HomeMy WebLinkAboutRes 2015-01-09 Signature Forms for TxCDBG ProjectCITY OF ANNA, TEXAS
RESOLUTION NO. 2015-01-09
A RESOLUTION BY THE CITY COUNCIL OF THE CITY OF ANNA, TEXAS,
DESIGNATING AUTHORIZED SIGNATORIES FOR CONTRACTUAL DOCUMENTS AND
DOCUMENTS FOR REQUESTING FUNDS PERTAINING TO THE TEXAS COMMUNITY
DEVELOPMENT BLOCK GRANT PROGRAM (TxCDBG) PROJECT.
WHEREAS; the City of Anna, Texas has received a 2014 Texas Community Development
Block Grant award to provide sewer improvements, and;
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 Anna, 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 ANNA,
TEXAS, THAT:
The Mayor and City Manager are authorized to execute contractual documents between the
Texas Department of Agriculture and the City of Anna for the 2014 Texas Community
Development Block Grant Program, 4
The Mayor, Mayor Pro -Tem, City Manager and City Secretary are authorized to execute the
State of Texas Request for Payment Form document required for requesting funds approved
in the 2014 Texas Community Development Block Grant Program.
PASSED AND APPROVED by the City Council of the City of Anna, Texas, on this the 13th
day of January 2015.
ATTEST:
Natha Wilkison, City
Res. 2015-01-09 TxCDBG project Signatories for
APPROV D:
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'IUI ii Crist, Mayor
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�74-176
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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%ancel existing direct deposit information.
Transaction Type
For Comptrollers Use Only
z0 pal New setup (Sections 2, 3, 4 and 5) ❑ Change account type (Sections 2, 3, 4 and 5)
U F] Change financial institution (Sections 2, 3, 4 and 5) ❑ Cancellation (Sections 2 and 5 -Sections 6 and 7 for state agency use)
U) E]Change account number (Sections 2, 3, 4 and 5)
Payee Identification
Financial Institution (Completion by financial institution is recommended.)
Payee type
Texas Identification Number TIN
❑ (TIN)
❑Individual Taxpayer Identification Number (ITIN)
Mail code /f not known,
State
❑ State employee
❑ Employer Identification Number (EIN)
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leave blank)
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(�( Vendor or other recipient
[_1 Social Security Number (SSN)
Routing transit number (9 digits)
Comments
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Type of account
1 1 1 , 1 1 1 1 1 1 1 1
1 1 1
1
P:
Payee name
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❑ SavingsO
9 Checking
Phone number
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City of Anna
Title (optional)
972-924-3325 ext.
Mailing address
City
State
ZIP code
Phone number (optional)
101 N. Powell
Date (optional)
Anna
TX
75409
Financial Institution (Completion by financial institution is recommended.)
International Payments Verification (required)
Will these payments be forwarded to a financial institution outside the United States?......................................................... ❑ YES ❑ NO
to if "YES,"also complete the ACH (Direct Deposit) Payment Destination Confirmation (Form 74-227).
Authorization for Setup, Chanqes or Cancellation (required)
Financial institution name
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Cityqq
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State
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Routing transit number (9 digits)
Comments
Customer account number (maximum 17 characters)
Type of account
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❑ SavingsO
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representative name (optional)
Title (optional)
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Financial representative signature (optional)
Phone number (optional)
Date (optional)
ext.
International Payments Verification (required)
Will these payments be forwarded to a financial institution outside the United States?......................................................... ❑ YES ❑ NO
to if "YES,"also complete the ACH (Direct Deposit) Payment Destination Confirmation (Form 74-227).
Authorization for Setup, Chanqes or Cancellation (required)
Cancellation by Agency (forstate agency use)
co I Reason I Date
W
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Authorized Signature (for state agencv use)
authorize the Texas Comptroller of Public Accounts to deposit my payments from the state of Texas to my financial institution electronically.
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understand that the Texas Comptroller of Public Accounts will reverse any payments made to my account in error.
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1 further understand that tpe Texas Comptr le4of ublicAccountswill comply at all times with the National Automated Clearing House Association's
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rules. (Forfurtherinfo tion these r s, pa cont ur financial institution.)
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UAgency
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sign Authorized si
here /
Primed name
1
Date
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Cancellation by Agency (forstate agency use)
co I Reason I Date
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Authorized Signature (for state agencv use)
Please return your completed form to:
Texas Department of Agriculture
Accounts Payable/Direct Deposit Program
1700 North Congress Avenue
Austin, TX 78701-1436
Phone: 512463-7476
sign/ Signature
here
Date
r
Phone number
Agency number
Z
ext.
551
UAgency
name
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Texas Department of Agriculture
Comments
Please return your completed form to:
Texas Department of Agriculture
Accounts Payable/Direct Deposit Program
1700 North Congress Avenue
Austin, TX 78701-1436
Phone: 512463-7476
202
Depository/Authorized Signatories Designation Form
TEXAS COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
DEPOSITORY/AUTHORIZED SIGNATORIES DESIGNATION FORM
Grant Recipient CITY OF ANNA
TxCDBG Contract No. 7214349
The individuals listed below are designated by resolution as authorized signatories for contractual
documents.
Mike Crist
(Name)
Mayor
(Title
1
(Signature)
Natha Wilkison
(Name)
City Secretary
(Title)
Y.a, y
(Signature)
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).
Philip Sanders
(Name)
City Manager
(Title)
i
(Signature)
Chad Barnes
(Name)
Mayor Pro Tem
(Sign ure)
Natha Wilkison
(Name)
City Secretary
(Title)
(Signature)
(Name)
(Title)
(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.
A202
Depository/Authorized Signatories Designation Form
TEXAS COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
DEPOSITORYIAUTHORIZED SIGNATORIES DESIGNATION FORM
Grant Recipient CITY OF ANNA TxCDBG Contract No. 7214349
The individuals listed below are designated by resolution as authorized signatories for contractual
documents.
Mike Crist Philip Sanders
(Name) (Name)
Mayor ` City Manager
s (Title)` (Title)
,,..,' Mme^' �;;
(Si nature) - 1 (Signature)
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).
Philip Sanders Carrie Smith
(Name) (Name)
city Manager City Secretary
(Title) (Title)
b7 - ignature) (Signature)
Chad Barnes Mike Crist
(Name) (Name)
Mayor Pro Tem Mayor /�
) j
ITrtl\e:) � ,/,,---7, (Title]
LLP
, v ' '(
(Signature) (Siigr"iture)
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.