HomeMy WebLinkAboutMINUTES - 12032013 - C.44RECOMMENDATION(S):
Re-appoint the following individuals to the Advisory Council on Aging with terms expiring on September 30, 2015
as recommended by the Family and Human Services Committee: At-Large Seat #11 - Edward Schroth; At-Large Seat
#15 - Mary Bruns; At-Large Seat #16 - Robert Leasure; At-Large Seat #19 - Laurie Ulrick; At-Large Seat #20 - Susan
Frederick.
FISCAL IMPACT:
None
BACKGROUND:
The Advisory Council on Aging advises the Board of Supervisors (acting as the Area Agency on Aging) and the
Aging and Adult Services Bureau of the Employment and Human Services Department on all matters related to the
development, operation, and administration of the annual Area Agency Plan. The Council provides a means for
Countywide planning, cooperation and coordination for individuals and groups interested in improving and
developing services and opportunities for the County's older residents.
On October 7, 2013, the Family and Human Services Committee reviewed the recommendation for re-appointments
to the Advisory Council on Aging and supported five of the recommendations for appointments by the Board of
Supervisors. The Committee asked the Department to recruit other candidates for the At-Large Seat #9 and return to
the Committee with a new recommendation.
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 12/03/2013 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Dorothy Sansoe,
925-335-1009
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: December 3, 2013
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
C. 44
To:Board of Supervisors
From:FAMILY & HUMAN SERVICES COMMITTEE
Date:December 3, 2013
Contra
Costa
County
Subject:Appointments to the Advisory Council on Aging
CONSEQUENCE OF NEGATIVE ACTION:
The seats will not be filled and the Council may not be able to perform their duties.
CHILDREN'S IMPACT STATEMENT:
Not applicable.
ATTACHMENTS
Recommendation Memo
Seat #11 Application
Seat #15 Application
Seat #16 Application
Seat #19 Application
Seat #20 Application
Kathy Gallagher, Director
40 Douglas Dr., Martinez, CA 94553 Phone: (925) 313-1579 Fax: (925) 313-1575 www.cccounty.us/ehsd.
MEMORANDUM
DATE: 09/16/2013
TO: Family and Human Services Committee
CC: John Cottrell, Director Aging and Adult Services
Lori Larks, Division Manager, Area Agency on Aging
FROM: Jaime Ray, Secretary for the Area Agency on Aging / Staff to the ACOA
SUBJECT: Advisory Council on Aging – Appointment Requested
The Contra Costa Area Agency on Aging (AAA) recommends the following individuals for
reappointment to At-Large seats on the Contra Costa Advisory Council on Aging (ACOA) with terms
expiring on September 30, 2015:
At-Large Seat #9 Lori Hefner
At-Large Seat #11 Edward Schroth
At-Large Seat #15 Mary Bruns
At-Large Seat #16 Robert Leasure
At-Large Seat #19 Laurie Ulrick
At-Large Seat #20 Susan Frederick
Recruitment is handled by both the Area Agency on Aging, the ACOA and the Clerk of the Board
using CCTV. Members of the AAA staff have encouraged interested individuals including minorities
to apply through announcements provided at the East, Central and West County Senior Coalition
meetings and at the regular monthly meetings of the ACOA. The Contra Costa County EHSD
website contains dedicated web content where interested members of the public are encouraged to
apply and are provided an application with instructions on whom to contact for ACOA related
inquiries, including application procedure.
All MAL applicants for reappointment were interviewed by members of the ACOA Membership
Committee. The Membership Committee and the Council’s President Dr. Robert Leasure
recommend the reappointment of all MAL applicants listed above; please find copies of applications
received for membership reappointment provided as separate attachments.
Thank You
Print Form
Contra
Costa
County
For Office Use Only For Reviewers Use Only:
Date Received: Accepted Rejected
BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION
MAIL OR DELIVER TO:
CaTa Coota CArty
a.ERK a:ll-E ElC\AAD
651 P'ne Street, Rm. 100
IVati1ez, Caibria 94553-1292
PLEASE lYPE OR PRINT IN IN<
(Each Position ~ires a SeparaIe AppicaIion)
BOARD, COMMITTEE OR COMMISSION NAME AND SEAT TITLE YOU ARE APPLYING FOR:
Itt>VfSOL'( Co VWC,'t.... ~N ~'-IN(;" /'filL-It,
PRINT EXACT NAME OF BOARD, COMMITTEE, OR COMMISSION PRINT EXACT SEAT NAME (if applicable)
1. Name: '-IE"II .s " L.6 /{~d£/l.r ~/L.,-eN
(Last Name) (First Name) (Middle Name)
2. Address: ~l.._G.lf,.:.....:....../!.....-...:f_f.!.....-r_:a.---=(.Il....(./_
(No.) (Street) (Apt.) (State)
_____
(Zip Code)
-
(Work No.) (Cell No.)
4. Email Address: e. +
(Home No.)
5. EDUCATION: Check appropriate box if you possess one of the following:
High School Diploma III G.E.D. Certificate D Califomia High School Proficiency Certificate D
Give Highest Grade or Educational Level Achieved 1) Oc..TDIl.. D t:' H (£ t> I C I " ~
Names of colleges I universities
attended Course of Study I Major
~ Degree
Awarded Units Completed Degree
Type
Date
Degree
Awarded
I
Semester Quarter
A) ulll'l. 11..,1.1 N"tll:!I PA,-f1IZI> Yes No . .. 1#
B) "I//~. 1'-'-11101 S H6J) 11:.1 ~IE Yes No :A I'f.]). If",,;z
C) Yes No
D) Other schools I training
completed: ~AJ/~. I '-1.1 liD I ~
Course Studied Hours Completed
Me f). 1L..s 1'bS/Ia"
Certificate Awarded :
,,~ Ye!~wa4-.·0~
THIS FORM IS A PUBLIC DOCUMENT
6. PLEASE FILL OUT THE FOLLOWING SECTION COMPLETELY. List experience that relates to the qualifications needed to
serve on the local appointive body. Begin with your most recent experience. A resume or other supporting documentation
may be attached but it may not be used as a substitute for completing this section.
A) Dates (Month, Day, Year) Duties Performed
From To 1t\G.llA-kr, ~~I-+4. G,~~o(l3 -""Se-.l' .' Ho u ~", "j G""'-1 P
Employer's Name and Address
Total: Yrs. Mos . ,. £ y.er. Co~lK .A <Iv ISDrr ec,kA~\ ( 0 f\
10 7~s.
• t (;.("ip "-pL e.5, S fA.+: II L,4:,', nj
Hrs. per week __. Volunteer IiJ
v~v~'-~/e..
8) Dates (Month, Day, Year) Title Duties Performed
From To pll"il c-1-i C«" of w.~A."d~ If"~ /11r
d..hv..( tr-.( s-f,,~+; ~" ;Employer's Name and Address
Total : Yrs. Mos . M ",-17 " f> {t!. -L cf-e
~c.L..3,°r vs . rYl~tA...IL (H J..,t c..: ~ '
,4-c.. 5 0 G.I to--/-l!. s
Hrs. per week (p D . Volunteer t:I 6 ~IOI e., cA4"5 .
C) Dates (Month, Day, Year) Duties Performed
From To ~vi $0'(11~O -(ffY-~
Employer's Name and Address
Total : Yrs . Mos . C £. C4,I.. b i'" ~ "" c.~+er
I y. 'f"~ .
(Hul) ~~)
~ "---J~$e
Hrs. per week __. Volunteer ~
tAVj. f_)..i...V''5/w i=.
Duties Performed
From To
TitleD) Dates (Month, Day, Year)
I(.d _i" j ~f~~~~j ~~ 0 f f1~c,J sJ.-161'11'\ -, 't 21 ~e. £ ~ cJ shit
Employer's Name and Address
Total: Yrs. Mos . C::ro 0 d S ~M""" : ~+bs p
~ ~~ ro~, cA
Hrs. per week~. Volunteer IJ
THIS FORM IS A PUBLIC DOCUMENT
7. How did you learn about this vacancy?
Dccc Homepage DWalk-ln !gJNewspaper Advertisement DDistrict Supervisor DOther __________
8. Do you have a Familial or Financial Relationship with a member of the Board of Supervisors? (Please see Board
Resolution no. 2011/55, attached): No ~Yes~ rJ o!
If Yes, please identify the nature of the relationship: ___________________
I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and
belief, and are made in good faith. I acknowledge and understand that all information in this application is publically
accessible. I understand and agree that misstatements 1 omissions of material fact may cause forfeiture of my rights to serve
on a Board, Committee, or Commission in Contra Costa County.
Sign Name ~J Date .4+.,.1. .3. ~0 13
Important Infonnation
1. This ~K::ation is a pubic 00ct.ment and is Stbject to the Califoolia PublK; Recads Pd. (CA GrN. Code §6250-6270).
2. Send the canpleted paper applCcfun to the 0fIi:e ci the C81< cithe 80crd at 651 Pine Street, Room 106, Martinez, CA 94553.
3. A resume or cther relevant infoonciDn may be SliJrnitted with this a~IK:cibn.
4. All members are requied to take the foIbMng Iraini1g: 1) The 8rcNJn Pd., 2) The Better Government Ordinarce, and 3) Ethics Trailing.
5. Members d bocrds, coornissions, and coorn~may be requied to: 1) file a Staemeri ci ECOI'lOOlc Interest Form also I<rloMl as a Form
700, and 2) ccmpIete the Stcie Ethics T rainilg Course as requied by AS 1234.
6. AdVtscry body meetings may be held in various locations and sane bcations may not be accessble by pubic transpof1aion.
7. Meeting dates and tines ae subject to change and may occur up to two days per month.
8. Some boards, COO1Il1ittees, or coovnissions may assign merrbers to sul:xxJTvntiees or 'MJrk grou~which may require ~ac:Idronal
canmimert d tine.
THIS FORM IS A PUBLIC DOCUMENT
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA and for
Special Districts, Agencies and Authorities Governed by the Board Adopted Resolution
no. 2011/55 on 2/08/2011 as follows:
IN TIIE MA ITER OF ADOPTING A POLICY MAKING F AMIL Y MEMBERS OF THE BOARD OF SUPERVISORS INELIGIBLE
FOR APPOINTMENT TO BOARDS, COMMIITEES OR COMMISSIONS FOR WHICH THE BOARD OF SUPERVISORS IS THE
APPOINTING AUTHORITY
WHEREAS the Board of Supervisors wishes to avoid the reality or appearance of improper influence or favoritism;
NOW, TIIEREFORE, BE IT RESOL YEO THAT the following policy is hereby adopted:
I. SCOPE: This policy applies to appointments to any seats on boards, committees or commissions for which the Contra Costa County
Board of Supervisors is the appointing authority.
II . POLICY: A person will not be eligible for appointment if he /she is related to a Board of Supervisors' Member in any of the following
relationships:
1. Mother, father, son , and daughter;
2. Brother, sister, grandmother, grandfather, grandson, and granddaughter;
3. Great-grandfather, great-grandmother, aunt, uncle, nephew, niece, great-grandson, and great-granddaughter;
4. First cousin;
5. Husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepson, and stepdaughter;
6. Sister-in-law (brother' s spouse or spouse's sister), brother-in-law (sister's spouse or spouse's brother), spouse's grandmother,
spouse's grandfather, spouse's granddaughter, and spouse's grandson;
7. Registered domestic partner, pursuant to CaJifornia Family Code section 297.
8. The relatives, as defined in 5 and 6 above, for a registered domestic partner.
9. Any person with whom a Board Member shares a financial interest as defined in the PoliticaJ Reform Act (Gov't Code §87103,
Financial Interest), such as a business partner or business associate.
THIS FORM IS A PUBLIC DOCUMENT
08/0 8/2 0 13 135PM TEL 8 2 5 378 37 2 1 Ulric k & AS SOcl a te s ~0 00 2/ 0 004
For Reviewers Use Only:
Accepted Rejected
For Office Use Only
Date Received :
BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION
Contra
Costa
County
5. EDUCATION: c~ppropriate box if you possess one of the following:
High School Diploma ~.E.D . Certificate 0 California High School Proficiency Certificate D
Give Highest Grade or Educational Level Achieved,_-'-U.........=.k...Jo..._-l.:::.-X_2.--,)I--___________
THIS FORM ISA PUBLIC DOCUMENT
08/08/2013 135PM TEL 825 318 3121 Ulrick & Associates @0003/00 04
6. PLEASE FILL OUT THE FOLLOWING SECTION COMPLETELY. LIst experience that relates to the qualifications need lid to
serve on the local appointive body. Begin with your most recent experlonce. A resume or other supporting documentation
may be attached but it may not be used as 8 substitute for completing this section.
B) ates (Month, Day, Year)
From To
Jtb~rT
. Tota~ Moo
Hr•. per weekJjkvo,unte~r r'l
O('C il-' ~ drr
C) Dates (Month, Day, Year)
Fro~1° ~
Total : Yrs. ~
D) Dates (Month, Day, Year)
From To
Total: Yrs .
Hrs. per wee~unteer [l
THIS FORM IS A PUBLIC DOCUMENT
OB/06/2013 135PM TEL B25 378 3721 Ulrick & Associates @0004/0004
7. How did you learn about this vacancy? l\ / II
OCCC Homopage DWalk-ln DNewspaper Advertisement D District SUP8rviso~h9r;=:-tlb~~~'--_-'-__
a. 00 you have a Familial or Financial Re~shlP wIth a member of the Board of Supervisors? (Please 888 Board
Re!polutlon no. 2011/55, attached): No -r Yes~
If Yes, please identify the naturQ of the relationship: ___________________
Important Information
1. This appfication is a public docUment and is suqed to the California Public Records Ad. (CA Gov. Code §6250-6270).
2. Serdtheaxnpjeted peperapprlCation toth9 Office of the Clerk of the Board at 651 PineSIreet, Room 106, Martinez, CA94553.
3. A resume CX' othef relevant infom1a~on may be submittEd with this application.
4. All members are required to take the following training: 1) The I3roIMl Ad, 2) The Better Government Ordinance, and 3) Bhlcs Training.
5. Members of ooarcls, axnmissions, and committees may be required to: 1) file a Statement of Economic Interest Form also kn()M1 as a Foon
700, and 2) complete the State Ethics Training Course as required by AB 1234.
6. Adliiscry body meeti~may be held in various locations and some locations may not be acoessible by public transJXll1afion.
7. Meeting dates ard times are subje:t to change and may occur up to two days pa" month.
8. &rna boards. committees, Of commissions may assign members to subcommittees or V'.Orl< groups vkiich may require an additional
commitment of lime.
THIS FORM IS A PUBLIC DOCUMENT
09/0 8/ 20 13 1 .35PM TEL 825 378 3721 Ulrick & Associates
19j 000 1/0004
Facsimile cover Sheet
TO:
Fax #
From:
Date:
Re:
NO OF
NO OF PAGES: 4
Jaime Ray, Secretary, AAA
925 602-4178
Laurie ulrick, MA
consulting Gerontologist
Narrative Time
Via 925 376-2771
September 6, 2013
Required Renewal Application Re:
MAL #19, Advisory Council on Aging
PAGE: 4
Jaime,
Here is the completed, signed application regarding
renewal of my seat with the ACOA.
Thank you.
\
-"--
. ..,---.····ILuvul_....
Print Form
For Office Use Only
Date Received:
Contra
Costa
County
For Reviewers Use Only:
Accepted Rejected
BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION
MAIL OR DELIVER TO:
Contra Costa County
CLERK a=THE BOARD
651 Pine Street,Rm.100
Martinez, California 94553-1292
PLEASE TYPE OR PRINT IN INK
(Each Position Requires a Separate Application)
BOARD, COMMIITEE OR COMMISSION NAME AND SEAT TITLEYOU ARE APPLYING FOR:
Area Council on Aging Member at Large
PRINT EXACT NAME OF BOARD, COMMIITEE, OR COMMISSION PRINT EXACT SEAT NAME (if applicable)
1.Name:Frederick-----------------------------------------------------------------------------(Last Name)
Susan
(First Name)
Jane
(Middle Name)
2.Address:
(No.)(Street)
3.Phones:
5. EDUCATION: Check appropriate box if you possess one of the following:
High School Diploma ~ G.E.D.Certificate D California High School Proficiency Certificate Ll
Give Highest Grade or Educational Level Achieved Masters in Health Services Administration
Date
Degree
Awarded
Names of colleges / universities
attended
Degree
Awarded Units Completed Degree
TypeCourse of Study / Major
Semester Quarter
A) Contra Costa Community College Nursing Yes No x AA 1976
B) New York State University Yes No x BSN 1985Nursing
C) St Marys College Calif.Yes No x DNursing MSHSA 1988
Certificate Awarded:
Yes No [j[J
Course Studied Hours CompletedD) Other schools / training
completed:
THIS FORM IS A PUBLIC DOCUMENT
6.PLEASE FILL OUT THE FOLLOWING SECTION COMPLETELY.List experience that relates to the qualifications needed to
serve on the local appointive body.Begin with your most recent experience.A resume or other supporting documentation
may be attached but it may not be used as a substitute for completing this section.
A)Dates (Month,Day,Year)
From To
1991 May 2001
Total:Yrs.Mos.
10
Hrs.per week40+.Volunteer D
B)Dates (Month,Day,Year)
From To
1976 1991
Total:Yrs.Mos.
15
Hrs.per week40+.Volunteer Ll
C)Dates (Month,Day,Year)
From To
Total:Yrs.Mos.
Hrs.per week __.Volunteer D
D)Dates (Month,Day,Year)
From To
Total:Yrs.Mos.
Hrs.per week __.Volunteer 0
Title
Duties Performed
Duties Performed
Managed Critical Care Unit
Intermediate Care Unit
I------------------i (for several years)Surgical UnitEmgloyer's Name and AddressContraCostaRegionalMedicalCenter
2500 Alhambra Ave.
Martinez Ca
Nurse Program Manager
Duties Performed
Nursing Care
Evening Nurse Supervisor
I----=:---:--:--:-:------:-c:--.,...-----l Head Nurse Medical unit
Employer's Name and Address Head Nurse Surgical unit
Veterans Administration Hospita Head Nurse Intensive Care unit
Muir Road
Martinez,Ca
Title
Registered Nurse
Title Duties Performed
Employer's Name and Address
Title
Employer's Name and Address
THIS FORM IS A PUBLIC DOCUMENT
7.How did you learn about this vacancy?
[JCCC Homepagel:lWalk-ln I:INewspaper Advertisement DDistrict Supervisor DOther Internet Pinole Patch
8.Do you have a Familial or Financial Relationship with a member of the Board of Supervisors?(Please see Board
Resolution no.2011/55,attached):No ~Yes~
If Yes,please identify the nature of the relationship:_
I CERTIFY that the statements made by me in this application are true,complete,and correct to the best of my knowledge and
belief,and are made in good faith.I acknowledge and understand that all information in this application is publically
accessible.I understand and agree that misstatements 1 omissions of material fact may cause forfeiture of my rights to serve
on a Board,Committee,or Commission in Contra Costa County.
SlgnName~~J 'Date:9-\~-\3
Important Information
1.This application is a public document and is suqect to the California Public Records Pet (CA GeN.Code §6250-6270).
2.Send the completed paper application to the Office of the Clerk of the Board at 651 Pine Street,Room 106,Martinez,CA 94553.
3.A resune or other relevant information may be submitted with this application.
4.All members are required to take the following training:1)The Brown Pet,2)The Better Govemment Ordinance,and 3)Ethics Training.
5.Members of boards,commissions,and committees may be required to:1)file a Statement of Economic Interest Form also known as a Form
700,and 2)complete the State Ethics Training Course as required by AS 1234.
6.Advisory body meetings may be hek::lin various locations and some locations may not be accessible by public transportation.
7.Meeting dates and times are subject to change and may occur up to two days per month.
8.Some boards,committees,or commissbns may assign members to subcommittees or 'NOfkgroups which may require an additional
commitment of time.
THIS FORM IS A PUBLIC DOCUMENT
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY,CALIFORNIA and for
Special Districts,Agencies and Authorities Governed by the Board Adopted Resolution
no.2011155 on 2/08/2011 as follows:
IN THE MATTER OF ADOPTING A POLICY MAKING FAMILY MEMBERS OF THE BOARD OF SUPERVISORS INELIGIBLE
FOR APPOINTMENT TO BOARDS,COMMITTEES OR COMMISSIONS FOR WHICH THE BOARD OF SUPERVISORS IS THE
APPOINTING AUTHORITY
WHEREAS the Board of Supervisors wishes to avoid the reality or appearance of improper influence or favoritism;
NOW,THEREFORE,BE IT RESOLVED THAT the following policy is hereby adopted:
I.SCOPE:This policy applies to appointments to any seats on boards,committees or commissions for which the Contra Costa County
Board of Supervisors is the appointing authority.
II.POLICY:A person will not be eligible tor appointment ifhe/she is related to a Board of Supervisors'Member in any of the following
relationships:
1.Mother,father,son,and daughter;
2.Brother,sister,grandmother,grandfather,grandson,and granddaughter;
3.Great-grandfather,great-grandmother,aunt,uncle,nephew,niece,great-grandson,and great-granddaughter;
4.First cousin;
5.Husband,wife,father-in-law,mother-in-law,son-in-law,daughter-in-law,stepson,and stepdaughter;
6.Sister-in-law (brother's spouse or spouse's sister),brother-in-law (sister's spouse or spouse's brother),spouse's grandmother,
spouse's grandfather,spouse's granddaughter,and spouse's grandson;
7.Registered domestic partner,pursuant to California Family Code section 297.
8.The relatives,as defined in 5 and 6 above,for a registered domestic partner.
9.Any person with whom a Board Member shares a financial interest as defined in the Political Reform Act (Gov't Code §87103,
Financial Interest),such as a business partner or business associate.
THIS FORM IS A PUBLIC DOCUMENT