CM-10-04-096Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
James R. Nuse, P.E.
Print Name
City Manager
Title - Owner/President/Other
of City of Round Rock Utilities Department
Corporation/Partnership/Entity Name
have authorized Kevin Chumbley and Peter Lai
Print Name of Agent/Engineer
of RJN Group, Inc.
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
Cwt- -02-1-0‘e
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.
-a3-)o
Applicant's ` ature Date
THE STATE OF1.'GXiAI §
County of \4I 11t1444,W §
BEFORE ME, the undersigned authority, on this day personally appeared /f".46V. base. 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.
141
GIVEN under my hand and seal of office on this c7 day of
2010FT444/L • littrAtt
SARA L. WHITE
MY COMMISSION EXPIRES
July 11, 2012
NOTARY PUBLIC
julizst
Typed or Printed Name of Notary
MY COMMISSION EXPIRES: 49A1�(' t11 TC/t7./
TCEQ-0599 (Rev.10/01/04) Page 2 of 2
ROUND ROCK, TEXAS
PURPOSE. PASSION. PROSPERITY.
Item Caption:
City Manager Approval Summary Sheet
Consider executing "Agent Authorization Form For Required Signature Edwards Aquifer
Protection Program Relating to 30 TAC Chapter 213" authorizing Kevin Chumbley and
Peter Lai of RJN Group, Inc., to represent and act on behalf of the City for the 2007-2008
Wastewater Collection System Rehabilitation Project.
Approval Date:
Department:
April 23, 2010
Water & Wastewater Utilities
Project Manager: Michael Thane
Item Summary:
This item authorizes RJN Group, Inc., to act as the City's agent for the purposes of gaining TCEQ approval of the
2007-2008 Wastewater Collection System Rehabilitation Project's plans and specifications. RJN Group, Inc. is the
Engineering Consultant working on this wastewater collection system rehabilitation project. This authorization
pertains only to this project specifically.
Goal 28.0 "Protect public health and protect the environment through proper waste
Strategic Plan Relevance: disposal."
Cost:
Source of Funds:
N/A
N/A
REV. 3/8/10
101909
Request for City CounciUCity Manager Action
® City Council CO City Manager
Submit completed form for all City Manager and City Council approvals.
For i 11' r `
c
Received:
's- ONLY
Tag #:,(
v - to -Ori -O9to
Original Documents Received: p
Department Name: Water and Wastewater Utilities Project Name: 2007-2008 Wastewater Collection System Rehabilitation
Contact Person: Chaz Gordon / Kathy Michna
Project Mgr/Resource: David Freireich
Project Coordinator. Michael Thane
Assigned Attomey: Steve Sheets
City Council or City Manager Approval Date:
Agenda Wording
ContractorNendor. TCEQ
Funding Source:
Additional funding Source:
Amount: N/A
Account Number: N/A
4/23/2010
Consider executing "Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213" authorizing Kevin Chumbley and Peter Lai of RJN
Group, Inc., to represent and act on behalf of the City for the 2007-2008 Wastewater Collection System Rehabilitation Project.
Finance Information
Is Funding Required? Yes pi No MI
Initial Construction Contract
Construction Contract Amendment u
Q Change Order
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 below)
Amount
FINANCE
N/A Approved
Finance/CIP
Finance/Acct
Purchasing
Budget
Date
Date
Date
Date
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval Required
MProved
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: �L ._ ' Date:
City Manager Signature: � Date:
#/if'/,o
`City Attorney signature is required for all items.
REVISED 4/16/2010
LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION
Required for Submission of ALL City Council and City Manager Items
Department Name: PW/Utilities
Project Mgr/Resource: Michael D. Thane
[Council Action:
ORDINANCE
Agenda Wording
2007-08 Wastewater Collection System
Project Name: Rehabilitation
ContractorNendor: TCEQ
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 Kevin Chumbley and Peter Lai of RJN Group, Inc., to represent and act on behalf of the City for the
2007-08 Wastewater Collection System Rehabilitation Project.
Attorney Approval
✓Attorney
Notes/Comments
Date /1/ i ;1
D
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Updated 6/3/08