06-15-2011 City Council Seeks Applicants to Serve on the City Minority-Owned and Women-Owned Business Utilization Board

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{,"I",trF mom.. ,y 911V Hp 5 SOUTH BEND CITIZEN APPLICATION FORM FOR CONSIDERATION FOR APPOINTMENT TO THE MBE/WBE UTILIZATION BOARD OF THE CITY OF SOUTH BEND INDIANA On April 11, 2011, the South Bend Common Council passed Ordinance No. 10081-11 [copy attached] which is aimed to maximize participation and opportunities in South Bend by facilitating networking, outreach, communication, education, training, internal accountability and employment opportunities for qualified Minority and Women Business Enterprises (MBE/WBE). This application is voluntarily completed and filed for consideration by the South Bend Common Council to be appointed to the 9-Member City MBE/WBE Utilization Board. I understand that, if appointed that I must: • Be a legal resident of the City of South Bend, Indiana and remain a legal resident throughout the tern of appointment • Serve without compensation and must comply with the State of Indiana's conflict of interest law • Have read and reviewed Ordinance No. 100 81-11 • May be removed at the pleasure of the Common Council • Must carry out the duties and responsibilities of the City MBE/WBE Utilization Board in a fair and equitable manner Last Name First Name Middle Initial Residential Street Address City State Zip Code Yrs of Residency at Address Home Phone Work Phone Cell Phone Email Address Educational Background [High School, College listing any degrees and name of colleges/universities] Employment [Current employer—Position—Description of Duties—Years of Service 1. Position Statement: Briefly described why you are interested in being considered to be appointed to the MBE/WBE Utilization Board.