CM-2018-1627 - 2/6/2018Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
I - Laurie Hadley ,
Print Name
_. City Manager ,
Title- Owner/P reside nttOther
of the City of Round Rock
Corporation/Partnership/Entity Name
have authorized Katie Baker, PLA
Print Name of Agent/Engineer
of City of Round Rock. PARD
Print Name of Firm
to represent and act on the behalf of the above named Corporation, Partnership, or Entity for
the purpose of preparing and submitting this plan application to the Texas Commission on
Environmental Quality (TCEQ) for the review and approval consideration of regulated
activities.
I also understand that:
1. The applicant is responsible for compliance with 30 Texas Administrative Code
Chapter 213 and any condition of the TCEQ's approval letter. The TCEQ is authorized
to assess administrative penalties of up to $10,000 per day per violation.
2. For those submitting an application who are not the property owner, but who have the
right to control and possess the property, additional authorization is required from the
owner.
3. Application fees are due and payable at the time the application is submitted. The
application fee must be sent to the TCEQ cashier or to the appropriate regional office.
The application will not be considered until the correct fee is received by the
commission.
4. A notarized copy of the Agent Authorization Form must be provided for the person
preparing the application, and this form must accompany the completed application.
5. No person shall commence any regulated activity on the Edwards Aquifer Recharge
Zone, Contributing Zone or Transition Zone until the appropriate application for the
activity has been filed with and approved by the Executive Director.
CM-) of
TCEQ-0599 (Rev.04/0112010)
Page 1 of 2
SIGNATURE PAGE:
yllylitVi4k6 - �1_
Applicant's Signature
THE STATE OF TX §
County of Wi fllQ.nr►SOyi §
Date
BEFORE ME, the undersigned authority, on this day personally appeared Lavnt �WlCy known
to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to
me that (s)he executed same for the purpose and consideration therein expressed.
GIVEN under my hand and seal of office on this _�_ day of
NOTARY PUB IC
_6 br160- C1 11115
Typed or Printed Name of Notary
MY COMMISSION EXPIRES: 3 _15-2-0
BLANCA GILLIS
!V.*Notary Public, State of Texas
vE Comm Expires 03-15-2020
Notary ID 130582367
TCEO-0599 (Rev 0410112010) Page 2 o(2
City of Round Rock
ROUNDROCK
TEXA Agenda Item Summary
Agenda Number:
Title: Consider executing TCEQ "Agent Authorization Form For Required
Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter
213" authorizing Katie Baker to represent and act on behalf of the City
regarding the Frontier Park Project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 2/2/2018
Dept Director: Rick Atkins, Director
Cost: $500.00
Indexes: 2014 General Obligation Bonds
Attachments: IAF - TCEQ Edwards Aquifer Protection Program - Frontier Park
(00393675xA08F8).pdf, f-0599 agent authorization_form.pdf
Department: Parks and Recreation Department
Text of Legislative File CM -2018-1627
Consider executing TCEQ "Agent Authorization Form For Required Signature Edwards
Aquifer Protection Program Relating to 30 TAC Chapter 213" authorizing Katie Baker to
represent and act on behalf of the City regarding the Frontier Park Project.
The Frontier Park Improvement Project is located over the Edwards Aquifer Recharge
Zone. In order to proceed with construction of the proposed park improvements
(basketball court seating, pavilion, looping trail, and park amenities) the City is filing and
Exception Request with the Texas Commission on Environmental Quality. Signature by
the City Manager is required for the application to be complete, as well as to authorize
Katie Baker to represent and act on behalf of the City during the duration of the project.
Cost: $500.00
Source of Funds: 2014 General Obligations Bond
City oI Round Rock Pape 1 Printed on 21112018