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Home My WebLink AboutItem 09 Library Advisory Board AppointmentsAGENDA ITEM SUMMARY Meeting Date: 9/21/2015 Meeting Type: Regular Meeting Staff Contact/Dept.: Rob Everett/Library Staff Phone No: 726-3756 Estimated Time: 5 minutes S P R I N G F I E L D C I T Y C O U N C I L Council Goals: Promote and Enhance our Hometown Feel while Focusing on Livability and Environmental Quality ITEM TITLE: LIBRARY ADVISORY BOARD APPOINTMENTS ACTION REQUESTED: Reappoint Barbara Stramler and Robyn Sattler to the Library Board with terms expiring December 31, 2015. Appoint Kristine Fuller to complete the term of the currently open seat on the Library Board with a term expiring December 31, 2016. Appoint Linda Mears and Kim Thompson to the Library Board with terms beginning January 1, 2016 and ending December 31, 2019. ISSUE STATEMENT: The Library Board is seeking to fill one (1) current and four (4) upcoming vacancies as four board position terms expire on December 31, 2015. ATTACHMENTS: Attachment 1 – Library Board Charge Attachment 2 – Library Board Roster Attachment 3 – Candidate Applications DISCUSSION/ FINANCIAL IMPACT: The Springfield Library Advisory Board interviewed four candidates at their September 1st regular meeting in an effort to fill a current vacancy caused by the early resignation of Gary Ross (term expires on December 31, 2016) and to fill upcoming vacancies caused by four December 31,2015 term expirations. Two candidates withdrew before the completion of the interview process. The Board forwarded its recommendations to the Council who, following their own interviews held on September 14th, 2015 determined to make the following appointments: reappoint Board members Barbara Stramler and Robyn Sattler to a second 4-year term (expires 12/31/2019); appoint Kristine Fuller to complete the term of the currently open seat (expires 12/31/2016); and appoint Linda Mears and Kim Thompson to 4 year terms beginning January 1, 2016 and ending December 31, 2019. Library Board CHARGE The Library Board acts in an advisory capacity for the City Manager and City Council with respect to opinions and recommendations for future Library development, expansion of Library service, and Library policy. Source of Existence Council/State of Oregon/Charter Bylaws: Yes Code: Springfield City Code, Chapter I, Article 9 Sunset Date: Council/Mandatory Membership Number: 7 In City: 6 Out of City: 1 – one board member may be a non-resident of the City if an owner of real property or tangible personal property subject to assessment and taxation situated within the city. Term (2 max): 4 Years Ward: No Qualifier: Yes, 6 in City of Springfield Appointed By: Council application Meeting Time Monthly – First Tuesday – 5:30-7:00 p.m. – City Hall Meeting Room 3 (Except December). Funding Source: General Fund Staff Liaison: Rob Everett, Library Director, 726-3756 Council Liaison: Sean VanGordon, Ward 1 ATTACHMENT 1 Springfield Library Board 2015 Dzierzek, Dwight (Chair-elect) ex. 12/31/17 398 N. 38th Pl. Springfield, OR 97478 Ph. 741-0115 (home) Ph. 541-953-2019 (cell) dhdzierzek@gmail.com Fehrs, Peter ex. 12/31/18 4351 Elderberry St. Springfield, OR 97478 Ph. 503-840-4146 peterfehrs@yahoo.com Friend, Janice ex.12/31/15 942 McKenzie Crest Dr. Springfield, OR 97477 Ph. 541-683-7600 friendcaptioning@gmail.com Sattler, Robyn ex.12/31/15 1133 Delrose Dr. Springfield, OR 97477 Ph. 541-744-2787 scottrobyns@comcast.net Stramler, Barbara (Chair) ex.12/31/15 958 McKenzie Crest Dr. Springfield, OR 97477 Ph. 541-687-5758 stramlerb@msn.org Stephens, Victoria ex. 12/31/15 1331 F St. Springfield, OR 97477 (Mail to PO Box 7452, Springfield, OR 97475) Van Gordon, Sean (Council Liaison) 2327 Clear Vue Lane Springfield, OR 97477 Ph. 541-221-8006 seanvangordon@gmail.com ATTACHMENT 2 Application for a City of Springfield Citizen Advisory Board/Commission/Committee City Manager's Office • 225 Fifth Street • Springfield, OR 97477 PLEASE NOTE: • When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget Committee. • When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to another city board, commission or committee. • When possible, the Council will appoint people to serve on one City board, commission or committee only. Board I Commission I Committee applying for: Library Advisory Board (A separate application must be completed for each board I commission I committee) Name: Barbara A. Stramler First Middle Initial Last Home address: 958 McKenzie Crest Dr. Springfield 97477 Street City Zip Mailing address: _S_a_m_e __________________________________ _ Street City Zip Day Phone: 541--687-5758 Evening phone: _5_4_1_-9_5_4_-_9_17_8 __________ _ Email Address: stramlerb@msn.com Preferred Form of Contact:_ Email Do you live within the Springfield city limits? m D Yes No Ward number (City residents only): _________ _ Are you a Springfield property owner? Are you a Springfield business owner? Are you a registered voter? ~Yes Yes Yes §No No No If yes, how long? ____ 9_y_e_a_r_s ___ _ Ifno, do you live inside Springfield's Urban Growth Boundary? D YesONo Occupation: ________________ Place of employment/School: Adult Activity Center Adult Activity Center Business address: ____________________________________ _ Education: 4 ears colle e Are you currently serving on any other board, committee, or commission? If so, please list them here: Applying for re-appointment to Library Board How did you hear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV D Word of mouth I./ I Board/Commission/Committee member For more information please call the City Manager's Office 541.726.3700 D Mail notice D Internet Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 (Over, please) Printed on Recycled Paper Attachment 3, Page 1 of 10 Application for a City of Springfield Citizen Advisory Board/Commission/Committee Please print or type: 1. What experiences I training I qualifications do you have for this particular board I commission I committee? I have 4 years experience working on the Library Advisory Board and am its current chair. 2. What specific contribution do you hope to make? I am the parent of 5 children who all frequent the library. We have taken advantage of many of the services the library offers and I am familiar with most sections of the Springfield Library. This allows me to see how families can best take advantage of what the library has to offer. I want to continue the work the board has begun in establishing a community dialog about the need for improved library services and a new library facility. 3. Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not necessarily disqualify you from consideration.) In past years I have been involved with Camp Fire USA, and Thurston High Band parent club. I have also worked at Page Elementary & Briggs Middle School. 4. What community topics concern you that relate to this board I commission I committee? Why do you want to become a member? One topic that concerns me are the cuts is the cuts in funding to the Springfield School District and cuts to the libraries in the schools. 1 feel the Library can develop programs to work with the schools. Another topic is the increase in the Hispanic population and how the library is meeting their needs. My family and I are regular users of the library and I would enjoy continuing my involvement w/ the board. 5. Most boards I commissions I committees meet monthly. Subcommittees may meet more frequently. Meetings generally last one and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news release for this position which contains the normal dates and times for these meetings and can be found at www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee? (!) YesQ No Comments=~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph. I will defend, indemnify and hold harmless the Oty of Springfield, its officers, employees, and agents from and against all liability or loss and against any and all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield. Applicant Signature: PJ~~)\ALO ~Sb -- For more information please call the City Manager's Office 541.726.3700 Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 2 of 10 ' . Application for a City of Springfield Citizen Advisory Board/Commission/Committee City Manager's Office • 225 Fifth Street• Springfield, OR 97477 PLEASE NOTE: • When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget Committee. • When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to another city board, commission or committee. • When possible, the Council will appoint people to serve on one City board, commission or committee only. ~Commission I Committee applying for: ~~~..rc,,Fte.\..D P~l<"-l-\\1~A-JZ.i 3oA:CU) (A separate application must be completed for each board I commission I committee) Name:~15lJJ First Home address: JI ~.3 l::>.S..1..KoSE-"' Street Mailing address: (.So.""'<.) Street L. Middle Initial City City 5Ao-T IWE. Ft, Last Zip Zip Day Phone: $1-// • 7 '-·l't • Z-7 8/ Evening phone: ----------------- Email Address: S<!J. +r V"bDJ\'\ .S@. CoW\CU.f-: V\~-r Preferred Form of Contact: Do you live within the Springfield city limits? ~s D No Ward number (City residents only):--+-------- Are you a Springfield property owner? Are you a Springfield business owner? Are you a registered voter? If yes, how long? / S--\f V'~ If no, do you live inside Springfield's Urban Growth Boundary? D YesONo Occupation:~ A-f-\\o '-<.. Place of employment/School:. ______________ _ Business address: ___________________________________ _ Education:-B~S~~E~:S:~1..-C~ti-o~_\.._O~G.;-jr------L.M--=i...rJ'-'o"--"tt..-==-----E~U&,___,,lc.L:#J=--='-$5=""-'c___------ Are you currently serving on any other board, committee, or commission? If so, please list them here: b• 'ov-~ 'r>oa..rr.t 1 CJ>At.-1 fM;1-1 nrt-s 5c,fl.oo'-b1~+. How did you liear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV D Mail notice D Word of mouth ~oard/Commission/Committee member 'e~ D Internet (Over, please) For more information please call the City Manager's Office 541.726.3700 Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 3 of 10 3. 4. 5. Application for a City of Springfield Citizen Advisory Board/Commission/Committee Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not necessarily disqualify you from consideration.) , 'I .. L _,_.. '-.."' f lo C~ ':I: ya l lf.M ~ ~ fJ\.,_ ~-c. -h-"4.J a :s; V\ ~I I 0 c..J I~ c-5 d,.;.\l.Y~ v>~ ~vc. ~""'-'~1 ; U. T al.Ao\ "/J.Jo ap.-~ 1k. ~l•-hu eof\l\.~t~ ~ ~ s~l ~ ... s-tn~r vLv~ ~~r re~~ Q,..~~ +c st:M.tro \ b ~. What community topics concern you that relate to this board I commission I committee? Why do you want to become a member? 'I ~4. Uk ~. ~v..ur-k '"tk ~'""6~ lc"t... t1"'--t'k... b ~•fin °i ~ G.\o,.AA-Q ~ ~ ~ ~ ~ ~~ ~2.~"'6·. ~ ~~-<.-V... fk. -t\W\C.. (-' hJi,.q-' J__ W'nl-l~ L:~<.. -to h~ ~ \d ~ Most boards I commissions I committees meet monthly. Subco~~es m~; ::~e fi'equently. Meetings generally last one and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news release for this position which contains the normal dates and times for these meetings and can be found at www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee? ~sQNo Comments: ______________________________________________ _ I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph. I will defend, indemnify and hold harmless the City of Springfield, its officers, employees, and agents from and against all liability or loss and against any and all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield. Applicant Sign~ ~c;:: ~ Date:_~?_-~;?._~_7_-~(_.S __ _ For more information~ Office 541.726.3700 Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 4 of 10 Application for a City of Springfield Citizen Advisory Board/Commission/Committee City Manager's Office • 225 Fifth Street• Springfield, OR 97477 PLEASE NOTE: • When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget Committee. • When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to another city board, commission or committee. • When possible, the Council will appoint people to serve on one City board, commission or committee only. Board I Commission I Committee applying for: Library Board (A separate application must be completed for each board I commission I committee) Name: Kimberly R Thompson First Middle Initial Last Home address: 1550 Walnut Rd Street Springfield OR City 97477 Zip Mailing address: _s_am_e_a_s_a_b_o_v_e _______________________________ _ Street Day Phone: 541-515-3543 Email Address: kthompson73@hotmail.com Preferred Form of Contact: _Email Do you live within the Springfield city limits? 0 Yes D No Ward number (City residents only): 2 Are you a Springfield property owner? Are you a Springfield business owner? Are you a registered voter? §Yes Yes Yes City Zip Evening phone: same as day phone §No No No If yes, how long? ____ 2_0~y_e_ar_s ___ _ Ifno, do you live inside Springfield's Urban Growth Boundary? 0 YesONo Occupation:_E_c_o_n_o_m_1_· s_t ___________ Place of employment/School: State of Oregon, Employment Researcg State of Oregon, Employment Research Division Business address: 1500 Valley River Rd, Suite 150 Eugene OR 97401 Education: Bachelor of Arts from University of Oregon in Spanish and Business Administration. Are you currently serving on any other board, committee, or commission? If so, please list them here: Willalamane Parks Foundation Board, Springfield Chamber of Commerce, and Chi Omega Sorority Corporation ID How did you hear about the above vacancy? D Newspaper ad D Newspaper article D Radio/TV D Word of mouth I./ I Board/Commission/Committee member For more information please call the City Manager's Office 541.726.3700 D Mail notice D Internet Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 (Over, please) Printed on Recycled Paper Attachment 3, Page 5 of 10 Application for a City of Springfield Citizen Advisory Board/Commission/Committee Please print or type: 1. What experiences I training I qualifications do you have for this particular board I commission I committee? I am a long time resident of Springfield Oregon and I've been a frequent library user most of the last twenty years. I care about sustaining this public resource. I've also been working with the Springfield Chamber and Willamalane for the last few years because youth resources are an area of interest for me. Education is a vital part of our economic prosperity in Springfield and library services as a part of early childhood education, which is where that process begins. 2. What specific contribution do you hope to make? I hope to help sustain a viable public library as a energetic and dedicated community member as well as contribute to new resources/library programs. I would like to help guide the future of our city's public resources. 3. Briefly describe your involvement in relevant community groups and activities. (Lack of previous involvement will not necessarily disqualify you from consideration.) I am a member of the Springfield Chamber board as well as on the executive committee for the board. I have been the Secretary for the Willamalane Park Foundation (formerly friends of Willamalane) for the last two years. We help fund-raise for low income youth services. I have been a mentor, advisor, and board member for the Chi Omega sorority in Eugene for the last 10 years. At the chamber, 1 have been involved in the education, Gateway, and economic development committees. 4. What community topics concern you that relate to this board I commission I committee? Why do you want to become a member? Maintenance of current library hours when the city budget is tight. How to keep the library relevant to community needs and the possibility of a new library and the capital campaign needed for this endeavor. 5. Most boards I commissions I committees meet monthly. Subcommittees may meet more frequently. Meetings generally last one and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news release for this position which contains the normal dates and times for these meetings and can be found at www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee? @ YesQ No Comments: ______________________________________________ _ I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading statements or missing information is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV records. I have reviewed the Advisory and meet the minimum requirements to serve/volunteer in the desired position. I also authorize to permit any materials listed above to be copied and retained by the City of Springfield. I authorize the use of my photograph. I will defend, indemnify and hold harmless the City of Springfield, its officers, employees, and agents from and against all liability or loss and against any and all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and expenses; except for losses, claims or actions resulting from the sole negligence of the City of Springfield. • 0 Digitally signed by THOMPSON Kimberly R THOMPSON Kimberly R DN: cn=THOMPSON Kimberly R Applicant Signature: . , bate: 2015.08.24 15:58:20 -oToo· Date: 8/24/15 For more information please call the City Manager's Office 541.726.3700 Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 6 of 10 Application for a City of Springfield Citizen Advisory Board/Commission/Committee City Manager's Office• 225 Fifth Street• Springfield, OR 97477 PLEASE NOTE: • When possible, council will not appoint people currently serving on another governing body to the Planning Commission or Budget Committee.· • When appointing people to any of the other city boards, commissions or committees, the Council shall take into account whether that person is being reappointed for a subsequent term, is currently serving on another governing body or currently appointed to another city board, commission or committee. • When possible, the Council will appoint people to serve on one City board, commission or committee only. Board/Co~ss' n/.CMtt~applyingfor/7 _/ • D .. __ J 1. '.tltt lr~ vwrv'r&Yc ~Pl (A separate application must be complet for each board I c 'ssion I committee) Name:____.U-=::<l...~L....llOL'J~«-J ---~])_. ---+-&/t_.._,1&=-"-a~r-5;.=----- Home address:___,___/ 2-_; 2-_irst_I_6Jrea __ ._f_ddl-e s;M-#--'tia-l ___,~'-P'.·'--"· ~"-"'=~;;..,....L. 1-~-~~o/_?r___.__,fl'----- Street City Zip Mailing address:------------------------------- Street DayPhon0'J() ?2{-S-5'20 City Zip Evening phone: { 9-/() 5 ;2J-3520 I flM(J_ v-.s ~ nwcu. C0>11 Email Address: Preferred Form of Contact: _ ~ '/ or flUM~/,~h. /Z31@yahec>.cfJvJ1 Do you live within the Springfield city limits? rg<s q Ifyes,howlong? /'f'ft;;-/°lt:/'J; 2()/( -~1f;:~ D No Ifno, do you live inside Springfield's 3 Urban Growth Boundary? Wardnumber(Cityresidentsonly):_,,,,t._. "'--------D YesONo ~: L fruegA-er ~ ftllffkr 1v/'I() 1S. ~/; CMll•'-" Are you a Springfield property owner? l=I ~:: Are you a registered voter? ~s Are you a Springfield business owner? Occupation: t'6J'/1/!1Ut1lr;::c/., (hts. Mgr Place of employment/School: ____________ _ Business address:._·------...,----------=-----...,,---------- Eduoati= 'BA/b/1tr.Ji/&:unuj-wduf¥t aeff / fl~Z.; JWS, ~'on ~;/ Are you currently serving on any other boar~ committee, or commissi:'iif so, please list them here: (l/d· CttlYrfflfU./~vwzff' How did you hear about the above vacancy? o·Newspaper ad D Newspaper article D RadioffV D Word of mouth D Board/Commission/Committee member For more information please call the City Manager's Office 541.726.3700 D Mail notice D Internet gt~.ry l>t5p~~ (Over, please) Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 7 of 10 Application for a City of Springfield Citizen Advisory Board/Commission/Committee Please print or type: 1. What experiences I training I qualifications do you have for this particular board I commission I committee? I have served as an information officer in the public and the private sectors for the last 18 years. Formerly, 1 was an educator in both secondary and higher education contexts. I hold a master's degree in the field of applied information management, and 1 have served as a long-term volunteer advocate for Lane County parks and open spaces. I raised three children in Springfield, and relied on the library and public parks for enrichment experiences for my family. And, today 1 am a caregiver for my 90-year old mother who visits the library weekly. 2. What specific contribution do you hope to make? 1 bring long term library patron experience; my household is also bilingual. Further, I am an audience communication expert. As the library considers new locations or new configurations to grow along with the City of Springfield, I would like to help evaluate how all potential library audiences will be served. 3. Briefly describe your involvement in, relevant community groups and activities. (Lack of previous involvement will not In 1991-92, I served as a volunteer communications officer for a citizen group working to pass Lane county's Ballot Measure 20-01, a charter amendment to dedicate 237 acres of the eastern portion of Alton Baker Park, Lane County's largest natural park space, to passive recreational uses. Following the successful bond measure, I served as a member of the East Alton Baker Park Citizens' Planning Committee, 1992-97. More recently, I am an early morning volunteer with Springfield's Egan Warming Centers. 4. What communi~y topics concern you that relate to this board I commission I committee? Why do you want to become a member? I am concerned with protecting and extending library access for all-seniors, children, the un-housed in our community, and established patrons of library services. As communications manager for a regional financial institution, I depend upon a community base of adult literacy and ESOL competency. Our public library extends literacy/ English language proficiency through providing access to literary and cultural enrichment resources. Ramifications of the "digital divide" also concern me- Our library plays a key role in helping all library patrons participate in society's online commons. and one-half hours. It is highly recommended you attend a meeting before submitting the application. Please read the news release for this position which contains the normal dates and times for these meetings and can be found at www.ci.springfield.or.us/CMO/newsrel.htm. Are you available to attend meetings on the dates listed for this committee? • YesQ No Comments:~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I certify the information in this application and attachments are true and complete to the best of my knowledge. I understand that false or misleading statements or missing h:iformation is cause for rejection of application, removal of name from eligible list, or dismissal from the position. I hereby waive my rights to claims or damages against any employer and the City of Springfield, its officers, agents, and employees, in regard to this exchange of information. I hereby authorize to permit the City of Springfield and/or the Springfield Police Department to review my background information and if required my DMV records. I have reviewed the Advisory and meet the minimum requirements to· serve/volunteer in the desired position. I also authorize to permit any materials listed above to be copied apd retained by the City of Springfield. I authorize the use of my photograph. I will defend, indemnify and hold harmless the Oty of•Springfield, its officers, employees, and agents from and against ·all liability or loss and against any and all claims, actions, causes of actions, proceedings or appeals based upon or arising out of or arising from or in connection with my conduct or performance as a volunteer with the City of Springfield including but not limited damage or injury to persons or property and including without limitation attorney fees and expenses; except for losses, claims or actions resulting from the sole negligence of the Oty of Springfield. Applicant Signature: drYJ.kiJ! ·1//U_A/l(:r-Date:_<J:__./2""'--b+--/ 'ZCJ-"--(_6_ I I For more information please call the City Manager's Office 541.726.3700 Return this application to the City Manager's Office, 225 Fifth Street, Springfield Oregon 97477 Printed on Recycled Paper Attachment 3, Page 8 of 10 Attachment 3, Page 9 of 10 Attachment 3, Page 10 of 10