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BOARD OF COUNTY COMMISSIONERS LEON COUNTY, FLORIDA

BOARD OF COUNTY COMMISSIONERS LEON COUNTY, FLORIDA

BOARD OF COUNTY COMMISSIONERS LEON COUNTY, FLORIDA

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In the space below briefly describe or list the following: any previous experience on other Committees; your<br />

educational background; your skills and experience you could contribute to a Committee; any of your professional<br />

licenses and/or designations and indicate how long you have held them and whether they are effective in Leon County;<br />

any charitable or community activities in which you participate; and reasons for your choice of the Committee indicated<br />

on this Application. Please attach your resume, if one is available.<br />

PhD in Higher Education with minor in Urban Planning; Founding Executive Director, LCRDA; FSU Director of Facilities<br />

Planning; Vice President for Administration, Thomas University; Director of Human Resources and Facilities, Elder<br />

Care Services; Professor of Engineering Technology, Polk Community College; Sr. Planner, Governor’s Office of<br />

Planning and Budgeting. President, Capital City Kiwanis Club; Chairman, Big Bend Immunization Coalition; President,<br />

LeMoyne Art Foundation; President, Barbershop Harmony Society; FSU Track & Field Official; Volunteer, Big Bend<br />

Hospice. I believe in the Research Park and want to help it grow.<br />

References (you must provide at least one personal reference who is not a family member):<br />

Name: Margaret Lynn Duggar______________________________ Telephone: 222-0080_____________<br />

Address: ML Duggar & Associates, 1018 Thomasville Road_________________________________________<br />

Name: Don Lanham______________________________________ Telephone: 877-7472______________<br />

Address: 1963 Lawson Road____________________________________________________________________<br />

IMPORTANT LEGAL REQUIREMENTS FOR ADVISORY COMMITTEE MEMBERSHIP<br />

AS A MEMBER <strong>OF</strong> AN ADVISORY COMMITTEE, YOU WILL BE OBLIGATED TO FOLLOW ANY APPLICABLE LAWS<br />

REGARDING GOVERNMENT-IN-THE-SUNSHINE, CODE <strong>OF</strong> ETHICS FOR PUBLIC <strong>OF</strong>FICERS, AND PUBLIC RECORDS<br />

DISCLOSURE. THE CONSEQUENCES <strong>OF</strong> VIOLATING THESE APPLICABLE LAWS INCLUDE CRIMINAL PENALTIES,<br />

CIVIL FINES, AND THE VOIDING <strong>OF</strong> ANY COMMITTEE ACTION AND <strong>OF</strong> ANY SUBSEQUENT ACTION BY THE <strong>BOARD</strong><br />

<strong>OF</strong> <strong>COUNTY</strong> <strong>COMMISSIONERS</strong>. IN ORDER TO BE FAMILIAR WITH THESE LAWS AND TO ASSIST YOU IN ANSWERING<br />

THE FOLLOWING QUESTIONS, YOU MUST COMPLETE THE ORIENTATION PUBLICATION<br />

www.leoncountyfl.gov/bcc/committees/training.asp BEFORE YOUR APPLICATION IS DEEMED COMPLETE.<br />

Have you completed the Orientation? X Yes 9 No<br />

Are you willing to complete a financial disclosure form and/or a background check, if applicable? X Yes 9 No<br />

Will you be receiving any compensation that is expected to influence your vote, action, or participation<br />

on a Committee? 9 Yes X No If yes, from whom? ___________________________________________<br />

Do you anticipate that you would be a stakeholder with regard to your participation on a Committee? 9 Yes X No<br />

Do you know of any circumstances that would result in you having to abstain from voting on a Committee due to voting<br />

conflicts? 9 Yes X No If yes, please explain __________________________________________________<br />

Do you or your employer, or your spouse or child or their employers, do business with Leon County? X Yes 9 No<br />

If yes, please explain _Elder Care Services receives funding from the County ________________________________<br />

Do you have any employment or contractual relationship with Leon County that would create a continuing or frequently<br />

recurring conflict with regard to your participation on a Committee? 9 Yes X No<br />

If yes, please explain _________________________________________________________________________________<br />

All statements and information provided in this application are true to the best of my knowledge.<br />

Signature: _Fred H. Williams_______________________________________________________________<br />

Please return Application<br />

by mail: Christine Coble, Agenda Coordinator by email: coblec@leoncountyfl.gov<br />

Leon County Board of County Commissioners<br />

301 South Monroe Street<br />

Tallahassee, FL 32301<br />

Page 2 of 2<br />

Attachment #16<br />

Page 2 of 4<br />

Page 194 of 282 Posted at 5:00 p.m. on August 31, 2012

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