Palmdale City Council
April 5, 2023

To receive the best available pricing, the City is utilizing cooperative pricing with Steelcase through Sourcewell pricing ID #121919.

FISCAL IMPACT
The project is budgeted in Account No. F0010 and has been funded through General Fund (101), Measure AV (157), and ARPA Funds (158). The account has a current available balance of $2,455,451. The fiscal impact and remaining account balance can be seen in the following table:

SCOPE OF WORK COST
Tangram Interiors $325,000
5% Contingency $16,250
Total Cost: $341,250
Account Number Starting Balance Anticipated
Expenditures
Anticipated
Remaining Balance
F0010101 $245,685 $131,485 $114,200
F0010157 $209,765 $209,765 $0
F0010158 $2,000,000 $0 $2,000,000

STRATEGIC PLAN
Goal 1: Maintain effective public safety and protection for life, property and the environment.

C. Use a variety of methods to communicate timely, useful, and trusted information about city programs, services and policies.

Prepared by: Lynn Glidden, P.E., Director of Public Works Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William P. Curley, III, Interim City Attorney City Council Staff Report
DATE: APRIL 5, 2023
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: PUBLIC WORKS
DISTRICT: 1
SUBJECT: APPROVE ADDITIONAL FUNDS OF $84,323.37 FOR P URCHASE ORDER NO. 20230423, WITH SERVPRO OF PALMDALE NORTH ,
dba P&C RESTORATION CLEANING CORP . FOR EMERGENCY

CLEAN UP SERVICES FOR THE CHIMBOLE CULTURAL CENTER ,
IN THE AMOUNT NOT TO EXCEED $304,324
ISSUE
Approve additional funds of $84,323.37 for Purchase Order No. 20230423, with Servpro Palmdale North, dba P&C Restoration Cleaning Corp. for emergency clean up services for the Chimbole Cultural Center in the amount not to exceed $304,324.

RECOMMENDATION
Staff recommends that the City Council:

1. Approve additional funds of $84,323.3 7 for Purchase Order No. 20230423, with Servpro Palmdale North , dba P&C Restoration Cleaning Corp . for emergency clean up services for the Chimbole Cultural Center in the amount not to exceed $304,324.

BACKGROUND
In January 2023, ServPro was awarded an emergency contract, in the amount of $220,000 for initial water extraction , cleanup, removal of all carpeting, affected drywall, ceiling tiles drapery and insulation and additional drying equipment to remove the potential of mold growth in the building . Due to actual costs of prevailing wage labor, equipment and additional removal of material, the final cost was $304,324, an increase of $84,323.37.

DISCUSSION
This unanticipated emergency work exceeds the signing aut hority of the City Manager.

Therefore, staff recommends that the City Council approve the additional funds as requested for the needed and unexpected emergency material removals.

FISCAL IMPACT
There are sufficient funds located in Account No. F0161, Chimbole Cultural Center Renovation.

Report to Mayor and City Council
Re: Approval of Additional Funding for Purchase Order 20230423 April 5, 2023

STRATEGIC PLAN
Goal III: Invest in infrastructure to improve community viability.

C. Plan and maintain safe and attractive neighborhoods, streets, facilities, and public spaces with exciting programming that promotes active fun for everyone.

Prepared by: Lynn Glidden P.E, Director of Public Works Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William P. Curley, Interim City Attorney

ATTACHMENTS
Purchase Order No. 20230423 - updated

City Council Staff Report
DATE: APRIL 5, 2023
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: NEIGHBORHOOD SERVICES

HOUSING DIVISION
DISTRICT: ALL
SUBJECT: APPROVE PROPOSAL TO AMEND THE 2019 -2020 ACTION PLAN

TO REPROGRAM COMMUNITY DEVELOPMENT BLOCK GRANT

COVID (CDBG -CV) FUNDS , REVIEW AND APPROVE BUDGET

ADJUSTMENTS TO SAVES CDBG AND SAVES CDBG-CV

BUDGETS AND DECREASE SAVES CDBG BUDGET
ISSUE
Approve proposal to amend the 2019-2020 Action Plan; Authorize the City Manager or their designee to execute documents necessary to amend said action Plan and obtain HUD approval , and agreements for Sub -Recipients; Review and approve budget adjustments to SAVES CDBG and SAVES CDBG -CV budgets; and decrease SAVES CDBG budget.

RECOMMENDATION
Staff recommends that the City Council:

1. Amend the 2019-2020 Action Plan for the CDBG-CV reprogramming of funds from the Mortgage Assistance Program CV and Grant Administration to SAVES CDBG- CV and Emergency Rental Assistance (COVID) Program; and

2. Authorize the City Manager or their designee to make necessary changes and submit the amendment to HUD, execute documents related to amend the Action Plan and agreements for Sub-Recipients; and

3. Approval of budget adjustments for SAVES CDBG and SAVES CDBG-CV; and

4. Approval of decrease of SAVES CDBG budget.

BACKGROUND
As an entitlement jurisdiction, the City of Palmdale receives an annual allocation of funds from U.S. Department of Housing and Urban Development (HUD) under its Community Development Block Grant (CDBG) Program. Additionally, t he City received special allocations of Community Development Block Grant COVID -19 (CDBG -CV) funding from HUD under the Corona virus Aid, Relief, and Economic Security Act (CARES), Report to Mayor and City Council
Re: Public Hearing to Reprogram CDBG CV
April 5, 2023

enacted on March 27, 2020, to be used to exclusively on eligible activities that prevent and respond to the COVID-19 pandemic.

CDBG-CV funding was allocated to eligible activities including South Antelope Valley Emergency Services (SAVES), Business Public Service, Economic Opportunity Programs, Mortgage Assistance, Rental Assistance and Administration of the grant funding.

In addition, SAVES received an allocation of Community Development Block Grant funds for the 2022-2023 Program Year for operations of the SAVES Program.

DISCUSSION
SAVES has continued to provide increased services to the community since the COVID emergency was initiated. Currently SAVES is providing 1,000 to 1,800 food orders weekly. Due to the high level of service provided by SAVES and increased costs for a period of time longer than anticipated when funding was initially provided, SAVES is requesting an increase of $180,000 funding, increasing funding from $575, 010 to $755,010.

The Emergency Rental Assistance (COVID) Program (ERAP) has an interest list of 344 households. Under ERAP rental assistance of up to a total of $10,000 for up to six consecutive months may be provided to eligible households. Housing Division Staff has requested additional funding of $178,000 increasing CDBG-CV funding from $300,000 to $478,000.

The Mortgage Assistance Program has determined 7 households may be eligible for assistance and have been provided applications. Under this program an eligible household’s payment assistance may be up to a total of $6,000 for up to six consecutive months. Funding of $42,000 is allocated for these applicants. Loans in forbearance are not eligible for assistance due to not being delinquent. The Mortgage Assistance Program CDBG-CV allocation available for reprogramming is $258,000.

The CDBG-CV grant provides 20% of the allocation for Administration of the grant.

Administration funds of $239,600 are currently available. Staff is utilizing Administration funding for processing program applications to maximize the funding available for direct program assistance and determined $100,000 may be reprogrammed for ERAP assistance.

The requested reprogramming of CDBG-CV funds is a non-substantial amendment to the 2019-2020 Action Plan in accordance with the approved Citizen Participation Plan.

Budget transfers are requested for SAVES CDBG-CV to allocate funding for operations accounts. Budget transfers are requested for SAVES to allocate funding for operations accounts. SAVES CDBG approved funding for Program Year 2022-2023 is $217,917 and the current budget is $226,560, requiring a reduction of $10,580.

Report to Mayor and City Council
Re: Public Hearing to Reprogram CDBG CV
April 5, 2023

FISCAL IMPACT
Reprogram and transfer funds from:
28027002-6103 Mortgage Assistance CDBG CV $258,000
28027002 CDBG CV Admin 100,000
Reprogram and transfer funds to:
28027002-6100 SAVES CDBG CV $180,000
28027002-6101 Rental Assistance CDBG CV $178,000
Budget transfers are requested for SAVES CDBG-CV, Org 28027002, to allocate funding for operations accounts. Budget transfers are requested for SAVES CDBG, Org 28019012, to allocate funding for operations accounts. Decrease SAVES CDBG budget, Org 28019012, $10,580, in accordance with approved funding.

STRATEGIC PLAN
Goal II: Ensure long-term fiscal health of the City and maintain funding for services.

A. Manage resources, costs, and liabilities to ensure the City’s long-term fiscal health.

Prepared by: Becky Bartlett, Management Analyst
Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William P. Curley, III, Interim City Attorney City Council Staff Report
DATE: APRIL 5, 2023
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: PUBLIC WORKS DEPARTMENT

CAPITAL IMPROVEMENT PROGRAM DIVISION
DISTRICT: 4
SUBJECT: AWARD CONSTRUCTION AGREEMENT WITH SOV SECURITY FOR PN 872, CITYWIDE SECURITY INFASTRUCTURE PROJECT , AT
CITY FACILITIES IN THE AMOUNT NOT TO EXCEED $973,833 AND DETERMINE THIS PROJECT TO BE EXEMPT FROM CEQA.

ISSUE
Award construction agreement with SOV Security , for PN 872, Citywide Security Infrastructure Project, at the City facilities, including City Hall, Palmdale Transportation Center, Palmdale Playhouse, and the Maintenance Yard , in the amount not to exceed $973,833 and determine this project to be exempt from CEQA.

RECOMMENDATION
Staff recommends that the City Council:

1. Award construction Agreement No. A -8729 with SOV Security for PN 872, Citywide Security Infrastructure Project, in the amount not to exceed $973,833.

2. Determine this project to be categorically exempt from the California Environmental Quality Act (CEQA) pursuant to 2 CCR 15301.

3. Authorize the City Manager or her designee to execute Agreement No. A-8279 with SOV Security in a form substantially similar to the city’s form contract provided in the bid package, whic h form may include minimal and/or non - substantive changes.

BACKGROUND
Project No. 872, Citywide Security Infrastructure Project, includes acquiring the services of an experienced and qualified vendor to provide/procure, install, configure, train, and warranty new enterprise security video/cameras, access control, and video management systems (VMS) to secure city facilities . The first phase of this pr oject includes providing the above services to: Palmdale City Hall, Development Services Building, Palmdale Transportation Center, Palmdale Maintenance Yard, and the Report to Mayor and City Council
Re: Award of PN 872, Agreement No. A-8279
April 5, 2023

Palmdale Playhouse. The project will provide a fully integrated end-to-end physical security system, complete with video surveillance and access control functionality. It is anticipated that construction will take approximately 365 calendar days from the date the City issues the Notice to Proceed and is projected to occur between May 2023 and May 2024.

DISCUSSION
Two (2) bids were received for this project on February 7 th, 2023, with only one deemed a responsive bidder and proposal costs are summarized below:

BIDDER LOCATION AMOUNT

1. SOV Security Agoura Hills $973,833
The project was released for public bid on December 22, 2022. Four (4) vendors were invited to participate in this project and were sent the bid documents for review. The prospective bidders are specialty security vendors with extensive experience in government and local agencies’ security infrastructure installation and management projects. Three (3) prospective bidders attended the mandatory pre-bid site visit. Only SOV Security submitted a responsive qualification/proposal package. On March 6, 2023, SOV Security provide a demonstration of the video surveillance equipment and software that was viewed and accepted by the security review committee.

References have been checked and staff recommend that the City Council award Project No. 872 to the qualified bidder, SOV Security, in the amount of $973,833.

CEQA
The proposed project is Categorically Exempt pursuant to Section 15301, Class 1, of the California Environmental Quality Act (CEQA) Guidelines, which permits the minor alteration of existing public structures/facilities involving negligible or no expansion of use beyond that existing at the time of the lead agency's determination. The proposed project involves the installation of new security cameras and access control systems within existing City facilities. A Notice of Exemption for the project was filed with the Los Angeles County Clerk on March 23, 2023, for compliance with the California Environmental Quality Act (CEQA).

FISCAL IMPACT
The project is budgeted in Account No. F0083 and has been funded with Measure AV (157) and Prop A Funds (203). The account has a current available balance of $1,461,550. The fiscal impact and remaining account balance can be seen in the following table:

Report to Mayor and City Council
Re: Award of PN 872, Agreement No. A-8279
April 5, 2023

SCOPE OF WORK COST
PN 872, Citywide Security Infrastructure Project $973,833 Construction Contingency (15%) $147,000
Administration and Inspection $10,000
Labor Compliance $9,500
Total Cost: $1,145,332
Account Number Starting Balance Remaining Balance
F0083157 $1,202,300 $316,218
F0083203 $259,250 -0-

STRATEGIC PLAN
Goal 1: Maintain effective public safety and protection for life, property, and the environment.

A. Provide comprehensive and innovative safety services to prevent crime and promote a safe community.

Goal III: Invest in infrastructure to improve community livability.

C. Plan and maintain safe and attractive neighborhoods,streets,facilities,and public spaces with exciting programming that promotes active fun for everyone.

Prepared by: Lynn Glidden, P.E., Director of Public Works Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William Patrick Curley III, Interim City Attorney City Council Staff Report
DATE: APRIL 5, 2023
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: PUBLIC WORKS
DISTRICT: ALL
SUBJECT: ADOPT RESOLUTION NO. CC 2023-023, A RESOLUTION OF THE

CITY COUNCIL OF THE CITY OF PALMDALE AUTHORIZING THE

EXECUTION OF A SURETY BOND TO MEET THE FINANCIAL
SECURITY REQUIREMENT FOR ENERGY FOR PALMDALE’S

INDEPENDENT CHOICE
ISSUE
Adopt Resolution No. CC 2023-023, a Resolution of the City Council of the City of Palmdale authorizing the execution of a Surety Bond to meet the financial security requirement for Energy for Palmdale’s Independent Choice.

RECOMMENDATION
Staff recommends that the City Council adopt Resolution No. CC 2023-023 authorizing the execution of a surety bond to meet the Financial Security Requirement for EPIC.

BACKGROUND
On April 2, 2019, City Council adopted Ordinance No. 1524 establishing the Palmdale Community Choice Aggregation ( CCA) program, Energy for Palmdale’s Independent Choice (EPIC). EPIC began serving electricity to customers in October 2022. EPIC’s mission is to provide the benefits of clean, renewable energy while achieving greater local control over electricity services, promoting competitively priced renewable energy options, and providing quality programs and services to the local community.

DISCUSSION
In 2018, the CPUC issued Decision 18-05-022 (Decision) which established reentry fees and Financial Security Requirements (FSR) for CCAs. The purpose of the FSR instrument is to cover reentry feesborne by the Investor Owned Utility (IOU) in the event of a mass involuntary return of CCA customers to the IOU, such as a decertification of a CCA or a CCA failure. The IOU may only withhold funds from the financial security instrument for unpaid administrative or procurement costs associated with the return of CCA customers to the IOU. Any withholding of those funds must first be approved by the CPUC.

Report to Mayor and City Council
Re: Adopt Resolution No. CC 2023-023 Authorizing the execution of a surety bond to meet the Financial Security Requirement for Energy for Palmdale’s Independent Choice April 5, 2023

The Decision required all CCAs, including EPIC, to submit an Advice Letter with the FSR instrument to the CPUC to show compliance with the Decision. The City’s CCA consultants, California Choice Energy Authority (CalChoice), worked with its legal team to draft the advice letter, which was submitted with a copy of an executed Letter of Credit, which was the instrument used to satisfy the FSR obligation. The FSR amount has been $147,000 since the initial posting of the Letter of Credit in 2021. The Letter of Credit, issued by River City Bank (RCB), is collateralized by a cash deposit of $147,000 in an account held with RCB in the City’s name.

The methodology used to calculate the FSR amount for CCAs is under review at the CPUC to ensure that IOUs do not unreasonably bear costs associated with CCA customer returns to the IOU. In anticipation of a change to the methodology to calculate the FSR amount which may result in an increase in the FSR amount, staff is proposing replacing the current Letter of Credit, which requires dollar-for-dollar cash collateral, with a surety bond, which is more flexible and has an approximate one percent (1%) annual fee. Because the methodology used to calculate the FSR includes benchmarks related to energy pricing, which can move up and down depending on market conditions, staff is requesting a not to exceed amount that contemplates future volatility in the energy market. Currently, the estimated fee for the first year is less than $2,000. When the current Letter of Credit expires, the $147,000 cash collateral will be released to the City.

Based on the foregoing, staff recommends the City Council adopt Resolution No. 2023- 023 authorizing the execution of a surety bond and related documents for the purpose of satisfying the Financial Security Requirement as required by the California Public Utilities Commission.

FISCAL IMPACT
Fees for FY 2022-2023 are approximated around $2,000 and have already been budgeted for in account 35034003-721411. Staff is requesting a not to exceed amount that contemplates future volatility in the energy market and is not to exceed $25,000, annually. Sufficient revenues will be generated by EPIC to cover operating expenses, including surety bond fees.

Report to Mayor and City Council
Re: Adopt Resolution No. CC 2023-023 Authorizing the execution of a surety bond to meet the Financial Security Requirement for Energy for Palmdale’s Independent Choice April 5, 2023

STRATEGIC PLAN
Goal III: Invest in infrastructure to improve community livability.

B: Implement and administer environmentally sustainable programs.

Prepared by: Lynn Glidden, Director of Public Works
Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William P. Curley, III, Interim City Attorney

ATTACHMENTS

1. Resolution No. 2023-023

2. Form of Surety Bond

3. Form of Commercial General Agreement of Indemnity

CITY COUNCIL

CITY OF PALMDALE, CALIFORNIA
RESOLUTION NO. CC 2023-023

A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PALMDALE

AUTHORIZING THE EXECUTION OF A SURETY BOND TO MEET THE

FINANCIAL SECURITY REQUIREMENT FOR ENERGY FOR
PALMDALE’S INDEPENDENT CHOICE
WHEREAS, Community Choice Aggregation (CCA), authorized by Assembly Bill 117, is a State law that allows cities, counties, and other authorized entities to aggregate electricity demand within their jurisdictions in order to purchase and/or generate alternative energy supplies for residents and businesses within their jurisdiction while maintaining the existing electricity provider for transmission and distribution services; and
WHEREAS, on April 2, 2019, the City Council of the City of Palmdale adopted Ordinance No, 1524 Establishing a Community Choice Aggregation Program, Energy for Palmdale’s Independent Choice (EPIC); and
WHEREAS, the California Public Utilities Code Section 394.25 requires the posting of a bond or insurance sufficient to cover costs of an involuntary return of customers, also known as the Financial Security Requirement (FSR); and WHEREAS, the minimum FSR is $147,000, but may increase because of market conditions or regulatory decisions; and
WHEREAS, the City of Palmdale, on behalf of EPIC, has previously satisfied the FSR through the issuance of a letter of credit; and
WHEREAS, the City of Palmdale, on behalf of EPIC, now seeks to satisfy the FSR through the issuance of a Surety Bond.

NOW THEREFORE, BE IT RESOLVED, THE CITY COUNCIL OF THE CITY OF

PALMDALE DOES HEREBY FIND, DETERMINE, RESOLVE AND ORDER AS FOLLOWS:

SECTION 1. Findings. That based upon and in consideration of staff reports, presentations, public testimony and comment, and such other matters presented to the City Council during the public meeting on this matter, the City Council finds and declares the foregoing recitals to be true and correct and incorporates the same as substantive findings herein.

Resolution No. CC 2023-023

SECTION 2. Authorization. That the City Manager is authorized to execute documents to enable the issuance of, and amendments to, a Surety Bond in satisfaction of EPIC’s FSR.

SECTION 3. This Resolution shall take effect immediately upon its adoption.

SECTION 4. The City Clerk shall certify to the adoption of this resolution.

PASSED, APPROVED and ADOPTED this 5th day of April, 2023. _________________________________
Approved as to form: Laura Bettencourt, Mayor
ATTEST:
___________________________ _________________________________ William P. Curley, III Rochelle Scott, Acting City Clerk Interim City Attorney
I, Rochelle Scott, Acting City Clerk of the City of Palmdale, California, do hereby certify that the foregoing resolution was duly passed, approved, and adopted by the City Council of the City of Palmdale at a regular meeting of said Council held on the 5th day of April, 2023 by the following roll call vote:

AYES: ___________________________________________________________ NOES: ___________________________________________________________ ABSTAIN: ______________________ABSENT:___________________________ Date: ______________________________ _____________________________ Rochelle Scott, Acting City Clerk

SURETY BOND
Bond No: [____]
Community Choice Aggregator Name: ______________________________ This Surety Bond (“Bond”), dated and effective as of [date of execution] (“Effective Date”), is issued by [Surety’s legal name], a [form of business entity and state of registration] and an admitted surety insurer authorized to transact the business of surety in the State of California (“Surety”), on behalf of CCA’s/JPA’s legal name], a [form of business entity and state of registration] (“Principal”), in favor of Southern California Edison Company, a California corporation (“SCE” or “Obligee”).

A. Principal is required to post financial security as the Financial Security Requirement (“FSR”) defined in the SCE Rule 23 (“the Tariff”).

B. Principal has elected to satisfy its obligation to post FSR by having Surety issue this Bond to Obligee, and Obligee has agreed to accept this Bond as FSR.

The Principal and Surety, each intending to be legally bound, agree as follows:

1. Payment upon Demand.
(a) Surety irrevocably and unconditionally agrees to pay to Obligee amounts not to exceed $ (One Hundred Forty-Seven Thousand U.S. Dollars) in the aggregate (“Maximum Bond Amount”), in accordance with the terms of this Bond.
(b) No later than fifteen (15) Business Days after Surety receives from Obligee a demand notice substantially in the form attached hereto as Exhibit A (“Demand Notice”), Surety shall pay to Obligee, by wire transfer of immediately available funds, the amount specified by Obligee in such Demand Notice.
(c) For purposes of this Bond, “Business Day” means any day other than a Saturday, Sunday, or a Federal Reserve Bank holiday.

2. Multiple Draws Permitted. Obligee may demand multiple payments from Surety under this Bond by providing Demand Notices to Surety from time to time in accordance herewith.

3. Principal Pays Bond Costs. Principal shall pay all commissions, charges, fees, and other costs associated with this Bond. Principal’s failure to pay any such commissions, charges, fees, or costs is not grounds for termination of this Bond.

4. Term. The term of this Bond (“Original Term”) commences on the Effective Date and ends at 5:00 p.m., California time, on [insert date that Bond’s Original Term ends] or, if such date is not a Business Day, at 5:00 p.m., California time, on the next Business Day; provided, however, that this Bond shall, subject to Section 6 hereof, be automatically renewed for a term of 365 calendar days upon the expiration of the Original Term and any renewed 365 calendar day term (“Renewed Term”).

5. Reinstatement of Bond. Notwithstanding anything to the contrary set forth herein, including but not limited to Section 6 hereof, this Bond and the obligations of Surety hereunder shall be reinstated if, at any time following (a) the termination of this Bond by its terms, or (b) the payment by Surety of the Maximum Bond Amount, any payment made by Surety to Obligee pursuant to a Demand Notice under this Bond is rescinded or must otherwise be returned by the Obligee or other person as a preference, fraudulent transfer, or otherwise, or as a result of the insolvency, bankruptcy, reorganization, dissolution or liquidation of Principal, Surety, or otherwise, and such reinstatement shall return the parties hereto to be bound by their obligations hereunder, all as though such rescinded or returned payment had not been made. In the event of any reinstatement of this Bond and the obligations of Surety hereunder, the then-effective term of this Bond shall end on the later of (x) the term that would have otherwise been effective hereunder, and (y) sixty (60) Business Days after the date that this Bond is reinstated.

6. Termination.
(a) Surety may terminate this Bond by providing Notice (as defined in Section 7 hereof) to each of Obligee and Principal at least sixty (60) calendar days before the expiration of the Original Term or the Renewed Term, as applicable, of Surety’s intention to terminate this Bond, in which case this Bond shall terminate as of the end of the Original Term or the Renewed Term, as applicable; provided, however, that (i) Surety’s liability under this Bond shall survive such termination and remain in full force and effect as to obligations incurred by Principal during the Original Term and each Renewed Term, or respective portion thereof, and (ii) if Principal does not provide alternative financial security consistent with the FSR obligation in the Tariff at least twenty (20) Business Days before the expiration of the Original Term or the Renewed Term, as applicable, Surety shall, no later than fifteen (15) Business Days after Surety receives from Obligee a Demand Notice, pay to Obligee, by wire transfer of immediately available funds, the amount specified by Obligee in such Demand Notice, which amount, when aggregated with all prior payments made by Surety hereunder and not previously rescinded or returned as described in Section 6 hereof, shall not exceed the Maximum Bond Amount. (b) Subject to Section 5 hereof, the obligation of the Surety to make payments pursuant to this Bond shall terminate automatically and without further notice or action upon the delivery of any payment to the Obligee pursuant to a Demand Notice which, when aggregated with all prior payments to the Obligee pursuant to a Demand Notice, equals or exceeds the Maximum Bond Amount and, if applicable, any additional amounts due to Obligee in accordance with Section 9 hereof.

7. Notice. All notices (including, without limitation, Cure Notices (as defined in Section 11(b) hereof) and Demand Notices), requests, or other communications (“Notices”) under or relating to this Bond shall be in writing and shall be delivered by facsimile or other means of electronic transmission, hand delivery, or overnight courier service, and shall be deemed delivered as follows: (a) Notice by facsimile or other means of electronic transmission or by hand delivery shall be deemed delivered on the date and at the time actually received, if received during business hours on a Business Day, and otherwise shall be deemed delivered at 8:00 a.m. on the next Business Day; and (b) Notice by overnight courier service shall be deemed delivered on the next Business Day after such Notice is sent. A party may change its designated representatives, addresses and other contact information by providing Notice of such change(s) in accordance with this Section 7. The Notice information is as follows:

If to Principal: [CCA’s or JPA’s legal name]
[CCA’s or JPA’s address]
Attention: [Title or person’s name]
Tel No.: [Phone number]
Email Address: [Email address]
If to Obligee: Southern California Edison Company
Manager of Risk Operations and Collateral Management
2244 Walnut Grove Avenue, GO1, Q2B
Rosemead, CA 91770
Tel No.: (626) 302-3464
Email Address: [email protected]
If to Surety: [Surety’s name]
[Surety’s address]
Attention: [Title or person’s name]
Tel No.: [Phone number]
Email Address: [Email address]

8. Obligations Unconditional; Waiver of Defenses.
(a) Surety’s obligations under this Bond (i) are unconditional, irrevocable, and independent of Principal, and (ii) shall not be affected by any circumstance that constitutes a legal or equitable discharge of a surety or guarantor.
(b) Surety irrevocably and unconditionally waives any defense whatsoever to payment of amounts owing by Principal to Obligee, including, without limitation, any defense relating to the following: (i) the existence of an indebtedness of Principal to Obligee in excess of the Bond Amount; (ii) release of Principal by agreement or by operation of law; (iii) Obligee’s taking, amendment to, or release of any additional security, guaranty or surety for Principal’s obligations under the Tariff; (iv) Obligee’s waiver or election of, or failure to pursue any right or remedy available to it, including, without limitation, Obligee’s waiver or election of, or failure to pursue any right or remedy available to it under the Tariff; (v) any and all of the rights and defenses described in subdivision (a) of Section 2856 of the California Civil Code, as may be amended from time to time, including, without limitation, any and all rights and defenses that are or may become available to Surety by reason of Sections 2787 to 2855 thereof, inclusive; (vi) any right of Surety or Principal to require Obligee to first proceed against Principal, any other guarantor or surety, or any other collateral Obligee may hold; (vii) the validity or enforceability of Principal’s obligations to Obligee; (viii) any amendments or other modification made from time to time to the Tariff; (ix) any defenses, setoffs, or counterclaims that Principal may allege or assert with respect to the Maximum Bond Amount (or any portion thereof); (x) the benefit of any statute of limitations affecting Surety’s liability under this Bond or the enforcement of this Bond; and (xi) any other act or omission, or delay to do any other act that might to any extent vary the risk of Surety as an obligor under this Bond, including, without limitation, Principal’s failure to provide a copy of a Cure Notice to Surety pursuant to Section 11(b) hereof. (c) Surety shall pay all amounts demanded by Obligee in accordance with this Bond without setoff, abatement, reduction or counterclaim of any kind whatsoever.

9. Disputes; Enforcement Action. If Surety and/or Principal in any way dispute the terms of this Bond or the payment of any or all of the Maximum Bond Amount, then, notwithstanding such dispute, Surety shall pay the Maximum Bond Amount without setoff, abatement, reduction or counterclaim of any kind whatsoever, other than a reduction for any amounts already validly paid by Surety to Obligee pursuant to Demand Notices previously honored by Surety. Surety shall pay all reasonable costs, damages, and expenses incurred by Obligee arising out of or otherwise associated with the enforcement of this Bond, including, without limitation, reasonable attorney fees and expenses.

Surety’s obligation to pay such costs, damages, fees, and expenses shall be in addition to its obligation to pay the Maximum Bond Amount, and shall in no way be interpreted or deemed to be limited by the Maximum Bond Amount.

10. Representations, Warranties and Covenants.
(a) On the Effective Date, Principal and Surety each represents and warrants that (i) it is duly organized, validly existing and in good standing under the laws of the jurisdiction of its formation, (ii) the execution and delivery of, and performance under this Bond are within its powers, have been duly authorized by all necessary action and do not violate any of the terms and conditions in its governing documents, any contracts to which it is a party, or any law, rule, regulation, order or the like applicable to it, (iii) this Bond constitutes a legally valid and binding obligation enforceable against it in accordance with its terms, and (iv) there is not pending, or to its knowledge, threatened against it any legal proceeding that could materially adversely affect its ability to perform under this Bond.
(b) Surety represents and warrants that, on the Effective Date, (i) it is listed on the United States Department of Treasury’s most recent and effective listing of approved sureties (Circular 570 or its successor), (ii) it is an admitted surety insurer authorized to transact the business of surety in the State of California, (iii) it has a credit rating of A- or better by Standard and Poor’s or A3 or better by Moody’s, and (iv) either (x) the Maximum Bond Amount is not greater than its underwriting limitation, as set forth in Circular 570 or its successor, or (y) to the extent that any portion of the Maximum Bond Amount is in excess of such underwriting limitation, such excess amount is protected with reinsurance as specified in 31 CFR 223.10-11 or its successor. (c) Surety covenants that during the Original Term and each Renewed Term, (i) it shall be listed on the United States Department of Treasury’s most recent and effective listing of approved sureties (Circular 570 or its successor), (ii) it shall be an admitted surety insurer authorized to transact the business of surety in the State of California, (iii) it has a credit rating of A- or better by Standard and Poor’s or A3 or better by Moody’s, and (iv) either (x) the Maximum Bond Amount shall not be greater than its underwriting limitation, as set forth in the most recent Circular 570 or its successor, or (y) to the extent that any portion of the Maximum Bond Amount is in excess of such underwriting limitation, such excess amount is protected with reinsurance as specified in 31 CFR223.10-11 or its successor.

11. Miscellaneous.
(a) Subject to Sections 5 and 9 hereof, the total amount of Surety’s obligations under this Bond for payment to the Obligee shall not exceed the Maximum Bond Amount. (b) If the Obligee issues a notice to Principal requesting the cure of a default under the Tariff (“Cure Notice”) at any time during the Original Term or any Renewed Term, Principal shall ensure that a copy of such Cure Notice is delivered to Surety pursuant to the procedure set forth in Section 7 hereof.
(c) This Bond shall be governed by the laws of the State of California without regard to conflict of laws principles. Surety and Principal irrevocably submit to the jurisdiction of any California court or any United States court sitting in California over any action or proceeding arising out of or relating to this Bond and irrevocably agree that all claims in such action or proceeding may be heard and determined by such court. Surety and Principal agree that a final judgment in any such action or proceeding shall be conclusive and may be enforced in other jurisdictions by suit on the judgment or in any other manner provided by law. Surety and Principal waive any objection to venue on the basis of forum non conveniens. Surety and Principal irrevocably consent to the service of process in any action or proceeding by the mailing of copies of such process to Surety and Principal, as applicable at their respective addresses set forth in, and otherwise in accordance with Section 7 hereof. Nothing in this Bond shall affect the right of Obligee to bring any action or proceeding against Surety and/or Principal or their respective property in the courts of any other jurisdictions.
(d) This Bond may be waived, altered, amended or supplemented only by a writing signed by Surety and Obligee.
(e) Neither this Bond nor any right or interest under this Bond may be assigned by Principal or Surety without the prior written consent of Obligee, which consent shall not be unreasonably withheld. Any direct or indirect change of control of Principal or Surety (whether voluntary or by operation of law) shall be deemed an assignment in violation of this Bond, and will require the prior written consent of Obligee.
(f) If any provision of this Bond is determined to be prohibited or unenforceable by reason of any applicable law of a jurisdiction, then such provision shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions thereof, and any such prohibition or unenforceability in such jurisdiction shall not invalidate or render unenforceable such provisions in any other jurisdiction. (g) The parties to this Bond are represented by legal counsel. The terms of this Bond and the language used herein shall be deemed to be the terms and language chosen by the parties hereto to express their mutual intent. This Bond shall be construed without regard to any presumption or rule requiring construction against the party causing such instrument or any portion thereof to be drafted, or in favor of the party receiving a particular benefit under this Bond. No rule of strict construction will be applied against any party.
(h) This Bond may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. [signature page follows]
IN WITNESS THEREOF, each of Surety and Principal has caused this Bond to be executed on its behalf by its duly authorized officer as of the Effective Date. [CCA’S / JPA’S LEGAL NAME]
By: ___________________________________
Name: [Authorized representative’s name]
Title: [Authorized Representative’s title]
[SURETY’S LEGAL NAME]
By: ___________________________________
Name: [Authorized representative’s name]
Title: [Authorized Representative’s title]1

1 [If Surety’s agent is signing on behalf of Surety, a Power of Attorney form for agent is required.] EXHIBIT A TO SURETY BOND NO. [_____]

FORM OF DEMAND NOTICE
Southern California Edison Company
Attn: Manager of Risk Operations and Collateral Management 2244 Walnut Grove Avenue, GO1, Q2B
Rosemead, CA 91770
[Date]
[Surety’s name
Surety’s address]
Re: Demand Notice under Surety Bond, No. [____], dated and effective as of [Effective Date of Bond] (“Bond”), entered into by [Surety’s legal name] (“Surety”) and [CCA’s / JPA’s full legal name] (“Principal”) and issued by Surety on behalf of Principal in favor of Southern California Edison Company (“Obligee”)
Ladies and Gentlemen:

This letter constitutes Obligee’s Demand Notice to Surety in accordance with the Bond. All capitalized terms used and not otherwise defined in this Demand Notice have the meanings assigned to them in the Bond.
[Insert one or both of the following two paragraphs, as applicable:

The undersigned hereby certifies to Surety that ($[dollar amount]) is due and owing from Principal to Obligee under the terms of SCE’s Rule 23 Tariff. Obligee hereby demands payment from Surety in the amount of $[dollar amount].
- or -
The undersigned hereby certifies to Surety that, as of the close of business on [date less than twenty (20) Business Days before the expiration of the Bond], Principal has not provided Obligee alternative financial security that complies with Tariff Rule 23. Obligee hereby demands payment from Surety in the amount of $[dollar amount].

Please pay this amount in accordance with the following payment instructions no later than fifteen (15) Business Days after your receipt of this Demand Notice, with such receipt determined in accordance with Section 7 (Notice) of the Bond: [SCE’s wire transfer instructions] Sincerely,
Southern California Edison Company
By: ___________________________________
Name: [Authorized representative’s name]
Title: [Authorized representative’s title]

January 2016

CHUBB SURETY
436 Walnut Street, 10th Floor
Philadelphia, Pennsylvania 19107
General Agreement of Indemnity
This General Agreement of Indemnity (this "Agreement") is made and entered into by the undersigned (individually and collectively, the “INDEMNITORS”) for the benefit of Federal Insurance Company and Westchester Fire Insurance Company, their respective direct and indirect subsidiaries, parent companies, and affiliates, whether in existence now or formed or acquired hereafter, co-sureties, fronting companies, companies which any of them may procure to issue or deliver any Bonds for, on behalf of or at the request of any of the Indemnitors, and reinsurers, and the successors and assigns of each of them (individually and collectively, the “SURETY”), for the purpose of indemnifying the SURETY from any and all loss, cost and expense in connection with any and all surety bonds, undertakings, guarantees and/or contractual obligations previously or hereafter executed, issued, procured, delivered or undertaken by the Surety, whether directly or as a result of any asset purchase, merger, acquisition or similar transaction, including any renewals, modifications and/or extensions thereof, for, on behalf of or at the request of: any of the Indemnitors, whether individually or jointly with others; any current or hereafter created or acquired subsidiary, affiliate, joint venture and/or other legal entity in which any of the INDEMNITORS has a substantial, material or beneficial interest; and/or any other party at the request of any of the INDEMNITORS (each a "Bond" and collectively "Bonds").

NOW THEREFORE, in consideration of the SURETY executing the Bonds, the INDEMNITORS agree that:

1. PREMIUMS & COLLATERAL FOR SURETYSHIP- The INDEMNITORS shall pay or cause to be paid to the SURETY both the agreed premium and, upon written request by the SURETY at any time, collateral security for its suretyship until the INDEMNITORS shall furnish to the SURETY competent written evidence, satisfactory to the SURETY, of the termination of any past, present and future liability under any Bond. The INDEMNITORS expressly waive any right to interest which may be earned on the collateral security and further consents that the collateral security provided in consideration of suretyship may be held by the SURETY in any investment or depository that the SURETY in its sole discretion deems advisable and prudent. The Surety’s election not to demand collateral now or at any time shall not operate as a waiver of the right to demand and receive such collateral at any time before liability has terminated under any Bond.

2. INDEMNITY & COLLATERAL FOR CLAIM- The INDEMNITORS shall indemnify and save harmless the SURETY from and against any and all liability, claim, demand, loss, damages, expense, cost, attorney’s fees and expenses, including without limitation, fees and disbursements of counsel incurred by the SURETY in any action or proceeding between the INDEMNITORS and the SURETY, or between the SURETY and any third party, which SURETY shall at any time incur by reason of its execution of any Bond or its payment of or its liability to pay any claim, irrespective of whether the claim is made against the SURETY as a joint or several obligor and whether the INDEMNITORS are then liable to make such payment, and to place the SURETY in funds to meet all of its liability under any Bond, promptly upon request and before the SURETY may be required to make any payment thereunder; and copy of the claim, demand, voucher or other evidence of the payment by the SURETY of any liability, claim, demand, loss, damage, expense, cost and attorney’s fees, shall be prima facie evidence of the fact and amount of INDEMNITORS’ liability to the SURETY under this Agreement. Any demand upon the SURETY by the Obligee shall be sufficient to conclude that a liability exists and the INDEMNITORS shall then place the SURETY with sufficient funds in a form and amount deemed acceptable in the SURETY’S sole discretion, as collateral security to cover the liability.

3. OTHER INDEMNITY -- The INDEMNITORS shall continue to remain bound under the terms of this Agreement even though the SURETY may have heretofore or hereafter, with or without notice to or knowledge of the INDEMNITORS, accepted or released other agreements of indemnity or collateral in connection with the execution or procurement of said Bonds, from the INDEMNITORS or others. The rights, powers and remedies given the SURETY under this Agreement shall be and are in addition to and not in lieu of, any and all other rights, powers and remedies which the SURETY may have

January 2016
or acquire against the INDEMNITORS or others, whether by the terms of any agreement or by operation of law or otherwise.

4. INVALIDITY- In case any of the INDEMNITORS fail to execute this Agreement, or in case the execution hereof by any of the INDEMNITORS be defective or invalid for any reason, such failure, defect or invalidity shall not in any manner affect the validity of this Agreement or the liability hereunder of any of the INDEMNITORS executing the same, but each and every INDEMNITOR so executing shall be and remain full bound and liable hereunder to the same extent as if such failure, defect or invalidity had not existed.

5. SURETIES - All of the terms, provisions and conditions of this Agreement shall be extended to and for the benefit not only of the SURETY, either as a direct writing company or as a co-surety or reinsurer, but also for the benefit of any surety or insurance company or companies with which the SURETY may participate as a co-surety or reinsurer and also for the benefit of any other company which may execute any bond or bonds at the request of the SURETY on behalf of any of the Principals.

6. DECLINE EXECUTION - Unless otherwise specifically agreed in writing, the SURETY may decline to execute any bond and the INDEMNITORS shall make no claim to the contrary.

7. CHANGES, WAIVER OF NOTICE - The INDEMNITORS hereby waive notice of changes to the Bonds or the obligations covered by the Bonds , and agrees that any such changes will not affect INDEMNITORS’ obligations under the terms of this Agreement. Such changes may include but are not limited to continuations, extensions or renewals of the Bonds, the execution of any substitute or substitutes therefore, with the same or different conditions, provisions and obligees with the same or larger or smaller penalties; it being expressly understood and agreed that the INDEMNITOR shall remain bound under the terms of this Agreement even though any such change does or might substantially increase the liability of the INDEMNITORS. The INDEMNITORS waive notice of the execution of Bonds, acceptance of this Agreement, default or other acts giving rise to a bond claim or liability of the SURETY under Bonds.

8. TERMINATION - This Agreement may be terminated by any of the INDEMNITORS upon twenty days’ written notice sent by registered mail to the SURETY at its home office at Chubb Surety, WA10G, 436 Walnut Street, Philadelphia, Pennsylvania 19106-3703, but any such notice of termination shall not operate to modify, bar or discharge the INDEMNITOR as to the Bonds that may have been executed before the date on which such termination notice becomes effective.

9. SEVERABILITY - If any provision or provisions of this Agreement be declared void or unenforceable under any law governing its construction or enforcement, this Agreement shall not be void or vitiated thereby, but shall be construed and enforced with the same effect as though such provision or provisions were omitted.

10. SPECIFIC PERFORMANCE – The INDEMNITORS hereby represent and acknowledge that if any INDEMNITOR breaches its obligations set forth in paragraphs 1 or 2 of this Agreement, the SURETY will have no adequate remedy at law, will suffer irreparable harm, and shall be entitled to injunctive relief enforcing the terms of such paragraph, as well as a final decree, order or judgment granting SURETY specific performance of the terms of such paragraph.

11. CHOICE OF LAW/FORUM - It is mutually agreed that this Agreement is deemed made in the State of New York, regardless of the order in which the signatures of the parties shall have been affixed and shall be interpreted, and the rights and liabilities of the parties determined in accordance with the laws of the State of New York. INDEMNITORS agree that all actions or proceedings arising directly or indirectly from this Agreement shall be litigated only in courts having status within the State of New York, and consents to the personal jurisdiction and venue of any local, state or Federal Court located therein.

12. JOINT/SEVERAL - Each undersigned INDEMNITOR, its successors and assigns, is jointly and severally bound by the foregoing conditions of this Agreement.

January 2016

13. PAY ON DEMAND BONDS – INDEMNITORS may request that SURETY, from time to time, execute Bonds which may require the SURETY to make payment to the Obligees of such Bonds upon such Obligees’ demand (“Pay on Demand Bonds”). INDEMNITORS undertake and warrant that they will deposit cash with the SURETY in such amount and form as demanded by the SURETY within 5 business days following receipt of a written demand from the SURETY stating that it has received a claim on one or more such Pay On Demand Bonds.

14. FACSIMILE – This Agreement bearing the signature of the INDEMNITORS shall be valid, effective and enforceable whether received by the Surety as an original, digital or scanned image, or as a facsimile transmission.

IN WITNESS WHEREOF, INDEMNITOR has signed this Agreement this _______ day of , 20____.

(Full Name & Address of Indemnitor)
Address:

Tax ID:

Attest: By:

CORPORATE ACKNOWLEDGMENT
State of _______________________
County of _________________________ ss:

On this _________________________ day of ___________________________________, 20 ______________,before me personally came to me known, who being by me duly sworn, deposed and says that he/she is the _____________________of ________________________, the corporation described in and which executed the foregoing Agreement; that he/she knows the seal of the said corporation; that the seal affixed to the said Agreement is such corporate seal; that it was so affixed by the order of the Board of Directors of said corporation, and that he/she signed his/ her name thereto by like order.
___________________________________________
(Signature of Notary Public)
My commission expires _______________________
City Council Staff Report
DATE: APRIL 5, 2023
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY MANAGER’S OFFICE – CITY CLERK DIVISION
DISTRICT: ALL
SUBJECT: CITY COUNCIL NOMINATION AND APPOINTMENT OF SEVEN (7) MEMBERS AND ONE (1) ALTERNATE TO THE HUMAN RIGHTS

ADVISORY COMMITTEE
ISSUE
City Council Nomination and Appointment of seven (7) Members and one (1) Alternate to the Human Rights Advisory Committee.

RECOMMENDATION
Staff recommends that the City Council nominate and appoint seven (7) individuals to serve as Committee Members and one (1) individual to serve as the Alternate on the Human Rights Advisory Committee for a term to expire on April 30,2025.

DISTRICT 1 DISTRICT 2 DISTRICT 3 DISTRICT 4 DISTRICT 5 OUT OF

BOUNDARIES
Councilmember
Bishop
Councilmember
Loa
Mayor
Bettencourt
Councilmember
Ohlsen
Mayor Pro Tem
Alarcón
Covel Jenkins Xavier Flores Marcos Alvarez Margaret Hicks Elizabeth Henriquez Donovan “Sky” Jung Jovan Hicks Rudolpho Perez II Tanya Rincon Belen Sigala Hestia Sartika

BACKGROUND
At the September 2, 2020, City Council meeting, the City Council approved Ordinance No. 1550, adding Chapter 2.55 to the Palmdale Municipal Code creating the Palmdale Human Rights Advisory Committee (“Committee”). Under Ordinance No. 1550, the Committee was created by the City Council to act in an advisory capacity to the Mayor, City Council and City Manager. The Committee would provide advice and actionable recommendations to the Mayor, City Council and City Manager in their efforts to build and maintain a n inclusive community by cultivating awareness, increasing diversity, encouraging sensitivity, promoting equity, and improving relations with various segments of the community. Residency in the City of Palmdale is not required.

Report to Mayor and City Council
Re: City Council Nomination and Appointment of Seven (7) Members and One (1) Alternate to the Human Rights Advisory Committee
April 5, 2023

DISCUSSION
The terms for the current Human Rights Advisory Committee Members expire April 2023. City Council directed staff to open a recruitment for the Human Rights Advisory Committee. A recruitment advertisement was placed in the AV Press for interested citizens to apply. The Communications Division also provided a press release to the public, including the application submittal deadline, and posted the advertisement on the city’s Social Media pages. The Classified Ad and the application were made available on the Board & Commission webpage and the HRAC webpage, as well as in the Office of the City Clerk. Staff received twelve (12) applications by the March 9, 2023, 6:00 p.m. deadline.

Appointments to the Human Rights Advisory Committee are made according to

2.08.030(C) & (D), All such applications shall be provided to the City Council for review, who shall, at a regularly scheduled City Council meeting, nominate, from among such applicants, the persons whom the City Councilmembers desire to appoint by making a motion for each such appointment. If the nomination is approved by a majority vote of the City Council, the nominating City Councilmember may then proceed to appoint the person to the board or commission under consideration.

This item is brought forth for City Council Nomination and Appointment of seven (7) Members and one (1) Alternate to the Human Rights Advisory Committee for terms to expire April 2025.

A Livescan fingerprint submission via the California Department of Justice is required for the appointment to be complete. The State of California requires a Statement of Economic Interest Form 700 be filed within 30-days of the appointment.

FISCAL IMPACT
Approximately $4,166 in advertising cost. Committee Member compensation of $150 per meeting, a maximum of $300 per month for the Chair, and $100 per meeting, a maximum of $200 per month for all other Members. The Committee meets bi-monthly.

Report to Mayor and City Council
Re: City Council Nomination and Appointment of Seven (7) Members and One (1) Alternate to the Human Rights Advisory Committee
April 5, 2023

STRATEGIC PLAN
Goal II: Ensure long-term fiscal health of the City and maintain funding for services.

C. Involve and expand engagement to enhance public oversight and transparency.

Prepared by: Rochelle Scott, Acting City Clerk
Certified as to availability of Funds: Janelle Samson, Director of Finance Approved by: Ronda Perez, City Manager
Approved as to form: William P. Curley, III Interim City Attorney

ATTACHMENTS
Redacted Applications
1 From:
[email protected]
Sent:

Monday, February 20, 2023 5:20 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
Follow Up Flag:

Follow up
Flag Status:

Flagged
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Covel Jenkins

Date

2/20/2023

Business Telephone

Home Telephone

Cell Phone

2 Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

Present Address

City

Palmdale

State

Ca

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Field not completed.

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

No

Are you
currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

3 Do you or any members of
your imm
ediate family own
any interest in any real
property adjacent to or
within the City of Palmdale?

No

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest?

No

List all current organizat
ions
and societies of which you
are a member.

None

Please describe any public
service experience serving
on a commission or public
body?

None

How do you feel you would
add value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications, perceptions,
and experiences would you
bring to the Committee?

I am a veteran and have been living in Palmdale my whole life.

My views
are always trying to better Palmdale. This position is
perfect for me I'm very outspoken individuals and I'm 29 and can relate to our growing youth in Palmdale. There views are my views. I will help with relevant conversations

What are your long
-
term
goal
s as a Human Right
Advisory Committee
member?

I don't know yet

What additional
information would you like
us to know to better assess
your suitability for the
Human Rights Advisory
Committee?

I am a proud African American who wants to help all

(Section B
reak)

Education, Training and Experience

4 High School

Name

Covel Jenkins

Address

Number of Years
Completed

4 Did you Graduate?

Yes

Degree or Diploma

Covel Jenkins

GPA (i.e., A=4.0)

3.0 College/University

Name

Covel Jenkins

Address

Field not completed.

Number of Years
Completed

Covel Jenkins

Did you graduate?

Field not completed.

Degree or Diploma

Covel Jenkins

GPA (i.e., A=4.0)

Field not completed.

Vocational

Name

Covel Jenkins

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Field not completed.

Degree or Diploma

Covel Jenkins

GPA (i.e., A=4.0)

Covel Jenkins

Other

Covel Jenkins

5 (Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Covel Jenkins

Address

Field not completed.

Type of Business

Covel Jenkins

Telephone Number

6617898693

Your Supervisor's Name

Covel Jenkins

Your Position and Duties

19d calvary scout

Major Accomplishments

Nom commissioned officer school

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Ready to go

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Covel Jenkins

Address

Field not completed.

Type of Business

Covel Jenkins

Telephone Number

6617898693

Your Supervisor's Name

Covel Jenkins

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

6 Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Covel Jenkins

Address

Field not completed.

Type of Business

Covel Jenkins

Telephone Number

6617898693

Your Supervisor's Name

Covel Jenkins

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Covel Jenkins

Address

Field not completed.

7 City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Oc
cupation

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Covel Jenkins

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Covel Jenkins

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

8 Please read carefully, initial each paragraph and sign below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect m
y chances for appointment. I understand that any
misstatement or omission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the tim
e elapsed before discovery of the
misstatement or omission. I further certify that I, the applicant, have personally completed this application.

Initials

Covel Jenkins

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize the references I have listed, all prior employers, and all edu
cational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all

other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, to the fullest extent permitted by law, f
rom any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, employees, and representatives, to the fullest extent permitted by law, from any and all claims, dem
ands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and representatives.

Initials

Covel Jenkins

I further understand and agree that as a conditi
on to being appointed to the Human
Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices and policies as set forth in the Human Resources Rules, the Brown Act, and the Public Records Acts,
copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I expressly consent to, and I waive any rights of privacy I might otherwise h ave in
9 connection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

Covel Jenkins

I understand that as part of the final selection process, I will be required to pass a livescan fingerprint scan

submission via the California Department of Justice. I
understand that information collected during this background check will be limited to that appropriate to determining my suitability for this Human Rights Advisory Committee position and that such inf
ormation collected during the check will be
kept confidential.

Initials

Covel Jenkins

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

Field not completed.

Foreign Language

Covel Jenkins

Do you?

Field not completed.

Foreign Language

Covel Jenkins

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

Computer Skills

Field not completed.

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

10 Home Phone

Work Phone

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

No

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the Ci
ty of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

2/20/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Covel Jenkins

Applicants are encouraged
to attach a resume.

Field not completed.

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View it in your browser.

1 From:
[email protected]
Sent:

Friday, March 3, 2023 5:54 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Xavier Gonzalez Flores

Date

Business Telephone

Field not completed.

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

Palmdale

State

CA

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Field not completed.

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

Yes

Please
Explain

I was a Parks and Rec commissioner for the city of San
Fernando for more than 14 years

Are you currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

3 Do you or any members of
your immediate family own
any interest in any real
property adjacent
to or
within the City of Palmdale?

Yes

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest?

No

List all current organizations
and societies of which you
are a member.

1. Antelope Valley League of United Latin American Citizens

2. The Palmdale Prevention Community Coalition

Please describe any public
service experience serving
on a commission or pub
lic
body?

As a Parks and Rec commissioner, we gave direction to staff and input to the San Fernando city council in the form of recommendations for improving services to residents.

How do you feel you would
add value to the Human
Rights Advisory Committe
e?
What unique
characteristics,
qualifications, perceptions,
and experiences would you
bring to the Committee?

Through the course of my employment and my civic engaged for the past fifty (50) years, I have dealt with human relations issues and concerns and

have strove to improve conditions
and ameliorate root causes that prevent us from understanding one another and prevent us from moving forward as one
people. Issues like barrio warfare to racial inequality in employment and education to the need for polit
ical
representations ands economic viability are examples.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

Strides have been made and human relations have improved over the past 50 years, but there remains a way to go. I have ide
as on how we can improve human relations in Palmdale and make the city more equal and equitable. There is a need to improve the lot of the most downtrodden, the immigrant
community, of which there are 40,000 in the city. Bringing them out of the shadows an
d into the social fabric of our society can
be done without hurting anyone and ultimately benefiting all. .

What additional
information would you like
us to know to better assess
your suitability for the
Human Rights Advisory
Committee?

I have vast exper
ience in the area of human relations and
believe I would be an asset to the city if given the opportunity and support. We can make Palmdale an exemplary city by
making it it one of the healthiest and safest cities in California and the Nation. There is no
reason why the city cannot be
labelled a Blue Zone by the World Health Organization and this is what I would like to accomplish.

(Section Break)

4 Education, Training and Experience

High School

Name

Channel Islands High

Address

Oxnard CA

Number of Years
Completed

2 Did you Graduate?

No

Degree or Diploma

none

GPA (i.e., A=4.0)

?

College/University

Name

CSUN

Address

Northridge CA

Number of Years
Completed

4 Did you graduate?

No

Degree or Diploma

none

GPA (i.e., A=4.0)

?

Vocational

Name

Ventura Community College

Address

Camarillo State Hospital

Number of Years
Completed

3 Did you graduate?

Yes

5 Degree or Diploma

Psych Tech

GPA (i.e., A=4.0)

4.0 Other

d for changes in the way cties give out alcohol CUPs. I co -
founded a non
-
profit in 1992 which continues to this day and is
responsible for paradigm shifts in political empowerment for Latinos in the NESan Fernando Valley and the way cities handle alcohol C
UP applications.

(Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Pueblo y Salud, Inc.

Ad
dress

1024 No. Macaly Ave., Ste. M
-
13, San Fernando, CA 91340

Type of Business

non
-
profit social human service agency

Telephone Number

818
-
837
-
2272

Your Supervisor's Name

Ruben Rodriguez

Your Position and Duties

I was executive director of the agency for the first 16 years and after a 3 year sabbatical, was Project

director for 12 years.

Major Accomplishments

Improved the health and safety of residents of Pacoima by reducing the number of alcohol outlets by 50%. Registered 60,000 citizens in the San Fernando Valley which created a political voice for the rseidents of Pacoima and San Fernando.

Dates of Employme
nt

From

6/1/1992

To

7/1/2022

Reason for Leaving

Retired.

Upon leaving, were you
eligible for rehire?

Yes

(Section Break)

6 Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

7 (Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Bishop Henry Hearns

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not complete
d.

Occupation

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Lilia Galindo

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Sam Roman

8 Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Prominent businessman and member of the AV Chamber of
Commerce

Telephone Number

Number of Years
Acquainted

Field not completed.

(Section Break)

Please read carefully, initial each paragraph and sign
below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect my chances for appointment. I understand that any misstatement or o
mission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery of the misstatement or omission. I furt
her certify that I, the applicant, have personally
completed this application.

Initials

XF

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for a
ppointment and further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but no t
limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers,
and educational institutions attended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, empl
oyees, and representatives, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities that may result from any use or

9 disclosure of such information by the City of Palmdale, or any of its agents, employees, and represe
ntatives.

Initials

XF

I further understand and agree that as a condition to being appointed to the Human Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices and policies as set forth in the Human

Resources Rules, the Brown Act, and the Public Records Acts, copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I expressly consent to, and I

waive any rights of privacy I might otherwise have in
connection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

XF

I understand that as part of the final selection process, I will be require d to pass a
livescan fingerprint scan submission via the California Department of Justice. I understand that information collected during this background check will be limited to that appropriate to determining my suitability for this Human Rights Advisory

Committee position and that such information collected during the check will be kept confidential.

Initials

XF

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

No

Foreign Language

Spanish

Do you?

Speak, Read , Write

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

10 Computer Skills

Field not completed.

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

no

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages

for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the City of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

2/28/2023

Electronic Signature
Agreement

Field not completed.

Electronic Signature

Xavier Flores

Applicants are encouraged
to attach a resume.

Field not completed.

11 Email not displaying correctly?
View it in your browser.

1 From:
[email protected]
Sent:

Thursday, March 9, 2023 5:01 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Jovan C. Hicks

Date

3/9/2023

Business Telephone

-
-

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

Palmdale

State

CA

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Jovan C. Hicks_Executive Summary.pdf

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

No

Are you currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

Do you or any members of
your immediate family own
any interest in any real
No

3 property adjacent

to or
within the City of Palmdale?

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest?

No

List all current organizations
and societies of which you
are a member.

Alpha Kappa Alpha Sorority, Incorporated

EveryoneOn, Executive Chair of the Board

Please describe any public
service experience serving
on a commission or public
body?

Although I do not currently serve on a commission or public body, I work very closely
with the California Public Utility
Commission, as well as digital equity advocacy groups to ensure all people in under
-
resourced communities have access
to affordable internet services, devices, and digital skills trainings.

How do you feel you would
add

value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications, perceptions,
and experiences would you
bring to the Committee?

At the center of everything I do is my commitment to recognize and honor the inherent dignity of each

human being, and value
the rich diversity of our communities. Throughout my career this guiding principle has opened the door for me to
meaningfully engage and stand in genuine solidarity with all people
–

particularly the most vulnerable
–

and contribute

to
the common good. It is my desire to continue my efforts by serving on the Palmdale Human Rights Advisory Committee, and advocate for residents of the city in which I live and love. I bring a wide range of professional experiences that would add value t
o the committee, to include, a middle school math and
science teacher in two of the most under
-
resourced
communities in California
-

South Central Los Angeles, and
West Oakland; a small business advisor to minority
-
owned
businesses; government affairs profe
ssional and DEI champion
for the world’s largest telecommunications company; the first woman and Black person to serve as Executive Chair of the Board of EveryoneOn, a National digital equity nonprofit organization; and the curator of DEI curriculum for th
e
University of California Santa Cruz Extension, which addresses highly complex social issues within a variety of industries while closing skills gaps and reducing DEI disparities.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

Technology is the thread that keeps us all connected. It touches every corner of our society
-

from education, housing,
employment, government, and race relations to social equity.

Never was that made more evident than when the world faced mandated isolati
on protocols due to the pandemic. Students,
working people, and families struggled to get and stay
4 connected. This is why I believe digital equity is a human rights issue and should be an integral part of the framework when building and maintaining an incl
usive community. One of my
long
-
term goals is to create more awareness around the
barriers to connectivity our community faces, and work to inform our digital inclusion policies, advocacy efforts, and funding to support connectivity for all our residents.

With the
passing of the unprecedented Infrastructure Investment and Jobs Act and Affordability Connectivity Program it presents an opportunity to create a more inclusive and equitable approach to digital equity.

What additional
information would you like

us to know to better assess
your suitability for the
Human Rights Advisory
Committee?

I am committed to strengthening inclusive strategies that better position the city of Palmdale to be the example of what is truly possible when you build a robust and su
stainable plan of action
based on a culture of diversity, inclusion, representation, and equality for all. I embrace the interdependence of diverse communities, and value the bonds of our mutuality. As Dr.

Martin Luther King Jr. stated, “Whatever affects o
ne directly
affects all indirectly.”

(Section Break)

Education, Training and Experience

High School

Name

Archbishop Mitty High School

Address

5000 Mitty Way, San Jose, CA 95129

Number of Years
Completed

4 Did you Graduate?

Yes

Degree or Diploma

Diploma

GPA (i.e., A=4.0)

~3.0

College/University

Name

Howard University & Mills College

5 Address

2400 6th Street NW, Washington, DC 20059/ 5000 MacArthur Blvd, Oakland, CA

Number of Years
Completed

4 Did you graduate?

Yes

Degree or Diploma

B.A./MBA/M.Ed.L

GPA (i.e., A=4.0)

~3.8

Vocational

Name

Field not completed.

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Field not completed.

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Other

Field not completed.

(Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

AT&T

Address

430 Bush S
treet, San Francisco, CA 94108

Type of Business

Telecommunications

Telephone Number

972
-
533
-
6081

Your Supervisor's Name

Karl Wardin

6 Your Position and Duties

Associate Director, Regulatory Relations
-

External &
Legislative Affairs

Responsible for sever
al key functions within the National
External Affairs/Regulatory organization including community relations, Public Utility Commission docket management, and a variety of regulatory and community affairs initiatives. I also serve on AT&T's DEI Talent and P
ipeline Committee, which
seeks to create a culture of intentional inclusion,
representation, and equity by strengthening and implementing inclusive hiring and retention strategies within the company.

Major Accomplishments

Nominated and selected to serve
on AT&T's DEI Talent and
Pipeline Committee; Successfully led the outreach efforts and strategic development for AT&T's low
-
cost broadband program,
Access from AT&T, which resulted in exceeding the projected adoption rates year
-
over
-
year.

Dates of Employment

From

1/24/2014

To

Field not completed.

Reason for Leaving

Current position

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

EveryoneOn

Address

718 7th Street NW, Second Floor, Washington, DC 20001

Type of Business

Nonprofit Organization

Telephone Number

3233630015

Your Supervisor's Name

Norma Fernandez

Your Position and Duties

Executive Chair of the Board of Directors

Serve as an advisor to the CEO. Lead the Board in a
collaborative effort toward creating social and economic opportunities for low
-
income families. Connect households to
affordable internet service, personal comput
ers, and digital
skills trainings. Serve on the Budget and Strategic Planning committees.

7 Major Accomplishments

Through a collective effort, EveryoneOn has connected over 1,000,000 people to the internet, provided over 6000
computers to low
-
income indivi
duals, and delivered digital skills
trainings to thousands of participants in the past two years.

Dates of Employment

From

1/1/2020

To

Field not completed.

Reason for Leaving

Current position

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

University of California Santa Cruz Extension

Address

175 Bowers Ave, Santa Clara, CA 95054

Type of Business

Education

Telephone Number

310
-
628
-
2056

Yo
ur Supervisor's Name

Shindale Seale

Your Position and Duties

Instructor, Diversity, Equity and Inclusion

Developed and implemented curriculum to address highly
complex social issues among professionals and within a variety of industries, while closing skills gaps and reducing diversity, equity, and inclusion disparities.

Major Accomplishments

Developed learn
ing modules that address DEI and social
justice issues.

Dates of Employment

From

6/1/2021

To

7/1/2022

Reason for Leaving

Due to the affects of the pandemic, the school experienced low student enrollment, which impacted my ability to meet the minimum requirement to continue the class.

Upon leaving, were you
eligible for rehire?

Yes

8 (Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Norma Fernandez

Address

Field not completed.

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

6 (Section Break)

Name

Kate Ijams

Address

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

6 (Section Break)

Name

Preston Arnold

Address

9 City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

20 (Section Break)

Please read carefully, initial each paragraph and sign
below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not wit hheld any information
that might adversely affect my chances for appointment. I understand that any misstatement or omission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate

discharge if I am appointed, regardless of the time elapsed before discovery of the misstatement or omission. I further certify that I, the applicant, have personally completed this application.

Initials

JH

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize the references I have listed, all prior employers, and all edu
cational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all

other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, to the fullest extent permitted by law, f
rom any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, employees, and representatives, to the fullest extent permitted by law, from any and all claims, dem
ands, fees, and liabilities that may result from any use or

10 disclosure of such information by the City of Palmdale, or any of its agents, employees, and representatives.

Initials

JH

I further understand and agree that as a condition to being

appointed to the Human
Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices and policies as set forth in the Human Resources Rules, the Brown Act, and the Public Records Act s,
copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I expressly consent to, and I waive any rights of privacy I might otherwise have in conn
ection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

JH

I understand that as part of the final selection process, I will be required to pass a livescan fingerprint scan submission via the Ca
lifornia Department of Justice. I
understand that information collected during this background check will be limited to that appropriate to determining my suitability for this Human Rights Advisory Committee position and that such information collected dur ing the check will be
kept confidential.

Initials

JH

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

No

Foreign Language

Field not completed.

Do you?

Field not completed.

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

11 Computer Skills

Word, Excel, Adobe Creator, PowerPoint

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the Ci
ty of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

3/9/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Jovan C. Hicks

Applicants are encouraged
to attach a resume.

Jovan C. Hicks Resume
-

03.09.23.pdf

12 Email not displaying correctly?
View it in your browser.

JOVAN
C.

HICKS

Associate Director
–

External and Legislative Affairs, AT&
T

EXECUTIVE SUMMARY

A
passionate

leader
who
roots

for the
underdog, Jovan

Hicks
has over
20 years of
combined
experience in
business development,
d
iversity,
equity,

and
i
nclusion

(DEI) instruction,
and client relationship management
in the telecommunications
and
technology industries.

Jovan’s background
also includes
notable highlights in
non
-
profit
governance,
and
as
a
n informed
panelist

at
education and
digital
equity

focused
speaking
engagements.

When Jovan is not
working, you
can

find her
on a golf course
chasing
a
birdie.

CONTACT

PHONE:

-
-

WEBSITE:

EMAIL:

EDUCATION

Howard University
-

Bachelor of Fine Arts

Mills College
-

Master of Business Administration
/
Master of Education
Leadership

Goldman Sachs Business Leadership Scholar, The Committee of 200 Scholar, Education Pioneers Fellow.

WORK EXPERIENCE

AT&T

-
Associate Director, External and Legislative Affairs

2014
–
Present

Proactive evaluation of

regu
lat
ory
issues affecting the compan
y and our
customers.

Selected to serve

on the
E&LA Diversity, Equity, and Inclusion
Task Force
,
as well as the

Talent Pipeline Subcommittee
.

EveryoneOn

-
Executive Chair of the Board of Directors

2020
–
Present

Advisor

to the CEO,
while
collaborating with

the board
on
issues
related to
the mission, vision, and
strategic initiatives of the organization.

University of California Santa Cruz
-
Instructor

of

Diversity, Equity & Inclusion

2021
–
2022

Develop and implement curriculum to address

highly complex social issues
,
close
skills gaps
,

and reduc
e

diversity, equity, and inclusion dispariti
es.

SPEAKING ENGAGEMENTS

ConnectHome USA

Summit
,
Panelist

20 22

Broadband 101:

Connectivity Solutions for ConnectHome USA and HUD
-
Assisted
Communities

The White House,
Panelist

2020

White House Initiative on Educational Excellence for African Americans (WHIEEAA), AfAmEd Connector

Virtual Roundtable:

Connecting the Dots
for Communities of Color with Academics, Broadband, and

Culture

National PTA Legislative Conference,
Speaker

2019

Low
-
cost Broadband Opportunities: Access from AT&T

1 From:
[email protected]
Sent:

Wednesday, March 1, 2023 8:09 AM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Marcos T Alvarez

Date

3/1/2023

Business Telephone

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

Palmdale

State

Zip Code

Permanent Address if
different from present
address

City

Palmdale

State

Zip Code

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Field not completed.

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

Yes

Please Explain

Current District 3 Planning Commissioner

Are you currently serving
as
an elected city or county
official?

Yes

Please Explain

SEIU 721 La county union shop steward for Department of Social Services.

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

3 Do you or any members of
your immediate family own
any interest in any real
property adjacent
to or
within the City of Palmdale?

No

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest?

No

List all current organizations
and societies of which you
are a member.

AV LULAC

Please describe any public
service experienc
e serving
on a commission or public
body?

Current planning commissioner for Dist 3 helping decide on CUP applications and development

How do you feel you would
add value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications,
perceptions,
and experiences would you
bring to the Committee?

Looking for equitable distribution and inclusiveness according to ordinances and current local regulations and LA County and California regualtions. Social equity for all citizens of Palmdale.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

To represent all people of Palmdale and give them equal representation under the law.

What additional
information would you like
us to know to better assess
your suitability for th
e
Human Rights Advisory
Committee?

I have a passion for human rights, I am bilingual. I am a visionary and look to continue to bring Palmdale to a better future for all residents.

(Section Break)

Education, Training and Experience

4 High School

Name

Garfield High School

Address

Number of Years
Completed

4 Did you Graduate?

Yes

Degree or Diploma

yes

GPA (i.e., A=4.0)

3.2 College/University

Name

University of Phoenix

Address

Field not completed.

Number of Years
Completed

3 Did you graduate?

Yes

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Vocational

Name

Field not completed.

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Field not completed.

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Other

Field not completed.

5 (Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

LA COUNTY Department of Social Services

Address

Field not completed.

Type of Business

Public servant Cal Works, Cal Fresh, Medical

Telephone Number

661 723 4013

Your Supervisor's Name

Iman Tryson

Your Position and Duties

Determine elegibility for public programs.

Major Accomplishments

Helped workers wrights and responsiblities and enabled 9/80 Regular days off

Dates of Employment

From

7/2/1992

To

Field not completed.

Reason for Leaving

Pres
ent

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

6 Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Juan Carillo

Address

Field not completed.

7 City

State

Field not completed.

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

4 (Section Break)

Name

Xavier Flores

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

4 (Section Break)

Name

Luis Salazar

Address

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

40 (Section Break)

8 Please read carefully, initial each paragraph and sign below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect my chances for appointment. I understand that any misstatement or o
mission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery of the misstatement or omission. I furt
her certify that I, the applicant, have personally
completed this application.

Initials

MTA

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but n ot
limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers,

and educational institutions attended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, emp
loyees, and representatives, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and repres
entatives.

Initials

MTA

I further understand and agree that as a condition to being appointed to the Human Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices

and policies as set forth
in the Human Resources Rules, the Brown Act, and the Public Records Acts, copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitte d by law, I
expressly consent to, and I waive any rights of privacy I might otherwise have in 9 connection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

MTA

I understand that as part of the final selection process, I will be required to pass a livescan fingerprint scan submission via the California Department of Justice. I understand that information collected during this background check will be limited to th
at appropriate to determining my suitability for this Human Rights Advisory Committee position and that such information collected during the check will be kept confidential.

Initials

MTA

(Section Break)

Applicant Information

REASONABLE

ACCOMMODAT
IONS

No

Foreign Language

Spanish

Do you?

Speak, Read , Write

Foreign Language

Spanish

Do you?

Speak, Read, Write

Specialized training/skills:

Union Organizer

Computer Skills

Word, Photoshop, Excel, PowerPoint

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

10 Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

no

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages

for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the City of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

3/1/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Marcos T. Alvarez

Applicants are encouraged
to attach a resume.

Field not completed.

Email not displaying correctly?
View it in your browser.

1 From:
[email protected]
Sent:

Wednesday, March 8, 2023 10:14 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Margaret Hicks

Date

3/8/2023

Business Telephone

Field not completed.

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

PALMDALE

State

CA

Zip Code

Permanent Address if
different from present
address

City

Palmdale

State

CA

Zip Code

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Resume 2021 (3).pdf

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency,

title of
position, and duties.

Yes

Please Explain

I was a CA MTSS Advisory member for the California
Department of Education, my self and other stakeholders were apart of the pilot program to help improve school climate and reduce suspensions for student
s of Color. I presented at the
CA MTSS Conference on "Discipline not Punishment for
Students of Color".

Are you currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise
which does or
might do business with the
Yes

3 City and/or the
Board/Commission?

Do you or any members of
your immediate family own
any interest in any real
property adjacent to or
within the City of Palmdale?

Yes

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of intere
st?

No

List all current organizations
and societies of which you
are a member.

California Teachers Association
-
Human Rights Cadre Trainer

Palmdale Elementary Teachers' Association

Schools for Girls of Color Learning Network

California Campaign to Counter Childhood Adversity 4CA

CA TeachPlus Fellow Alumni

Please describe any public
service experience serving
on a commission or public
body?

I was an advisory member for California
Multiple Tiers of
Support Advisory Committee, the purpose of the advisory committee was to serve as a sounding board for the state pilot and its implementation. The mission was to improve school climate and reduce student suspensions that disproportionalit y
impact low income students of Color. We met online and in person to help develop a framework and used a shared
approach to develop the components of the pilot program.

How do you feel you would
add value to the Human
Rights Advisory Committee?
What uniq
ue
characteristics,
qualifications, perceptions,
and experiences would you
bring to the Committee?

I currently serve as a Human Rights Cadre Trainer for the California Teachers Association. My subject area covers Transformative Social Emotional Learning, w
hich is a term
used to describe SEL that uses an equity and social justice lens to implement SEL for community members including
children and adults. It covers belonging, agency, identity, empowerment and self determination. I would use a
Transformative SE
L lens as a member to help elevate all
voices in our community.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

I hope to create an updated action plan that focuses on engaging community stakeholders, researching and creating opp
ortunities for the community members to learn how to build bridges, focus on equity and connect across various
intersections. We should also include in our action plan a recommendation for programs, policies and activities that reduce discrimination and in
crease a sense of belonging, and
promote civil and human rights for all. I would also advocate for more educational and informational material to be
disseminated related to discrimination, microaggressions, 4 inequity, etc. and ways community members can pos
itively
address issues when they occur. I would also like the city to partner with organizations such as Operation Respect that offer free resources that can be shared in our community. For example, Operation Respect shares ways we can celebrate diversity
in a manner where we identify differences and
similarities in a non judgmental way and become more
sensitive in how we respond to community members who may have different backgrounds than our own.

What additional
information would you like
us to know to
better assess
your suitability for the
Human Rights Advisory
Committee?

I have lived in Palmdale for over 25 years and I've witness our community diversify over the years. I want to be apart of a program where I'm of service and help the City of Palmdale c
ontinue to be an example for other communities in our area and state.

(Section Break)

Education, Training and Experience

High School

Name

Queen of Angels Academy

Address

823 East Compton Blvd

Number of Years
Completed

3 Did you Graduate?

Yes

Degree or Diploma

Diploma

GPA (i.e., A=4.0)

3.0 College/University

Name

California State Northridge

Address

18111 Nordhoff Street

Number of Years
Completed

2 5
Did you graduate?

Yes

Degree or Diploma

Bachelors

GPA (i.e., A=4.0)

2.75 Vocational

Name

Antelope Valley College

Address

3041 West Ave K

Number of Years
Completed

4 Did you graduate?

Yes

Degree or Diploma

Transfer

GPA (i.e., A=4.0)

3.00 Other

Masters in Educational Leadership from Cal State East Bay

(Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Palmdale School District

Address

39132 East 10st Street East

Type of Business

Public School

Telephone Number

6612851548

Your Supervisor's Name

Mr. Gatlin

Your Position and Duties

Teacher 5th/6th and Admin Intern. Responsible for the
instruction of students that have been referred to my site due to behavior referrals, expulsions and attendance issues.

Major Accomplishments

Site Teacher of the Year 2017
-
2018 and 2020
-
2021

6 Dates of
Employment

From

10/12/2010

To

3/8/2023

Reason for Leaving

Still employed

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

7 Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Fred Gatlin

Address

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

3 (Section Break)

Name

Lisa Adams

Address

City

State

Zip Code

8 Occupation

Telephone Number

Number of Years
Acquainted

3 (Section Break)

Name

Alfreda Moore

Address

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

5 (Section Break)

Please read carefully, initial each paragraph and sign
below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect my chances for appointment. I understand that any misstatement or o
mission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery of the misstatement or omission. I furt
her certify that I, the applicant, have personally
completed this application.

Initials

MH

9 I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for a
ppointment and further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but no t
limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers,
and educational institutions attended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, empl
oyees, and representatives, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and represe
ntatives.

Initials

MH

I further understand and agree that as a condition to being appointed to the Human Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices a nd policies as set forth
in the Human Resources Rules, the Brown Act, and the Public Records Acts, copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I
expressly consent to, and I waive any rights of privacy I might otherwise have in connection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

MH

I understand that as part of the final

selection process, I will be required to pass a
livescan fingerprint scan submission via the California Department of Justice. I understand that information collected during this background check will be limited to that appropriate to determining my suita
bility for this Human Rights Advisory
Committee position and that such information collected during the check will be kept confidential.

Initials

MH

(Section Break)

Applicant Information

10 REASONABLE

ACCOMMODATIONS

No

Foreign Language

Field not completed.

Do you?

Field not completed.

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

Computer Skills

Word, PowerPoint

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the Ci
ty of Palmdale and its elected and appointed officials, agents, and employees.

11 I hereby agree to the
Authorization and Release
set forth on this day

3/8/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Margaret Hicks

Applicants are encouraged
to attach a resume.

Resume 2021 (3)_1.pdf

Email not displaying correctly?
View it in your browser.

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Teacher Consultant withInverness Institute TeacherConsultant Response Networkcomprised of expert teachersacross California.

California TeachersAssociation Human RightsCadre Trainer

.
1 From:
[email protected]
Sent:

Tuesday, March 7, 2023 8:39 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Rudolpho Perez II

Date

3/7/2023

Business Telephone

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

State

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Perez R 2301.2 Resume.doc

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

Yes

Please Explain

Served as Committee member on the City of Palmdale Human Rights Advisory Committee from Ap
ril 2022 to present.

Are you currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

3 Do

you or any members of
your immediate family own
any interest in any real
property adjacent to or
within the City of Palmdale?

Yes

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest
?

No

List all current organizations
and societies of which you
are a member.

NASW

Please describe any public
service experience serving
on a commission or public
body?

Served as Committee member on the City of Palmdale Human Rights Advisory Committee from April 2022 to present.

How do you feel you would
add value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications, perceptions,
and experi
ences would you
bring to the Committee?

Having worked or volunteering in the field of social services for 20 years, has allowed me to develop and learn from diverse population that has shaped my understanding, empathy and dedication to increasing the aware
ness of human rights for all.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

I am dedicated to increasing the awareness, visibility and safety for all diverse or marginalized population.

What additional
information would you li
ke
us to know to better assess
your suitability for the
Human Rights Advisory
Committee?

I personally have an interest in representing the LGBTQIA community for the citizens living in and around the Antelope Valley specifically the City of Palmdale

(Sect
ion Break)

Education, Training and Experience

4 High School

Name

South Gate High

Address

3351 Firestone Blvd South Gate, CA 90280

Number of Years
Completed

4 Did you Graduate?

Yes

Degree or Diploma

Diploma

GPA (i.e., A=4.0)

3.0 College/University

Name

California State University, Los Angeles

Address

5151 State University Drive Los Angeles, CA 90032

Number of Years
Completed

6+

Did you graduate?

Yes

Degree or Diploma

BSW and MSW

GPA (i.e., A=4.0)

3.2 Vocational

Name

Los Angeles Training Institute for Alcohol & Drug Counseling

Address

1543 Palmdale Blvd G Palmdale, CA 93550

Number of Years
Completed

1 Did you graduate?

Yes

Degree or Diploma

Certificate

GPA (i.e., A=4.0)

Field not completed.

Other

Field not completed.

5 (Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Los Angeles LGBT Center

Address

1625 Schrader Blvd LA, CA 90028

Type of Business

Community Services

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

See resume

Major Accomplishments

Field not completed.

Dates of Employment

From

8/15/2022

To

3/7/2023

Reason for Leaving

NA

Upon leaving, were you
eligible for rehire?

Yes

(Section Break)

Name of Employer

Covenant House CA

Address

1325 Western Ave LA, CA 90027

Type of Business

Youth Homeless Shelter

Telephone Number

3234613131

Your Supervisor's Name

Field not completed.

Your Position and Duties

See resume

Major Accomplishments

Field not completed.

6 Dates of Employment

From

5/18/2015

To

3/7/2023

Reason for Leaving

NA

Upon leaving, were you
eligible for rehire?

Yes

(Section Break)

Name of Employer

Alba Wellness Group

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Patricia Alba

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

10/19/2020

To

3/7/2023

Reason for Leaving

NA

Upon leaving, were you
eligible for rehire?

Yes

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Patricia Alba

Address

Field not completed.

7 City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

2+

(Section Break)

Name

Josie Carbajal

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Telephone Number

Number of Years
Acquainted

5 (Section Break)

Name

Claudia Angel

Address

City

State

Zip Code

Occupation

Telephone Number

Number of Years
Acquainted

14 (Section Break)

8 Please read carefully, initial each paragraph and sign below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect my chances for appointment. I understand that any misstatement or o
mission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery of the misstatement or omission. I furt
her certify that I, the applicant, have personally
completed this application.

Initials

RP

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for a
ppointment and further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but no t
limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers,
and educational institutions attended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, empl
oyees, and representatives, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and represe
ntatives.

Initials

RP

I further understand and agree that as a condition to being appointed to the Human Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices a nd policies as set forth
in the Human Resources Rules, the Brown Act, and the Public Records Acts, copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I
expressly consent to, and I waive any rights of privacy I might otherwise have in 9 connection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

RP

I understand that as part of the final

selection process, I will be required to pass a
livescan fingerprint scan submission via the California Department of Justice. I understand that information collected during this background check will be limited to that appropriate to determining my suita
bility for this Human Rights Advisory
Committee position and that such information collected during the check will be kept confidential.

Initials

RP

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

No

Foreign Language

Spanish

Do you?

Read

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

Computer Skills

Word, Excel

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

10 Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

NA

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the Ci
ty of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

3/7/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Rudolpho Perez

Applicants are encouraged
to attach a resume.

Perez R 2301.2 Resume_1.doc

Email not displaying correctly?
View it in your browser.

Rudolpho Perez II,
LCSW#

Palmdale
, CA

1 Education
:

2020

RADT
-
1, California Consortium of Addiction Programs & Professionals

Los Angeles Training Institute for Alcohol & Drug Counseling, CA
(Pending)

2009

MSW, Masters of Social Work, Concentration in Forensics

California State University, Los A
ngeles
-

Los Angeles, CA

2006

BSW, Bachelors of Social Work and general studies.

California State University, Los Angeles
-

Los Angeles, CA

2000

Child Development and general studies

Cerritos Community College
–

Cerritos, CA

Community Involvement:

~

S
erv
ing

on
Human Rights Advisory
C
ommittee

for
the

City of Palmd
ale
, CA

20 22
-
2023
.

~ Motivati
onal Speaker for West

LA
PFLAG Speakers Bu
reau

2013
-
20 2

3. ~ Member of the
NASW

(National Associat
ion of Social
Workers)

varied

2009
-
20 2
2 .

~

Facilitate
&

Staff s
elf de
velop curriculum
via
Mom
entum Educa
tion
,
in LA
, CA

20 1
7 -
201
9 .

~ Vice President of Forensic Social Work Caucus (
CSULA
)

2008
-
2009.

L
os
A
ngeles

LG
BT Center
-

Hollywood, CA

08/22
-

Present

Mental Health Clinician III

•

Re
sponsible for
conducting

indiv
idual

and

couple

psychological

counseling services,
utilizing short term model in
treatment planning to the
greatest extent possible
;
referrals

primarily vi
a MediCal.

•

Managing telehealth scheduling
,

documenting

cl
ient

progress,
as well as
offering
general

information
for

crisis telephone calls

for

behavioral
and

functional
treatment plans
.

Alba

Wellness
Group
-

Pan
orama
City,

CA

1 0
/20
-

Present

Licensed Clinical T
herapist

•

A
t (f
ormally
known as
Al
ba
-
Walker Life Strategies
)
Re
sponsible for the
provision o
f psychological & behavioral services including assessmen t,
deve
lopmen
t
for

implementation of behavioral
or functional
treatment
plans
;
referrals

primarily via Kaiser Perm
anente
.

•

Consulted with interdisciplinary ser
vice provider
s as
needed

to assist
indiv
idu
als
/
families
in overcoming psychosocial
, emotional
&

medical
conditions.

A
cted
as patie
nt
’
s ad
vocate

&

coordinator

o
f care

services.

Covenant House California
-

Ho
llywood, CA

05/15
-

Pres
ent

Resident Advisor, Per Diem

•

Responsible for supervising
care

and security
for
multicultural

and
LGBT
QIA
young adult
living on site, to reduce negative behaviors,
maltreatmen
t to s
elf and/or others,
by applying general intervention
s for
conflict re
solution or b
oundary se
tting.

•

Interact with clients to allow for tru
st building and holding

safe space for
emotional expression to role
-
model or promote awareness of social
behavior
s.

Rudolpho Perez II,
LCSW#

Palmdale
, CA

2 L
os Angeles D
H
S

UCLA OVMC
(
via

Glob
al Resource Services
)
-

Sylmar
, CA

12/21
-

08/22

S
enior Clinical Social Worker

•

Provide
d clinical servi
ces

for patients

in
24hr

Emergency R
oom

at

UC
L
A
Olive View Medical Center
that include
s
intake
assessments and case
man
ag
ement

discharge

service

pla
nning

or

treatment

needs

for
:

mental
health
;

SUD
;

foodbanks
;

legal aid; financial as
s
istance
;
domestic viole
nce

and
insecur
e

housing/homelessness
.

•

Review
patient
charts
and
collaborate

with Medical Staff to
a
ct as
advocate to
evaluate
impediments to
medic
al
,
social

a
nd
phys
ical
conditi
ons

for
patient

progress
/well
-
being.

Pathways
College Com
munity S
ervices
-

M
ojave CA

03/20
-

01/21

Program D
irector

•

Facilitated all
S
taff

& Tea
m

meetings
;

on
-
site

& virtual

trainings &
individ
ual supervisions providing hands
-
on support to staff
.

•

Lead a team of
20 -
30 staff in the delivery &
coordination of

Adult & Child

mental h
ealth and SUD services through Supervision both administrative and clinical management;
with an effaces on consul
tation

for program
centered direction to
maintain

quality clinical services
.

•

Provided guidance in al
l crisis management at th
e clin
ic; in the
field
services; after
-
hour crisis

line; lead staff in comp
leting incident reports to
Coo
perate & County while also assi
sting in the creation of follow
-
up plans
around Safety Protocols & Qua
lity
Assurance for managi
ng clinic audits.

•

Develop
ed Pla
ns of Corre
ctions for increasing compliance;

contract
standards; prod
uctivity;
&

timeliness by co
nsistently monitoring standards;
resulting in better work performance for staff & client satisfaction .

Sharper Future: Pacif
ic Forensic Psy
-
Associate
s, Inc. L
os Angeles
, CA

10/18
-

03/19

Sta
ff Clinician

•

As a Forensic Behavioral Health Clinician,
working with California State
parole
es of
Registered High
-
Risk Sex Offenders, we
utiliz
ed

Nationall
y
approved Containment Model tr
eatment
curriculum.

•

R
egis
tered with CASOMB
to
use
Assessment tools L
SCMI
, ABLE

Assessment and

STABLE
-
2007
/ACUTE
-
2007
.

•

Responsibilities included mandated weekly gr
oup se
ss
ions (1.5
-
3hrs) and
monthly individual therapy session;

arranged client p
olygraph exam
s and

regular communicati
on with client
’s

A
gent

of

Record for attend
ance or
behavior violations.

Los Angeles
County
D
H
S

CRDF
(
via MAXIM

Sta
ffing
)
-

Lynwood
, CA

09 /16
-

04 /17

S
enior Clinical Social Worker

•

Provide
d clinical services

for female inmates at C
entury Regional
Detention

Facility
that in
clude
s
intake
asses
sments and case
manag
ement screening

needs towards

community
reentry
planning
for

alternative
s

to
cu
stody.

Rudolpho Perez II,
LCSW#

Palmdale
, CA

3 •

Coordinated services with other multidiscipli
nary personnel and agencies
for mental heal
th,
SUD
, medical needs, d
omestic violence/
parenting
clas
ses a
nd addressing housing/homelessness needs.

•

Supervised the work of M
edical Case Wo
rkers and community

Workers on
the WISP (Women’s Integrated Services Pi
lot Program) team; including
provisions of
clinical supervision and
guidance of assig
nments of case
s.

JWCH Institute Inc.

City of Commerce, CA

03/15
-

02/16

Menta
l Healt
h Specialist

07/06
-

02/15

**
Sr. Community Health Worker II

•

In Downtown LA “Skid
-
Row”
Center for Community Health was
Prima
r
y

Mental Health
HIV
Spec
ialist

at two lo
cations
under

the Ry
an White

O
utpatient

HI
V/AIDS
Medical Clinic
; conduct
ed

confidential

evaluations
.

•

Collaborate

withi
n professional
networks

&
agency
programs
referrals
within
the Ski
d R
ow
c
o
mmunity
,

to develop part
nerships for

seamless
adult managed
car
e

in accordance to HIPPA regulations.

•

Con
sult
ed

with
MD &
Psychiatrist on Medical Evaluation regardi
ng patient
me
dicat
ion compliance, observations, recommendation

for risk reduction
;
housing
n
eeds
or complicat
ions wi
th substance abuse

&

relapse
.

•

At An
dre
w
Escajada Clinic

in Pasadena h
osted weekl
y
gay
male support
group at local Senior Center for long
-
term s
urvivors livi
n
g with HIV/AIDS;
addressing internal
-
homophobia, marginalization etc.

•

**
A
s Lead
-
Counselor for Skid
-
row

HIV Intervention Pr
ogram (SHIP) a
n
d

the Commercial Sex Venue (CSV) Project,
Managed staff
of
6 -
10 persons
by

scheduling staff matrix, including
be
s
t prac
tic
e

training
for
new
-
hires on
paperwork, counseling skills, and
utiliz
at
ion of

interna
l/external refe
rral
services
.

Conducted couching s
e
ssions

for
staff

performance evaluations
.

•

**
R
esponsible for
assisting
Project C
oordinator
in constructing policie
s
an
d procedures by
provided Quality Assurance measures
in

developing
and org
anizing c
lient reports

accord
ing to HIPPA

regulations at 11
-
site
s
.

•

**
Rapid HIV/ST
I

Testing Counselor for CSV Project

by screening with
logged biological phlebotomy specimens.

Respo
ns
ible for distributing
health educational materials via on
-
site seminars r
elated to

Harm
Reduction focu
sed

HIV & ST
I

prevention to high
-
ri
s
k t
argeted locati
ons
and populations

for MSM

and
transgen
der individuals
.

Kedren Acute Psychiatric Hospital & Communi
ty Mental Health
-

Los Ange
les
, CA

03/13
-

03/15

Psychiatric

Social Worke
r

•

Clinical Lead

for
Field Capable Cli
nical
Services

(FCCS
)
in S
outh LA,
p
rovided psychiatric
ev
aluations
; with

crisis situations required
51/50

Hospitalization

as
-
needed
,

to

restore
patient
’
s

adaptive

f
unction
ing

levels
.

•

I
mplemented

Triage

evaluations

for

walk
-
in patients
&
f
ormulated full
-
adult
diagnostic asse
ssment
s in

Adult
Outpa
tient
(AOP)
;

c
o
ordination &

service
plans

with
the use of
Prevention and Early Intervention
(PEI)
model
s
(CORS
-
Crisis Oriented Rec
overy Services,
and
TF
-
CB
T or
I
-
CBT
).

Rudolpho Perez II,
LCSW#

Palmdale
, CA

4 •

Respo
nsib
le for billing &

maintaining electric
documentation ma
nag
ement;

repor
ted

progress to
Probatio
n Officers

for

ongoing case management

referral

activities

for clients in

AB109

Early
Rel
ease
Community
Integration
Program.

MASA
:

California
Hisp
anic Commission on Alcohol & Drug Abuse, Inc.
-

L
A
, CA

06/09
-

07/11

Mental
Health
Therapist

•

Here (formally Eastlake Y
outh Ser
vices Center)
Collaborated with
Certife
d
Alcohol & Drug Counselor
s

to

develop

curricu
lum for
you
th
group psycho
-
therapy &
SUD

relate
d treatment relapse prevention. Utilized E
BP

models
Seeking Safety &
TF
-
CB
T for

individual
crisis intervention
.

•

Provided clinical evaluation and

assessments with billable documentation
for seve
ral programs offered by a
gency (M
H
/S
UD

& MAT)
.

•

Serv
ed as
lead
mental he
alth
liaison

for agency’s J
uvenile Drug Court
Team to mon
itor

refe
rrals f
rom Commiss
ioner
or

court
services for youth
of
fenders

to

ensuring a high level of

confidentiality &
safety
.

•

S
uc
cessfully supervised as Student Preceptor
,

providin
g clinical guidance
to several interns from
loc
al
Universities.

L
os Angel
es

County
Health
Department

STD Program:

Syphilis

Campaign

(
via

Frasier Communications)

-

Los Ange
les
, CA

08/07
-
02/10

Outreach

Coordinator

•

Project Coordinator for a termed campaign(s), responsibl e for recruiting,
su
pervising
, payroll reconciliation and scheduling

for
6 -
9 employees
.

•

Trai
ned staff on safety
protocols and proper method
s to distribute media
messages or supplies

to M
SM
community
. Generally responsible for
material dissemination in and around greater L
A County.

•

A
ttended
and conducted regular departmen
t meetings and presented
project at

commun
ity forums to promote awareness of campaign
.

•

Pr
ovided reports analyzing effe
ctiveness of staffing and overall operation.

I
nternships:

~ BS
W
-
Intern 2005
-
2006:

Eggleston

Youth Center Inc.
(Hired)
.

~ MSW
-
Intern

2007
-
2008:

LAUSD: Office of Human

Relations, Diversity & Equity.

~ MSW
-
Intern 2008
-
2009:

Eastlake Youth Services
Ce
nter
→

MASA
(Hired).

1 From:
[email protected]
Sent:

Thursday, March 9, 2023 6:00 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Hestia Sartika

Date

Field not completed.

Business Telephone

Field not completed.

Home Telephone

Field not completed.

Cell Phone

Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

2 Present Address

City

State

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

HumanRightsAdvisory.pdf

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

Yes

Please Explain

As Vice President of Scholarship and later Regional Vice President of Technology for Phi T
heta Kappa Honor Society
International, I gained experience in cross
-
regional leadership
communications, event management, and technical project delivery. I maintained relationships with stakeholders and local communities, and developed successful educatio
nal programs
promoting diversity and cooperation. As Executive Liaison Officer in College of the Canyons' Student Government, I liaised between the board of education and trustees, gaining insight into local government operations.

Are you currently servin
g as
an elected city or county
official?

No

3 Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

Do you or any members of
your immediate family ow
n
any interest in any real
property adjacent to or
within the City of Palmdale?

Yes

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interest?

No

List all current organizations
and societies of which you
are a member.

• Psi Beta Honor Society

• Phi Theta Kappa Honor Society

• Pathway to Law Program

• IEEE (Institute of Electrical and Electronics Engineers)

• Women Who Code (as a mentor)

• Data Con
LA (as Host and Executive)

Please describe any public
service experience serving
on a commission or public
body?

As Vice President of Scholarship for Phi Theta Kappa at College of the Canyons, I conducted research and developed a successful mentorship pr
ogram for students seeking career
and educational guidance. This experience helped me develop skills that were transferable to my position as the Regional Vice President of Technology for Phi Theta Kappa Honor Society International, where I acted as a liai
son between the regional,
headquarters, and local community colleges. My
responsibilities included managing cross
-
regional leadership
communications and events, providing technical direction for project delivery, incident/problem management, and technical solutions for the region.

Participating in Board meetings allowed me to anticipate and assess the success of upcoming activities, events, and regional network infrastructure, which enabled me to develop,
implement, and present successful educational progr
ams that
promoted interregional cooperation and a positive attitude toward diversity. As the Executive Liaison Officer for the Student Government at College of the Canyons, I gained
4 insight into local government operations, worked with the board of educati
on, board of trustees, and liaised between the two
campuses.

My goal is to one day serve in my local government, and my involvement in public service organizations such as Phi Theta Kappa, Psi Beta Honor Society, Pathway to Law Program,
IEEE, Student Gove
rnment, as well as my volunteer work as a
Host and Executive in Data Con LA, where I gained valuable experience in event planning and management. In addition to mentorship in Women Who Code, where I helped other women excel in their technology careers, has

helped me develop the
skills and experience needed to achieve this goal. Overall, my public service experience has focused on education,
technology, diversity, and I am committed to advocating for the rights of minority and historically marginalized commu
nities.

How do you feel you would
add value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications, perceptions,
and experiences would you
bring to the Committee?

As an immigrant woman who has experienced discrimination and ab
use, I believe that I could bring a unique perspective to the Human Rights Advisory Committee. My experiences with discrimination within the math and engineering field have given me insight into issues related to employment and gender equality. Additionall
y, my personal experience of growing up in
an abusive household, experiencing homelessness, and
struggling to access food and basic needs has provided me with a deep understanding of issues related to social equity, housing, and poverty.

Furthermore, I ha
ve witnessed the struggles of my family
members who are living with mental illness and identify as LGBTQ, which has given me insight into issues related to the rights of minority and historically marginalized communities. My experience navigating the legal

system as an immigrant to
obtain a divorce and restraining order for my mother has also given me a unique understanding of civil rights and the challenges that can arise when trying to access justice.

My personal experiences have led me to a life dedicat
ed to
public service and community advocacy. Through my work, I have gained an understanding of the lack of support for individuals and communities experiencing discrimination, poverty, mental illness, and unsafe home environments. I believe that my backgr
ound and experiences could contribute
to the Human Rights Advisory Committee's mission to promote and protect the human rights of all individuals, particularly those who are marginalized and vulnerable.

5 What are your long
-
term
goals as a Human Right
Advi
sory Committee
member?

As a member of the Human Rights Advisory Committee, my
long
-
term goal is to advocate for and address the issues faced by marginalized communities. My experiences as an immigrant woman who has faced discrimination and abuse have given

me
a unique perspective on the challenges that these communities face. My focus would be on promoting education, housing, employment, race relations, social equity, LGBTQ rights, gender equality, civil rights, and the rights of any other minority or histo
rically marginalized communities. Having lived in an
unsafe home, with family members suffering from mental
health issues and disabilities, I aim to bring awareness and work towards a more inclusive and supportive community. I believe in the basic human ri
ghts of every individual and I am
committed to working towards creating a society that upholds these values to help create a more just and equitable society where all individuals have access to the resources and support they need to thrive.

What additiona
l
information would you like
us to know to better assess
your suitability for the
Human Rights Advisory
Committee?

Field not completed.

(Section Break)

Education, Training and Experience

High School

Name

Allan F. Daily High

Address

Glendale

Number of Years
Completed

2 Did you Graduate?

Yes

Degree or Diploma

Diploma

GPA (i.e., A=4.0)

2.5 6
College/University

Name

Iowa State University

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Yes

Degree or Diploma

Degree

GPA (i.e., A=4.0)

2.5 Vocational

Name

Field not completed.

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Field not completed.

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Other

Field not completed.

(Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Field not completed.

Ad
dress

Field not completed.

Type of Business

Field not completed.

7 Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not complete
d.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

8 Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Field not completed.

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Field not completed.

9 Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Field not completed.

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

(Section Break)

Please read carefully, initial each paragraph and sign
below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that might adversely affect my chances for appointment. I understand that any misstatement or o
mission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery of the 10 misstatement or omission. I furt
her certify that I, the applicant, have personally
completed this application.

Initials

HS

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize the references I have listed, all prior employers, and all edu
cational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all

other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, to the fullest extent permitted by law, f
rom any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, employees, and representatives, to the fullest extent permitted by law, from any and all claims, dem
ands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and representatives.

Initials

HS

I further understand and agree that as a condition to being

appointed to the Human
Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices and policies as set forth in the Human Resources Rules, the Brown Act, and the Public Records Act s,
copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I expressly consent to, and I waive any rights of privacy I might otherwise have in conn
ection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

HS

I understand that as part of the final selection process, I will be required to pass a livescan fingerprint scan submission via the Ca
lifornia Department of Justice. I
understand that information collected during this background check will be limited to that appropriate to determining my suitability for this Human Rights Advisory Committee position and that such information collected dur ing the check will be
kept confidential.

11 Initials

HS

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

Field not completed.

Foreign Language

Field not completed.

Do you?

Field not completed.

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

Computer Skills

Field not completed.

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

Home Phone

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

Field not completed.

(Section Break)

12 AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the Ci
ty of Palmdale and its elected and appointed officials, agents, and employees.

I hereby agree to the
Authorization and Release
set forth on this day

3/9/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Hestia Sartika

Applicants are encouraged
to attach a resume.

HestiaSartika
-
02142023.pdf

Email not displaying correctly?
View it in your browser.

Dear Human Rights Advisory Committee,

I am writing to express my interest in the Human Rights Advisory Committee position and am honored to apply for a position on your committee. As an immigrant from Indonesia, I have experienced discrimination, abuse, and financial hardship throughout my life. These experiences have given me a unique perspective on the importance of protecting the human rights of marginalized communities, including those who face challenges related to education, housing, employment, race relations, social equity, LGBTQ rights, gender equality, civil rights, and the rights of any other minority or historically marginalized communities.

My personal journey has inspired me to become an advocate for those who face similar challenges. As a woman who has experienced sexual, physical, and mental abuse, I understand the importance of creating safe spaces for survivors of trauma. Additionally, as someone who has faced discrimination within the math and engineering fields, I understand the importance of promoting diversity and inclusion in all areas of education and employment.

Growing up in a chaotic and abusive home, gave me an insight on the importance of safe and affordable housing for all individuals. My family struggled to put food on the table, and we often had to rely on food banks and community resources to survive. This experience has given me a deep appreciation for the importance of access to basic needs, such as food and shelter.

Furthermore, my family has also faced mental health challenges, including schizophrenia and bipolar disorder. My sister, who was born a lesbian, has also faced challenges navigating the world as a member of the LGBTQ community. Witnessing these struggles has given me a unique perspective on the importance of promoting mental health awareness and advocating for the rights of the LGBTQ community.

In my professional life, I have served as a Software Project Manager and as the Regional Vice President of Technology for Phi Theta Kappa Honor Society. Through my volunteer work with organizations such as Women Who Code and Data Con LA, I have also gained valuable experience working with diverse groups of people and advocating for the rights of marginalized communities.

I am committed to using my professional and personal experiences to make a difference in my community and beyond. I believe that my unique perspective and diverse background make me well-suited for a position on your committee. Thank you for your consideration.

Sincerely,
Hestia Sartika
Vice President of Honors in Action at College of the Canyons, Regional VP of Technology NV/CA,
Phi Theta Kappa, Alpha Nu Xi Chapter
Project Manager, Software Engineer focus in UI/UX
BS. Management Information Systems
AA. Mathematics and Sciences

1 | 3
P a g e

HESTIA SARTIKA

Palmdale, CA

ACTIVITIES
o

Psi Beta Honor Society
o

Phi Theta Kappa Honor Society


VP. Honors in Action


Regional VP of Technology
o

2014 IBM – ACM Programming
Competition
o

Iowa State University Women’s
Rugby & ISU Cultural
Ambassador
o

Data Con LA Volunteer & Host
o

Women Who Code – Mentor
o

NSF Scholar

IOWA STATE UNIVERSITY
o

May 2017 - BS. Management
Information Systems

COMMUNITY COLLEGE
o

May 2012 – AS. Mathematics &
Sciences
o

December 2023 – AA.

Psychology
o

December 2023 – Cert. Project
Management Professional (PMP)
o

December 2023 – AS. Electrical
& Computer Engineering
o

December 2023 – AA. Paralegal
Studies

CERTIFICATES
o

June 2014 - Lean Six Sigma –
White Belt
An Software Project Manager, Phi Theta Kappa Honor Society Regional Vice President of Technology, and mentor for Women Who Code, committed to implement the organization’s mission and vision, by leveraging my professional experience and diverse educational background in Management Information Systems, Computer Science & Engineering, Paralegal Studies, and Psychology in order to provide an unmatched understanding of design and architecture for a new generation of scalable, technological standard that will help your company to spring forward.

WORK EXPERIENCE

June 2021 – Present

NV/CA REGIONAL VP OF TECHNOLOGY

Phi Theta Kappa Honor Society International
.
•

Started as Vice President of Scholarship, then elected as Regional Vice President of Technology.
•

Applying project management expertise to organize tasks, allocate resources, keep to deadlines, and report progress.
•

Drive business processes, automation, and efficiency. Identify efficiencies, offer innovations, and create solutions.
•

Maintaining and expanding relationships with key stakeholders and the local community to ensure all performance objectives are met. •

Engaged in Board meetings to identify and evaluate future initiatives, events, and regional network performance, in addition to candidate interviews. •

Construct, execute, and deliver effective educational programs that foster inter- regional interactions and promote diversity.

January 2020 – July 2021

SOFTWARE PROJECT MANAGER
Quikstor Self Storage and Software
•

Leveraging project management expertise to identify and prioritize work streams, use resources, meet deadlines, and deliver status updates. •

Liaison to business, functional IT, and vendor/partner groups for support, acquisition implementations, system upgrades, and road planning. •

Facilitate morning stand-up meeting using all aspects of agile development and scrum practices.
•

Direct application maintenance, troubleshooting, and support, including production issue repairs, improvement proposals, and IT Support group collaboration for problem resolution.
•

Managed projects consisting of 6 engineers under a Technical Manager, CTO & CEO to collaborate with internal and external stakeholders toward gathering project requirements.
•

Tracking project timelines through all phases of Software Development Life Cycle (SDLC), deliverables and assessing project risks, while proactively resolving issues as defined by the PMBOK guide.
•

Investigate, debugged and fixed front end issues using Angular and backend issues using C# accessible through GIT, as well as writing SQL queries, batch scripting and stored procedures.
•

Create & design mockups, gather spec requirements, technical documentations and sequence diagram using Postman and StopLight to access our web API and C#, increase efficiencies, solve problems, and discover root cause analysis.

2 | 3 P a g e

June 2017 – February 2019 .NET SOFTWARE ENGINEER Proplanner .Net
• Designed & implemented UI/UX prototype for new upcoming features, researched and developed using C#, ASP.Net framework 4.5, to improve the software applications functionality. • Created Workflows (WCF) using XAML and create reports forms (WPF) using DevExpress and WinForm. • Created an excel sheet batch scripts for timesheets.
• We manage our projects through TFS & PBIs and Visual Studios 2017 shelvesets. • Investigated, debugged, and fixed application problems reported by testers and collaborated with technical lead managers.
• Identify issues and implemented solutions to complex problems in large-scale front-end infrastructure. Present solution into project that decreases the process time in UI issues/bug reports between customer, tester to developer.
• Set-up web config file according to application needs & used IIS to export and import SQL data.

May 2013 – January 2016 IT SUPPORT TECHNICIAN (ITS) Iowa State University
• Carried out in-depth analysis, performed and troubleshoots preventative tests as well as prioritized major technical issues projects.
• Provided Tier 1 to Tier 3 support through a ticketing system resolved either in person or remotely through VPN and VMware for graduates and faculties that needs troubleshooting, PC/Thin Client/MAC hardware repair, maintenance, installations, configurations and classroom/office/meeting room set-ups. • Repurpose and organize all computer parts such as (deleting) hard drives and memory cards. Supported, installed, configured and tested all network printers (TCP/IP, LAN), routers, switches and firewalls within the division. Image desktops and laptops using VDI desktop virtualization and SCCM through the school's VPN. • Managed classroom and office setup accurately and effectively and resolve difficult technical issues for end users.
• Worked closely and independently with faculties and graduates within Iowa State University to replace, repair, install and configure defective software and hardware.
• Troubleshoot, imaged, formatted and repaired (in-person or through remote desktop control) network print servers, desktops, and network issues. Also utilized SharePoint to create WebForms and VPN to load Linux on Windows environment.

June 2014 – August 2014 BUSINESS INTELLIGENCE ANALYST (INTERN) Payless ShoeSource
• Developed a solution to implement a functional way to search users through Active Directory using HTML and XML.
• Responsible to align, strategize and manage teams within 3 different states, as well as multiple departments and to report back to the CTO.
• Documented projects throughout all Software Development Life Cycle (SDLC) phases from beginning to end using waterfall methodology and practices.
• Created a documented business analysis for internal Law and Security Department's SharePoint site and migrated their SharePoint system from highly sensitive information type Entity Data Collection (EDC) to a Web Data Connector (WDC).
• Integrated and migrated of a highly customized WSS 3.0 to SharePoint 2010 including the implementation and integration of Active Directory, SQL, SharePoint security, forms-based authentication and custom workflows.

August 2007 – June 2009 IT FIELD TECHNICIAN H&R Block
• Exceeded expectations by improving productivity and accomplishing goals a week prior to due dates. • Provided Tier 1 to Tier 3 support to division that has been assigned to me which consisted of 20+ offices and classrooms that contains 10+ computers per office and/or classroom. • Troubleshoot, imaged through Ghost servers and SCCM, formatted and repaired Windows 2003 servers, POS and e-file systems, network print servers, network issues for offices to communicate to World Head Quarters.

July 2005 – June 2007 WEB CONTENT ADMINISTRATOR MySpace
• Improved in the way the company identified spammers by patterns and its daily usage. • Tracked issues of flagged users to update profiles in compliance to the Terms of Service (TOS) using HTML and CSS.
3 | 3 P a g e

TEXTBOOK EDITOR

February 2015 – April 2015 “How To Use Objects Code and Concepts” Pearson Textbook PLC: University of Tubingen – (Dr. Holger Gast)  Edited textbook called “How To Use Objects Code and Concepts” written by Dr. Horger Gast of University of Tubingen that focuses on Java, C# programming and its tools to create and edit using Eclipse. Sample Textbook: (https://goo.gl/Mup2aS)

December 2012 – January 2013 “Introduction to Agile Methods” Pearson Textbook PLC: Iowa State University – (Dr. Sondra Ashmore and Kristin Runyan)  Edited Dr. Sondra Ashmore and Kristin Runyan comprehend and use "Introduction to Agile Methods" by researching, revising, evaluating, and rewriting it. Sample Textbook: (https://goo.gl/8eZ3RT) 1 From:
[email protected]
Sent:

Wednesday, February 15, 2023 9:47 PM
To:

City Clerk Department
Subject:

Online Form Submittal: Human Rights Advisory Committee
Follow Up Flag:

Follow up
Flag Status:

Flagged
CAUTION:

This email originated from outside of the organization.

Human Rights Advisory Committee

Office of the City Clerk

38300 Sierra Highway, Suite C

Palmdale, CA 93550

(661) 267
-
5151

Human Rights Advisory Committee Application

The City of Palmdale is an equal opportunity employer and does not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex (including pregnancy, c
hildbirth and related medical conditions),
cancer, national origin, genetic characteristics, genetic information, ancestry, sexual orientation, gender, gender identity, gender expression, marital status, veteran status, disability, or any other basis prote
cted by applicable law. None of the
questions or information sought in this application are intended to discriminate based upon any status protected by law. If you need reasonable accommodation in completing this application, or in any other part of the ap plication process, please
contact the City Clerk’s Office at 661/267
-
5151.

Human Rights Advisory

Information:

Name

Elizabeth Henriquez

Date

2/15/2023

Business Telephone

Field not completed.

Home Telephone

Field not completed.

Cell Phone

2 Possession of a valid California driver's license and the ability to be insured with the City's insurance carrier is required.

Present Address

City

State

Zip Code

Permanent Address if
different from present
address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

(Section Break)

Personal Information

(Please attach additional sheets, if necessary.)

Upload Additional Sheets

Field not completed.

Have you had previous
public service experience
on a commission or public
body? If so, indicate the
public agency, title of
position, and duties.

No

Are you
currently serving as
an elected city or county
official?

No

Do you or any members of
your immediate family own
any interest in any
enterprise which does or
might do business with the
City and/or the
Board/Commission?

No

3 Do you or any members of
your immediate family own
any interest in any real
property adjacent to or
within the City of Palmdale?

No

Do you or any members of
your immediate family have
any interests or associations
which might present a
conflict of interes
t?

No

List all current organizations
and societies of which you
are a member.

IBEW local 18 vice president

Please describe any public
service experience serving
on a commission or public
body?

N/a

How do you feel you would
add value to the Human
Rights Advisory Committee?
What unique
characteristics,
qualifications, perceptions,
and experiences would you
bring

to the Committee?

Field not completed.

What are your long
-
term
goals as a Human Right
Advisory Committee
member?

Field not completed.

What additional
information would you like
us to know to better assess
your suitability for the
Human Rights Advisory
C
ommittee?

Field not completed.

(Section Break)

Education, Training and Experience

4 High School

Name

Downtown magnet high school

Address

1200 Colton street

Number of Years
Completed

4 Did you Graduate?

Yes

Degree or Diploma

High school graduate

GPA (i.e., A=4.0)

3.0 College/University

Name

Los Ángeles City college

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

No

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Vocational

Name

Field not completed.

Address

Field not completed.

Number of Years
Completed

Field not completed.

Did you graduate?

Field not completed.

Degree or Diploma

Field not completed.

GPA (i.e., A=4.0)

Field not completed.

Other

Field not completed.

5 (Section Break)

Employment History

List below all present and past employment for the last ten (10) years starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Los Angeles department o
f water and power

Address

111 n hope street

Type of Business

Municipality

Telephone Number

213
-
367
-
0727

Your Supervisor's Name

Joe Villareal

Your Position and Duties

Senior admin clerk

Payroll

Office advisor

Major Accomplishments

Field not comp
leted.

Dates of Employment

From

1/7/2007

To

2/15/2023

Reason for Leaving

Still employed

Upon leaving, were you
eligible for rehire?

No

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

6 Major Accomplishments

Field not completed.

Dates of Employment

From

Field not compl
eted.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

Name of Employer

Field not completed.

Address

Field not completed.

Type of Business

Field not completed.

Telephone Number

Field not completed.

Your Supervisor's Name

Field not completed.

Your Position and Duties

Field not completed.

Major Accomplishments

Field not completed.

Dates of Employment

From

Field not completed.

To

Field not completed.

Reason for Leaving

Field not completed.

Upon leaving, were you
eligible for rehire?

Field not completed.

(Section Break)

References

List below three persons not related to you who have knowledge of your civic activity within the last three years.

Name

Field not completed.

7 Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not complet
ed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Field not completed.

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

(Section Break)

Name

Field not completed.

Address

Field not completed.

City

Field not completed.

State

Field not completed.

Zip Code

Field not completed.

Occupation

Field not completed.

Telephone Number

Field not completed.

Number of Years
Acquainted

Field not completed.

8 (Section Break)

Please read carefully, initial each paragraph and sign
below:

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not withheld any information that migh
t adversely affect my chances for appointment. I understand that any misstatement or omission of fact on this application or any documents used to obtain an appointment may result in rejection of this application or immediate discharge if I am appointed, r
egardless of the time elapsed before discovery of the
misstatement or omission. I further certify that I, the applicant, have personally completed this application.

Initials

Eh

I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize the references I have listed, all prior employers, and all edu
cational institutions attended, to disclose to the City of Palmdale any and all letters, reports, and other information related to my records, including, but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all

other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutions attended, I release them, to the fullest extent permitted by law, f
rom any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, employees, and representatives, to the fullest extent permitted by law, from any and all claims, dem
ands, fees, and liabilities that may result from any use or disclosure of such information by the City of Palmdale, or any of its agents, employees, and representatives.

Initials

Eh

I further understand and agree that as a condition to being

appointed to the Human
Rights Advisory Committee, I will be required to agree to conduct myself in accordance with the City of Palmdale’s personnel practices and policies as set forth in the Human Resources Rules, the Brown Act, and the Public Records Act s,
copies of which I will be provided and will review prior to accepting an appointment to the Human Rights Advisory Committee. To the fullest extent permitted by law, I expressly consent to, and I waive any rights of privacy I might otherwise have in 9 conn
ection with the City’s Human Resources Rules in general and the above -
described sections in particular.

Initials

Eh

I understand that as part of the final selection process, I will be required to pass a livescan fingerprint scan submission via the Ca
lifornia Department of Justice. I
understand that information collected during this background check will be limited to that appropriate to determining my suitability for this Human Rights Advisory Committee position and that such information collected dur ing the check will be
kept confidential.

Initials

Eh

(Section Break)

Applicant Information

REASONABLE

ACCOMMODATIONS

No

Foreign Language

Spanish

Do you?

Speak, Read , Write

Foreign Language

Field not completed.

Do you?

Field not completed.

Specialized training/skills:

Field not completed.

Computer Skills

Word, Excel

(Section Break)

In Case of Emergency

Whom should we notify?

Name

Relationship

10 Home Phone

Field not completed.

Work Phone

Field not completed.

Do you have any medical
history that we should be
aware of in the event of an
emergency? (Allergies,
medications, etc.)

N/a

(Section Break)

AUTHORIZATION AND RELEASE

I hereby waive, release, and hold harmless from any liability or claims for damage s
for personal injury, including death, as well as from claims for property damage which may arise in connection with the above
-
named activity, against the
supervisor, the City of Palmdale and its elected and appointed officials, agents, and employees.

I

hereby agree to the
Authorization and Release
set forth on this day

2/15/2023

Electronic Signature
Agreement

I agree.

Electronic Signature

Elizabeth henriquez

Applicants are encouraged
to attach a resume.

Field not completed.

Email not displaying correctly?
View it in your browser.

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8. HowdoyoufeelyouwouldaddvaluetotheHumanRightsAdvisoryCommittee?Whatuniquecharacteristics, qualifications,perceptions,andexperienceswouldyoubringtotheCommittee?

9. What

are

y
our

long-term

goals

as

a

Human

Right

Advisory

Committee

member?

10. WhatadditionalinformationwouldyoulikeustoknowtobetterassessyoursuitabilityfortheHumanRights AdvisoryCommittee?
I can easily connect w/ everyone I come across. I am deeply compassionate about others and that may be why its so easy to do so. My professional experience w/ people of all ages & financial circumstances have given me knowledge and confidence to help others in a very effective way in every setting professional and not.

To promote this committee as well as the rest of the programs that are offered in a way that hasnt been done before. Through social media, events, schools, game nights, vendors. To have more meetings where the public can access information more easily and not be so intimidated to be a part of the cities voice.

Now more than ever especially with the Pandemic, there is a disconnect, even in ones own home at times. I am determined to research, study and learn anything I can to help nut sometimes all it takes is for someone to listen and talk with those that are in need instead of just seeing them as a statistic or talking at them and handing them informational brochures. We all long to feel accepted and loved.
n/a
n/a
Palmdale Promise Parent Ambassador, PTA member and teachers aid volunteer at Dos Caminos School

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Mira Monte,
Mission Viejo

3.7 Antelope Valley
College
CA
Licensed
Real Estate and Life
and Health Insurance
Future Star Tutoring Services
service was provided in each individuals home
Foster Youth Tutoring Services
323
419-8102
Tom
Tutor, Test, Assess placements , build trust and a connection with students was always requested to stay on with the student as long as they were approved 12/20/19
3/7/20
due to covid, I could no longer enter their homes and zoom was not offered RespiteWorks
Mission Viejo, CA
Behavioral Health Support - Medical
949
861-7342
Genesis
Case worker , Provide relief for primary caregivers of disabled individuals promoting independence, performing care tasks on their behalf, and creating and implement lesson plan
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Tracy
949
11/20/15
4/4/16
needed a fulltime posistion
Monex Deposit Company
Newport Beach, CA
Investment/ Precious Metal Trade
752-1400
Manage 12 account managers database, audit filesImplemented charts for budget and targets 9/5/16
3/1/17
had my daughter
Oswaldo Valdivia
1 Josie Romero
5 Laura Leon

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I hereby authorize the City of Palmdale to investigate my references, prior employers, work record, education, and other matters related to my suitability for appointment and further, authorize thereferences

I have listed, all prior employers, and all educational institutions attended, to disclose tothe City of Palmdale any and all letters, reports, and other information related to my records,including,

but not limited to, my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers, and educational institutionsattended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees, and liabilities for providing the City of Palmdale with all information. I release the City of Palmdale, its agents, employees, and representatives, tothefullest

extent permitted by law, from any and all claims, demands, fees, and liabilities thatmay

result from any use or disclosure of such information by the City of Palmdale, or anyof itsagents, employees, and representatives.____(Initials) ,

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