CM-08-12-280Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
I James R. Nuse, P.E.
Print Name
City Manager
Title - Owner/President/Other
of City of Round Rock
Corporation/Partnership/Entity Name
have authorized Jeff Seiler, P.E.
of Huggins/Seiler & Associates
Print Name of Firm
Print Name of Agent/Engineer
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.
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 applicants 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.
TCEQ-0599 (Rev.10/01/04)
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Hays 1 (Au 2
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.
(2.5 cry
Applica �� ignature Date
THE STATE OF tW §
County of tAXIIiitivt §
BEFORE ME, the undersigned authority, on this day personally appeared 1M -l2 • 1-ei 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 r-74day of b2&NRLP-r-- 2108.
SARA L WHITE
MY COMMISSION EXPIRES
Juyr11,2012
TCEQ-0599 (Rev.10/01/04)
Zvym.. klitchl
NOTARY PUBLIC
fN D L • V\ti i-feJ
Typed or Printed Name of Notary
MY COMMISSION EXPIRES: 1.(( • 2012
IIayE 2 0O 2
DATE: November 26, 2008
SUBJECT: City Manager Approval — December 5, 2008
ITEM: Consider executing the "Agent Authorization Form for Required Signature
Edwards Aquifer Protection Relating to 30 TAC Chapter 213" authorizing Jeff
Seiler, P.E. of Huggins/Seiler & Associates to represent and act on behalf of the
City.
Deoartment: Transportation Services
Staff Person: Thomas G. Martin, P.E., Director
Justification:
Huggins/Seiler and Associates is currently designing improvements for Mays Extension, OId
Settler's Boulevard to Jeffrey Way. Because this project involved work over the Edwards
Aquifer, it is necessary, in conjunction with the preparation of a plan for regulated activities for
review by the Texas Commission on Environmental Quality (TCEQ), that an Agent Authorization
Form be executed by the City.
Funding:
Cost: N/A
Source of funds: N/A
Outside Resources: Huggins/Seiler & Associates
Background Information:
The City Council adopted Resolution R -08-01-24-10E1 on January 24, 2008 authorizing the
Mayor to execute a Professional Services Agreement with Huggins/Seiler and Associates for the
design of the Mays Extension Project, OId Settler's Boulevard to Jeffrey Way.
Public Comment: N/A
UPDATED APRIL 2008