HomeMy WebLinkAboutAgenda Packet 01-09-2014Cape Canaveral Public Library Board
Advanced Agenda
January 9, 2 014
To be held at the Cape Canaveral Public Library Meeting Room
Cape Canaveral, FL 32920
Phone: 321.868.1102
1. Call to Order 2:OOpm
a. Approval of Minutes - November 14, 2013
b. Chairperson's Report
1. Interview of Desmond Wassell - 2:15
2. Interview of Tom Griffin - 2:30
3. Interview of Alden Moe - 2:45
4. Interview of Connie Benz - 3:00
5. Interview of Brad Pervell - 3:15
6. Interview of Lawrence Holmes - 3:30
c. Friends of Cape Canaveral Public Library Report
d. Report of Library Director
e. Public Input
2. Old Business
3. New business
4. Announcements
a. The next Cape Canaveral Public Library Board Meeting will be
held on Thursday, March 13, 2014 at 2:0Opm at the Cape
Canaveral Public Library Meeting room.
b. The next Brevard County Library Advisory Board Meeting will
be held on Wednesday, January 15, 2014 at the Port St. John
Library located at 6500 Carole Avenue, Cocoa, Florida.
"IF A PERSON DECIDES TO APPEAL ANY DECISION MADE BY THE BOARD, AGENCY, OR COMMISSION WITH RESPECT TO ANY
MATTERS AT SUCH MEETING OR HEARING, HE OR SHE WILL NEED A RECORD OF THE PROCEEDINGS, AND THAT FOR SUCH
PURPOSE, HE OR SHE MAY NEED TO ENSURE, THAT A VERBATIM RECORD OF THE PROCEEDINGS IS MADE, WHICH RECORD
INCLUDES THE TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED." (FS 286.0105)
"PERSONS SEEKING TO PRESERVE A VERBATIM TRANSCRIPT OF THE RECORD MUST MAKE THOSE ARRANGEMENTS AT
THEIR OWN EXPENSE."
THE NEEDS OF HEARING OR VISUALLY IMPAIRED PERSONS SHALL BE MET IF THE DEPARTMENT SPONSORING THE
MEETING/HEARING IS CONTACTED AT LEAST FIVE (5) DAYS PRIOR TO THE PUBLIC MEETING/HEARING BY ANY PERSON
WISHING ASSISTANCE."
"THIS MEETING MAY INCLUDE THE ATTENDANCE OF ONE (1) OR MORE MEMBERS OF THE CAPE CAAVERAL CITY COUNCIL
WHO MAY OR MAY NOT PARTICIPATE IN BOARD DISCUSSSIONS HELD AT THIS PUBLIC MEETING."
CITT OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out an appl,ication. City Code,also
prohibits a person from serving on a City Board or Committee if that person has been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided:
A. GENERAL
1. Applicant Name: DESMOND A WASSELL
2. Home Address: 8903 LAGUNA LANE #504
3. Home and Cellular Telephone:321-613-5283(H) 703-780-7818 (C)
4, Occupation: RETIRED
5. Business Telephone: N/A
6. Business Address: N/A
7. E -Mail: DESANN224@MSN.COM
The information provided in this section is for purposes of determining whether you, are eligible to
serve on a City advisory board or committee.
1. Are you duly registered to vote in Brevard County?
(Y)X (N)
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y) X (N)
3a. Are you a Business owner: (Y) (N) X
3b. If yes to 3a, please list the name:
4a. Have you ever been convicted or found guilty, regardless
of adjudication, or a felony in any jurisdiction'? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question, (Y) (N') X
4b, If yes to 4a, have your civil rights been restored? (Y) (N) X
5a, Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) _ (N) X
5b. If yes to 5a, please list each:
Page 1 of 3
6. City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or committee. Do you voluntarily
consent to having a standard background check
performed on you by the City of Cape Canaveral? DW
7a. Are you related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? NO
7b. If yes to 7a, please provide name(s) of person(s) and relationship to you:
C. INTERESTS/EXPERIENCE
Briefly state your interest in serving on a City advisory board or committee:
2. In numerical sequence (1 = most interested), please rank which advisory board or committee
on which you wish to serve:
a.
Board of Adjustment*
b.
Business and Economic Development Board*
C.
Code Enforcement Board*
d.
Community Appearance Board*
e.
Construction Board of Adjustment and Appeals*
f.
Culture and Leisure Services Board
g.
Library Board X
h.
Planning and Zoning Board*
L
Other:
*Members of these boards are required to complete and file with the supervisor of Elections a
Financial Disclosure Form upon appointment to said board and prior to July 9 of each year following
the initial appointment while still a member of said board.
3. Briefly state any prior experiences in serving on any governmental board or committee:
4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.)
that you feel help to qualify you for membership on the desired board or committee.
D. STATE REPORTING REQUIREMENTS
Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes:
Page 2 of 3
RACE
GENDER
African-American
Male X
Asian -American
Female
Hispanic -American
Not Known
Native -American
x Caucasian
DISABILITY
Not Known
Physically disabled
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
Appointment to any City board is subject to City Council approval following a brief interview
before the City Council at a regularly scheduled meeting.
Your application will remain effective for one year from date of completion.
If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature: DESMOND A WOSSEL 11/26/13
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920
For Office Use Only:
Date application received:
Date Appointed:
Appointed by:
Board Appointed to:
Term Expires:
Page 3 of 3
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD; OR COMMITTEE,
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out an application, City Code,also
prohibits a person from serving on a City Board or Committee if that person has been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided:
6, 7
A. GENERAL
1 Applicant Name: TOM GRIFFIN
2.
Home Address: 2011 INTERNATIONAL DR #757
3. 218-393-2728
Home and Cellular Telephone:
4.
Occupation: RETIRED/VOLUNTEER
5.
Business Telephone:
6.
Business Address:
7.
E -Mail: -7)
tgriffin@hotmail.com
B.
ELIGIBILITY
The
information provided in this section is for purposes of determining whether you are eligible to
serve on a City advisory board or committee.
1.
Are you duly registered to vote in Brevard County? (Y)
(N) x
2,
Have you been a resident of the City of Cape
Canaveral for 12 months or longer?cond owner (N) x
3a.
Are you a Business owner: (Y)
(N) x
3b.
If yes to 3a, please list the name.
4a.
Have you ever been convicted or found guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (Y)
(N) x
4b. If yes to 4a, have your civil rights, been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) x
5b. If yes to 5a, please list each:
Page 1 of 3
6. City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent V
to a standard criminal background check before being 'a
appointed to a board or committee. Do you voluntarily TG initials
consent to having a standard background check
performed on you by the City of Cape Canaveral? (Y) X(N)
7a. Are you related to a City of Cape Canaveral Council I /
member by blood, adoption, or marriage? (Y) (N) x
7b. If yes to 7a, please provide name(s) of person(s) and relationship to you:
C. INTERESTS/EXPERIENCE
1. Briefly state your interest in serving on a City advisory board or committee:
HELP KEEP OUR LIBRARY ONE OF THE BEST IN THE COUNTY
2.
L
2. In numerical sequence (1 = most interested), please rank which advisory board or committee
on which you wish to serve:
Board of Adjustment*
Business and Economic Development Board*
Code Enforcement Board*
Community Appearance Board*
Construction Board of Adjustment and Appeals*
Culture and Leisure Services Board
Library Board X
Planning and Zoning Board*
Other:
*Members of these boards are required to complete and rile with the supervisor of Elections a
Financial Disclosure Form upon appointment to said board and prior to July 1 of each year following
the initial appointment while still a member of said board.
3. Briefly state any prior experiences in serving on any governmental board or committee:
NONE
4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.)
that you feel help to qualify you for tmembershipon the desired board or committee. C -r-t--1
VOLUNTEER PAST TWO YEARS AT CC LIBRARY. MASTERS IN HIGHER EDUCATION
D. STATE REPORTING REQUIREMENTS
Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes:
Page 2 of 3
RACE
African-American
Asian -American
Hispanic -American Not Known
Native -American
Caucasian X
DISABILITY
Not Known Physically disabled
GENDER
MALE X
FEMAILE
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE,AND THE CITY OF CAPECANAVERAL HAS A RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326 FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWAS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council' at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
« If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature:TOM GRIFFIN Dater, 16 DEC 13
Please return to: City of Cape CanaveaL,
Office of the City Clerk
106 Polk. Avenue
Cape Canaveral Florida 32920,
For Office Use Only:
Date application received:
Date Appointed:
Appointed by:.
Board Appointed to:
Term Expires:
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out.an application. City Code also
prohibits a person from serving on a City Board or Committee if the persoin has,been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided:
GENERAL
1. Applicant Name:ALDEN J. MOE ADMIN
2. Home Address: 8914 PUERTO DEL RIO DR #201
3. Home and Cellular Telephone: 321-613-5114 OR 610-594-3221
4. Occupation - RETIRED PROFESSOR SEE ATTACHED
5. Business Telephone:
6. Business Address*
7. E -Mail: mOEALDENJ@BELLSOUTH.NET
The information provided in this section is for purposes of determining whether you are eligible to
serve on a City advisory board or committee,
1, Are you duly registered to vote in Brevard County? (Y) X(N)
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y)X (N)
3. Are you a Business owner: (Y) (N) X
3b. If yes to 3a, please list the name:
4a. Have you ever been convicted or found: guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (y) (N) X
4b. If yes to 4a, have your civil rights been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) X
5b. If yes to 5a, please list each:
Page I of 3
6. City ordinance requires that all' persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or COMMittee. Do you voluntarily
consent to having a standard background check
performed on you by the City of Cape Canaveral? AJM
7a. Are You related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? (Y) (N)X
7b. If yes to 7a, please provide name,(s) of person(s) and relationship to you.,
1 Briefly stateYour intrest in serving on a City advisory board or committee:
Board of Adjustment*
I HAVE BEEN A USER OF BOOKS AND LIBRARIES ALL MY LIFE. PLEASE SEE ATTACHED RESUME.
2, In numerical sequence (1 -roost interested), please rank which advisory board or committee
on which you wish to serve:
Business and Economic Development Board'
Code Enforcement Board'
Community Appearance, Board'
Board of Adjustment*
Business and Economic Development Board'
Code Enforcement Board'
Community Appearance, Board'
Construction Board of Adjustment and Appeals*
Culture and LOiSUre Services Board
Library Board
Planning and Zoning Board*
Other:
Members of these boards are required to complete and file with the supervisor of Elections a
Financial Disclosure Form (1f)00 appointment to said board and prior to July I of each year following
the initial appointment while still a member of said board.
1 Briefly state an prior experiences, in serving on any governmental board or committee:
LeHigh valley (Pennsylvania) Business - Education Partnership (1993-1996) See attached.
4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.)
that YOU feel help to quality YOU for membership on the desired board or committee
I hold a PhD in leteracy learning educational psychology and child development. See attached.
D. STATE REPORTING REQUIREMENTS
Section 760,.80, Florida Statutes, requires that the City annually Submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes-.
African-Arnerican
Asian -American
Hispanic-Arnerican
Native -American
Caucasian x
Not Known
GENDER
Male x
Female
NotKnown
DISABILITY
Physically disabled
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE,AND THE CITY OF CAPECANAVERAL HAS A RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326 FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council' at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
« If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature: ALDEN J. MOE
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920,
Fair Office Use Only:
Date application received:
Date Appointed:,
Appointed by: _
Term Expires:
Page 3 of 3
Date: 12-20-13
ALDEN JOHN MOE
Home: 8914 Puerto Del Rio Dr. #201
Cape Canaveral, FL 32920
Home telephone: (321) 613-5114
Cell: (610) 597-3221
PERSONAL DATA
Email: MoeAldenJ(abellsouth.net
Birthdate: April 9, 1939
Birthplace: Crookston, Minnesota
Married to Elayne Ackerman Moe; one daughter, one son, one stepdaughter, & one stepson
EDUCATION
B.S. University of Minnesota, Minneapolis 1963
(Elementary Education/Mathematics)
M.A. Clarke College 1967
(Elementary Education/Reading)
Ph.D. University of Minnesota 1971
(Education/Educ. Psy. & Child Dev.)
PROFESSIONAL EXPERIENCE
Richard James Mertz Chair, Department of Education, Rollins College 2003-2009
Distinguished University Service Professor of Education, Lehigh University 1996-2003
Professor and Dean, College of Education, Lehigh University 1988-1996
Associate Dean for Academic Affairs, College of Education,
Louisiana State University 1985-1988
Professor and Chairman, Department of Curriculum and Instruction,
Louisiana State University 1982-1985
Chairman, Elementary Education, Purdue University 1975-1982
Associate Professor of Education, Purdue University 1975-1982
Assistant Professor of Education, Purdue University 1971-1975
Instructor in Elementary Education, University of Minnesota, Minneapolis 1969-1971
Instructor in Education, Clarke College 1967-1969
Classroom teacher, Minneapolis & St. Anthony Village Public Schools 1963-1966
Alden Moe has been a teacher, professor, dept. chair, and/or dean for over 40 years. He retired from Rollins
College in 2009, but continues to teach one course a year. He recently completed teaching a course in the Rollins
Lifelong Learning Program titled "Children's Literature for Grandparents." He was formerly on the Board of
Directors of the International Reading Association and has served on state and local boards. He is the author,
coauthor, or editor of over 100 publications including ten books. He is also the senior author of the Keystones for
Reading Series, a series of instructional workbooks for grades 1— 6. Reading, writing, teaching, and public
service are a major part of his life.
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out.an application. City Code also
prohibits a person from serving on a City Board or Committee if the persoin has,been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided: A. GENERAL
1. Applicant Name: CONNIE L. BENZ
2. Home Address: 300 COLUMBIA DR #1306 CAPE CANAVERAL
3. Home and Cellular Telephone: 804-229-2274
4. Occupation: Realtor
5. Business Telephone: 321-613-5605
6. Business address: 6200 Altantic Ave #6
7. Email: connie@coralcsrealty.com
The information provided in this section is for purposes of determining whether you are eligible to
serve on a City advisory board or committee,
1, Are you duly registered to vote in Brevard County? (Y) X(N)
2. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y) (N) x i have been living in brevard county for 2 yrs
3. Are you a Business owner: (Y) (N) X
3b. If yes to 3a, please list the name:
4a. Have you ever been convicted or found: guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (y) (N) X
4b. If yes to 4a, have your civil rights been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) X
5b. If yes to 5a, please list each:
Page I of 3
6. City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or committee. Do you voluntarily
consent to having a standard background check
performed on you by the City of Cape Canaveral? cb initials
7a. Are you related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? N
7b. If yes to 7a, please provide name(s) of person(s) and relationship to you:
C. INTERESTS/EXPERIENCE
11 Q f)
itials
(Y) / (N)
Briefly state your interest in serving on. a City advisory Poar,d or committee:
2. In numerical sequence (1 = most interested), please rank
on which you wish to serve:
a. Board of Adjustment*
b. Business and Economic Development Board*
C, Code Enforcement Board*
d. Community Appearance Board*
e. Construction Board of Adjustment and Appeals*
f, Culture and Leisure Services Board 2
g. Library Board 1
h. Planning and Zoning Board*
L Other:
advisory board or committee
*Members of these boards are required to complete and file with the supervisor of Elections a
Financial Disclosure Form upon appointment to said board and prior to July I of each year following
the initial appointment while still a member of said board.
3. Briefly state any prior experiences in serving on any governmental board or committee:
4. Please list any specialized skill's and training (e.g., architect, engineer, general contractor, etc.);
that you feel help to qualify you for membership on the desired board or committee.
D. STATE REPORTING REQUIREMENTS
Section 760.8,0, Florida Statutes, requires that the City annually submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes:
Z. -Mum
RACE African-Arnerican
Asian -American
Hispanic-Arnerican
Native -American
Caucasian x
Not Known
GENDER
Male
Female x
NotKnown
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE,AND THE CITY OF CAPECANAVERAL HAS A RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326 FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council' at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
« If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature: CONNIE BENZ
Date: 1/2/14
Please return to: City -dTCape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920
For Office Use Only:
Date application received':
jAppointed by:
Board Appointed to:
ITerm Expires:
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out an application. City Code also
prohibits a person from serving on a City Board or Committee if that person has been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided;' '
A. GENERAL
1 Applicant Name: BRAD PERVELL
2. Home Address: 510 JACKSON AVE, CAPE CANAVERAL, FL
3. Home and Cellular Telephone: 714-612-0814
4, Occupation: SALES MANAGER FOR SILVER LACE COOKIE CO
5. Business Telephone: 714-612-0814
6. Business Address: 141 FREEMAN AVE, ISLIP NY
7 E -Mail:BRADPERVELL@GMAIL.COM
B. ELIGIBILITY
The information provided in this section is for purposes of determining whether you are eligible to
serve on a City advisory board or committee,
1. Are you duly registered to vote in Brevard County? (y)X (N)
2, Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (y)X (N)
3a. Are you a Business owner.* (Y) (N) X
3b. If yes to 3a, please list the narne:
4a. Have you ever been convicted or found guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (Y) (N) X
4b. If yes to 4a, have your civil rights been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) X
5b. If yes to 5a, please list each:
6, City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or committee. Do you voluntarily
consent to having a standard background check BLP INITIALS
performed on you by the City of Cape Canaveral?
7a. Are you related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? N
7b. If yes to 7a, please provide name(s) of person(s) and relationship to you:
1. Briefly state your interest in serving, on a City advisory -board -or committee.
2, In numerical sequence (I = most interested), please rank which advisory board or committee
on which you wish to serve:
a. Board of Adjustment*
b. Business and Economic Development Board*
C. Code Enforcement Board*
d. Community Appearance Board*
e. Construction Board of Adjustment and Appeals*
f. Culture and Leisure Services Board 2
g. Library Board 1
h, Planning and Zoning Board*
i. Other:
'Members of these boards are required to complete and file with the supervisor of Elections a
Financial Disclosure Form upon appointment to said board and prior to July I of each year following
the initial appointment while still a member of said board.
1 Briefily sate any prior experiences in serving on any governmental board or committee:
N/A
4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc,)
that you feel helpto qualify you for membership on the desired board or committee.
see attached
D. STATE REPORTING; REQUIREMENTS
Section 760,80, Florida Statutes, requires that the City annually submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes:
Page 2 of 3
RACE African-Arnerican
Asian -American
Hispanic-Arnerican
Native -American
Caucasian x
Not Known
GENDER
Male
Female x
NotKnown
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE,AND THE CITY OF CAPECANAVERAL HAS A RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326 FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council' at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
« If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature: BRAD PERVELL
Date.
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920
For Office Use Only:
Date application received:
Date Appointed:
Appointed by:
Board Appointed to:
Term Expires:
Page 3 of 3
C. Interests/Experience
1. I have several reasons why I want to apply for the Library Board
a. Give back to my town of Cape Canaveral
b. The belief that the Library can be/should be the learning and cultural
center of our community
c. To honor my Mom — In Sayreville NJ she was the former President of the
Sayreville Library Advisory Board
i. Her leadership & forethought help the town to build a new Library
& place the building between the only High School & Middle
School in town.
ii. This location was a central location & gave students the
opportunity for additional research after school
d. I also believe that the Library can compete with electronic books by
developing a e -reader concept
4. Specialized skills
a. My skill set is being a National Account Manger selling to major
supermarket chains at the Corporate Level and understanding multi-
million dollar accounts
i. Publix
ii.' B -Lo Holdings {formerly Winn Dixie
iii. Wegmans
iv. Price Chopper
b. My skill is building presentations
i. Noting Features/Benefits
ii. R.O.I
iii. Profitability
iv. And most importantly needs
1. Customer
2. Community
3. Individual
CITY OF CAPE CANAVERAL
APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE
Pursuant to Section 2-171, Cape Canaveral Code
City Code requires prospective and existing board members to fill out an application. City Code also
prohibits a person from serving on a City Board or Committee if that person has been convicted of a
felony, unless their civil rights have been restored.
Please complete the following in the space provided:
A. GENERAL
1. Applicant Name: LAWRENCE HOLMES (LARRY)
2. Home Address: 266 POLK AVE, CAPE CANAVERAL, FL
3. Home and Cellular Telephone: 321-613-3236
4, Occupation: PILOT AIRTRAN AIRWAYS
5, Business Telephone: 1-800-247-8726
6. Business Address: 2702 LOVEFIELD DRIVE, DALLAS, TEXAS 75235
7. E -Mail:LNJSHOLMES@AOL.COM
ELIGIBLITY
The information provided in this section is for purposes of determining whether you are eligible to
serve on a City advisory board or committee.
1. Are you duly registered to vote in Brevard County?
(y) _X _ (N) -
2'. Have you been a resident of the City of Cape
Canaveral for 12 months or longer? (Y)X (N)
3a. Are you a Business owner: (Y) (N)
3b, If yes to 3a, please list the name:
4a. Have you ever been convicted or found guilty, regardless
of adjudication, or a felony in any jurisdiction? Any plea
of nolo contendere (no contest) shall be considered a
conviction for purposes of this question. (Y) - (N) X
4b. If yes to 4a, have your civil rights been restored? (Y) (N)
5a. Do you presently serve on any other City of Cape
Canaveral advisory board or committee? (Y) (N) X
5b. If yes to 5a, please list each:
6. City ordinance requires that all persons applying for a
City advisory board or committee must voluntarily consent
to a standard criminal background check before being
appointed to a board or committee. Do you voluntarily
consent to having a standard background check
performed on you by the City of Cape Canaveral? LD
7a. Are you related to a City of Cape Canaveral Council
member by blood, adoption, or marriage? N
7B. If yes to 7a, please provide name(s) of person(s) and relationship to you:
INTERESTSIEXPERIENCE
Briefly state your interest in serving on a City advisory board or committee:
All my life I have loved books, reading and
libraries. Spend many hours studying and research there.
In numerical sequence (1 = most interested), please rank which advisory board or committee
on which you wish to serve:
Board of Adjustment*
Business and Economic Development Board*
Code Enforcement Board*
Community Appearance Board*
Construction Board of Adjustment and Appeals*
Culture and Leisure Services Board
Library Board x
Planning and Zoning Board*
Other:
*Members of these boards are required to complete and file with the supervisor of Elections a
Financial Disclosure Form upon appointment to said board and prior to July 1 of each year following
the initial appointment while still a member of said board.
3. Briefly state any prior experiences in,serving on any governmental board or committee:
Commanding officer of fleet air recon squadron 2
One of the largest squadrons in the navey
4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.)
you feel help to qualify you for membership on the desired board or committee.
Masters in managment Troy State Un, masters strategic studies from naval war college
D. STATE REPORTING REQUIREMENTS
Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of
State disclosing race, gender, and physical disabilities of board and committee members. Please
check the appropriate boxes:
Page 2 of 3
RACE African-Arnerican
Asian -American
Hispanic-Arnerican x
Native -American
Caucasian
Not Known
GENDER
Male x
Female
NotKnown
YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF
PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE
BEST OF YOUR KNOWLEDGE,AND THE CITY OF CAPECANAVERAL HAS A RIGHT TO
RELY ON THAT INFORMATION.
YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC
OFFICERS [SECTIONS 112.311-326 FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE
LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE
APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR
SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS.
PLEASE NOTE:
• Appointment to any City board is subject to City Council approval following a brief interview
before the City Council' at a regularly scheduled meeting.
• Your application will remain effective for one year from date of completion.
« If you should have any questions regarding the completion of this application, please contact
the City Clerk's Office at (321) 868-1220 ext. 221.
Signature: Lawrence Holmes Date: 12-11-13
Please return to: City of Cape Canaveral
Office of the City Clerk
105 Polk Avenue
Cape Canaveral Florida 32920
For Office Use Only:
Date application received:
Date Appointed:
Term Expires:
Page 3 of 3