2024-08-06 Exhibit 2, Item IV. C. • • Exhibit 2
08/06/2024(..(,
.d`� F Ok~h, .�,L.F I '-.C.
MEMORANDUM
TO: Mayor Watford & City Council DATE: July 29. 2024
FROM: City Clerk Gamiotea SUBJECT: Appoint Alternate Member to
Planning Board-Board of Adjustment-
Design Review Board
Mr. James Dean Murray has resigned from the Planning Board-Board of Adjustment-Design
Review Board effective June 24, 2024. We received one new citizen board application from
Ms. Dora Foltz Roberts. Her term will be August 7. 2024, through April 30, 2027, as the City's
second Alternate Member, filling Mr. Murray's vacancy.
Please consider appointing Ms. Roberts as an alternate member.
Thank You!
• •
CITY OF OKEECHOBEE
55 Southeast 3rd Avenue, Okeechobee, Florida 34974 Phone: (863)763-3372
APPLICATION FOR CITY CITIZEN BOARD/COMMITTEE APPOINTMENT
Please print or type all information. The information from this application will be used by the City
Council when considering action on your appointment. The application MUST BE COMPLETED IN
FULL. Answer "None""Not Applicable"or"N/A' where appropriate.
CHECK THE BOARD(S) OF INTEREST TO YOU
A COPY OF EACH BOARD'S DUTIES,MEETING DATES,AND TIMES ARE ATTACHED
Planning Board/Board of Adjustment&Appeals/Design Review Board
=Okeechobee Utility Authority Board of Directors(City Residents Oath
Police Officers'Pension. Firefighters' Pension,or General Employees'Retirement System Board of Trustees
(City Resident Trustee: OR Fifth Member Trustee:
= Other:
APPLICANT'S FULL NAME: Dora Foltz Roberts
NAME COMMONLY USED: Dora
RESIDENCE ADDRESS: =L
HOW LONG AT ADDRESS:
Years: Is this in the City Limits? iYes =No
MAILING ADDRESS: .�'F,i(4E ttLOV.E
TELEPHONE/CELL: F/7- 7525.,3)/
EMAIL: ybpAPC rLT=.2EAV17-1 -//IL',IlE'T
ARE YOU A US CITIZEN? VYes =No,explain:
FLORIDA REGISTERED VOTER? VYes County Registered in: CJICEEL{'r-b.EEE
=No
High Name(,'&I neahornel Year(raduateg
EDUCATION: 9/0)-{ W116 Hi IONE//L 19 7/
ftLk_h_ 7APciI1._ v'GJit.&ti — Carrene_Nameist Cen,ticateiDeareets)Awarded Datetst&Item
POST SECONDARY EDUCATION: LACE LL,JG CO LFFAE A,A S. 1`77/_/`l72
CIt!/L EC16//UkER1/i6 TECNAIOLDa 1 J:9Ameoll. IL .A,A c l'276-i47
Branrhtest ) Dales of Service Discharge Daretst
!st_
MILITARY SERVICE:
CURRENT OR MOST RECENT EMPLOYER: P 55L74/1T�.;/('%VfJ5(_JL/l7i'JG.E/J i//FF
JOB TITLE/DESCRIPTION: j a_lE_ T AlN}/JA E/
WORK ADDRESS: 6.2,i 9 50U7 1 57T�. �I J fJ/ .t1 //4/0/kitlif-04-/_`-1 MM./ 16227
WORK TELEPHONE: 1 7-7 -1
Page 1 of 5 Last Name&First.Initial__k{ZFT P-1r1 0,
• •
ARE YOU CURRENTLY EMPLOYED AS: E General Contractor =Business Person ii Architect
(CHECK ALL THAT APPLY) C Engineer =Sub-Contractor =Realtor
C Attorney =Doctor =Surveyor
^/1 R. RE TIIR:ED C Lay Person 1 Urban Planner =Landscape Architect
Have you ever be, appointed to, or do you currently serve on, a citizen or community board for any other agency or
government? [No Ei Yes*, and list; `if you are currently serving on another Board that the State deems an-office,"your
application cannot be considered. Each Board will have to be reviewed and verified.
AGENCY BOAR()NAME POSITION DATFISI
Are you now, or have you ever been, elected or appointed to any public office? VNo C Yes,and list:
LEVEL OF GOVERNMENT OFFICE TITLE DATE OF ELECTION TERM/SI
Do you work with pr have any association with a current member of the board/committee to which you are requesting
appointment? VNo ❑Yes, and list:
NAME OF BOARD/COMMITTEE MEMBER{St RELATIONSHIP/ASSOCIATION
Are you related to.or employed by, any City of Okeechobee employees or elected officials? Jo ❑Yes, and list:
NA?.SE OF EMPLOYEE/ELECTED OFFICIAL RFLATIONSHIPiASSOCIATION
Have you ever been fund to be in violation of Florida Statutes Chapter 112, Part III, Code of Ethics for Public Officers
and Employees? VNo D Yes,and list:
pArFisl J1ATI IRE OF VIOL ATV-IN
Have you ever been convicted of a FELONY, plead guilty or ng,contest,or entered into an agreement setting forth the
terms leading to the reduction or dismissal of the charges? VNo ❑Yes,and list:
DATF(SI VIOI ATION CITY AM)STATE
Page 2 of 5 Last Name&First Initial f'( E1 /A, [3,
• •
ALL INFORMATION PROVIDED ON THIS FORM IS A PUBLIC RECORD. Information for certain individuals with a
specific public records exemption can be withheld. In order to claim the exemption, complete the following:
Are you a current or former. the spouse of a current or former. or the child of a current or former sworn or civilian law
enforcement personnel, certified firefighter. EMT, paramedic, code enforcement officer,or other covered employee who
is exempt from 9ublic records disclosure under Florida Statute 119.071?Review list of other covered employees before
responding. g No 0 Yes,and list:
JOR TIT OR COVERED)POSIT ION TITLE RELATIONSHIP
Describe any skills, experiences, interests and/or background information about yourself that would be helpful to the
Board you wish to serve on. Include personal accomplishments that qualify you for the appointment.
I/more space,s necdep.please atraca an add,I;ona/page.
e C I ll/L &n(O61AiETEILIG 7 C/f/11LO Y. DE6.
4 Wit k 14:l) 40 YFAI'9 AS A ; r�fFr.T MA4J I)_,8C_)C_Y /6 f,e I
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• NOR K Eat Fr)f Pi F L1I- I9F j'iji/A/1F`la 5 -17/0 .CYIT Z/PRFAI
Fi - AI/DAa yAv
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Q Y �T / Aj ru /.(1 .._iud.711:,DP A_I (1-19,1-3_, /V rtiebt7 67• f /'M ITE ?` R. :ft)/l<()//) E 1�=P�L LMRLF- �V.l L9 /- _ .
,tom
11(/' 14 /�►I DOA/ _�7 //l;A:lth J
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,J E'?Z L T ��/T/ ,�tT.7 1= i �'/� ^,D i)Ei fl/J /i )t ��1�`ii� .
/
-
Fage 3 of 5 Last Name&First Initial R j L } 0
• •
THE FOLLOWING INFORMATION IS USED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL
ORIGIN, AGE, DISABILITY, OR MARITAL STATUS. HOWEVER, THE FEDERAL AND STATE GOVERNMENTS
REQUIRE THE CITY TO PROVIDE STATISTICS ON THE NUMBER OF WOMEN, MINORITIES, VETERANS, AND
DISABLED PERSONS THAT ARE APPOINTED TO BOARDS. INFORMATION WILL BE USED FOR STATISTICAL
PURPOSES ONLY AND HAVE NO BEARING ON YOUR APPOINTMENT:
SEX: =MALE =tFEMALE
ETHNIC GROUP: At4AUCASIAN =BLACK =SPANISH HERITAGE = NATIVE AMERICAN
=ASIAN OR PACIFIC ISLANDER 2 OTHER(specify):
CHECK ALL THAT APPLY: WA TIME PERIOD VETERAN =DISABLED VETERAN =VIETNAM VETERAN
HANDICAPPED STATUSu�� NO 2 YES,AND LIST THE HANDICAP:
STATEMENT OF APPLICANT: I certify that the answers are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application. I hereby release all companies, schools, or persons from all
liability for any damage for issuing this information. I understand that the City may request a copy of my driver's license. I
have the right to request that the City completely and accurately disclose to me the contents of any investigation or reports
upon request to the Office of the City Clerk. I further understand all information provided becomes a matter of public record.
CERTIFICATION: I understand that falsification, omission, misleading statements. or misrepresentation is cause for
rejection of this application. I understand that this application is a Public Record and is subject to the provisions of Florida
Statutes Chapter 119.
FINANCIAL DISCLOSURE REPORTING: I understand that should I be appointed to a City of Okeechobee citizen board I
am required to complete and file a State of Florida Financial Disclosure Form 1 upon my appointment, annually and a
Financial Disclosure Form 1-Final upon my resignation/sunset of term.
PUBLIC RECORDS/OPEN MEETINGS LAWS: I understand and agree that should I be appointed to a citizen
board/committee for the City of Okeechobee, I will comply with all State Statutes, Florida Administrative Code, and State
Constitution regarding public records,records retention,public record requests,and the open public meeting requirements.
I hereby acknowledge that I have read and understand each of the above statements.
Signature of Applicant: ?„,) C/ l 7 Date: 71i0 JD2
J
1.The City Code Book Sec,70-151,70-171,70-19170-211 read: -....membership of the board.'where possible,shall consist of any of
the following: architect, engineer, surveyor, urban planner, landscape architect, general contractor, realtor, business person, and lay
persons.-
2. Other covered jobs include current or former, their spouse. and children: correctional and correctional probation officers;juvenile
probation officers, supervisors, detention superintendents and assistants: Department of Juvenile Justice: detention officers I and Il,
detention office supervisors. residential officers, residential officer supervisors I and II. counselors and supervisors, human services
counselor administrators, senior human services counselor administrators, rehabilitation therapists, and social services counselors:
certain personnel of:the Department of Children and Families;the Department of Health;the Department of Financial Services;and the
Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support
enforcement;investigators or inspectors of the Department of Business and Professional Regulation;the Office of the Inspector General
or internal audit department justices of the Supreme Court;judges of the district court of appeals,circuit court,and county court;general
and special magistrates,judges of compensation claims,administrative law judges of the Divisions of Administrative Hearings,and child
support enforcement hearing officers: state attorneys and assistants, statewide prosecutors and assistants; public defenders and
assistants,criminal conflict and civil regional counsel and assistants;guardians ad litem;human resource,labor relations,or employee
relations directors and assistants.managers or assistant managers of any local government agency or water management district whose
duties include hiring and firing employees, labor contract negotiations, administration,or other personnel-related duties;tax collectors;
certain impaired practitioners and consultants;[see '119.071, Florida Statutes].
Page 4 of 5 Last Name&First Initial _Th .,
FILE
cr f 010 Ce
iehibrfrZ
Katie Rogers
From: Katie Rogers
Sent: Thursday, August 1, 2024 10:54 AM
To: 'dorafoltz@earthlink.net'
Cc: Lane Gamiotea; Caya Ortega
Subject: Planning Board - Board of Adjustment - Design Review Board Appointment, 8/6/2024
Council Agenda
Attachments: 2024 08 06 Exhibit 2.pdf; 2024 08 06 Agenda.pdf
Good morning, Dora.
On behalf of City Clerk Gamiotea, attached is a copy of the 8/6/2024 City Council Agenda and Exhibit.
Your appointment is being considered under the Consent Items. You are not required to attend, but it
is encouraged. If you choose to attend, please note the meeting's time change to 5:00 P.M.
Katie Rogers I Deputy Clerk
CITY CLERK'S OFFICE
CITY OF OKEECHOBEE
55 SE 3RD AVENUE, OKEECHOBEE, FL 34974
PHONE: (863) 763-3372 EXT. 9814
FAX: (863) 763-1686
EMAIL: DEPUPTYCLERK@CITYOFOKEECHOBEE.COM
Under Florida law, email addresses are public records. If you do not want your email address
released in response to a public records request, do not send electronic mail to this entity. Instead,
contact this office by phone or in writing, Florida Statute 668.6076.
CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public
records law. Most written communications to or from local officials regarding city business are public
records available to the public and media upon request. Your correspondence via e-mail, text
message, voice mail, etc., may therefore be subject to public disclosure.