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CM-09-10-214Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213 Effective June 1, 1999 I JIM NUSE Print Name CITY MANAGER Title - Owner/President/Other of CITY OF ROUND ROCK Corporation/Partnership/Entity Name have authorized Craig Hebbe, PE Print Name of Agent/Engineer of RODRIGUEZ TRANSPORTATION GROUP 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 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) Page 1 of 2 0, tYA- 0°(- o- 2 l 4 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. 10 03-0ai Applicant's Sign a Date JamesKNu ?E. C� Mav\Cei THE STATE OF T'ClW § County of Will jAM9itiN § BEFORE ME, the undersigned authority, on this day personally appearedIR, W., 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 2 day of 701. SARA L WHITE MY COMMISSION EXP!PEI, Jdy 11, 2012 NOTARY PUBLIC &tit.. \AM t4 --R Typed or Printed Name of Notary "3MY COMMISSION EXPIRES: \% 1,11 v TCEQ-0599 (Rev.10/01/04) Page 2 of 2 DATE: October 21, 2009 SUBJECT: City Manager Approval — October 23, 2009 ITEM: Consider executing "Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213" authorizing Craig Hebbe of Rodriguez Transportation Group, to represent and act on behalf of the City for the Chisholm Trail Improvements Project. Department: Transportation Services Staff Person: Thomas E. Word, P.E., Chief of Public Works Operations Justification: This Agent Authorization Form is required to properly administer the WPAP to TCEQ regarding the Chisholm Trail Water Pollution Abatement Plan. Rodriquez Transportation Group is the engineering firm contracted with the City of Round Rock on this project. Strategic Plan Relevance: The Chisholm Trail Water Pollution Abatement Plan, which is part of the Chisholm Trail Improvements Project, has a relevance to the City's Strategic Plan pertaining to providing for effective management of storm water as well as fostering a transportation system for future connectivity and mobility needs. Funding: Cost: $6,500.00 Source of funds: 2002 G. O. Bonds Outside Resources: TCEQ Rodriguez Transportation Group Public Comment: N/A UPDATED APRIL 2008 5117!2009 Request for City Council/City Manager Action City Council rol City Manager Submit completed form for all City Manager and City Council approvals. Department Name: Transportation Services Contact Person: Chaz Gordon / Kathy Michna Project Mgr/Resource: an Stablein Project Coordinator: Tom word Assigned Attorney: Stephan Sheets City Council or City Manager Approval Date: Agenda Wording Received: cff T 2J 2119 i\`7? - Tag IP. '(61--eci-10-211- Original Documents Received: Project Name: Chisholm Tral Contractor/Vendor: TCEQ Funding Source: 2 Cz,Z Additional funding Source: Amount: s Account Number. 10/23/2009 (.), &vats 6,500.00 Consider executing "Agent Authorization Form for Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213' authorizing Craig Hebbe of Rodriguez Transportation Group, to represent and act on behalf of the City for the Chisholm Trail Improvements Project. Finance Information Is Funding Required? Yes 10 No n Initial Construction Contract Construction Contract Amendment Change Order Change in Quantity Initial Professional Services Agreement Supplemental Professional Service Agreement PurchasinglService Agreement Purchase Order Item(s) to be purchased Unforeseen Circumstances Other (Please dearly identify action on lines below) Agent Authorization Form Amount $ 6,500.00 I:NFNANCE NAA D Approved 1 El El CD CI Finance/CIP Finance/Acct Purchasing Budget Date Date Date Date APPROVALS (to be completed ONLY by Finance) rral / maw/ Approval Required APProved Finance Director Date Cnce approvals nave been chtairied. please torvaro the HFA. blue sheet. back up mtormatron and originals to City Secretary, Sara White. ITEMS WILL NOT BE PLACED ON THE COUNCIL AGENDA WITHOUT FINANCE AND LEGAL APPROVAL PRIOR TO SUBMISSION. Required for Submission of ALL City Council and City Manager Items Project Mgr. Signature: Dept Director Signature: *City Attorney Signature: City Manager Signature: Date: 1C -/C, -0c Date: /0// /0 Date: j (- ..)3-r1 Date: 'City Attorney signature is required for at items. REVISED 10/16/2009 5/1272009 Request for City IunciUCity Manager Action j1 City Council El City Manager Submit completed form for all City Manager and City Council approvals. Department Name: Transportation Services Contact Person: Chaz Gordon / Kathy Michna Project Mgr/Resource: Biu Stablein Project Coordinator: Torn Word Assigned Attomey: Stephan Sheets City Council or City Manager Approval Date: Agenda Wording For Administration Use ONLY Received: Tag #: Original Documents Received: Project Name: Chisholm Trail ContractorNendor: TCEQ Funding Source: 2002 General obligation Bonds Additional funding Source: Amount: $ Account Number: 10/23/2009 6,500.00 Consider executing 'Agent Authorization Form for Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213' authorizing Craig Hebbe of Rodriguez Transportation Group, to represent and act on behalf of the City for the Chisholm Trail Improvements Project Finance Information Is Funding Required? Yes Initial Construction Contract Construction Contract Amendment O Change Order 6 No Amount Change in Quantity Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Service Agreement Purchasing/Service Agreement Purchase Order Item(s) to be purchased Other (Please clearly identify action on lines below) S 6,500.00 Agent Authorization Form APPROVALS (to be completed ONLY by Finance) FINANCE N/A Approved j] [] Finance/CIP L.Olsen Date 10/21/2009 0 0 Finance/Acct E. Wilson Date 10/21/2009 ©[J Purchasing EE Bowden Date 10/20/2009 0 CI Budget P. Bryan Date 10/20/2009 Final Finance Approval Required Approved Cheryl Delaney 10/21/2009 Finance Director Date Once approvals have been obtained, please forward the RFA. blue sheet, back up information and originals to City Secretary, Sara White. ITEMS WILL NOT BE PLACED ON THE COUNCIL AGENDA WITHOUT FINANCE AND LEGAL APPROVAL PRIOR TO SUBMISSION. Required for Submission of ALL City Council and City Manager Items Project Mgr. Signature: Dept. Director Signature: 'City Attorney Signature: City Manager Signature: Date: Date: Date: Date: *City Attomey signature is required for all items. REVISED 10/21/2009 LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION Required for Submission of ALL City Council and City Manager Items Department Name: PWlrransportation Project MgrlResource: Bill Stableln [1Council Action: ORDINANCE Agenda Wording Project Name: Chisholm Trail ContractorNendor: TCEQ I-1 RESOLUTION City Manager Approval CMA Wording Consider executing "Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213" authorizing Craig Hebbe of Rodriguez Transportation Group, to represent and act on behalf of the City for the Chisholm Trait Improvements Project. Attorney Approval _r\;torney Notes/Comments Date /Z7/6/0 O:\wdox\SCCInts\9119910000\M ISC100173946.XLS Updated 6/3108