2021-03-09 US Dept Housing and Urban Deveopment Request for Release Funds and CertificationRequest for Release of Funds U.S. Department of Housing OMB No. 2506-0087
and Urban Development (exp. 08/31/2023)
and Certification Office of Community Planning
and Development
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. Program Description and Request for Release of Funds (to be completed by Responsible Entity)
Blair, NE CDBG Economic Development RLF
FDA No. 14.219
Grant Anderson, (402) 444-6866 ext. 3222
8. HUD or State
State of Nebraska Department of Economic
Development
3.
5. Name
City of Blair, NE: 218 South 16th Street, Blair, NE 68008
7. Name and address of
The recipients) 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
county, state)
Blair Holiday Inn Express Vacant Lot, Blair, NE; Legal Description: BC HAYDEN PLACE
FIRST ADD REPLAT ONE LOT 2 114 PC 2 1.59 AC
11. Program Activity/Project Description
The City of Blair (City) proposes to obligate the full balance of its CDBG Economic
Development RLF towards the development of a new Holiday Inn Express. The total
estimated hotel project cost is $7.5 million. The City is prepared to obligate $1,390,000
to $1,590,000 from the following sources: LB 840 forgivable loan, $400,000; TIF,
$800,000 to $1,000,000; and Local CDBG RLF, $190,732. Of the Local CDBG RLF
contribution, the City proposes to lend approximately $120,000 at 0-2% interest for 10
years for land acquisition and approximately $70,000 for working capital at 0-2% interest
For 7 years. The developer will finance the remaining costs with a combination of private
capital and conventional loans. The project will meet the HUD National Objective in the
creation of 10 permanent full-time equivalent (FTE) positions of which no less than 51 %
will be held by or made available to low and moderate income (LMI) persons. No
persons or businesses will be displaced as a result of this project.
Previous editions are obsolete form HUD -7015.15 (1/99)
Part 2 Environmental Certification (to be completed by responsible entity)
With reference to the above Program Activity(les)/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. The responsible entity has assumed responsibility for and complied with and will continue to comply with Section 106 of the National
Historic Preservation Act, and its implementing regulations 36 CFR 800, including consultation with the State Historic Preservation
Officer, Indian tribes and Native Hawaiian organizations, and the public.
4. 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 ❑ did not ® require the preparation and
dissemination of an environmental impact statement.
5. 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.
6. 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.
7. 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:
8. 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.
9. 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.
Signature of Certifying Officer of the Responsible Entity
Address
Title of Certi in Officer
Mayor
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
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)