HomeMy WebLinkAbout2019-R-01 - TxCDBG Signatories RESOLUTION NO.2019-R-01
A RESOLUTION BY THE CITY COUNCIL OF THE CITY OF STEPHENVILLE, TEXAS, DESIGNATING
AUTHORIZED SIGNATORIES FOR CONTRACTUAL DOCUMENTS AND DOCUMENTS FOR REQUESTING
FUNDS PERTAINING TO THE TEXAS COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM (TxCDBG)
CONTRACT NUMBER 7218469.
WHEREAS,the City of Stephenville,Texas has received a 2018 Texas Community Development Block
Grant award to provide water improvements.
WHEREAS, it is necessary to appoint persons to execute contractual documents and documents for
requesting funds from the Texas Department of Agriculture, and;
WHEREAS, an original signed copy of the TxCDBG Depository/Authorized Signatories Designation Form
(Form A202) is to be submitted with a copy of this Resolution, and;
WHEREAS,the City of Stephenville,Texas acknowledges that in the event that an authorized signatory of
the City changes(elections, illness, resignations,etc.),the City must provide TxCDBG with the following:
• a resolution stating who the new authorized signatory is (not required if this original resolution names
only the title and not the name of the signatory);and
• a revised TxCDBG Depository/Authorized Signatories Designation Form (Form A202).
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF STEPHENVILLE,
TEXAS,AS FOLLOWS:
The Mayor and City Administrator be authorized to execute contractual documents between the Texas
Department of Agriculture and the City for the 2018 Texas Community Development Block Grant
Program.
The Mayor, Mayor Pro-Tem,City Administrator, Director of Finance, and Accountant be authorized to
execute the State of Texas Purchase Voucher and Request for Payment Form documents required for
requesting funds approved in the 2018 Texas Community Development Block Grant Program.
PASSED AND APPROVED this the 8th day of January, 2019.
''-Doug Svie , ayor
•• ---,
ATTEST: r ;':'
Staci King, Ci ecretary
RESOLUTION#2019-R-01 Page 1 of 5
dt.40?(4.4.1,„,---
Allen Barnes, City Administrator
Reviewed
Randy Thomas, City Attorney
Approved as to form and legality
RESOLUTION#2019-R-01 Page 2 of 5
1A202
Depository/Authorized Signatories Designation Form
Grant Recipient City of Stephenville TxCDBG Contract No.7218469
The individuals listed below are designated by resolution as authorized signatories for contractual
documents.
Doug Svien Allen L. Barnes
(Name) (Name)
Mayor City Administrator
Cr.6,1/45 ) - " (Title)
(Signature) (Signa re)
In addition to the individuals listed above,the individuals listed below are designated by resolution
as authorized signatories for the Request for Payment Form (Form A203)—(At least two (2)
signatories required).
Brady Pendleton Monica Harris
(Name) (Name)
ayo Pro-Tern Director of Finance
r„.1
(Title) (Title)
1.40.9—(2).\.
-4.giTaleire) (Signature)
Lisa Slemmons
(Name) (Name)
Accountant
(Title) (Title)
0 .
(Signature) (Signature)
NOTE:A copy of a Resolution passed by the city council or county commissioner's court authorizing the
signatories must be submitted along with this form. Grant Recipients are strongly encouraged to use the
sample resolution provided.
Manual Page 1
2016 TxCDBG Implementation
Form required as of September 1,2016.
-176 o)FM STATE OF TEXAS For Comptroller's Use Only
Direct Deposit Authorization
This form may be used by vendors,individual recipients or state employees to receive payments
from the state of Texas by direct deposit or to change/cancel existing direct deposit information.
Transaction Types
1.Select transaction types
ZO 6,6 New setup(Sections 2.3,5 and 6) ❑ Change account type(Sections 2.3,4.5 and 6)
U ❑ Change financial institution(Sections 2,3.4,5 and 6) ❑ Cancellation(Sections 2 and 6-Sections 7 and 8 for state agency use)
lig 0 Change account number(Sections 2,3,4.5 and 6) ❑ Change custodial agency t t t t
Payee Identification
2,Payee type 3.Identification number 0 Social Security number(SSN)' 4.Mail code(If not known.
leave blank)
0 State employee
�,
0 Texas Identification Number(TIN) 0 Individual Taxpayer Identification Number°TIN)
Z Vendor or other recipient
0 ❑Employer Identification Number(EIN)
f.- 5.Payee name 6.Phone(Area code and number)
U
City of Stephenville ( 254 ) 918-1292 ext.
7.Mailing address(Street,city,state and ZIP code)
298 W.Washington St. Stephenville TX 76401
New Account Information(Setups and Changes)(Completion by financial institution is recommended)
8.Finan I institution name 9.City 10State
cVis Ran z hcnvi !it -1
X
.
M 11.Routing number digits, 12.Customer unt numer mimm
baxu1 characters) 13.Account type
O I O i ai4' 8' .r - �j I g1U tol.t Jt�t I_ t , , , tit II , IChecking ❑Savings
U14.Finanaal representative name(optional) 15,Title(optional)
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16.Financial representative signature(optional) 17.Phone Area code and number)(optional) 18.Date(optional)od
( ) /(p5.31640 ext.
Existing Account Information (Changes Only)
a 19.Routing number(9 digits) 20.Customer account number(maximum 17 characters) 21.Account type
V _ _
y l 1 t t I l t 1 1 I l_J l t t t t t t t , , t I I t , , , , ❑Checking ❑Savings
International Payments Verification(required)
U 22.Will these payments be forwarded to a financial institution outside the United States? 0 YES [if NO
la 3 If"YES."also complete the ACH(Direct Deposit)Payment Destination Confirmation(Form 74-227).
Authorization for Setup,Changes or Cancellation (required)
I authorize the Texas Comptroller of Public Accounts to electronically deposit my payments from the state of Texas to my financial institution.
I understand that the Texas Comptroller of Public Accounts will reverse any payments made to my account in error.
O I further understand that the Texas Comptroller of Public Accounts will comply at all times with the National Automated Clearing House Association's
P rules.(For further information on these rules,please contact your financial institution.)
w
Cr) sign, is23.Autho,ed signature " 24.Panted name
25.
here • - DouSvien //3/2.01q
Cancellation by Agenc' (for state agency use)
r 26.Reason
U 27.Date
W
N
State Agency Contact(for state agency use)
28.Authorized signature 29.Date
sign
here r following address:
c0 30.Phone(Area code and number) 31.Agency number
z Texas Department of Agriculture
.--. O ( ) ext. 551 Accounts Payable/Direct Deposit Program
o 32.Agency name 1700 North Congress Avenue
Texas Department of Agriculture Austin,TX 78701-1436
33.Comments Phone:512-463-7476
•See Federal Privacy Act Statement on page 2
Form 74-176(6ack)(Rev.9-17120)
Instructions for Direct Deposit Authorization
You have certain rights under Chapters 552 and 559,Government Code,to review,request and correct information we have on
file about you.To request information for review or to request error correction,use the contact information on this form.
Section 1:Transaction Type(s)
1.Select the appropriate transaction type(s)and complete the corresponding sections.
Note:Requests to change custodial agency number are processed based on Payment Services research and guidelines.
Section 2: Payee Identification(Required)
2.Payee type:Indicate whether the payee is a state employee or a vendor/recipient.
Note:Agencies must complete box 34 with the appropriate agency's return address for the selected payee type.
3.Identification number.Indicate the type of identification number and provide the associated 9-or 11-digit number.
4.Mail code:Enter the 3-digit mall code.
6.Payee name:Enter the payee's name.
6.Phone:Enter the payee's area code,phone number(and extension,if applicable).
7.Mailing address:Enter the payee's mailing address,city,state and ZIP code.
Section 3: New Account Information(Setups and changes) (Completion by financial institution is recommended)
8.Financial Institution name:Enter the name of the payee's financial institution.
9.City:Enter the city of the payee's financial institution.
10.State:Enter the 2-character abbreviation for state of the payee's financial institution.
11.Routing number.Enter the 9-digit routing number of the payee's financial institution.
12.Customer account number.Enter the payee's account number(maximum 17 characters).
13.Type of account:Indicate whether the payee's account type is a checking account or a savings account.
14.Financial representative name:(optional)Enter the name of the financial representative.
15.Title:(optional)Enter the title of the financial Institution representative.
16.Financial representative signature:(optional)Original signature of the financial representative.
17.Phone:(optional)Enter the area code,phone number(and extension,if applicable)of the financial representative.
18.Date:(optional)Enter the date the financial representative signed the form.
Section 4: Existing Account Information(Changes only)
19.Routing number:Enter the 9-digit routing number currently on file with the Comptroller's office.
20.Customer account number.Enter the payee's account number currently on file with the Comptroller's office.
21.Account type:Select the payee's account type currently on file with the Comptroller's office.
Section 5:International Payments Verification(Required)
22.Payment Destination:Select YES or NO to indicate if state payments will be forwarded to a financial institution outside the U.S.
Note:If YES,the payee must also complete the ACH(Direct Deposit)Payment Destination Confirmation(Form 74-227).
Section 6:Authorization for Setup,Changes or Cancellation(Required)
23.Authorized signature:Original signature of the payee Is required.
24.Printed name:Enter or print the name of the payee or vendor/recipient signing the form.
25.Date:Enter or print the date the form was signed.
Section 7:Cancellation by Agency(for state agency use)
28.Reason:Enter the reason for cancellation of the payee's direct deposit information.
27.Date:Enter the date the cancellation was determined.
Section 8:State Agency Contact(for state agency use)
Z8.Authorized signature:Original signature of the agency's authorized representative is required.
29.Date:Enter the date the agency's representative signed the form.
30.Phone:Enter the area code,phone number and extension(if applicable)of the agency's representative.
31.Agency number.Enter the 3-digit agency number.
32.Agency name:Enter the agency's name.
33.Comments:(optional)Enter comments,if needed.
34.Return to Paying State Agency:This area autopopulates with the name and address of the paying state agency to
which this form will be returned.
Questions?
State Employees: Contact your agency's Human Resource department or payroll staff.
Vendors/Recipients: Contact the paying agency's accounts payable staff.
State Agencies: Contact Fiscal Management,Payment Services at 512-936-8138.
*Federal Privacy Act Statement Ofadosure of your Social Security number is required and authorized under law for the purpose of tax administration and identif Calon Of any indmdual effected by
applicable law,42 U.S.C.§405(c)(2)(C)(i)end Tax.Gov't Code§§403.011,403.015,403.055,403.058 and 403.078.The Public Information Ad,Tex.Gov't Code Ch.522,and appkcable federal law
shall govern release of information on this form in response to a public information request.