CM-11-12-239C/V14-11:231 RECEIVED
NOV 3 0 2011
City Manager Approval Form
Item Caption: Execute a Request for Release of Funds HUD Form 7015.15
Approval Date: December 2, 2011
Department Name: Finance Department
Project Manager: Liz Alvarado
Assigned Attorney: Jason Rammel
Item Summary:
Requesting execution of the HUD Form 7015 -Request for Release of Funds for the Texas Baptist Children's Home/YMCA
construction of restrooms at 1301 North Mays Street in the amount of $100,000.
Any project or activity not Exempt under Section 58.34(a)) or Categorically Excluded under Section 58.35(b))
requires posting or publishing notice of intent to request release of funds and certification (HUD form 7015.15).
A Combined Notice of Finding of No Significant Impact and Intent to Request Release of Funds was published in the
Round Rock Leader on November 10, 2011. A minimum comment period of 15 days is required, and none have been received
and the City can request release of funds on activities or projects listed in the published notice.
No. of Originals Submitted: 1
Project Name: Public Facility Improvements
Cost: $100,000
Source of Funds: CDBG HUD Entitlement Grants
Source of Funds (if applicable): Select Source Fund
Account Number:
Finance Director Approval: S. Carter for Cheryl Delaney
Date: 11/29/2011
Department Director Approval: S. Carter for Cheryl Delaney Date: 11/29/2011
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP El Budget
N/A OK N/A OK
Purchasing
111
Accounting
N/A OK N/A OK
ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL
REV. 6/20/11
Request for Release of Funds
and Certification
U.S. Department of Housing
and Urban Development
Office of Community Planning
and Development
OMB No. 2508-0087
(exp. 10/31/2014)
This form is to be used by Responsible Entities and Recipients (as defined in 24 CFR 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 government and States. Public reporting burden for this collection of information is estimated
to average 36 minutes 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, and
a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.
Part 1. Program Description and Request for Release of Funds (to be completed by. Responsible Entity)
1. Program Titie(s)
CDBO
2. HUD/State Identification Number
1B-11-MC48-0514
3. (RecipM identification Number
DUNS#10-274-0792
4. OMB Catalog Number(s)
14.218
8. For information about this request, contact (name & phone number)
Liz Alvarado 512-341-3328
5. Name and address of responsible entity
Steve Norwood, City Manager
City of Round Rock Texas
221 East Main Street
Round Rock, TX 78664
8. HUD or State Agency and office unit to receive request
U.S. Dept. of Housing & Urban Development
106 S. St Mary's St., Ste 405
San Antonio, TX 78205
7. Name and address of recipient Of different than responsible entity)
The recipients) 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(ies)/Proiect Name(s)
Public Facility Improvements
10. Location (Street address, city, county, State)
1301 North Mays Street
Round Rock, TX 78664
11. Program Activity/Protect Description
Construction of Restrooms at 1301 North Mays Street in the amount of $100,000
Previous editions are obsolete
Cm ---11-12_- Z3,
form HUD -7015.15 (1/99)
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:
I. The responsible entity has fully carried out its responsibilities for environmental review, decision-making and action pertaining to
the project(s) named above.
2. The responsible entity has assumed responsibility for and complied with and will continue to comply with, the National
Environmental Policy Act of 1969, as amended, and the environmental procedures, permit requirements and statutory obligations
of the laws cited in 24 CFR 58.5; and also agrees to comply with the authorities in 24 CFR 58.6 and applicable State and local laws.
3. 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 proposal []did KI did not require the preparation and dissemination
of an environmental impact statement.
4. The responsible entity has disseminated and/or published in the manner prescribed by 24 CPR 58.43 and 58.55 a notice to the public
in accordance with 24 CFR 58.70 and as evidenced by the attached copy (copies) or evidence of posting and mailing procedure.
5. The dates for all statutory and regulatory time periods for review, cotntnent or other action are in compliance with procedures and
requirements of 24 CFR Part 58.
6. In accordance with 24 CFR 58.71(b), the responsible entity will advise the recipient (if different from the responsible entity) of any
special environmental conditions that trust be adhered to in carrying out the project.
As the duly designated certifying official of the responsible entity, I also certify that:
7. 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 CPR 58.5 list of NEPA-related authorities insofar as the provisions of these laws apply
to the HUD responsibilities for environmental review, decision-making and action that have been assumed by the responsible entity.
8. 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
X
Address of Certifying Officer
22( .ivtwinS+.
12.ovnd R ock,TX 1-8Q(04
Tide of Certifying Officer
Ci Mo41 atleit
Date signs
/ZAS—
Part 3. To be completed when the Recipient is not the Responsible Entity
The recipient requests the release of funds for the programs and activities identified in Part 1 and 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 enviromnental conditions in accordance with 24 CFR 58.71(b).
Signature of Authorized Officer of the Recipient Tide of Authorized Officer
Date signed
X
Warning: HUD will prosecute false daims and statements. Conviction may result in criminal andlor civil penalties. (18 U.S.C. 1001 ,1010, 1012; 31 U.S.C. 3729,
3802)
Previous editions are obsolete
form HUD -7015.15 (1/99)