HomeMy WebLinkAboutMACH ACADEMY IMPROVEMENTS REQUEST FOR RELEASE OF FUNDS AND CERTIFICATIO N HUD
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", ' R.equest for Release
of Funds and
Certification
U.S. Department of Housing
and Urban Development
Office of Community Planning
and Development
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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. Proqram Description and Request for Release of Funds (to be completed by Responsible EntitY)
1. Program Title(s) 2. HUD/State Identification Number 3. Recipient Identification
Community Development Block Grant Number (optional)
Program - Entitlement B-07-MC-13-0003
4. OMB Catalog Number(s) 5. Name and address of responsible entity
14.218 & 14.239 City of Augusta, Georgia
530 Greene Street, Room 805
Augusta, GA 30901
6. For information about this request, contact (name
& phone number)
Chester A. Wheeler, III
(706) 821-1797
7. Name and address of recipient (if different than responsible
entity)
Same as #5
8. HUD or State Agency and office unit to receive.
request
U.S. Dept. of Housing & Urban Development,
Environmental Branch, 40 Marietta St., 4th Floor,
Atlanta, GA 30303-2806
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 followino
9. Program Activity(ies)/Project Name(s)
MACH Academy Improvements
CDBG #07037
10. Location (Street address, city, county, State)
1823-1850 Chester Avenue, Augusta,
Richmond, Georgia
11. Program Activity/Project Description
The project will consist of improvements which include a new classroom, office, storage
room, conference room, tennis court lighting and expansion of fitness room.
The expansion and improvements will enable MACH Academy to accommodate more
low income youths in their after school tutoring program, computer classes, life skills
and tennis lessons.
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Previous editions are obsolete
Page 1 of 2
form HUD-7015.15 (1/99)
Previous editions are obsolete
Page 2 of2
form HUD-7015.15 (1/99)
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Part 2. Environmental Certification to be com leted by res onsible entit
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-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 Brequire the
preparation and dissemination of an environmental impact statement. .
4. The responsible entity has disseminated and/or published in the manner 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 officialofthe 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 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. 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.
f Certifying Officer of the Responsible Entity
cJ! J J.
Title of Certifying Officer
Mayor, City of Augusta, GA
Address of Certifying Officer
530 Greene Street, Room 805, Augusta, Georgia 30901
Date ~gned I
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Part 3. To be com leted when the Reci ient is not the Res onsible Entit
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
an chan e in environmental conditions in accordance with 24 CFR 58.71 b .
Signature of Authorized Officer of the Recipient Title of Authorized Officer
Date signed
Warning: HUDWlllproseaJlefalsedairrsandstalements. Convdionmayresulinatninalandlordvi~. (18U.S.C.1001, 1010, 1012; 31
U.S.C. 3729, 3002)