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RECEIVED
CITY CLERKS OFFICE Please return completed applications to:
CITY OF RICHHOND
Clerk of the Board of Supervisors
Contra
2022 OCT 20 AMID: 36 1025 Escobar Street, 1st Floor
Costa
Martinez, CA 94553
County or email to: [email protected]
BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION
First Name Last Name
Cate Burkhart
Home Address - Street City Zip Code
Richmond 94804
Phone (best number to reach you) Email
Resident of Supervisorial District:
EDUCATION Check appropriate box if you possess one of the following:
High School Diploma CA High School Proficiency Certificate G.E.D. Certificate Colleges or Universities Attended Course of Study/Major Degree Awarded Univ. of Connecticut General Ed Yes No
Yes No
Yes • No
Other Training Completed:
Board, Committee or Commission Name Seat Name
Commission on Aging for the
Have you ever attended a meeting of the advisory board for which you are applying? No Yes If yes, how many?
Please explain why you would like to serve on this particular board, committee, or commission.
I am currently on the Commissin of Againg for the city of Richmond, and realize that West Counyt is missing out on many services because we are under represented on boards and committees.
Describe your qualifications for this appointment. (NOTE: you may also include a copy of your resume with this application)
I have been involved in the community for many years, from PTA, Richmond Annex Neighborhood Council to currently serving on Richmond Commision on Aging. I've live in Ruchmond for 56 years.
I am including my resume with this application:
Please check one: • Yes • No
I would like to be considered for appointment to other advisory bodies for which I may be qualified.
Please check one: • Yes No
THIS FORM IS A PUBLIC DOCUMENT
Are you currently or have you ever been appointed to a Contra Costa County advisory board? Please check one: • Yes • No
List any volunteer and community experience, including any boards on which you have served.
Do you have a familial relationship with a member of the Board of Supervisors? (Please refer to the relationships listed below or Resolution no. 2011/55) Please check one: • Yes • No
If Yes, please identify the nature of the relationship:
Do you have any financial relationships with the county, such as grants, contracts, or other economic relationships?
Please check one: • Yes • No
If Yes, please identify the nature of the relationship:
I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I acknowledge and understand that all information in this application is publicly accessible. I understand and agree that misstatements and/or ommissions of material fact may cause forfeiture of my rights to serve on a board, committee, or commission in Contra Costa County.
Signed: Date:
Submit this application to: [email protected] OR Clerk of the Board of Supervisors 1025 Escobar Street, 1st Floor
Martinez, CA 94553
Questions about this application? Contact the Clerk of the Board at (925) 655-2000 or by email at [email protected]
Important Information
1. This application and any attachments you provide to it is a public document and is subject to the California Public Records Act (CA Government Code §6250-6270).
2. All members of appointed bodies are required to take the advisory body training provided by Contra Costa County.
3. Members of certain boards, commissions, and committees may be required to: 1) file a Statement of Economic Interest Form also known as a Form 700, and 2) complete the State Ethics Training Course as required by AB 1234.
4. Meetings may be held in various locations and some locations may not be accessible by public transportation.
5. Meeting dates and times are subject to change and may occur up to two (2) days per month.
6. Some boards, committees, or commissions may assign members to subcommittees or work groups which may require an additional commitment of time.
7. As indicated in Board Resolution 2011/55, a person will not be eligible for appointment if he/she is related to a Board of Supervisors member in any of the following relationships: mother, father, son, daughter, brother, sister, grandmother, grandfather, grandson, granddaughter, great- grandfather, great-grandmother, aunt, uncle, nephew, niece, great-grandson, great-granddaughter, first-cousin, husband, wife, father-in-law, mother-in-law, daughter-in-law, stepson, stepdaughter, sister-in-law, brother-in-law, spouse's grandmother, spouse's grandfather, spouse's granddaughter, and spouses' grandson, registered domestic partner, relatives of a registered domestic partner as listed above.
8. A person will not be eligible to serve if the person shares a financial interest as defined in Government Code §87103 with a Board of Supervisors Member.
THIS FORM IS A PUBLIC DOCUMENTI