CM-06-08-163Request for Release of Funds
and Certification
U.S. Department of Housing OMB No. 2506-0087 (exp. 6/30/2001)
and Urban Development
This form is to be used by Responsible Entities and Recipients (as defined in 24 CFR part 58.2) when requesting the release of funds, and requesting
the authority to use such funds, for HUD programs identified by statutes that provide for the assumption of the environmental review responsibility by
units of general local govemment and States. Public reporting burden for this collection of information is estimated to average 0.6 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. This agency may not conduct or sponsor this collection of information, and a person is not required to respond to questions
about this requirement, unless the collection request
displays a valid OMB control number.
Part 1. Program Description and Request for Release of Funds (to be completed by Responsible Entity)
1. Program Title(s): 2. HUD/State Identification Number: 3. Recipient Identification Number (optional)
Public Facilities
4. OMB Catalog No(s):
B -04 -MC -48-0514
DUNS #10-274-0792
6. For information about this request, Contact:
Mona Ryan, Community Development Coordinator
301 West Bagdad, Suite 140, Round Rock, TX 78664
512-218-5416
8. HUD or State Agency & Office Unit to Receive Request:
US Department of Housing and Urban Development, CPD Division
One Alamo Center
106 South St. Mary's Street, Suite 405
San Antonio, TX 78205
B -04 -MC -48-0514
DUNS #10-274-0792
4. Name & Address of Responsible Entity:
City of Round Rock
221 East Main Street
Round Rock, TX 78664
7. Name & Address of Recipient: (if different from responsible entity)
The recipient(s) of assistance under the program(s) listed above requests the release of funds and removal of environmental grant conditions
governing the use of the assistance for the following:
9. Program Activity/Project Name:
AGAPE Rehabilitation
11. Program Activity/Project Description:
The project will expand the existing space located at 104 E Main St. by adding an additional 2800 sqft of building. The
additional space is required to handle the increased case load of unanticipated referrals from agencies, such as DHS
(Medicaid) and Head Start Prenatal. The additional space will house areas for intake, counseling, class rooms, and
storage.
10. Location: (street, address, city, county, & state)
Round Rock, Williamson County, Texas
form HUD -7015.15 (2/98)
Part 2. Environmental Certification (to be completed by responsible entity)
With reference to the above Program Activity(ies)/Project(s), I, the undersigned officer of the responsible entity, certify that:
1. The responsible entity has assumed responsibility for and complied with, or will continue to comply with, the National Environmental policy Act
of 1969, as amended; the environmental procedures, permit requirements and statutory obligations of the laws cited in 24 CFR 58.5 and 24 CFR
58.6; and the applicable State and Local laws.
2. After considering the type and degree of environmental effects identified by the environmental review completed for the proposed project
described in Part 1 of this request, I have found that the project ❑ did X did not require the preparation and dissemination of an of an
environmental impact statement.
3. The responsible entity has disseminated and/or published in the manner prescribed by 24 CFR 58.43 and 58.60 a notice to the public in
accordance with 24 CFR 58.70 and as evidenced by the attached copy (copies) or provide evidence of posting and mailing procedure.
4. The dates for all statutory and regulatory time periods for review, comment or other action are in compliance with procedures and requirements
of 24 CFR Part 58.
5. In accordance with 24 CFR Part 58.71 (b) the responsible entity will advise the recipient (if different from the responsible entity) of any special
environmental conditions that must be adhered to in carrying out the project.
As the duly designated certifying official of the responsible entity, I also certify that:
6. I am authorized to and do consent to assume the status of federal official under the National Environmental Policy Act of 1969 and each
provision of law designated in the 24 CFR Part 58.5 and 24 CFR Part 58.6 list of NEPA-related authorities insofar as the provisions of these laws
apply to the HUD responsibilities for environmental review, decision making and actions that have been assumed by the responsible entity.
7. I am authorized to and do accept, on behalf of the recipient personally, the jurisdiction of the federal courts for the enforcement of all these
responsibilities, in my capacity as certifying officer of the responsible entity.
Signature of Certifying Officer of the Responsible Entity:
Nuse, P.E.
Address of Certifying Officer:
City of Round Rock
221 East Main Street
Round Rock, TX 78664
Title of Certifying Officer:
City Manager
Date Signed
8-I i -o69
Part 3. To be completed when the Recipient is not the Responsible Entity
The recipient agrees to abide by the special conditions, procedures and requirements of the environmental review and to advise the responsible entity
of any proposed change in the scope of the project or any change in environmental conditions in accordance with 24 CFR 58.71 (b).
Signature of Authorized Officer of the Recipient:
Title of Authorized Officer:
Date Signed:
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties (18 USC 1001, 1010, 1012; 31 USC 3729, 3802).
form HUD•7015.15 (2/98)
DATE: August 4, 2006
SUBJECT: City Manager Approval
ITEM: Consider a resolution authorizing the City Manager to execute a
Request for Release of Funds and Certification for authorization
to use Community Development Block Grant funds for the
AGAPE facility expansion.
Department: Planning
Staff Person: Mona Ryan, Community Development Coordinator
Justification: Authorization to use grant funds must be formalized with
HUD Form 7015. A project cannot be funded until the City
requests a release of funds and HUD signs the Form 7015.
Funding:
Cost: $116,691
Source of funds: CDBG HUD Entitlement Funds
Background Information: A Combined Notice of Finding of No Significant
Impact and Intent to Request Release of Funds
was published in the Round Rock Leader on
May 4, 2006. A minimum period of 15 days is
required for comments. Anytime after May 19,
2006 the City can forward the Form 7015 to
HUD, where upon receipt of this document by
HUD, another 15 day comment period starts.
At the end of the second comment period, HUD
will sign the Form 7015 and notify the City that
it can release project funds.
Updated 3-10-05