with the $8, 871. 00 contract award to Nick E. Pokrajac, Inc.
of Templeton, Calif.
BACKGROUND:
In July of 1988, the City drilled a well at Mitchell Park. The well
production was measured at 50 gallons per minute and until now, the well
has been used for irrigation of the park. Because of .the continuing
drought, staff recommends activating this well for municipal purposes.
The Architectural Review Committee reviewed the original proposed project
approximately a year ago and indicated that they would not approve the
project until a Master Plan for Mitchell Park was prepared. Utilities
staff have requested that the Recreation Director budget for the
preparation of a Master Plan for the park. Due to the continuing
drought, staff requests that Council waive the Commission's requirement
for the Master Plan as a condition of this project.
The original project required permanent facilities to be constructed at
the well site which is located in a high visibility area adjacent to the
flag pole area. The current project would mitigate the visual impacts
by locating the improvements behind the existing Senior Citizens Building
within the fenced in area. The project will involve the construction a
chlorine building similar to the existing buildings located at other City
well sites. The building will be painted to match the existing Senior
Citizens building and will use matching roofing materials. The existing
well head has approximately 7 feet of piping exposed above ground. After
modifications, there will be approximately 3 feet of exposed piping. The
project will also install a driveway and gate for access to the chlorine
building from Buchon Street. Parks and Recreation staff have been
involved in the design of the project and have agreed to the proposed
modifications.
Bids were requested from three local contractors. The low bid was
submitted by Nick E. Pokrajac of Templeton, Calif. in the amount of
$8,871. 00.
;10111ibu►IVllll11 city of San lugs OBISp0
COUNCIL AGENDA REPORT
Page Two
FISCAL IMPACT:
A total of $2, 350, 000 was approved as part of the 1990-91 Budget to
support the Groundwater Development Project, Phase III, (1989-91
Financial Plan & Approved 1990-91 Budget, page H-16) . A total of $58, 480
has been expended to date, leaving a balance of $2, 291, 520 available to
support this amendment.
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Attachment:
Proposal
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CITY OF SAN LUIS OBISPO
San Luis Obispo, California
PROPOSAL
Proposal is to be in a sealed envelope marked:
Proposal: Mirrhell Park rhlnrine Building
Anti Well TmnrnvPmanrs
Due:
Place: OFFICE OF CITY ENGINEER
955 Morro Street, SLO
Date: February 18. 1991
Time• 3:00 P.M.
CONTRACTOR
NICK E. POKRAJAC INC.
P. 0. BOX 539
TEIMPLETON, CA 93465
Date: February 19 . 1991
City Engineer
City of San Luis Obispo
955 Morro Street
San Luis Obispo, CA 93401
THE UNDERSIGNED, Contractor, hereinafter known as Contractor,
hereby proposes to furnish at his own cost and expense all labor
and material, together with the tools and other equipment, (except
N 0 N r
necessary to do and fully complete the following described work for
the City of San Luis Obispo, hereinafter known as City, at
Mitchell Park
in the City of San Luis obispo, County of San Luis Obispo, Calif.
The following is a description of the work: In eeneral. remove existing
concrete and fencing; install new driveway. concrete slab electrical
conduits and chlorine buildine.
NOTE: It shall be the responsibility of the
Contractor to notify each property owner or
tenant, by phone, personal contact or door
hanger (furnished by the City) approximately
one (1) week before moving into the area, where
work is to be conducted.
- 1 -
C3 -3
It is understood that the performance of said work is to be done
in conformity with the standard specifications of the City of San
Luis obispo and any special provisions currently in use by the City
Engineer which becomes a part hereof and also that performance of
said work is to be entirely under the Contractor's supervision,
direction, and control.
It is agreed that an extension of time for the completion of the
work will be granted for a period equal to the period of any delays
caused by any failure of the City on obtaining City furnished
materials necessary for the prosecution of the work. Should the
failure to obtain such materials delay the work for a period
exceeding thirty (30) calendar days and result in a complete
stoppage of the work, the Contractor will be compensated for any
actual increase in cost of labor to him, which, in the opinion of
the City Engineer, is caused by such delay. The Contractor waives
hereby all claims against the City and its officers for any loss
sustained by him on such delays of less than thirty (30) calendar
days.
It is agreed that where two or more contractors are employed on
related or adjacent work, each shall conduct his operations in such
a manner as not to cause any unnecessary delay or hindrance to the
other. Each contractor shall be responsible to the other for all
damage to work, to person, or property, or for loss caused by
failure to finish the work within the time specified for
completion.
If at any time during one year after the date of completion and
acceptance of the work described herein, any part of the material
or workmanship furnished by the Contractor shall prove to be
defective, the Contractor will, upon receipt of the City' s written
notice to that effect, replace or repair defective parts to the
satisfaction of the City without cost to the City.
Any changes and/or alterations in the work required to be performed
by the Contractor hereunder shall be made solely in the manner
provided for in the standard specifications and special provisions
currently in use by the City Engineer, which are incorporated
herein and made a part hereof by reference thereto. The Contractor
shall not be entitled to payment for changes and/or alterations
unless the same are made as hereinabove provided. Any changes
and/or alterations which are made as hereinabove provided shall not
in any way release any surety on any Contractor' s bond furnished
the City hereunder. Where no bond is required by the City,
Contractor, upon written notice from City as a condition precedent
to any payment to be made to Contractor hereunder, shall execute
and deliver to the City or its representative an affidavit stating
that the Contractor has paid in full for all labor, materials,
rented equipment, transportation, and all other charges in
connection with the work being performed under this proposal.
2
Contractor's Insurance: The Contractor shall not commence work
under this contract until he shall have obtained all insurance
required under this Section and such insurance shall have been
approved by the City as to form, amount, carrier, nor shall
Contractor allow any subcontractor to commence work on his
subcontract until similar insurance required of the subcontractor
shall have been so obtained and approved.
(a) Compensation Insurance: The Contractor shall take out and
maintain, during the life of this contract, workman' s
compensation insurance for all his employees employed at the
site of improvement, and in case any work is sublet, Contractor
shall require subcontractor similarly to provide workmen's
compensation insurance for all of the latter's employees are
covered by the protection afforded by Contractor. Contractor
indemnifies City for any damage resulting to it from failure
of either the Contractor or the subcontractor to take out or
maintain such insurance.
(b) Public Liability and Property Damage Insurance: The
Contractor shall take out and maintain during the life of this
Contract, such public liability and property damage insurance
as shall protect the City, its elective and appointive boards,
officers, agents, and employees, Contractor and any subcon-
tractor performing work covered by this Contract from claims
for property damage which may arise from Contractor's or
subcontractor's operations under this contract, whether such
operations be by the Contractor, or by any subcontractor, or
by anyone directly or indirectly employed by either Contractor
or subcontractor, and the minimum amounts of such insurance
shall be as follows:
1. Bodily Injury Liability $500, 000. 00 $1, 0001000. 00
each person each occurrence
Property Damage Liability $250, 000. 00 $500, 000. 00
each person each occurrence
2 . A single limit for Bodily $500, 000. 00 $500, 000. 00
Injury Liability and each occurrence aggregate
Property Damage Combined of
PROOF OF CARRIAGE OF INSURANCE: CONTRACTOR SHALL FURNISH THE CITY
OF SAN LUIS OBISPO, CALIFORNIA CONCURRENTLY WITH THE EXECUTION
HEREOF WITH A CERTIFICATE OF INSURANCE REQUIRED, WHICH SHALL
CONTAIN THE FOLLOWING:
"NAME AS ADDITIONAL INSURED PARTIES: THE CITY OF SAN LUIS
OBISPO, ITS ELECTIVE AND APPOINTIVE BOARD, OFFICERS, AGENTS
AND ANY SUBCONTRACTORS IN THE PERFORMANCE OF WORK FOR THE
CITY OF SAN LUIS OBISPO.
3
e-3-S
THIRTY (30) DAYS PRIOR NOTICE SHALL BE GIVEN TO THE CITY OF SAN
LUIS OBISPO OF ANY REDUCTION IN INSURANCE COVERAGE OR OF
CANCELLATION OF INSURANCE.
Contractor agrees to defend, indemnify, protect and hold City and
its agents, officers and employees harmless from and against any
and all claims asserted or liability established for damages or
injuries to any person or property, including injury to
Contractor's employees, agents or officers which arise from or are
connected with or are caused or claimed to be caused by the acts
or omissions of Contractor, and its agents, officers or employees,
in performing work or services herein, and all expenses of
investigating and defending against same; provided, however, that
Contractor's duty to indemnify and hold harmless shall not include
any claims or liability arising from the established sole
negligence or willful misconduct of the City, its agents, officers
or employees.
Contractor will comply with all safety regulations as set forth in
the Standard Specifications and special provisions currently in use
by the City Engineer.
City reserves the right to audit the records of the Contractor
insofar as they apply to work performed on a cost-plus basis.
Contractor will obtain and pay for licenses and permits which may
be required by City, County, or State.
Reference is hereby made to Section 3 . 24 . 190-B of the San Luis
Obispo City Municipal Code entitled, "Preference given Residents,
defining condition under which contracts for such work shall be
awarded. "
Acceptance of City endorsed hereon shall constitute this binding
contract, and Contractor will commence said work within five
( S ) days after such acceptance hereof and notification to
proceed, and will diligently prosecute the same to the completion
within ten (10 ) days thereafter. In the event of cessation
of labor for three or more consecutive working days or in the event
of Contractor's failure of performance, City may take over the work
and complete it or have the same completed at Contractor' s expense,
deducting the cost thereof from the contract price.
If required by City to do so, Contractor will furnish prior to the
commencement of said work, a contractor' s bond with a surety
company acceptable to the City, guaranteeing and conditioned for
the Contractor's full and faithful performance of said work and
this contract and also guaranteeing and conditioned for the payment
in full of all the claims of all performing labor upon or
furnishing materials to be used in said work, the form of said bond
and the amount thereof to be approved by the City.
4
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Contractor shall not assign or sublet any portion of said work
without written consent of City.
The hourly wage rate shall not be less than the general prevailing
hourly wage rate for each craft or type of workman or mechanic
needed to complete the project.
All work is to be done in a thorough and workmanshiplike manner;
and all labor and materials are to be the best of their kind,
subject to the approval of the City's authorized representative,
and in accordance with the above-mentioned provisions.
The job is to be fully completed, including the removal of all
surplus material and rubbish, all parkways and adjacent excavated
areas shall be backfilled to grade. The backfill material shall
be native material unless otherwise specified. All slope at back
of walk shall be two to one. All lawn area shall be reseeded.
Work at each individual property shall be awarded separately to the
low bidder unless otherwise specified on the bid sheet.
This PROPOSAL does not constitute authority to proceed with the
work; such authority will be by PURCHASE ORDER properly executed
and signed by the purchasing agent for the City. TWENTY-FOUR 24
HOUR NOTICE MUST BE GIVEN TO THE CITY ENGINEER PRIOR TO STARTING
WORK.
Licensed in accordance with an act providing for the registration
of contractors, License No. 496795 Expiration Date 8/31/92 .
The above statement is made under penalty of perjury, and any bid
not containing this information "shall be considered nonresponsive
and shall be rejected" by the City.
Mitchell Park Chlorine Building
and Well Improvements Proposed: February_ 19 19 91
(Description)
NICK E . POKI2AJAACC INC .
$8 , 871.00 �/ � ���^ President
(Charge) (Contr or)
Approved: , 19_ Accepted: , 19_
CITY OF SAN LUIS OBISPO
Bond (_isj (is not) required
By:
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CONTRACT FOR
MITCHELL PARK CHLORINE BUILDING. AND WELL IMPROVEMENTS
1. Remove existing curb, gutter and sidewalk, and install a
27 ' driveway ramp per City Standard #2110.
2. Remove 136 sq. ft. of existing walkway and replace with
total 620 sq. ft. of new concrete. New concrete drive
area. shall be 6" thick with 6" Class III base installed to
City specifications.
3. Remove existing wood fence and install two 121w x5 'h chain
link gates per State Standard F-10. Attach existing
fences to new gate posts. Gates shall be installed to
open away from sidewalks and shall have a standard hasp
with drop pin to keep gate stationary when locked closed.
4. Install a 6 'x6 'x4" concrete slab with 12" wide x 12" deep
footings around the perimeter. Slab and footings shall be
reinforced with #4 bar 24" O.C. Construct a 61x6 ' wood
frame building with T1-11 siding or approved equal. Trim
and style to match existing pump house on Calle Joaquin.
Paint color to match existing Senior Citizen's Center
building. Roofing to match existing Senior Citizen's
Center building. Building shall have one 2 '-6" x 618"
exterior grade door with sweep. Door hardware and lock-
keyed to match existing City system. Install a minimum of
3 lower vents and 2 upper vents in building.
5. Install two 1" conduits from interior of new building to
existing well head. Install two 1" conduits to pump
controls and switch gear. All conduits shall have long
radius bends. All conduits shall have pull ropes. All
trenching operations, conduit and pull boxes shall meet
N.E.C. requirements. All conduits and fittings shall be
Schedule 80.
6. Remove backflow preventer assembly and cap. Remove
irrigation meter and vault assembly. Deliver used pipe,
meter, vault, backflow to City yard at 25 Prado Road.
7. Remove existing 4" pipe above grade. Furnish and install
approximately 7 ' of 4" diameter galvanized pipe and
fittings below grade. Pipe and fittings shall include all
necessary material to connect to existing water meter in
existing vault. Disinfect all new piping and pressure
test to the satisfaction of the City.
1
8. Provide all backfill, site clean-up and restore all turf
and other landscaping to its original condition. Repair
all irrigation lines and wiring to the satisfaction of the
city, if damaged during trenching operations.
All work is to be performed
for the lump sum price of $
Contractor's Signature
Date License No.
rtt/mltchell
2
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Varies
s"
�I'high lip
See note 5
Class 3 aggregate base 6"min.depth unless
otherwise specified. R min.=55, SE min.--25
SECTION
•Cold joint or .'
expansion joint Dowels
i
Weakened
plane joint'.:
PLAN
e'(6"curb) Driveway3'(6°curb)
4'(8"curb) Width 4'(8"curb) Sidewalk
CURB FACE .,'.
Gutter grade
ELEVATION
NOTES
1 -A depression in a new curb and gutter for a driveway will not be permitted unless
the ramp is constructed also.
2-Slope of ramp is a straight grade from the top of the back of sidewalk to the
top of the V lip at the gutter.
3 -Concrete shall be 5-sack,slump:2"min.,4-max.
4-Dowels at expansion, or cold,joint with new construction shall be 1/2"smooth bars,
18" long at 24"o.c. One end shall be sleeved or greased.
5-All driveways shall be reinforced with rebar, #4 CW 24" O.C., both ways.
6 -Commercial & industrial driveways and driveway ramps serving more than six(6) parking spaces
shall be IOft. deep( long) unless otherwise approved by the City Engineer.
7-Gutter construction adjacent to existing A.C.paving shall include sawcutt ing,removal,
and replacement of A.C.paving 18"min. from edgeof gutter, 2"thickerthan existing 5"min.
ADOPTED BY RESOLUTION.No. 1156 (1989)
APPROVED BY THE CITY ENGINEER DATE
/) PARKING $ DRIVEWAY STANDARDS
STANDARD.
REVISIONS BY APP DATE ='' _°- ' DRIVEWAY RAMP
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LAS -!�
MEETING AUENUA A_f
`TE �= ITEM #
��IIIIIIIIIIIIIIIIIIIIIII���� �llllllllllll
sAn cit 0 loBispo
990 Palm Street/Post Office Box 8100 • Sart Luis Obispo, CA 93403.8100
February 25, 1991
MEMORANDUM
TO: City Council
FROM: Mayor Ron Dunin
SUBJECT: APPOINTMENTS TO THE HOUSING AUTHORITY
As required by State law (State of California Health and Safety Code, Sections 34200 et
seq.), the Mayor is required to recommend appointments to the Housing Authority.
After discussion with George Moylan, Executive Director of the Housing Authority, and
review of all current applications on file, I am pleased to recommend the reappointment
of those listed below. Tenant commissioners serve two year terms.
Term to Expire
Jamie Daniel 3/31/93
Alice M. Martin 3/31/93
Elizabeth "Biz" Steinberg 3/31/95
Applications of appointees are attached. All others are available for review in the Council
Office.
As
Attachments
COPLESM:
❑CJ
Action n ❑'
11CDD DIR
I ACRO ❑ FIMEC}EF
WNEY El FW DIR.
CLERK/ORIC. ❑ POpa CH
❑ . TFAMM.❑ DR
s
OINTMENT
APPLIG. ON TO�IITTYPADVI ADVISORY BODY fMENT RECEIVED
LE D4N I E Advisory Body Applied For: A10 1191
NAME OF APPUCANT
CALg& SAIq //
SIDENCE STREET RESS CITY X
5yq - x//33 5`1 1c/3s' 2) Nuwi�ti, o�L lr7 I bMol
DAY PHONE EVENING PHONE (INTERVIEWS ARE REQUIRED FOR EACH CHOICE.)
Registered voter of the city? / 0 NO
How long have you lived in the city? `T Ihv"?Z S
Present Occupation/Employer: clzll. ix 0- 5 LD 5 nci A j S&ALU c p s
Education:
Membership In Organizations:
Please explain why you would like to serve (use reverse side for additional information):
c7- 5 -d &,.,7'�r f �1 6X.0 IY n r/5 vL,i
Previous service on SLO advisory bodies (names/dates):q
PLEASE NOTE: If appointed to the Planning Commission,Architectural Review Commission, or the City Housing Authority,
you are required by State law to file a Statement of Economic Interest disclosing all reportable Interests held by you at the
time of appointment. A copy of this form is available from the City Clerk.
Applications are accepted year-round, however, If you are applying for a current vacancy,your application must be returned '
to the City Clerk by to be considered for the current round of interviews.
OFFICE USE ONLY
SCREENING RECOMMEND FOR
INTERVIEW DATE COMMITTEE APPOINTMENT_YES_NO
SCREENING RECOMMEND FOR
INTERVIEW DATE: COMMITTEE APPOINTMENT:_YES_NO
TERM BEGINS: TERM ENDS: UNEXPIRED TERM: FULL TERM:
JITIONAL COMMENTS:
LTR SENT(Date)
d:advbod.app
APPLIC. .ON FOR ❑APPOINTMENT❑REAPF .TMENT
/ /1n TO A CITY ADVISORY BODY
Advisory Body Applied For:
l I NAME OF APPLICANT
RESID CE STREET ADDRESS CITY LP
DAY PHONEEVENING PHONE (INTERVIEWS ARE REQUIRED FOR EACH CHOICE.)
Registered voter of the city? YES NO
How long have you lived in the city? e_!g�E :�a
Present Occupation/Employer: 1 9VV L r/n Z2-2-
Education: V
Membership in Organizations: A J si >7�1' tS 1/
Please expla n why you would like to serve (use reverse side for additional Information):
Previous service on SLO advisory bodies (names/dates): DEC 1 l�uU
'�CIT yC U CIL
SAWLU S OBISPO, CA
PLEASE NOTE: If appointed to the Planning Commission, Architectural Review Commission, or the City Housing Authority,
you are required by State In.,to file a Statement of Economic Interest disclosing all reportable interests held by you at the
time of appointment. A copy of this form is available from the City Clerk.
Applications are accepted year-round, however, if you are applying for a current vacancy, your application must be returned
to the City Clerk by to be considered for the current round of interviews.
OFFICE USE ONLY
SCREENING RECOMMEND FOR
INTERVIEW DATE COMMITTEE APPOINTMENT_YES_NO
SCREENING RECOMMEND FOR
INTERVIEW DATE: COMMITTEE APPOINTMENT:_YES_NO
TERM BEGINS: TERM ENDS: UNEXPIRED TERM: FULL TERM:
DITIONAL COMMENTS:
LTR SENT(Date)
Madvbod.app
APPL. ,ION FOR ❑APPOINTMENT❑REAF NTMENT
TO A CITY ADVISORY BODY
Fli .ah h "Biz" Steinberg Advisory Body Applied For:
NAME OF APPUCANT
1585 Cordova Drive, San Luis Obispo, CA 93405 1) Housing Authority Commission
RESIDENCE STREET ADDRESS CITY ZIP
544-4355 543-1392 2)
DAY PHONE EVENING PHONE (INTERVIEWS ARE REQUIRED FOR EACH CHOICE.)
Registered voter of the city? XYES NO
How long have you lived in the city? 1 R years
Present Occupation/Employer. Executive Director - Economic Opportunity Commission
Education: B.S. Home Fe-University of Wisconsin. Madison. M.A. Thesis in progress at Pacific Oaks College,
Human Development - Human Services Administration
Membership in Organizations: NAFYC_ Cal Neva. Community Partners in Child Care Commission on Self
Esteem, Delta Kappa Gamma, Homeless Coalition, SSCC, etc.
Please explain why you would like to serve (use reverse side for additional Information):
T would like to continue serve on the Housing Authority Commission I have a great concern for
affordable housing in the City of San Luis Obispo, as a city resident. My job of working with the
economically disadvantaged continues to be more challenging as the economics become more complex and
devastating. The Housing Authority is committed to finding ways of creating more affordable housing -
R
Previous service on SLO advisory bodies (names/dates): ItLUIS
U `�
SAOBI 0.CA
dousing Authority 1987 to Present
PLEASE NOTE: If appointed to the Planning Commission,Architectural Review Commission, or the City Housing Authority,
you are required by State law to file a Statement of Economic Interest disclosing a:l reportable Interests held by you at the
time of appointment A copy of this form Is available from the City Clerk.
Applications are accepted year-round, however, if you are applying for a current vacancy, your application must be returned
to the City Clerk by to be considered for the current round of interviews.
OFFICE USE ONLY
SCREENING RECOMMEND FOR
INTERVIEW DATE COMMITTEE APPOINTMENT_YES_NO
SCREENING RECOMMEND FOR
INTERVIEW DATE: COMMITTEE APPOINTMENT:_YES_NO
TERM BEGINS: TERM ENDS: UNEXPIRED TERM: FULL TERM:
DDmONAL COMMENTS:
LTR SENT(Daze)
d:advbod.app
M EETI�-5-�JAGENDA
TE ffEM #
III�III
cityof sAn WISOBISPO
990 Palm Street/Post Office Box 8100 • San Luis Obispo, CA 93403-8100
February 21, 1991
MEMORANDUM
TO: City Council P
FROM: Councilmembers Pinard and Roalman'�' ��
Subcommittee to the Human Relations Commission
SUBJECT: RECOMMENDATION FOR APPOINTMENT TO THE
HUMAN RELATIONS COMMISSION
During the last round of interviews and appointments (three) in October, 1990, the
Subcommittee (Pinard/Roalman) recommended that should another vacancy occur, Mr.
Dwight Brouillard would be appointed. The Subcommittee was highly impressed with Mr.
Brouillard's qualifications and after reviewing the current file of applications (11), feel that
he is the best candidate. He has become familiar with on-going issues and projects over
the last few months by receiving the HRC agenda and minutes.
The Subcommittee is pleased to recommend the appointment of Mr. Brouillard to serve a
term of four years to expire on March 31, 1995.
Mr. Brouillard's application is attached. All other applications are available in the Council
Office for review.
/ss
Attachment.
C�OI'lES'DO:
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❑ °�"F;a T-T
D5%721 APPOINTMENT
REAPPOINTMENT
APPLICATION FOR APPOINTMENT/REAPPOINTMENT TO A CITY ADVISORY BODY
Advisory Body Applied For:
Na a of Applicant
1 • 4t"wkaM 94 G
Si_O
Residence Street Address & City 2.
( If a second choice is indicated. a
-5+9*—Phone 5 Evening
`h Phone
second interview will be required. )
Day Phone Evening Phone
1 . Are you a registered voter of the city? YES NO
2. How long have you lived in the city? -7 +• y
3. Present occupation and employer: En ine P,- ,,,-at
4. Education: --�YJ"�
..,L, E. l� � � ..o 11 ►9i1,4�. •
5. Membership In organizations: D;r -Ht-
6.
}•grqFA� y�o�d� rJ A� N�,�� ��,• ,
6. Please specify the reasons why ;
you feel you shoe!,+ be oF,pointed to this
adv1scry body (use reverse side for additional information) :
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7. Previous service on any SLO advisory bodies (names and dates) :
N N.9
PLEASE NOTE: If you are appointed to the Planning Commission. Architectural
Review Commission, or the City Housing Authority, you are required by State
law to file a Statement of Economic Interest disclosing all reportable interests
held by you at the time of appointment. A copy of this form is available from
the City Clerk. .
Applications are accepted year round. however, if you are applying for a current
vacancy, your application must be returned to the City Clerk by
in order to be considered for the current round of interviews.
***TO
11 BE FILLED OUT BY CITY CLERK'S �OIFFICE***
Interview Date: �Z3 U Screening Committee P1.1n
***TO BE FILLED OUT BY SCREENING COMMITTEE CHAIR***
Recommend for Appointment: YES Q NO ` 3 10L+f1
Recommendation is for: Q SA
term Full Unexpired term Irrcou IL�
�-,//• D N LUIS UB ' 0, CA
Additional comments: WXL�LlitieruP �39v