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INTERNATIONAL FIRE & BUILDING CODES REVIEW COM1VIlTTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to setve 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 Charter, 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: ~ / Address: ~s 0 Work Phone: Home Phone: l~~' ~J~ '"cY✓~~ Fax: 43- ( J / ' qe7A~ E-mail Address: , 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. ~~~*/ft 6nvl~~4 Personal Background The City Council is interested in appointing membets 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 backbround description. ❑ Alarm Contractor ❑ Commercial Building Contractar ❑ Downtown Aroperty 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 Gharter and the laws of the State of Texas regarding nepotism and conflicts af 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 to 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 1 am not appointed, I agree to be placed in a database for possib(e future notitication 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 disgualification. 1 further affirm that I have not predetermined a final opinion on the adoption of the International Building Code or International Fire Code and will approach committee deliberations and recommendations with an open and constructive mind. I authorize the City of Paris to verify ail information provided in this application. In accordance w' ectio 52 of the Local Government Code, I understand that information provided in this application may be availabl o e ba' n request. Signature of Candidate: / Date: (TIIOZ~J_~ Conflict of Interest: Y/ N 1n0ebtedness: Y/ N Nepotism: Y/ N Dist.: 1 2 3 4 5 6 7 City of Paris Revised 7/18/09 - _ -254