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Mayor's City Builder AwardThe Mayor's City Builder Award is a civic honour created to recognize an individual, group or organization that has, through their outstanding volunteerism or exemplary action, demonstrated an extraordinary commitment to making our city a better place today and for the future. This may include life-long service, outstanding acts of kindness, inspiring charitable work, community building or any other exemplary achievements. The award will be presented at the beginning of each Ottawa City Council meeting. Nomination: Individuals, groups or organizations may be nominated by members of City Council or the public. To nominate a candidate, the nominator should complete the nomination form attached below describing the efforts and achievements of the nominee. Submissions should be sent to: Patrick Champagne Special Assistant to the Mayor Office of Mayor Jim Watson City of Ottawa 110 Laurier Avenue West Ottawa, Ontario K1P 1J1 P: 613-580-2424 x 25426 F: 613-580-2509 patrick.champagne@ottawa.ca Selection: The award recipient will be presented with a certificate from the Mayor and the Ward Councillor. The Mayor's Office will coordinate the recipient's attendance at council. Recipients will be selected by the Mayor and notified by the Mayor's Office. Nominations shall be valid for one year after submission, during which time the nominee may be selected to be recognized.

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Mayor's City Builder Award Nomination FormAny youth, adult, senior or group in the City of Ottawa who willingly volunteers their time and efforts to benefit others is eligible for a Mayor's City Builder Award provided they live in, operate a business in, or volunteer within the City of Ottawa. Employees of the City of Ottawa and individuals serving on City of Ottawa committees, boards or agencies are eligible for nomination provided their volunteer activity is not an extension of their role as an employee, or Committee/Board/Agency representative.

Nominator Information

Fax Number:

Work Telephone Number:

E-mail:

Home Telephone Number:

Postal Code:City:

Home Address:

Last Name:First Name:

Other

Ms.Mrs.Mr.

Mr. Mrs. Ms.

Volunteer Being Nominated (Nominee)

Other:

First Name: Last Name:

Home Address:

City: Postal Code:

Home Telephone Number:

E-mail:

Work Telephone Number:

Fax Number:

Outline the volunteer's activities / accomplishments.

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How does the volunteer positively impact the community?

References Nominations must include at least one reference that may be contacted to verify the nature and extent of the nominee's volunteer activity. References should be those familiar with the nominee's accomplishments. Members of the nominee's immediate family may not be submitted as references.

Fax Number:

Reference 2Mr. Mrs. Ms. Other

First Name: Last Name:

Relationship to Nominee:

Home Address:

City: Postal Code:

Home Telephone Number:

E-mail:

Work Telephone Number:

Fax Number:

Work Telephone Number:

E-mail:

Home Telephone Number:

Postal Code:City:

Home Address:

Relationship to Nominee:

Last Name:First Name:

OtherMr. Mrs. Ms.Reference 1

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Is the Nominee aware of this nomination? Yes No

I certify, to the best of my knowledge, that the information provided in this nomination form is correct. Signature of Nominator: Date: Thank you for nominating a deserving volunteer in our city. Personal information contained on this form is collected under authority of the Municipal Act RSO 1990, c.M.45, s.207 (45). Information collected will only be used to evaluate nominees and notify recipients of the Mayor's City Builder Award.