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INTERNATIONAL FIRE & BUILDIIVG CODES REVIEW COMMITTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve on an ad hoc committee to review the International Building and Fire Codes and consider recommendations for adoption by the Council. In addition to the general qualifications listed in the certification below, other qualifications may be mandated by statute, City Gharter, ordinance, or resolution. Please complete the information requested below and return by Monday, August 3, 2009, to: City Clerk, 150 First Street SE/P.O. Box 9037, Paris, Texas, 75461. Candidate Information Name: I C Address: Work Phonet" - 2 1 Z~7 Home Phone: Fax: 9`~ ~f'- ~ t c 7 E-mail Address: (i7 i 7~f~i % ~J~~~ Please note any special knowledge, education, or experience you have that is applicable to the function of the committee (attach additional pages if necessary). If applicable, list dates of service on any City boards, commissions, or committees. fi Y'7 ~'?"v! ~ ) V ~ /--'/'~-'/G.'c_-_'/~~:"~' /f~ - ~~~/'""~~i.~~ i /G?~-~`L~'G- ~C ~ ~-~2_ ° ~'C.•~ f-- Personal Background The City Council is interested in appointing members with a general interest in the building and fire codes but also recognizes the need to have members with specialized knowledge. Please check the appropriate box below and for "Other," describe your occupation or other appropriate backg.round description. ❑ Alarm Contractor ❑ Commercial Building Contractor 211ro-wntown Property Owner Certification and Authorization ❑ Historic District Property Owner ❑ Insurance Agent ❑ Other: By signing below, I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the State of Texas regarding negotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness ta the City during my term. I understand that the number of positions on this committee are limited and that I may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify that the information given by me in this application is true and correct and any false information or misrepresentation is sufficient grounds for disqualification. I further affirm that I liave not predetermined a final opinion on the adaption of the International Build~ng Code or Intemational Fire Code and will appraach committee deliberations and recommendations with an open and ¢onstructive mind. /r-authorize the City of Paris to verify all information provided in this application. In accordance with Section 552 of t~e`' Lbcal Government Code, I understand that informatiqn provided in this application may be available to the,~public up qye5't. . ~ Signature of Candidate: Date: . FOT C3XV 3CICTkj5` use olllk / r Canflict of interes#: Y/ N Indebtedness: Y I N Nepotism: Y!'N Dist.: 12 3 4 5 6 7 City of Paris Revised 7/18/09 -0 - v 1. V 7