CM-11-12-240cm-11-12_2LIO RECEIVED
NOV 3 01011
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 Williamson Burnet Counties Opportunities
construction of sidewalks, curb and gutters in the amount of $58,708 at the New Head Start Building at 1001 East Main Street.
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: $58,708
Source of Funds: CDBG HUD Entitlement Grants
Source of Funds (if applicable): Select Source Fund
Account Number:
Finance Director Approval: 5. Carter for Cheryl Delaney
Date: 11/29/2011
Department Director Approval: 5. Carter for Cheryl Delaney Date: 11/29/2011
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP ❑ Budget
N/A OK N/A OK
Purchasing ❑ 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. 2506-0087
(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 exis Ing 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 (o be completed by Responsible Entity)
1. Program Title(s)
CDBG
2. HUD/State Identification Number 3. Recipient identification Number
(optlonal)
B-11-MC48-0514 DUNS#10-274-0792
4. OMB Catalog Number(s)
14-218
6. For information about this request, contact (name & phone number)
Liz Alvarado 512-341-3328
5. Name and address of responsible entlty
Steve Norwood, City Manager
City of Round Rook, Texas
221 Bast Main Street
Round Rook, TX 78664
8. HUD or State Agency and office unit to receive request
U.S. Dept. of Housing & Urban Development
106 South St. Mary's Street, Ste. 405
San Antonio, TX 78205
7. Name and address of recipient (if different than responsible entity)
The recipient(s) 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 Activiry(ies)/Project Name(s) 10. Location (Street address, city, county,,State)
Public Facility Improvements 1001 Raat Main Street
Round Rook, TX 78664
11. Program Activity/Project Descdption
Construction of sidewalks, curb and gutters at the New Head Start Building in the amount
of $58,708.00
Previous editions are obsolete
CM -U- I2 --Z%-f d
form HUD -7015.18 (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:
1. The responsible entity has fully carried out its responsibilities for environmental review, decision -snaking and action pertaining to
the project(s) named above.
2. The responsible entity has assurned 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, 1 havcfound that the proposal 0did Vjdid not require the preparation and dissemination
of an environmental impact statement.
4. The responsible entity has disseminated and/or published in the inanner prescribed by 24 CFR 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, comment 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 must be adhered to in carrying out the project.
As the duly designated certifying official of the responsible entity, I also certify that:
7. 1 ain 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 CFR 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. 1 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
Title of Certifying Officer
C iill Akan &I er
Date signs
J
Address of Certifying Officer
WAG(it ocK,13 I$(o(Q1l
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 environmental conditions in accordance with 24 CFR 58.71(b).
Signature of Authorized Officer of the Recipient Title of Authorized Officer
Date signed
X
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or 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)