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Packet - PRAB - 04-13-2017
HOME OF ' TO ESTABLISHED 2006 MEETING MINUTES CITY OF MILTON PARKS AND RECREATION ADVISORY BOARD Thursday, April 13, 2017 7:00 PM Council Chambers, Milton City Hall CALL TO ORDER Meeting was called to order by Mr. Stachowski at 7:00 PM. ROLL CALL Roll call was taken by Mr. Stachowski. MEMBERS PRESENT Scott Stachowski Joey Costanzo Ron Hill Van Kottis Phil Cranmer Sue Rekuc OTHERS PRESENT Jim Cregge, Parks and Recreation Director Tom McKlveen, Parks and Recreation Program Manager Quorum was announced by Mr. Stachowski. APPROVAL OF MEETING AGENDA A motion to approve the agenda and move item VIII a. (presentation from Milton Steelers) before committee reports was made by Mrs. Rekuc and seconded by Mr. Kottis. The vote passed unanimously. APPROVAL OF PAST MINUTES A motion was made by Mr. Kottis and seconded by Mrs. Rekuc to approve the February 2017 minutes. The vote passed unanimously. PHONE: 678.242.2500 1 FAX: 678.242.2499 G"r`een 'J *cyaEthn l* y 5 ;Ls y. info@cityofmiWILDLIFE Communit ltonga.us I www.cityofmiltonga.us �� � 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 - ""*""° °"°":` 's` April 13, 2017 - PRAB Meeting Minutes NEW BUSINESS 1. Presentation by the NFL-YFL Milton Steelers a. Milton Steelers made a presentation showing the plans to offer free football to the City of Milton and City of Alpharetta residents. b. Through sponsorships and private donations, they explained the feasibility and sustainability of the program without charging the participants of tackle football for registration. c. Milton Steelers showed how they can utilize the field at Bell Memorial Park and accommodate a program of 231 kids. d. Growing the program offering to include middle school (6th grade through 8th grade) will allow more players to participate in games and give the players more time with the coaches. e. Flag football will be $125 per registration and pads are an additional $60. f. The following people offered public comment on this item: i. Jeremy Bennett - Cambridge Youth Feeder Program ii. Eugene Stephens - NFL YFL iii. Lonnie Estes - NFL YFL iv. Matt Kramer - NFL YFL v. Beth Wilson - NFL YFL vi. Anthony Pumareys - NFL YFL vii. Brent Becherd - NFL YFL viii. Tom Owens - NFL YFL ix. Jessie Weatherby - NFL YFL x. John Gaines - NFL YFL A. Alan Brock - NFL YFL xii. Bob Ellis - Fulton County Board Commissioner - NFL YFL xiii. Mark Lazzara submitted a Public Comment Card but left without speaking g. A motion was made by Mr. Kottis to direct staff to amend the contract with the following changes: i. Tackle football will be offered for free to participants from the City of Milton and the City of Alpharetta ii. Scholarships are capped at 10% of the tackle registration iii. The age groups are expanded to Kindergarten thru 8th grade April 13, 2017 - PRAB Meeting Minutes iv. NFL-YFL will pay a commission to the City of $49.20 per non - scholarship tackle football participant. This is 15% of the value of the tackle program based upon last year's numbers. The motion was seconded by Mr. Hill. The motion passed 6 - 0. COMMITTEE REPORTS None UNFINISHED BUSINESS Fee changes for rentals at facilities a. Fee changes were recommended by staff to make the rental rates more appropriate across all facilities. b. The PRAB recommended that council amend the field rental policy to disallow any organization that has a program the city already offers to rent a field or facility unless there is approval of the Director of Parks & Recreation. A motion to approve the above suggested changes (].a. and l.b.) was made by Mr. Kottis. It was seconded by Mrs. Rekuc. The motion was approved by a unanimous vote. 2. The discussion regarding the PRAB meeting time and date has been deferred to the next meeting. 3. A motion to move the discussion on the Wall of Fame to the next meeting was made by Mr. Kottis. It was seconded by Mrs. Rekuc. The motion was approved by a unanimous vote. CITY STAFF REPORTS AND COMMUNICATIONS 1. Master Plan Report a. The master plan for Parks and Recreation along with the master plan for Providence Park will begin soon. The contract was delivered to the contractor to sign this week. 2. Mini Libraries a. A motion was made by Mr. Cranmer to defer this discussion to the May meeting. It was seconded by Mr. Kottis. The motion was approved by a unanimous vote. April 13, 2017 - PRAB Meeting Minutes 3. Program Status Report a. The spring athletics programs are running smooth. b. Sperber Music will offer a PNO (Parents' Night Out) program that will coincide with the Party on the Plaza event on April 29th. c. Core Physique will be offering yoga and other fitness programming in the coming weeks. OTHER Discussion on the $50 stipend for PRAB members. ADJOURNMENT Motion made to adjourn by Mr. Kottis. The motion was seconded by Mrs. Rekuc. The motion was approved by a unanimous vote. The meeting was ended by Mr. Stachowski at 9:42 PM. HOME OFIM I L,TC) ` ESTABLISHED 2006 Parks and Recreation Advisory Board Agenda 7:00 p.m., Thursday, April 13, 2017 Council Chambers, Milton City Hall Call to Order and Roll Call II. Pledge of Allegiance III. Approval of Meeting Agenda IV. Approval of Minutes from the February 16, 2017 meeting V. Public Comment - Public comment is a time for citizens to share information with the PRAB and to provide input and opinions on any matter that is not scheduled for its own public hearing during today's meeting. VI. Committee Reports a. Hopewell Baseball -Shannon b. Milton Steelers-Kottis c. Eagle Stix - Costanzo VII. Unfinished Business a. Discussion on Possible Fee Changes for Rentals (Deferred) b. Discussion on Meeting Date/Time Change c. Discussion on Wall of Fame VIII. New Business a. Presentation by the NFL-YFL Milton Steelers IX, City Staff Reports and Communications a. Master Plan Report - Cregge b. Mini Libraries - Cregge c. Program Status Report - McKlveen X. Other Business XI. Adjournment - Next Meeting Date: May 18, 2017 2006 Heritage Walk Milton, GA P: 678.242.25001 F: 678.242.2499 intoa.cityofmiltonga.us I www.cityofmiltonga.us HOME OF 'THE BEST QUALITY OF LIFE IN GEORGIA' I—t LTON% ESTABLISHED 2006 MEETING MINUTES CITY OF MILTON PARKS AND RECREATION ADVISORY BOARD Thursday, February 16, 2017 11:30 AM Council Chambers, Milton City Hall CALL TO ORDER Meeting was called to order by Mr. Stachowski at 1 1:36am. ROLL CALL Roll call was taken by Mr. Stachowski. MEMBERS PRESENT Scott Stachowski Dave Shannon Sue Rekuc Ron Hill Van Kottis Phil Cranmer OTHERS PRESENT Jim Cregge, Parks and Recreation Director Tom McKlveen, Parks and Recreation Program Manager Quorum was announced by Mr. Stachowski. APPROVAL OF MEETING AGENDA A motion was made by Mr. Shannon and seconded by Ms. Rekuc to approve the agenda. The vote passed unanimously. APPROVAL OF PAST MINUTES 1 /19 Meeting: A motion was made by Mrs. Rekuc to approve the minutes from the previous meeting. It was seconded by Mr. Hill. The motion passed unanimously. �0 y o u fi ` PHONE: 678.242.25001 FAX: 678.242.2499 - *Cettifed * �ar�r-iH� .12or infoQcityofmiltanga.us 1 www.cityatmilfanga.us C1tliPi1lii'il1nit cCh«4j - 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 a." " CERTIFIED BRONZE - �?a`` February 16, 2017 PRAB Minutes 2/2 Special Called Meeting: A motion was made by Mr. Cranmer to approve the minutes from the previous meeting, adding Ms. Rekuc to the attendance. It was seconded by Mr. Kottis. The motion passed unanimously. PUBLIC COMMENT None COMMITTEE REPORTS 1. Hopewell Baseball: There are now over 400 registered players. Practices have started for recreational teams. 2. Milton Steelers: Discussions were made with the board. PRAB believes that the program is "going in the right direction". 3. Eagle Stix: Mr. Cranmer had a discussion with Eagle Stix leadership. They would not like competing programs on the Milton fields. UNFINISHED BUSINESS 1. Fees changes for facility rentals a. A motion to defer fee changes to the next meeting was made by Mr. Kottis. It was seconded by Ms. Rekuc. The motion was approved by unanimous vote. 2. Move PRAB Meeting time a. It was discussed that an evening start might be better attended b. A motion was made by Ms. Rekuc to defer this topic to the next meeting. It was seconded by Mr. Kottis. The motion was approved by unanimous vote. 3. Field Rental Policy a. A motion was made by Ms. Rekuc to recommend that council leave the rental policy in place as currently written. It was seconded by Mr. Shannon. The motion passed unanimously. 4. MOU with The City of Alpharetta a. The Memorandum of Understanding (MOU) between the City of Milton (Milton) and the City of Alpharetta (Alpharetta) is serving the residents of Milton participating in sporting and senior activities with over 14,000 registrations of Milton residents in Alpharetta programs. The following are recommendations to Council of the City of Milton (Council) for consideration in updating the MOU: i. The Parks and Recreation Advisory Board (PRAB) recommends revising the MOU by removing inclusion in the February 16, 2017 PRAB Minutes MOU of four (4) competing programs: Baseball, Basketball, Boys Lacrosse and Football. ii. The PRAB further recommends Council contemplate a "carve out" or exception in the MOU pertaining to Milton residents residing in Alpharetta school districts for participation in the above referenced four (4) competing programs. iii. The PRAB further recommends that Council nominate a committee comprised of council members, Milton staff and a member of the PRAB to review and negotiate changes to the MOU in anticipation of a May 1 notification date deadline. iv. The motion regarding the above recommendations was offered by Ms. Rekuc. It was seconded by Mr. Kottis. The motion passed unanimously. 5. Wall of Fame a. A printout was handed out to members of the PRAB, showing a couple options for the Wall of Fame and Wall of Champions plate designs. b. A motion was made by Mr. Kottis to recommend the use of the color plaque design for the Wall of Champions and the approval of the only Wall of Fame design. It was seconded by Mr. Hill. The motion passed unanimously. NEW BUSINESS 1. None CITY STAFF REPORTS AND COMMUNICATIONS 1. Master Planning a. Bids were collected for the new Park Wide Master Plan and Master Plan for Providence Park. b. 7 Bids were received. City Staff has narrowed the field down to 3 firms. 2. Program Update a. The City of Milton has contracted with Core Physique to offer fitness programming out of the Bethwell Community Center and Bell Memorial Park. Activity will start in February. b. Sperber Music is offering the Parents Night Out program on 2/24/17. 3. For the next meeting: a. How do we promote our Program Partner activities? b. How can we improve that? February 16, 2017 PRAB Minutes c. An invitation to the next PRAB meeting will go out to the Communications Department ADJOURNMENT Motion made to adjourn by Mr. Kottis. The motion was seconded by Mrs. Rekuc. The motion was approved by a unanimous vote. The meeting ended by Mr. Stachowski at 12:38 pm. NEXT MEETING The next regularly scheduled meeting is on Thursday March 16th at 1 1:30 am in City Hall Council Chambers. 4/13/2017 ------ — -.A- FREE FOOTBALL WILL EXPOSE OPPORTUNITIES FOR: DIVERSITY FIGHT OBESITY BUILD CHARACTER PERMITTEACHING OF TACKLE FOOTBALL FUNDAMENTALS KEEP THE GAME OF FOOTBALL ALIVE AND SAFE 1 4/13/2017 (All 11tI 'T i I U ) HII-,III';: I BOYS AND GIRLS WHO ARE MILTON AND ALPHARETTA, GEORGIA RESIDENTS FOR THEIR ZONED TEAM NON MILTON B ALPHARETTA STUDENTS WILL PLAY FOR MILTON STEELERS TEAMS MILTON AND ALPHARETTA RLSIDLNTS WILL HAVL THE PRIVILEGE TO PARTICIPATE IN RECREATIONAL TACKLE FOOTBALL OUT OF CITY RESIDENTS WILL PAY IOR OUT OL CITY FEE REQUIRED BY THE CITY OF MILTON TACKLE FOOTBALL PLAYERS GRADE K -S WILL BE MANDATED TO WEAR GUARDIAN CAPS THE GUARDIAN CAP IS THE LEADING SOFT SHELL HELMET COVER ENGINELRED FOR IMPACT REDUCTION. IT BRINGS A PADDED. SOFT-SHELL LAYER TO THE OUTSIDE OF THE DECADL5 OLD HARD-SHELL FOOTBALL HELMET AND REDUCES IMPACT UP TO 33 MILTON EAGLES K-8 REC ANY PLAYER ZONED FOR MILTON HS MILTON BEARS K-8 REC ANY PLAYER ZONED FOR CAMBRIDGE HIS MILTON STEELERS K.B. ANY PLAYER WHO DOES NOT LIVE IN MILTON OR ALPHARETTA AND WANTS TO PLAY WITH NEW FOUND LIFE YOUTH FOOTBALL LEAGUE MILTON STEELERS ELITE GRADES 0 PLAYERS V11TII 3 - 4 OR MORE YEARS Of FOOTBALL EXPERIENC: WHO ARE MILTON OP. ALPHARETTA RESIDENTS OR NON RESIDENTS WHO WANT TO Pll.Y TRAVEL TACKLE FOOTBALL 2 4/13/2017 TO ACQUIRE ATOTAL OF 231 YOUTH ATHLETES FROM THE CITY OF MILTON AND ALPHARETTA TO TAP INTO THE CITY OF ROSWELL RESIDENTS WHO ARE ZONED FOR MILTON HIGH SCHOOL uAl:: :al3A 1.".11',; 7.`4R:L'{';LT ► NORTH MEI►O IOOTBALI LEAGUE INMII. 1.4.6 NO RECRUITING (OTHER THAN TO LNCOURAGE TO REGISTER FOR THE TEAM). OR TRYOUTS WILL BE PERMITTED. PLAYERS HOME TEAM WILL BE THE HIGH SCHOOL AREA IN WHICH THE PLAYER LIVES. IN AREA WHERE NO TEAM IN THAT AREA IS REPRESENTED. TEAMS MAY SEEK PLAYERS ADJACENT TO THEIR AREA. ALL EXCEPTIONS MUST BE CLEARED TFIRU AN EXECUTIVE BOARD MEMBER. 'AYA-11WINIP WrOVIHIlp, PH FC VFA RULES L IVLAWS DISMIC: C. BEGINNING WITH THE 2017 REGISTRATION. RETURNING PLAYERS WILL BE REQUIRED TO: A. REGISTER WITH THEIR EXISTING BOOSTER CLUB: B. REGISTER WITH THE BOOSTER CLUB BASED ON THE NIGH SCHOOL DISTRICT OF THEIR PRIMARY RESIDENCE. 3 4/13/2017 L i ilj',�ll L; ',t' . , I O ;, , , . PLEASE NOTE: CELL RULES STATE THAT EACH CHILD MUST PLAY IN THE HIGH SCHOOL DI STRICT THEY RESIDE. FAILURE TO DO SO COULD RESULT IN TEAM FORFEITURE. IF YOU ARE NOT SURE OF YOUR DISTRICT. PLEASE REFER TO THE "DISTRICT I INDEW PAGE AND INPUT YOUR ADDRESS. IN ORDER TO CORRECTLY IDENTITY YOUR HIGH SCHOOL. YOU MUST INDICATE A HIGH SCHOOL GRADE. PLEASE SCE THE SAMPLE BELOW AND FOLLOW THE LINK PROVIDED. OAl r<`lA,I � TO PROGRESS WITH OUR PLAYERS TO PROVIDE OUR CITY RESIDENTS CONTINUE TO BUILD ON FUNDAMENTALS AND BE A TEACHER OF THEGAME NOT JUST A COACH DECREASE "DADDY BALL" AND INCREASE PLAYING OPPORTUNITY DECREASE FOOTBALL POLITICS EXPOSE PLAYERS TO A HIGHER LEVEL Of COMPETITION �y Fj ��j( r� r• FJ�IIiFIIFI�RV11��rAr�ti��.VNM,NkA11.�11!NII;�'iII- IIi'�l tii E: MORE EXPERIENCED COACHES STATE OF THE ART TRAINING EQUIPMENT FOCUS ON FOOTBALL FUNDAMENTALS AND PLAYING TIME BY KEEPING TEAM NUMBER LOW L--- 0 4/13/2017 ��Ayl I4nV►1 S'.N.Wd 113,I1fil Er i NEW FOUND LIFE YOUTH ASSOCIATION WAS ABLE TO SECURE SPONSORSHIPS FROM THE fi FOLLOWING: RETIRED NFL PLAYERS SPONSORSHIP t�/ CORPORATE SPONSORSHIPS � PRIVATE SPONSORSHIPS TJE ME u 0 TAKEALLTEAMS flA KATIOMAL �C�CJI'IAMSIIR'IArRMAMENT!! X=S12MUS PracliceHours: 6:00-1:15m & 7.15-9.Mgm e + 5 4/13/2017 r'- o L 0 "M I LTO N it PUBLIC COMMENT CARD (Please print & fill in completely ESTARL151fED 1. Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about ** bout an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below) Y Agenda Item No.: I Zoning Case No. : TODAY'S DATE: NAME: ���` �CtGr��I ' �C,(-A-- ADDRESS: 1 .f-f L M', I-ve,- (, A 3666H PHONE: %7a-1L.S- cSb(, Please check ALL that apply: I am in SUPPORT of this Agenda Item .A- I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission 1 am a paid representative of either the support or opposition LO`� h1, .l c F«A 1 am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood S***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. �rt want to speak about this Agenda Item 1 I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOME OF .......... .. . ; 1�l I LTC) ITT' I:STA[SLI StIEt) 200[. PUBLIC COMMENT CARD (Please print & fill in com letel Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: 1 would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) X I would like to speak about an Agenda Item or Zoning Case. *"(Please indicate Agenda Item No. below) ** Agenda Item No. : Zoning Case No. : TODAY'S DATE: c%i3 7 NAME: I.-tkkk F/U,f= ADDRESS: PHONE: Please check ALL that apply: I am in SUPPORT of this Agenda Item 1 I am in OPPOSITION of this Agenda Item -1 1 am a Milton resident A I am a Milton business owner -I I am a local lobbyist duly registered with the State Ethics Commission 7 I am a paid representative of either the support or opposition -1 1 am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : ❑Yes n No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOME C>F M I LTO N LSTA6LIS11[D 200G PUBLIC COMMENT CARD (Please print & fill in com letel Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below) ** Agenda Item No.: Zoning Case No. : TODAY'S DATE: NAME: Lo ✓� vt : Fs - S ADDRESS: 1 4 wo v�(ar0` �anAL PHONE: -71tO - Lis 3 - S $ 41 PI se check ALL that apply: 71✓ 1 am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : []Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. M I LT O ITT' I` [STABLISIIED 2000 PUBLIC COMMENT CARD (Please 2daf & fill in com letel Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about lan A ends Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No.: �1 Zoning Case No. : TODAY'S DATE: NAME: ADDRESS: / 2' PHONE: Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner 1 am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. i I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a -group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a -group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "yes" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. `*- "M I LTO N ESTABLISHED 2006 PUBLIC COMMENT CARD (Please print & fill in completely Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (skip to Today's Date) ;ail would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No.: Zoning Case No. : TODAY'S DATE: NAME: 1t \" wk\%O. ADDRESS: \` ���5� Y\<���li�:) \,j� PHONE: L�\� C V6Vk s \ Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : []Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. *-- HOME i r l I LJ 1 O N ESTABL IS I ED 2006 PUBLIC COMMENT CARD (Please print & fill in completely Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (skip to Today's Date) s.l would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No. : Zoning Case No. : TODAY'S DATE: \�I NAME: �/1v�1`I�VYVmra(?I) ` V ADDRESS: y `�-I 4311 k� e V 1 PHONE: Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item -I"am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item 1 DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "yes" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOME l _ l 1 L i O N PUBLIC COMMENT CARD (Please Lint & fill in completeIV ESTABLISHED 2006 Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about an Agenda Item or Zoning Case. "(Please indicate Agenda Item No. below)** Agenda Item No. : Zoning Case No. : TODAY'S DATE; 7`l;3 NAME:— ji jrf-h ADDRESS: -�Iso PHONE: Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood`** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : []Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOMEOF M I LTC N; ESTABLISHED 2006 PUBLIC COMMENT CARD (Please print & fill in completely Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) k"I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No. Zoning Case No. : TODAY'S DATE: I / ,?-I � NAME: D,,,1 OV 1 ADDRESS:�- PHONE: 7 7 0- 3& 3- 9 2 1 1 Please check ALL that apply: 1 I am in SUPPORT of this Agenda Item -� I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : []Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. M I LTO [ l*k- ESTABLISTIED 2006 PUBLIC COMMENT CARD (Please print & fill in com letel Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: 1 would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (skip to Today's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No.: ` h Zoning Case No.: TODAY'S DATE: I3 D f NAME: ADDRESS: ��vIS(}�►fM <G��I�r ��(�, PHONE: � ill —(D `f Please check ALL that apply: !�-I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition 1 am affiliated with a Group or Neighborhood*** Name of GroupANeighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. '**- NA I L i O N' PUBLIC COMMENT CARD (Please print & fill in completely ESTA 6LI51IED 2000. Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: -] Plwould like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No.: S. Zoning Case No. : TODAY'S DATE: L' /I 3 t "j NAME: John lTr"'-1e1 ADDRESS: 02�0� Co,,�,, PHONE: E,� 1 , Ci 13 Please check ALL that apply: I am in SUPPORT of this Agenda Item 1 am in OPPOSITION of this Agenda Item �I am a Milton resident I am a Milton business owner 1 am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition VI am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) / ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. v! I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "yes" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOME OF '-. -- M I LTO N ESTARLI SI IED 200(. PUBLIC COMMENT CARD (Please 2Liat & fill in com letel Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Todav's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No.: Abr`L 14J10,� Zoning Case No.: TODAY'S DATE: - I D NAME:_ ffloo dal ADDRESS: 1 D 3(/� �Cc if err PHONE: ilJ C\ � 19 S �2-q S �; �2 Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner :1 1 am a local lobbyist duly registered with the State Ethics Commission A I am a paid representative of either the support or opposition -1 1 am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. i I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a _group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "yes" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOMr Of NA I LTo N*- �srnnuseie� zoos. PUBLIC COMMENT CARD (Please print & fill in completely Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Today's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No. : Zoning Case No. : TODAY'S DATE: �) 3 NAME ADDRESS: PHONE: -7-7 Please check ALL that apply: i! I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item -j I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission -7 I am a paid representative of either the support or opposition 1 am affiliated with a Group or Neighborhood*** Name of Group/Neighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. 1 1 want to speak about this Agenda Item i I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : []Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. PUBLIC COMMENT CARD (Please print & fill in completely I" I LTO-N N' ESTA6LIS11ED 200(. Instructions: Instructions: 1. Complete this card in its entirety (DO NOT leave anything blank) 2. Give the card to the City Clerk BEFORE THE COUNCIL MEETING BEGINS. 3. When your name is called, approach the podium and speak directly into the microphone and state your name and address. Please complete the following information: I would like to make a General Comment that does NOT pertain to an Agenda Item or Zoning Case. (Skip to Todav's Date) I would like to speak about an Agenda Item or Zoning Case. **(Please indicate Agenda Item No. below)** Agenda Item No. : Zoning Case No. : TODAY'S DATE: _ NAME: ADDRESS: I ., . L PHONE: L,e� C,2 fo re Pei,ki 0 Please check ALL that apply: I am in SUPPORT of this Agenda Item I am in OPPOSITION of this Agenda Item I am a Milton resident I am a Milton business owner I am a local lobbyist duly registered with the State Ethics Commission I am a paid representative of either the support or opposition I am affiliated with a Group or Neighborhood*** Name of GroupiNeighborhood ***(complete attached form) ***You are required to fill out the attached Affidavit before speaking on behalf of the group you are representing. I want to speak about this Agenda Item I DO NOT want to speak but I would like the following comments read into the record: (Please use the back of this card for additional writing space.) **Please read the following RULES regarding Public Comment: • Public Comment is allowed on an Agenda Item or a General Public Comment can be made about something that is not on the Agenda. • NO Public Comment is allowed regarding Consent Agenda Items or First Presentation Items. • All General Public Comments are allowed a total of five minutes. • ALL Public Comments in SUPPORT of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in SUPPORT have a total of ten minutes as a -group. • ALL Public Comments in OPPOSITION of an Agenda Item are allowed a TOTAL of ten minutes. This means that ALL people who wish to speak in OPPOSITION have a total of ten minutes as a -group. ---------------------------------------------------------------------------------------------------------------------------------------------- If you have made any campaign contributions to a Councilmember aggregating $250.00 or more, please check "ves" or "no" : ❑Yes ❑ No. When you have completed this card, please give it to the CITY CLERK before the meeting begins. Please see the CITY CLERK if you have any questions regarding this Public Comment Card. HOME OF 'THE BEST QUALITY OF LIFE IN GEORGIA' M I L ON%' ESTABLISHED 2006 Employee Information Employee # Personal Information Full Name: Last First M.I. Address: Street Address Apartment/Unit # City State ZIP Code Home Phone: (_ ) Alternate Phone: ( ) Social Security Number or Government ID: Birth Date: Marital Status: Race: Sex: ee Information Title: Supervisor: Department: City Hall 2006 Heritage Walk Work Location: Milton, GA 30004 E-mail Address: @cityofmiltonga.us Business Work Phone: ( ) Cell Phone: ( ? Hire Date: Emergency Contact Information Primary Contact: Address Street Address City Primary Phone: ( ) Relationship: Secondary Contact: Last Address: Primary Phone: Relationship: Apartment/Unit # ZIP Code Alternate Phone: Street Address Apartment/Unit # Alternate Phone: ZIP Code HOME OF 'THE BEST QUALITY OF LIFE IN GEORGIA' MI....-.LTON ESTABLISHED 2oo6 DIRECT DEPOSIT AUTHORIZATION FORM The City of Milton offers direct deposit so that employee's checks are directly deposited to their designated accounts each payday. Note: Direct Deposit is mandatory for all new employees. Name Social Security Number Deposit Number 1: Check One: ❑ Checking ❑ Savings Check One: ❑ New Account ❑ Change Existing Account ❑ Cancel Account Bank Name: Transit/Routing Number Account Number ***Deposit Net Pay*** Note: Please attach a voided check for verification. A deposit slip is not valid. Deposit Number 2: Check One: ❑ Checking ❑ Savings Check One: ❑ New Account ❑ Change Existing Account ❑ Cancel Account Bank Name Transit/Routing Number Account Number Deposit Fixed Amount $ Note: Please attach a voided check for verification. A deposit slip is not valid. Deposit Number 3: Check One: ❑ Checking ❑ Savings Check One: ❑ New Account ❑ Change Existing Account ❑ Cancel Account Bank Name Transit/Routing Number Account Number Deposit Fixed Amount $ Note: Please attach a voided check for verification. A deposit slip is not valid. Youmb,s �r PHONE: 678.242.25001 FAX: 678.242.2499 fA6EAw�A�6 7f,1 *Certified info@cityofmiitonga.us ( www.cityofmiitongo.us E i i 0 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 „c,cf„ E .' . ,; E: kk�ff 4444J HOME OF 'THE BEST QUALITY OF LIFE IN GEORGIA' MIL,TON% ESTABLISHED 2006 Authorization: By signing below, I authorize the City of Milton to initiate direct deposit (credit) entries into my designated account/accounts. If funds to which I am not entitled are deposited to my account, I authorize the City of Milton to direct the bank to return said funds (debit). I understand that my bank must be a member of the Automated Clearing House (ACH) in order for my net pay to be processed via Electronic Funds Transfer (EFT). This authorization is to remain in effect until it is changed or canceled by me via the Direct Deposit Authorization Form. I understand that I must allow sufficient time for the processing of such changes or cancellation. Employee Signature Date You PHONE: 678.242.25001 FAX: 678.242,2499 0 l *s � * Certified City of 1 info@cityofmiitonga.us I www.cityofmiltonga.us mmunity i EdTics 0 1 -IN tr 1' i . 17 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 ceHTii rD rsra _ '�®{�``� p ( A 7 The exceptions don't apply to supplemental wages Nonwage income. If you have a large amount of ® ` .L / greater than $1,000,000. nonwage income, such as interest or dividends, Basic instructions. If you aren't exempt, complete consider making estimated tax payments using Form Purpose. Complete Form W-4 so that your the Personal Allowances Worksheet below. The 1040-ES, Estimated Tax for Individuals. Otherwise, employer can withhold the correct federal income worksheets on page 2 further adjust your you may owe additional tax. If you have pension or tax from your pay. Consider completing a new Form withholding allowances based on itemized annuity income, see Pub. 505 to find out if you should W-4 each year and when your personal or financial deductions, certain credits, adjustments to income, adjust your withholding on Form W-4 or W-4P. situation changes. or two-earners/multiple jobs situations. Two earners or multiple jobs. If you have a Exemption from withholding. If you are exempt, Complete all worksheets that apply. However, you working spouse or more than one job, figure the complete only lines 1, 2, 3, 4, and 7 and sign the may claim fewer (or zero) allowances. For regular total number of allowances you are entitled to claim form to validate it. Your exemption for 2017 expires wages, withholding must be based on allowances on all jobs using worksheets from only one Form February 15, 2018. See Pub. 505, Tax Withholding you claimed and may not be a flat amount or W-4• Your withholding usually will be most accurate and Estimated Tax. percentage of wages. when all allowances are claimed on the Form W-4 Note: If another person can claim you as a dependent Head of household. Generally, you can claim head for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details. on his or her tax return, you can't claim exemption of household filing status on your tax return only if from withholding if your total income exceeds $1,050 you are unmarried and pay more than 50% of the Nonresident alien. if you are a nonresident alien, see and includes more than $350 of unearned income (for costs of keeping up a home for yourself and your Notice 1392, Supplemental Form W-4 Instructions for example, interest and dividends). dependent(s) or other qualifying individuals. See Nonresident Aliens, before completing this form. Exceptions. An employee may be able to claim Pub. 501, Exemptions, Standard Deduction, and Check your withholding. After your Form W-4 takes exemption from withholding even if the employee is Filing Information, for information. effect, use Pub. 505 to see how the amount you are a dependent, if the employee: Tax credits. You can take projected tax credits into having withheld compares to your projected total tax • Is age 65 or older, account in figuring your allowable number of withholding allowances. Credits for child or dependent for 2017. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married). • Is blind, or care expenses and the child tax credit may be claimed Future developments. Information about any future • Will claim adjustments to income; tax credits; or income; using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other developments affecting Form W-4 (such as legislation enacted after we release it) will be posted itemized deductions, on his her tax return. credits into withholding allowances. at www.irs.gov/w4. Personal Allowances Worksheet (Keep for your records.) A Enter "1 " for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A ( • You're single and have only one job; or I B Enter "1" if: j • You're married, have only one job, and your spouse doesn't work; or B Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. C Enter "1 " for your spouse. But, you may choose to enter "-0-" if you are married and have either a working spouse or more than one job. (Entering "-0-" may help you avoid having too little tax withheld.) . . . . . . . . . . . . . C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D E Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above) E F Enter "1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit F (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. • If your total income will be less than $70,000 ($100,000 if married), enter "2" for each eligible child; then less "1" if you have two to four eligible children or less "2" if you have five or more eligible children. • If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each eligible child. G H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) ► H • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions For accuracy, and Adjustments Worksheet on page 2. complete all • If you are single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply, to avoid having too little tax withheld. • If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. ----- Separate here and give Form W-4 to your employer. Keep the top part for your records. Form ® Employee's Withholding Allowance Certificate Department of the Treasury 0, Whether you are entitled to claim a certain number of allowances or exemption from withholding is Internal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 1 Your first name and middle initial I Last name O v...,.. OMB No. 1545-0074 � 17 O security number Home address (number and street or rural route) 3 ❑ Single ❑ Married ❑ Married, but withhold at higher Single rate. Note: If married, but legally separated, or spouse is a nonresident alien, check the "Sinale" box. City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. ► ❑ 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . 6 $ 7 1 claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write "Exempt" here . . . . . . . . . . . . . . . 10- 7 Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee's signature (This form is not valid unless you sign it.) ► 8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 1 9 Office code (optional) Date ► 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2017) Form W-4 (2017) Da o i Deductions and Adjustments Worksheet Note: Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estimate of your 2017 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 10% of your income, and miscellaneous deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you're married filing jointly or you're a qualifying widow(er); $287,650 if you're head of household; $261,500 if you're single, not head of household and not a qualifying widow(er); or $156,900 if you're married filing separately. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . 1 $ $12,700 if married filing jointly or qualifying widow(er) 2 Enter: $9,350 if head of household I 2 $ $6,350 if single or married filing separately 3 Subtract line 2 from line 1. If zero or less, enter "-0-" . . . . . . . . . . . . . . . . 3 $ 4 Enter an estimate of your 2017 adjustments to income and any additional standard deduction (see Pub. 505) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2017 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . . 5 $ 6 Enter an estimate of your 2017 nonwage income (such as dividends or interest) . . . . . . . . 6 $ 7 Subtract line 6 from line 5. if zero or less, enter "-0-" . . . . . . . . . . . . . . . . 7 $ 8 Divide the amount on line 7 by $4,050 and enter the result here. Drop any fraction . . . . . . . 8 9 Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . . 9 10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10 Two-Earners/Multiple Jobs Worksheet See Two earners or multiple jobs on page 1. Note: Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than "3" . . . . . 3 if line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter "-0-") and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . 3 Note: If line 1 is less than line 2, enter "-0-" on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from fine 2 of this worksheet . . . . . . . . . . 4 5 Enter the number from line 1 of this worksheet . . . . . . . . . . 5 6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $ 8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . 8 $ 9 Divide line 8 by the number of pay periods remaining in 2017. For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2017. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $ Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others If wages from LOWEST Enter on If wages from LOWEST Enter on If wages from HIGHEST Enter on If wages from HIGHEST Enter on paying job are- line 2 above paying job are- line 2 above paying job are- line 7 above paying job are- line 7 above $0 - $7,000 0 $0 - $8,000 0 $0 - $76,000 $610 $0 - $38,000 $610 7,001 - 14,000 1 8,001 - 16,000 1 75,001 - 135,000 1,010 38,001 - 85,000 1,010 14,001 - 22,000 2 16,001 - 26,000 2 135,001 - 205,000 1,130 85,001 - 185,000 1,130 22,001 - 27,000 3 26,001 - 34,000 3 205,001 - 360,000 1,340 185,001 - 400,000 1,340 27,001 - 35,000 4 34,001 - 44,000 4 360,001 - 405,000 1,420 400,001 and over 1,600 35,001 - 44,000 5 44,001 - 70,000 5 405,001 and over 1,600 44,001 - 55,000 6 70,001 - 85,000 6 55,001 - 65,000 7 85,001 - 110,000 7 65,001 - 75,000 8 110,001 - 125,000 8 75,001 - 80,000 9 125,001 - 140,000 9 80,001 - 95,000 10 140,001 and over 10 95,001 - 115,000 11 115,001 - 130,000 12 130,001 - 140,000 13 140,001 - 150,000 14 150,001 and over 15 Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return. FORM G4(Rev.0104) STATE OF GEORGlA EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE 1. YOUR FULL NAME 2. YOUR SOCIAL SECURITY NUMBER HOME ADDRESS (Number, Street, or Rural Route) CITY, STATEAND ZIP CODE PLEASE READ INSTRUCTIONS ONREVERSE SIDE BEFORE COMPLETING LINES 3'V 3. MARITAL STATUS (If you do not wish to claim an aUowanca, entmr^U^ in the brackets beside your marital status.) A. Single: enter Oor1 ................................... [ ] 4. DEPENDENT ALLOWANCES ........... ] B. Married Filing Joint, both spouses working: enter Our1or2............. [ ] C. Married Filing Joint, one 5. ADDITIONAL ALLOWANCES ........... [ ] spouse working: enter 0or1or2............... [ ] (complete workoheetbelow) D. Married Filing Separate: enter Oor1 or2..................................... ' [ ] E. Head ofHousehold: G. ADDITIONAL WITHHOLDING ........... G__________ enter Onr1 or2......................................... [ ] 7.LETTER USED (Marital StatusA,B.C,D.orE) _ TOTAL ALLOWANCES (Total ofLines 3'5)�� (Employer: The lefterindicates the tax tables on pages 10through 35 ofthe Employer's Tax Guide) 8. EXEMPT. I claim exemption from withholding because I incurred no Georgia income tax liability last year and I do not expect to have a Georgia income tax liability this year. Check here E7. | certify under penalty ofperjury that |amentitled tothe number ofwithholding allowances orthe exemption from withholding status claimed on this Fnnn G4. Also, | authorize myemployer to deduct per pay period the additional amount listed above. Employee's Signature Date Employer: Complete Line 9 if the employee claims over 14 allowances or exempt from withholding Georgia Department of Revenue, Withholding Tax Unit, P. 0. Box 49432, Atlanta, GA 30359. 0. EMPLOYER'S NAME AND ADDRESS: BNPLOYER'GFBN: EyNPLOYER'SVVH#: Mail entire form to WORKSHEET FOR CALCULATING ADDITIONAL ALLOWANCES 1. COMPLETE THIS LINE ONLY |FUSING STANDARD DEDUCTION: Yourself- Age 85orover F� Blind R Spouse: Age05orover F� Blind Fl Number ofboxes checked ___x13OO........... $ 2.ADD|T0NALALLOVANCESFOR DEDUCTIONS: A.Federal Estimated Itemized Deductions ................................................................ $ B. Georgia Standard Deduction (enter nne): Single/Head ofHousehold $2.300 Each Spouse $1.500 C.Subtract Line 8from Line A ................................................ ''—.'—'''——'—' D.Allowable Deductions toFederal Adjusted Gross Income ............................................................ E.Add the Amounts onLines 1.2C.and 2D............................................................... ................... F. Estimate ofTaxable Income not Subject hoWithholding .............................................................. G. Subtract Line Ffrom Line E(if zero cxless, stop here) ............................................................... H. Divide theAmourdonLine {9by$3.O0U.Entertoto|here and onLine 5above ............................ ([his isthe number ofadditional allowances. Ifthe remainder isover $1.5UDround up). CREATE AS MANY COPIES A8NEEDED Enter your full name, address and social security number in boxes 1 and 2. Line 3: Write the number of allowances you are claiming in the brackets beside your marital status. A. Single - enter 1 if you are claiming yourself B. Married Filing Joint, both spouses working - enter 1 if you claim yourself or 2 if you claim yourself and your spouse C. Married Filing Joint, one spouse working - enter 1 if you claim yourself or 2 if you claim yourself and your spouse D. Married Filing Separate - enter 1 if you claim yourself or 2 if you claim yourself and your spouse E. Head of Household - enter 1 if you claim yourself but the individual(s) for whom you maintain a home does not qualify as a dependent; or 2 if you claim yourself and a qualified dependent for whom you maintain a home Do not claim a deduction on Line 4 for a dependent used to qualify you as head of household Line 4: Enter the number of dependent allowances you are entitled to claim. Line 5: Use the worksheet at the bottom of Form G-4 to determine the number of additional allowances to which you are entitled and enter the total here. Line 6: Enter a specific dollar amount that you authorize your employer to withhold in addition to the tax withheld based on your marital status and number of allowances. Line 7: Enter the letter of your marital status from Line 3. Enter total of the numbers on Lines 3 - 5. Line 8: Check the box if you qualify to claim exempt from withholding. You can claim exempt if you filed a Georgia income tax return last year and did not have a tax liability, and you expect to file a Georgia tax return this year and will not have a tax liability. You can not claim exempt if you did not file a Georgia income tax return for the previous tax year. O.C.G.A. 48-7-102 requires you to complete and submit Form G-4 to your employer in order to have tax withheld from your wages. By correctly completing this form, you can adjust the amount of tax withheld to meet your tax liability. Failure to submit a properly completed Form G-4 will result in your employer withholding tax as though you are single with zero allowances. Employers are required to mail any Form G-4 claiming more than 14 allowances or exempt from withholding to the Georgia Department of Revenue for approval. Employers will honor the form as submitted pending notification from the Withholding Tax Unit. Upon approval, such forms remain in effect until changed or until February 15 of the following year. NOTE: Employers who know that a G-4 is erroneous should not honor the form and should withhold as if the employee is single claiming zero allowances until a corrected form has been received. o Employment Eligibility Verification USCIS y o Department of Homeland Security Form I-9 .4 U.S. Citizenship and Immigration Services OMB No. 1615-0047 Expires 08/31/2019 ►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI -DISCRIMINATION NOTICE: It is illegal to discriminate against work -authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any) Address (Street Number and Name) Apt. Number City or Town State ZIP Code Date of Birth (mmlddlyyyy) U.S. Social Security Number m Employee's E-mail Address Employee's Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number/USCIS Number): 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9: An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number. 1. Alien Registration Number/USCIS Number: OR 2. Form 1-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance: Signature of Employee I Today's Date (mmlddlyyyy) QR Code - Section 1 Do Not Write In This Space Preparer and/or Translator Certification (check one): tI I slid not use a preparer or translator. ❑ A preparers) and/or translator($) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers andlor translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that i have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator Last Name (Family Name) Address (Street Number and Name) First Name (Given Name) City or Town Employer Completes Next Page Today's Date (mmlddlyyyy) State IZIP Code Form I-9 11/14/2016 N Page 1 of 3 Employment Eligibility Verification USCIS Department of Homeland Security Form I-9 U.S. Citizenship and Immigration Services OMB 0 Expireess 08/31/31/2019 Employee Info from Section 1 I Last Name (Family Name) Identity and Employment Authorization Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) First Name (Given Name) I M.I. I Citizenship/Immigration Status Identity Document Title Issuing Authority Document Number Expiration Date (ifany)(mm/dd/yyyy) Additional Information "z'i ., Employment Authorization Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) QR Code - Sections 2 & 3 Do Not Write In This Space Certification: I attest, under penalty of perjury, that (1) 1 have examined the document(s) presented by the above -named employee, (2) the above -listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions) Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) I Title of Employer or Authorized Representative Last Name of Employer or Authorized Representative I First Name of Employer or Authorized Representative I Employer's Business or Organization Name Employer's Business or Organization Address (Street Number and Name) I City or Town State I ZIP Code Section 3. Reverifiication and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) B. Date of Rehire (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy) C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below. Document Title Document Number Expiration Date (if any) (mm/dd/yyyy) unu01 Ncuany V1 Ne1jury, urat to the Debt oT my Knowieage, tnis employee is autnonzea to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. >ignature of Employer or Authorized Repf!T day's Date (mm/dd/yyyy) Name of Employer or Authorized Representative Form I-9 11/14/2016 N Page 2 of 3 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. LIST A LIST B LIST C Documents that Establish Documents that Establish Documents that Establish Both Identity and Identity Employment Authorization Employment Authorization OR AND 1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION 2. Permanent Resident Card or Alien Registration Receipt Card (Form 1-551) 3. Foreign passport that contains a temporary 1-551 stamp or temporary 1-551 printed notation on a machine- readable immigrant visa 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 4. Employment Authorization Document that contains a photograph (Form 1-766) 2. Certification of Birth Abroad issued by the Department of State (Form FS-545) 3. School ID card with a photograph 5. For a nonimmigrant alien authorized 3. Certification of Report of Birth 4. Voter's registration card to work for a specific employer issued by the Department of State because of his or her status: a. Foreign passport; and (Form DS-1350) 5. U.S. Military card or draft record 4. Original or certified copy of birth 6. Military dependent's ID card b. Form 1-94 or Form 1-94A that has certificate issued by a State, the following:county, (1) The same name as the passport; and (2) An endorsement of the alien's municipal authority, or territory of the United States bearing an official seal 7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document 5. Native American tribal document 9. Driver's license issued by a Canadian government authority 6. U.S. Citizen ID Card (Form 1-197) nonimmigrant status as long as that period of endorsement has 7. Identification Card for Use of Resident Citizen in the United States (Form 1-179) not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. �I For persons under age 18 who are unable to present a document listed above: 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form 1-94 or Form 1-94A indicating 8. Employment authorization document issued by the Department of Homeland Security 10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 11/14/2016 N Page 3 of 3 Employee Acknowledgment Form This Personnel Handbook describes the policies and procedures at the City of Milton, Georgia and I understand that I should consult Human Resources regarding any questions not answered in the Personnel Handbook. I acknowledge that I am an employee at -will and have entered into my employment with the City of Milton voluntarily and acknowledge that there is no specified length of employment. Any employment agreement that would alter my status as an employee at -will must be specified and executed in writing by the City Manager and myself, and approved by the City Council. No other agreements will be enforceable or change my status as an employee at -will. This Personnel Handbook replaces and supersedes any earlier personnel practice, policy, or guideline. However, since the policies and procedures described within this handbook are subject to change from time to time, I acknowledge that revisions may occur. I understand that such changes may supersede, modify, or revoke existing policies. The City Manager has the power to change the policy and may do so at any time without notice. Furthermore, I acknowledge that the Personnel Handbook is neither a contract of employment nor a legal document. I have received a copy of the City of Milton Personnel Handbook and I understand that it is my responsibility to read and comply with the policies contained in the manual and any revisions made to it. Employee Name: Employee Signature: Date: Notice of Workers' Compensation Procedures This is to certify that I have read and understand the Workers' Compensation PANEL OF PHYSICIANS notice. I understand that when I am involved in an on-the-job injury my employer will pay medical costs for treatment by the physician(s) I select from the Panel of Physicians. If I desire to obtain medical services from a physician not listed on the Panel, I may do so: however, 1 will be liable for those medical expenses. The physician selected from the Panel of Physicians may arrange for appropriate consultations, referrals, and other specialized medical services as the nature of the injury requires. If I am dissatisfied with the physician selected, I may make one change without permission to a second physician also listed on the Panel. Upon notification of the employer or its administrator, an Independent Medical Examination may be elected as set forth by the law. However, any further changes require the permission of the employer/insurer, self -insurer claims office, or the State Board of Workers' Compensation. In the case of a bona -fide emergency involving severe injury or when a Panel of Physicians is not available, I should seek medical care from the nearest Hospital Emergency Room. However, all follow-up care must, thereafter, be rendered by a physician from the Panel, or a Panel Physician's referral. I further understand that I must notify my immediate supervisor or a member of the departments administrative staff or the Personnel Office as soon the injury occurs, regardless of the extent of the injury, and when possible prior to seeking treatment. I understand that the treating physician will verify my employment and eligibility for treatment with my employer before commencing treatment unless the nature of the injury so prohibits. Delay in notification may result in denial of payment for medical services rendered. (Please print name) Social Security # (Signature of Employee) Date (Signature of Witness) Date icMARC 401 PLAN EMPLOYEE ENROLLMENT FORM Use this form to open an account with the ICMA Retirement Corporation. Read instructions on the back carefully before completing this form. Please print legibly in blue or black ink. To make legal changes (i.e., change of name, marital status, or beneficiary changes) use the Employee Information Change Form. Return this form to your employer promptly. Your employer must provide this form to ICMA Retirement Corporation before the payroll date of your first deferral. To make address chan es, investment allocation changes or fund transfers, please visit Vanta eLink (www.icmarc.org) or use Vanta Line (1-800-669-7400). 1 Employer Plan Number Employer Plan Name State 108025 City of Milton 401- Part Time P a ctpan Information Social Security Number Required - Information Full Name of Participant in this box must be completed to avoid processing and investment La5t delays. Mailing Address/Street rJ Beneficiary Designation If mamed, special rules apply, See i nstructiorrs on reverse side, City Date of Birth Month Oay 'Fear Job Title: Daytime Phone Number Area Code Date Employed/Rehired v fon.n —Dayy Year Evening Phone Number Area Code State Zip Code Rehired? ❑Check if yes Email Address mi Gender Marital Status 17 17 El M F Married Single Name Date of Birth Relationship to you Social Security Number % of benefit Primary Beneficiaries: rl Spouse n Other: MSpouse ❑ Other: Spouse nOther Total = 100% Contingent Beneficiaries, if any: �L ri Spouse rl Other: ® Spouse Other: ❑ Spouse Other: Total = 1007A 3 My Instructions for my Employer - I authorize my Employer to deduct a(n): Amount of ❑✓ Mandatory pre-tax deferral of 3.75 % or $ from my pay each pay period. Contributions ❑ Mandatory after-tax deferral of % or $ from my pay each pay period. ❑ Elective pre-tax deferral of % or $ from my pay each pay period (for 401(k) plans only). ❑ Voluntary after-tax deferral of % or $ from my pay each pay period. As an individual who has reached or will reach age 50 by December 31 of this year, I also authorize my employer to deduct an additional pre-tax deferral of $ from my pay each pay period.' * Note to Employers This separate item is provided to allow you to separately track these "age 50 catch-up contributions" for purposes of limit testing. For employer use: The employer will contribute %u or $ . The employee will contribute % or $ 4 Fill in the boxes at right with codes of EMPLOYER ACCOUNT EMPLOYEE ACCOUNT the toffun5)you want codes invest oun Code Percent Code Percent Code Percent Code Percent Allocation of list of funds and codes can be found Contributions on the investment Options sheet. State law, local law, or your employer may place restrictions on investment in these funds, TOTAL = 100% TOTAL =100% 5 1 acknowledge that I have read and agreed to the disclosure (see 5 & 6) on the back of this form. Employee Si nature Participant Signature Date 6 Employer Plan Number Employer's — — — — — — Authorization Authorized Employer Official's Signature Date ICMA Retirement Corporation • P. 0. Box 96220 - Washington, DC 20090-6220 - Toll Free 1-800-669-7400 • En Espanol 1-800-669-8216 • www.icmarc.org • Fax 202-682-6439 FRM010-039-200605-384 ICM/>kR aKn"g Rrrremrnr .wry 401 PLAN EMPLOYEE ENROLLMENT FORM INSTRUCTIONS Before you complete this form, please read the accompanying literature so you understand the plan's provisions. To make future changes to your account such as address changes and/ or fund transfers, please use VantageLink (www.icmare.org) or VantageLine (1-800-669-7400). IMPORTANT NOTE: Please do not delay in submitting this form. If we do not have your form by the time we receive your first deferral, we will be unable to invest your retirement plan assets, and they will be returned to your employer. You will receive a confirmation of your enrollment as well as quarterly financial statements. Please review these carefully. 1. PARTICIPANT INFORMATION Please complete this section carefully. The information will be used to establish your account and you will receive your statements at the address listed. The employer plan number is available from your employer or ICMA-RC's Investor Services at 1-800-669-7400, 2. DESIGNATION OF BENEFICIARY Use this section to designate your beneficiary(ies). If this form is not signed, the beneficiary(ies) you selected will not be valid If a valid form is not on file at the time of your death, benefits will be paid as outlined in your employer's plan document. PLEASE NOTE: If a Social Security number is not provided and RC cannot locate the named beneficiary, the account balance will be paid to your estate. Beneficiary Designation - SINGLE PARTICIPANTS Your designation of beneficiary(ies) tells us who should receive the accumulated value of your account if you die before full distribution of your account. If no primary beneficiary(ies) lives longer than you, the benefits will be paid to your contingent beneficiary(ies). If none of your primary or contingent benefi- ciaries are living at the time of your death, the proceeds will be paid as outlined in your employer's plan document. Beneficiary Designation - MARRIED PARTICIPANTS You may name your spouse as beneficiary for up to 100 percent of your account. You may also waive naming your spouse as beneficiary for any part of your account and then name someone else as beneficiary. However, if you waive naming your spouse as beneficiary, your spouse must consent to this waiver. Your employer's plan may require that your spouse be the beneficiary for at least 50 percent or more of your account. If this is the case, the waiver and consent rules mentioned above still apply. If you are unsure which provision applies to you, check with your employer or ICMA-RC's Investor Services at 1-800-669-7400. Complete details about waiving this benefit, including the required waiver and consent forms, are available from ICMA- RC's Investor Services at 1-800-669-7400. SPECIAL CERTIFICATION FOR PARTICIPANTS IN COMMUNITY PROPERTY STATES If you are married and live in a Community Property state, you must generally name your spouse as your beneficiary, unless your spouse waives this right. ICMA-RC cannot be responsible for an employee's failure to properly designate a beneficiary in accordance with state law requirements and the employee's failure to provide the certification required by this enrollment process. Please be advised that failure to meet state law requirements with respect to your beneficiary designation may result in your beneficiary designation being invalid, and the payment of benefits to someone other than your designated beneficiary. If you choose to name a beneficiary that is not your spouse, you and your spouse will need to complete the Community Property Spousal Waiver form. Contact 1-800-669- 7400 for more information and to request the waiver form. 3. AMOUNT OF FUTURE CONTRIBUTIONS This section is used only by your employer. In this section, you provide instructions for your plan contributions to your employer. Please check with your employer to see what types of employee contributions are permitted. Enter the total percentage or dollar amount that you wish to contribute to your account as either a mandatory* pre-tax deferral (401(a) and 401(k) plans), mandatory* after-tax (401(a) and 401(k) plans) elective pre-tax deferral (401(k) plans only), or voluntary after-tax deferral (401(a) and 401(k) plans). Elective and/or voluntary contributions may not be allowed in some plans. Please check with your Employer or ICMA-RC's Investor Services at 1-800-669-7400 if you have questions concerning contributions. *Mandatory contribution amounts are established through the plan document. Changes to mandatory contribution amounts can only be accomplished through your employer's amend- ment of the plan document. See your employer for more information. 4. ALLOCATION OF FUTURE CONTRIBUTIONS Use this section to provide allocation instructions for both your employee account and your employer account. For each account type, you may design your own portfolio with any number of funds. State law, local law or your employer may place restrictions on investment in these funds. You may place your contributions in one investment option or in any combination as long as you use whole percentages (e.g., 50 percent, not 33 1/3 percent). Please see the VantageTrust Company's Making Sound Investment Decisions: A Retirement Investment Guide for full descriptions of the funds. 5 & 6. AUTHORIZED SIGNATURES Once you have completed this form, sign it, and submit it to your Employer for approval, if required. Fax or mail the original form to ICMA-RC. Our fax number is 1-202-962-4601 and our address is located on the bottom of the form. Your employer should retain a copy of the form for their records. Note that by signing this form you acknowledge that you agree to the following: I have received and read the current VantageTrust Company's Making Sound Investment Decisions: A Retirement Investment Guide and the Vantagepoint Prospectus. I understand that the Retirement Corporation has established required procedures for Internet and telephone transfers that include personal identification numbers, recording of instructions, and written confirmations. If allowed by my employer and in the event I choose to transfer funds by Internet or telephone, I agree that neither the VantageTrust Company, the ICMA Retirement Corporation, ICMA-RC Services, LLC, nor Vantagepoint Trans- fer Agents, LLC, will be liable for any loss, cost, or expense for acting upon any Internet or telephone instructions believed by it to be genuine and in accordance with the required proce- dures. An authorizing signature does not represent an obligation to use the telephone transfer feature available on VantageLine. Welcome to the ICMA Retirement Corporation! Social Security Administration Statement Concerning Your Employment in a Job Not Covered by Social Security Employee Name Employer Name Employee ID# Employer ID# Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected. Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2013, the maximum monthly reduction in your Social Security benefit as a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, "Windfall Elimination Provision." Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension. For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, "Government Pension Offset." For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at www.socialsecurity-gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office. I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security Benefits. Signature of Employee Date Form SSA-1946 (01-2013) Destroy Prior Editions information SocialForm SSA-1945 Statement Concerning ,..,•; Your Employment in a• • i Covered :• Social New legislation [Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004] requires State and local government employers to provide a statement to employees hired January 1, 2005 or later in a job not covered under Social Security. The statement explains how a pension from that job could affect future Social Security benefits to which they may become entitled. Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is the document that employers should use to meet the requirements of the law. The SSA-1945 explains the potential effects of two provisions in the Social Security law for workers who also receive a pension based on their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a worker's Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a Social Security benefit received as a spouse, surviving spouse, or an ex -spouse. Employers must: Give the statement to the employee prior to the start of employment; Get the employee's signature on the form; and Submit a copy of the signed form to the pension paying agency. Social Security will not be setting any additional guidelines for the use of this form. Copies of the SSA-1945 are available online at the Social Security website, www.socialsecurity.-gov/online/ssa-1945.pd . Paper copies can be requested by email at ofsm.oswm.rgct.orders@ssa.gov or by fax at 410-965-2037. The request must include the name, complete address and telephone number of the employer. Forms will not be sent to a post office box. Also, if appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in packages of 25. Please refer to Inventory Control Number (ICN) 276950 when ordering. Form SSA-1946 (01-2013) ESTABLISHED 2006 " r WAIVER OF PAYMENT MAYOR CITY COUNCIL Joe Lockwood Karen Thurman Burt Hewitt Matt Kunz Joe Longoria Bill Lusk Rick Mohrig I understand that as an appointed member of a City of Milton Board or Commission, the City has approved payment of $50 per scheduled meeting that I attend. However, at my request, I would like to waive payment for my attendance at all meetings. I understand that I can request, at any time, to rescind this waiver and begin receiving payment by notifying my city staff liaison. Signature Date Printed name 2006 Heritage Walk Milton, GA P: 678.242.25001 F: 678.242.2499 infoOcityofmiltonga.us I www.cifyofmiltonga.us 0000 City of Milton Parks and Recreation Department: Facility and Fields Use Policy Ptwpo.e and'Vt+Kiml The City of Milton Parks and Recreation Department (hereinafter referred to as "MPRD") has a variety of facilities and fields located within the City of Milton, Georgia ("City") that are available to rent when not in use for City -sponsored programs or City partner programs. MPRD's mission is to serve the residents of the City, and therefore City residents enjoy the first opportunity to rent available space after other programming needs are met. MPRD hereby establishes these universal policies and procedures (the "Policy") pertaining to the rental of such fields and facilities for distribution to City employees and the general public as appropriate to ensure consistency in MPRD operations. It should be noted that each rental facility and field is unique and has specific guidelines that renters must adhere to in addition to those listed in this Policy. Rental fees will vary for each specific facility/field. Facilities include, but may not be limited to, picnic pavilions, meeting rooms, gymnasiums and tennis courts identified by MPRD. Fields include, but may not be limited to, baseball/softball fields and multi -purpose rectangular athletic fields identified by MPRD. MPRD facilities and fields are intended to be used by residents of the City, and City residents shall be given first priority to rent after City -sponsored programs or City partner programs. MPRD reserves the right to request participation information (including participant names and addresses) from any individual or group requesting to rent fields or facilities. Factors that may be considered by MPRD in considering a request to rent include the number of City residents involved in the rental activity. Rentals will be subject to the following restrictions: 1. Facilities will not be available when an event sponsored by the City or an activity approved by the City is being conducted. 2. With the exception of the Bethwell Community Center, indoor rentals will not be allowed on City recognized holidays. 3. All rentals, except outdoor athletic facilities, will end no later than 11:00pm. Outdoor athletic facility rentals must end at 10:00pm. 4. Reservations of indoor facilities during regular hours of operation are not allowed. 5. Reservations of indoor and outdoor facilities may be made no earlier than six (6) months prior to and no later than three (3) business days prior to the requested event date. MPRD reserves the right to amend this Policy, including the fee schedule, Rental Requests provisions, Universal Guidelines, and Fields/Facilities below, as deemed appropriate with thirty (30) days prior written notice of amendment by posting on the City's website. Per the terms of the Memorandum of Understanding with the City of Alpharetta ("Alpharetta") effective December 1, 2012, Alpharetta residents shall be allowed to rent City facilities and fields, VeFslen 44 August " 9WVersion 4.2 -_A 1113. 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy provided space is available, and shall pay the same fees as City residents. For the purposes of this Policy, the word "Resident" shall include residents of the Cities of Alpharetta and Milton unless noted otherwise. Version 4.2 -April 13, 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy Rental Requests All applicants shall complete a Field License Agreement or a Facility License Agreement ("Agreement'), copies of which are included with this Policy. Requests to rent a facility/field shall be treated as follows: 1. A request related to a program or athletic sport already offered by MPRD, or its partners, will be permitted a maximum of three rental periods in a calendar year. A rental period may consist of up to seven consecutive days. 2. Athletic teams representing a sport (or a certain level of sport) that is not offered by the MPRD may rent a field based on availability if the field has not been closed for repair or maintenance. 3. Social activities/events may be scheduled on any field as long as the field is available and there would be sufficient time after the rental to prepare/maintain the field for its next scheduled use. 4. In the event a rental request is made that does not fall under item 2 or 3 above, the MPRD Director ("Director") shall determine if the rental request will be allowed. All requests must be made via a completed Field License Agreement or Facility License Agreement no more than six (6) months prior to the requested date. Requests will N(A�4� Accra e a first e a fiFst served basis. FEkeh «. nth a the 1 n and 151 of the month (or- the nemt business day if said date Wis an a weekend er Gity heliday), ihefe will be an aplifeval 0 fental requests (appreN,al date). The eempieted Field Use Agreement of Faeility Use Agreement must be submitted to the N4PRD Difeeter- fie less then dwee (3) business days prior. t&4he appreval de£ Requests for facilities and field usage are prioritized as follows: 1_) Elected Officials and City Staff for official purposes 2) City Boards 3) City Program Partners and Non Profit Organizations 4) City of Milton Residents 5,) Open Rental to any non-residents_ In the event of competing dates/times for the same facility or field from the sank p iorit-, _1 applican, a drawing will be held to approve the rental. The approved renter will be notified via the contact email on the completed Agreement. Other Departments of the City will be allowed to reserve MPRD facilities during regular business hours for employee functions at no cost, depending on availability. Requests for Department usage outside of regular business hours will be handled on a case by case basis by the Director. VeFS*eR 44 August 4, Version 4.2 - April 13, 2017 Formatted: List Paragraph, Numbered + Level: 1 + Numbering Style: 1, 2, 3, ... + Start at: 1 + Alignment: Left + Aligned at: 0.5" + Indent at: 0.75' Formatted: Font: (Default) Times New Roman, 12 pt City of Milton Parks and Recreation Department: Facility and Fields Use Policy No individual or group may make a rental request more than two (2) times in a calendar quarter. Separate individuals affiliated with the same group will not be allowed to individually apply in an effort to circumvent these two (2) requests in a calendar quarter restriction. Non Profit organizations that are performing work that is mutually agreed upon as directly serving the City of Milton will not be charged to use city facilities or fields Any Non Profit renting the city facilities or fields must provide a valid business license number. Anv_business which rents_a city field or_facility must ry ovide a valid business license number. Fees and Deposits will be set forth in the Fee Schedule below. VeFsien A 1 August 4 201- Version 4.2 -April 13. 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy Fee Schedule Rentals contracted with non -Milton and non -Alpharetta residents will be charged an out of city fee of an additional 50% of the fees set forth below. Time requested for rental should include set-up and clean-up. A. Meeting Rooms a. Bethwell Community Center Rental $50/hour_Two hour minimum i. Refundable t leanintdeposit - $50 b. Bell Memorial PaA Meeting Reem $20,%eur-, two hour- . (Bell Memorial Park Meeting Room no longer available for public rental) h. Community Place $50/hour. Two hour minimum i. Refundable deposit - $200 B. Gymnasiums — Not available for rental per FCBoE agreement. C. Picnic Pavilion - $10/hour, two hour minimum. D. Tennis Courts —Not available for rental per FCBoE agreement E. Athletic Field (Diamond) - , fields Fields at Bell Memorial Park, Hopewell Middle School and Northwestern Middle School are available for rental a. Without lights, $25/hour, $175/day, two hour minimum. a.i. Refundable Security deposit - $100 b_With lights. $37.50/hour, $225/day two hour minimum. t3:i_Refundable Security deposit.--$I00 c. Include drag and line field — $75/field/usage d. Special event - $500/day/field F. Athletic Field (Rectangular) ; ag{eetile f{; Artificial turf fields at Bell Memorial Park are available for rental a. Without lights - $75/hour, two hour minimum. a.-i. Refundable Security deposit - $100, b. With lights - $100/hour, two hour minimum. i. Refundable Security deposit - $100 c__Other fees might be necessary and determined on a case by case basis •----- Formatted Formatted: Font: (Default) Times New Roman, 12 pt Formatted Formatted Formatted: Font: (Default) Times New Roman, 12 pt Formatted Formatted: Font: (Default) Times New Roman, 12 pt Natural turf fields at Birmingham Falls Elementary School Cogburn Woods Elementary ------- Formatted: Normal, Indent: Left: 0.31", Hanging: 0.19 School Crabapple Crossing Elementary School Hopewell Middle School Northwestern No bullets or numbering Middle School, are available for rental a) No lights are available-$25/hour. $175/dav, two hour minimum. V eFS O 4.' August ^, 20' Version 4.2 -April 13, 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy Eb t G. Broadwell Pavilion a. A`iihout lights WAieur, four hour mininium h.a. With lights - $50/hour, four -two hour minimum. i. Refundable Security deposit - SW $350 ii. Personal Gas Grill usage refundable deposit - $100 H. Other fees might be necessary and determined on a case by case basis Full refunds will be granted if a rental is cancelled by MPRD. Refunds will be granted if requested by the renter at least ten (10) business days prior to the rental. A $15.00 administrative fee will be deducted from all approved refunds. Events that are rained out will be offered a full refund or the opportunity to reschedule to another date. If any costs have been incurred by the city prior to the rain out (such as field preparation) those fees will still be billable. Refunds will not be granted if a rental group does not show up for their reserved time without advance notice (at least 10 business days). Security deposits will be refunded provided that all trash is stored in receptacles, the facility is clean and there is no damage to any portion of the facility. VeBiBH 4.' August 4, 20 Version 4.2 - Aoril 13, 2017 Formatted: Font: (Default) Times New Roman, 12 pt Formatted: Nbered + Level: 1 + Numbering Style: a, b, c, ... + $tart at: 1 +umAlignment: Left + Aligned at: 0.56" + Indent at: 0.81" City of Milton Parks and Recreation Department: Facility and Fields Use Policy Universal Guidelines 1. No one under the age of 21 years shall be permitted to enter into an Agreement with MPRD. 2. Renter (person whose name is on the Agreement) must be present during the entire scheduled event. Failure to do so may result in immediate forfeiture of any applicable fees and deposits, and renter may not be allowed to use any City facility in the future for a period up to, but not exceeding, two years. 3. Renter is responsible for ensuring that any guest asked to leave the premises by any MPRD employee due to misconduct and/or violation of MPRD rules leaves the MPRD property immediately and without incident. 4. MPRD reserves the right to cancel, postpone or reschedule any rental. The renter will be given a choice of a refund or to have an alternative date scheduled. 5. For the safety of all, if MPRD is closed due to inclement weather, all facility reservations will be cancelled. The renter will be entitled to a full refund or may reschedule at another time as agreed upon in writing by MPRD and renter. 6. Requested times of use shall include set-up and clean-up times. 7. Per City ordinance, the use of tobacco and all tobacco products is strictly prohibited in City parks, fields and facilities. 8. Per City ordinance, the use of alcohol in City parks, fields and facilities requires a special permit. 9. Except for guide animals, pets are not allowed in or on facilities or fields. Pets are otherwise allowed in the parks if kept on a leash. 10. The renter shall not have the right to assign a rental agreement or any rights hereunder or to sublet MPRD facilities or fields. 11. Renter must provide at least one (1) adult chaperone for every fifteen (15) youth (i.e. individuals under the age of 18 years) in attendance. 12. Renter shall use only the facilities or fields that have been formally rented as identified in the Agreement. Rental activities shall not hinder or obstruct the activities of the occupants of the facility, or the accompanying or adjacent park areas. 13. MPRD has the right to immediately cancel any rental on site if the actions of the group put the group, any member of the group, any City employee, the general public, and/or the facility or field at risk or in danger. 14. Renter is responsible for discouraging participants at the event from the use of offensive language. MPRD has the right to order the removal from the premises any guest(s) who engages in physical abuse or threat of physical abuse toward another guest, a City employee or the general public. 15. Upon request, Renter must provide a Certificate of Insurance ($1,000,000 minimum). The City of Milton should be listed as an additional insured. 16. MPRD reserves the right to rent different areas of the same facility or field to different groups at the same time. Vefsien 4.1 August n 2016 Version 4.2 - April 13, 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy 17. MPRD does not guarantee the use of equipment, tables, chairs, etc. No tables, chairs or other City personal property may be removed from a facility or field. 18. Portable grills of any kind are only permitted in support of concession stand operations at Bell Memorial Park. At the Broadwell Pavilion, a personal portable gas grill may be brought on site and used provided an additional security deposit has been paid and the grill is used only in the designated location. 19. Athletic field participants are prohibited from gaining access to any field by climbing over a fence. 20. Only stakes or posts that can be pushed by hand into the ground may be used on any baseball/softball field. No stakes or posts of any kind may be pushed into the surface of the artificial turf fields. 21. Renters are NOT allowed to use any paint or other similar materials on athletic fields. 22. All trash and garbage must be placed in the proper receptacles provided by the City. VeFSie'".'August 4,'^"Version4.2-Aori113.2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy Facilities/Fields Bell Memorial Park Rectangular fields - Field I and Field 2: 360' x 160' Diamond fields — Field 3 — 290', Field 4 — 190', Field 5 — 200', Field 6 — 200' 1 Playground Pavilion north of fields I & 2 4 Picnic Tables 2 Standard Tables 2 Americans with Disabilities Act compliant Table ("ADA Table") Pavilion in front of Concession Stand 2 Picnic Tables 2 ADA Tables Multiple standard tables in close proximity Friendship Community Park — IGA Facility, not rentable 1 Multi -Purpose Rectangular Field approximately 'h acre 1 Half -Court Basketball Court with I Basketball Goal Circular Pavilion — 24 feet X 24 feet 3 Picnic Tables 2 Standard Tables ADA Table Birminaham Falls Elementary — IGA Facility, :o rentable 1 Multi -Purpose Rectangular Field approximately 2.5 acres 1 Indoor Gymnasium Coeburn Woods Elementary IGA Facility 1 Multi -Purpose Rectangular Field approximately 1 acre 1 Indoor Gymnasium Hopewell Middle — IGA Facility, not rentable I Multi -Purpose Rectangular Field approximately 1.5 acres 1 Diamond shaped field —190 feet I Indoor Gymnasium Northwestern Middle— IGA Facility, not rentable 1 Multi -Purpose Rectangular Field approximately 2 acres 1 Diamond Shaped Field 1 Indoor Gymnasium Bethwell Community Center 1 Indoor facility approximately 1300 square feet, capacity for 55 people 1 Outdoor Grill 2 Picnic Tables 1 Playground "_F_'en 4.1 " .o_s. " 20 ` Version 4.2 - April 13, 2017 City of Milton Parks and Recreation Department: Facility and Fields Use Policy BroadHell Pavilion 1 Open Air Facility 1 Platform for a Portable Grill (grill not provided) 6 Picnic Tables 1 Play rQ ound Community Place 1 Indoor facility approximately 400 square feet. racily for 22 people 1 screen and proiector VeFSieA 4.1 August 4 2016 Version 4.2 - April 13, 2017 Wall of Fame Process Discussion - Eligibility: 1) Any Milton athlete who achieved athletic success beyond the High School level, 2) Any coaches, volunteers or administrators who demonstrated a selfless devotion to an athletic program, 3) Other individuals or groups of individuals as deemed worthy by the PRAB. Questions: A) Must the candidate be a Milton resident or can he/she be a resident of another city/county that participated in Milton recreation Programs? B) Can a resident or non-resident who attended High School at Cambridge HS, Milton HS, King's Ridge HS, St. Francis HS or Mill Springs Academy who did not play recreation sports in Milton be eligible? C) Must the coaches, volunteers, administrators or other individuals or groups deemed worthy be residents of Milton? D) Maximum number per year? E) Eligibility to re -apply if not elected? 4) Application submission via a fillable form on the City website. Timing: 1) Applications may be accepted throughout the year, but are formally considered how often? Once? 2) Consideration at June Meeting? Provide a recommendation to Elected Officials? 3) Elected Officials to review/approve in July? August? 4) Installation in September? Promotion: 1) News Article in Milton Herald 2) Social Media 3) City Website About Little Free Library I Little Free Library Page 1 of 7 t"Y I.,,..1.......... About Us A Visit to Little Free Library Headquarters Who We Are r - Little Free Library is a nonprofit organization that inspires a love of reading, builds community, and sparks creativity by fostering neighborhood book exchanges around the world. Through Little Free Libraries, millions of books are exchanged each year, profoundly increasing access to books for readers of all ages and backgrounds. https://Iittlefreelibrary.org/about/ 4/13/2017 About Little Free Library I Little Free Library Page 2 of 7 Why Does Book Access Matter? One of the most successful ways to improve the reading achievement of children is to increase their access to books, especially at home (McGill -Franzen & Allington, 2009). But according to the U.S. Department of Education, up to 61 % of low-income families do not have any books for their kids at home. Little Free Libraries play an essential role by providing 24/7 access to books (and encouraging a love of reading!) in areas where books are scarce. Our Impact 50,000+ Libraries https:Hlittlefreelibrary.org/about/ 4/13/2017 About Little Free Library I Little Free Library Page 3 of 7 https:Hlittlefreelibrary.org/about/ 4/13/2017 About Little Free Library I Little Free Library Page 4 of 7 The first Little Free Library, built by Todd Bol in honor of his mother. What We Do Our staff is dedicated to increasing book access and forging community connections by helping people around the globe start and maintain Little Free Library book exchanges. What exactly is a Little Free Library? We provide support to our volunteer Little Free Library stewards by providing free building instructions, online resources and ongoing support from Little Free Library staff, access to free or discounted books through our partners, and an online store that offers Library kits and pre -built Library models. https:Hlittlefreelibrary.org/about/ 4/13/2017 About Little Free Library I Little Free Library Page 5 of 7 We also maintain a world map of registered Little Free Libraries to help people find and share books wherever they are, and we donate Little Free Libraries to communities where they can make a big difference and provide access to books through our Impact Fund. Milestones and More Information We were recently named a Top -Rated Nonprofit by the Great Nonprofits Organization! Discover more of our milestones and awards. Little Free Library is also the recipient of the National Book Foundation's Innovations in Reading Prize, the American Library Association's Movers and Shakers Award, and the Library of Congress Literacy Award Looking to learn more? Meet the Little Free Library staff, learn how Little Free Library , or check out our recent media stories. If you're a member of the press, please review our press resources. ENO N P4P ONPR00 Partners and Friends GUIDESTAR ..�� J ! f) https://littlefreelibrary.org/about/ 4/ 13/2017 About Little Free Library I Little Free Library Page 6 of 7 4D Girl Scouts Habitat for Humanity`: �.�ONs 0 n:41 :lafi-I ��NATIOMa� Penguin Random House %emu CHEVROLEr At COFFEE HOUSE PRESS C--. Home us LIBRARYOF CONGRESS Alt CENTER "'R BOOK TEXAS C H R O N I C L E BOOKS RIF Reading Is Fundamental —A, — Ir. BOY SCOUTS OF AMFRICA Los Angdcs cKimes 2 EB IOKSL umwnasam.awaM. L: LOWE'S WEAP0, S POLICE theV f V BB 9 12 Copyright © 2009 - 2017 Little Free Library I Developed by Moonlight Designs Studio General Mills https:Hlittlefreelibrary.org/about/ 4/ 13/2017