CM-12-04-062ROUND ROM, TEXAS
RIIMMERUMMOMMY
Item Caption:
C1/-12 roY-r)472RECEIVED
APR 112012
City Manager Approval Form
Consider executing "Agent Authorization Form For Required Signature Edwards Aquifer Protection
program Relating to 30 TAC Chapter 213" authorizing Gary Hudder to represent and act on behalf of the
city
Approval Date: April 13, 2012
Department Name: Transportation Department
Project Manager:
Gary Hudder
Assigned Attorney:
Item Summary:
Texas Commission on Environmental Quality (TCEQ) requires an Agent Authorization Form to allow someone other than the City
Manager to submit plan applications to the TCEQ for the review and approval consideration of regulated activities. The form will
appoint Gary Hudder as a City of Round Rock agent.
No. of Originals Submitted: 1
Project Name: N/A
Cost: 0.00
Source of Funds: Select Source Fund
Source of Funds (if applicable): Select Source Fund
Account Number:
Finance Director Approval: Cheryl Delaney
Date: 4/10/12
Department Director Approval: Gary Hudder Date: 4/9/12
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP ❑1 Budget ❑� ❑ Purchasing ❑ El Accounting 1-1
N/A OK N/A OK 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
Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
Steve Norwood
of
have authorized
Print Name
City Manager
Title - Owner/President/Other
City of Round Rock, Texas
Corporation/Partnership/Entity Name
Gary Hudder, Transportation Director
Print Name of Agent/Engineer
of City of Round Rock, Texas
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 those submitting an application 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.
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.
5. No person shall commence any regulated activity on the Edwards Aquifer Recharge
Zone, Contributing Zone or Transition Zone until the appropriate application for the
activity has been filed with and approved by the Executive Director.
TCEQ-0599 (Rev.04/01/2010) Page 1 of 2
CM-- (Z'6w- 00,
SIGNATURE PAGE:
Applicant's ignature Date
THE STATE OF l §
County of tiVillf 'MSat §
BEFORE ME, the undersigned authority, on this day personally appeared ' 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 \ay of Afri (
tt
NOTARY. PUBLI
212444A_
gra L. l,aid-e
Typed or Printed Name of Notary
MY COMMISSION EXPIRES:
-2o
TCEQ-0599 (Rev.04/01/2010) Page 2 of 2