CM-09-10-218Executive Director
Texas Commission on Environmental Quality
Storm Water and Pretreatment Team
P.O. Box 13087, MC -148
Austin, TX 78711-3087
Subject: Delegation of Signatories to Reports
Facility/Company/Site Name: City of Round Rock MS4
TPDES Permit Number: TXR040253
Dear Executive Director:
This letter serves to designate the following people or positions as authorized personnel
for signing reports, storm water pollution prevention plans, certifications or other
information requested by the Executive Director or required by the general permit, as set
forth by 30 TAC §305.128 (see page 2).
Name or Position
City Engineer
Name or Position
Name or Position
Name or Position
I understand that this authorization does not extend to the signing of a Notice of Intent for
obtaining coverage under a storm water general permit.
By signing this authorization, I confirm that I meet the requirements to make such a
designation as set forth in 30 TAC §305.44 (see page 2).
Sincerely,
Nacre
TCEQ-20403 (7/10/07)
en -o61-10 -zip
Jame5E.Nuse,PE. - C� -{ (Y1044R 10-30-09
Title Date
Delegation of Signatories to Reports
Page 2
RELEVANT PROVISIONS
305.128(a) All reports requested by permits and other information requested by the executive director shall
be signed by a person described in §305.44(a) of this title (relating to Signatories to Applications) or by a
duly authorized representative of that person. A person is a duly authorized representative only if:
(1) the authorization is made in writing by a person described in §305.44(a) of this title (relating to
Signatories to Applications);
(2) the authorization specifies either an individual or a position having responsibility for the overall
operation of the regulated facility or activity or for environmental matters for the applicant, such as the
position of plant manager, operator of a well or well field, environmental manager, or a position of
equivalent responsibility. (A duly authorized representative may thus be either a named individual or any
individual occupying a named position); and
(3) the written authorization is submitted to the executive director.
(b) If an authorization under this section is no longer accurate because of a change in individuals or
position, a new authorization satisfying the requirements of this section must be submitted to the executive
director prior to or together with any reports, information, or applications to be signed by an authorized
representative.
(c) Any person signing a report required by a permit shall make the certification set forth in §305.44(b) of
this title (relating to Signatories to Applications).
305.44(a) All applications shall be signed as follows.
(1) For a corporation, the application shall be signed by a responsible corporate officer. For purposes of
this paragraph, a responsible corporate officer means a president, secretary, treasurer, or vice-president of
the corporation in charge of a principal business function, or any other person who performs similar policy
or decision-making functions for the corporation; or the manager of one or more manufacturing,
production, or operating facilities employing more than 250 persons or having gross annual sales or
expenditures exceeding $25 million (in second-quarter 1980 dollars), if authority to sign documents has
been assigned or delegated to the manager in accordance with corporate procedures. Corporate procedures
governing authority to sign permit or post -closure order applications may provide for assignment or
delegation to applicable corporate positions rather than to specific individuals.
(2) For a partnership or sole proprietorship, the application shall be signed by a general partner or the
proprietor, respectively.
(3) For a municipality, state, federal, or other public agency, the application shall be signed by either a
principal executive officer or a ranking elected official. For purposes of this paragraph, a principal
executive officer of a federal agency includes the chief executive officer of the agency, or a senior
executive officer having responsibility for the overall operations of a principal geographic unit of the
agency (e.g., regional administrator of the EPA).
(b) A person signing an application shall make the following certification: "I certify under penalty of law
that this document and all attachments were prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
TCEQ-20403 (7/10/07)
DATE: October 28, 2009
SUBJECT: City Manager Approval — October 30, 2009
ITEM: Consider executing "Delegation of Signatories to Reports" form to grant the City
Engineer Signatory Authority to sign for future annual Storm Water Management
(MS4) reports relating to the City's MS4 permit with TCEQ.
Department:
Staff Person:
Engineering and Development Services
Danny Ha!den, P.E. City Engineer
Justification: Delegating signatory authority for annual Storm Water Management (MS4)
reports will allow the City Engineer to sign future MS4 annual reports to Texas Commission on
Environmental Quality (TCEQ).
Strategic Plan Relevance: Item is relevant to strategic Goal 29 providing for effective storm
water management.
Funding:
Cost: NA
Source of funds: NA
Outside Resources : NA
Public Comment : NA
UPDATED: October 19, 2009
10.1909
Request for City Council/City Manager Action
® City Council 1 City Manager/
Submit completed form for all City Manager and City Council approvals.
Department Name: Engineering & Development Services
Contact Person: Chaz Gordon / Kathy Michna
Project Mgr/Resource: Danny Halden
Project Coordinator:
Assigned Attorney:
NA
NA
City Council or City Manager Approval Date:
Agenda Wording
For A(
Received:
T 2 3
Tag#: CM -09-10-212
Original Documents Received:
Project Name: Delegation of Signatory Authority (MS4 Permit)
ContractorNendor. NA
Funding Source:
Additional funding Source: NA
Amount: NA
Account Number: NA
10/30/2009
Consider executing "Delegation of Signatories to Reports' form to grant the City Engineer Signatory Authority to sign for future annual Storm Water Management (MS4) reports relating to the C
Finance Information
Is Funding Required?
Yes
Initial Construction Contract
Q Construction Contract Amendment #
Change Order #
Change in Quantity Unforeseen Circumstances
EJ Initial Professional Services Agreement
EJ Supplemental Professional Service Agreement
EJ Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
No
Other (Please clearly identify action below)
Amount
FINANCE
WA Approved
ED Finance/CIP Date
Finance/Acct Date
ElPurchasing Date
O ED Budget Date
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval Required
Approved
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 Attomey Signature:
City Manager Signature:
Date:
ate:
-C.
Date:
Date:
10!26/09
1 o- -oq
I o "3o-0`1
*City Attorney signature is required for all items.
REVISED 10/23/2009
10.19.09
Request for City Council/City Manager Action
® City Council City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Engineering & Development Services
Contact Person: Chaz Gordon / Kathy Michna
Project Mgr/Resource: Danny Heiden
Project Coordinator:
Assigned Attorney:
NA
NA
City Council or City Manager Approval Date:
Agenda Wording
Adm
Received:
Tag #:
Original Documents Received:
Project Name: Delegation of Signatory Authority (MS4 Permit)
ContractorNendor: NA
Funding Source:
Additional funding Source: NA
Amount: NA
Account Number: NA
10/30/2009
Consider executing "Delegation of Signatories to Reports" form to grant the City Engineer Signatory Authority to sign for future annual Storm Water Management (MS4) reports relating to the
Finance Information
Is Funding Required?
Yes ri No i
Initial Construction Contract
Construction Contract Amendment
ED Change Urder #
=Change in Quantity =Unforeseen Circumstances
Initial Professional Services Agreement
ED Supplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Other (Please clearly identify action below)
Amount
FINANCE
Finance/CIP L.Olsen
Finance/Acct E. Wilson
Purchasing EE Bowden
Budget P. Bryan
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval Required
Date 10/28/2009
Date 10/28/2009
Date 10/28/2009
Date 10/27/2009
Approved
Cheryl Delaney 10/28/2009
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: Date:
Dept. Director Signature: Date:
*City Attorney Signature: Date:
City Manager Signature: Date: *City Attomey signature is required for all items.
REVISED 10/28/2009
LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION
Required for Submission of ALL City Council and City Manager Items
Department Name: PW/Engineering and Development Project Name: N/A
Project Mgr/Resource: Danny Harden
1]Council Action:
ORDINANCE
Agenda Wording
ContractorNendor: TCEQ
El RESOLUTION
City Manager Approval
CMA Wording
Consider executing "Delegation of Signatories to Reports" form to grant the City Engineer Signatory Authority to sign for future
annual Storm Water Management (MS4) reports relating to the City's MS4 permit with TCEQ.
Attorney Approval
Attorney
Notes/Comments
Date
A.(4
(fl