2021-37Do not recreate, revise, or copy this form. Revisions, recreations, and copies will not be accepted. Failure to complete and
return the necessary documents per instructions will result in your municipality not receiving an Incentive Payment for
Calendar Year 2021. Documents include the ori incl Signing Resolution, Year -End Certification(s), and a copy of
documentation of the appointment(s) of the City Street Superintendent(s). These must be received at the NDOT by December
31, 2x21.
RESOLUTION
SIGNING OF THE
YEAR-END CERTIFICATION OF CITY STREET SUPERINTENDENT
2021
Resolution No. 2021-37
Whereas: State of Nebraska Statutes, sections 39-2302, and 39-2511 through 39-2515 details the requirements
that must be met in order for a municipality to qualify for an annual Incentive Payment; and
Whereas: The State of Nebraska Department of Transportation (NDOT) requires that each incorporated
municipality must annually certify (by December 315' of each year) the appointment of the City Street
Superintendent(s) to the NDOT using the Year -End Certification of City Street Superintendent form; and
Whereas: The NDOT requires that each certification shall also include a copy of the documentation of the city
street superintendent's appointment, i.e., meeting minutes; showing the appointment of the City Street
Superintendent by their name as it appears on their License (if applicable), their License Number (if applicable),
and Class of License (if applicable), and type of appointment, i.e., employed, contract (consultant, or interlocal
agreement with another incorporated municipality and/or county), and the beginning date of the appointment; and
Whereas: The NDOT also requires that such Year -End Certification of City Street Superintendent form shall be
signed by the Mayor or Village Board Chairperson and shall include a copy a resolution of the governing body
authorizing the signing of the Year -End Certification of City Street Superintendent form by the Mayor or Village
Board Chairperson.
Be it resolved that the MayorU Village Board Chairperson ❑ of Blair
(Check one box) (Print Name of Manicipatity)
is hereby authorized to sign the attached Year -End Certification of City Street Superintendent completed form(s).
Adopted this 9th day of November 12021 at Blair Nebraska.
(Date) (Month)
City CouncilNillage Board Members
Martv Shepard
Jon Stewart
Mindy Rump
Kevin Willis
Attest:
(Signature of Clerk)
Frank Wolff
Andrew Schank
Kevin Hall
Chris Jensen
City CouncilNillage Board Member Schank
Moved the adoption of said resolution
Member Wolff Seconded the Motion
Roll Call 7 Yes 0 No Abstained 1 Absent
Resolution adopted, signed, and billed as adopted.
Page 1 of 3
Attach Documentation of the City Street Superintendent(s) Appointment for 2021 here:
For most municipalities this information may be found in the November or December 2020 or the January 2021
meetings minutes. Some may involve mayoral appointments, or interlocal agreement (relinquishment of funds).
Call 402-479-4436 if you have any questions about what to submit for documentation.
Page 3 of 3
NEBRASKA_
Good Life. Great Journey.
October 29, 2021
Notice to file the Year -End Certification of City Street Superintendent, Signing Resolution, and Documentation of the
Appointment(s) of City Street Superintendent(s) for Calendar Year 2021 with the Nebraska Department of
Transportation (NDOT) by December 31, 2021.
The attached YEAR-END CERTIFICATION OF CITY STREET SUPERINTENDENT and SIGNING RESOLUTION, together
with a copy of the DOCUMENTATION OF THE CITY STREET SUPERINTENDENT(S) APPOINTMENT for CALENDAR YEAR
2021, is the basis for determining the calendar year 2021 Incentive Payment. Please complete and return the following to
the NDOT by December 31, 2021:
➢
Signing Resolution (Page 1): The original Signing Resolution, authorizing the signing of the Year -End Certifications)
by the Mayor or the Village Board Chairperson.
➢ Year -End Certification of City Street Superintendent (Page 2): If more than one individual provided street
superintending services during Calendar Year 2021, or if the municipality did not have an appointed street
superintendent, document each successive appointed city street superintendent and/or period without an appointed
city street superintendent using a separate Year -End Certification form. Copy the form as needed.
➢ Documentation of the City Street Superintendent(s) Appointment (Page 3): Attach to page 3 a copy of the City
Council or Village Board meeting minutes showing the appointment of the City Street Superintendent(s) for Calendar
Year 2021 by their name as it appears on their License (if applicable), their License Number (if applicable), and Class
of License (if applicable), and the type of appointment, i.e., employed, contract (consultant or interlocal agreement with
another county and/or incorporated municipality), and the beginning date of the appointment. For most
municipalities this information may be found in the November ar December 2026 or the January 2021 meetings
minutes.
Failure to complete and return: If a municipality had an appointed and Licensed City Street Superintendent for all or part of
Calendar Year 2021 and the municipality does not complete and return the above documentation to the NDOT by December
31 2021 the municipality will not receive an Incentive Pavment for Calendar Year 2021.
Payment: If your municipality qualifies, payment will be scheduled for February 2022. Reference Neb. Rev. Stat. §39-2515.
Please let me know if you have any questions.
Sincerely,
-J, M.'_ 1�' �
LeMoyne D. Schulz
Highway Local Liaison Coordinator
Boards -Liaison Services Section
Local Assistance Division
Nebraska Department of Transportation
Email: lemoyne.schulz a_nebraska.gov
Phone: (402) 479-4436
LDS/2021
Attachments (3)
John R. Selmer, P.E., Director
Department of Transportation
MAILING ADDRESS PHYSICALADDRESS
PO Box 94759 1500 Highway 2
Lincoln, NE 68509 4759 Lincoln, NE 68502
dot.nebraska.gov
Do not recreate or revise this document. Revisions and recreations will not be accepted. Copying this form is acceptable; see (3)
below. Failure to complete and return the necessary documents per instructions will result inyour municipality not receiving
an Incentive Payment for Calendar Year 2021. Documents include the ori final Signing Resolution, Year -End Certification (s), and
a copy of documentation of the appointment(s) of the City Street Superintendent(s). These must be received at the NDOT
December 31, 2021_.
Year -End Certification of City Street Superintendent
For Determining Incentive Payment
January 1, 2021 to December 31, 2021
*(1)(a) Certification of the municipality of City of Blair that: Allen Schoemaker was
(Print name of City or Village)) (Print name of Superintendent as appears on license card if applicable)
the appointed City Street Superintendent from January 1 , 2021 to December 31 '2021,
(Mlonth) (Date) (Alionth) (Date)
(b) the above listed individual is not ❑ or is a Licensed City Street Superintendent, License Number S-1073 Class A
(Check this box is the above listed individual is not licensed (A or 8)
(c) the above listed individual is not ❑ or is a Licensed Engineer in Nebraska, License Number E -
(Check this box is the above listed individual is not licensed
(d) the superintending services of the above listed individual were provided by: (Check one box)
fR Employment
with this
Municipality
❑ Contract
(consultant)
with this
Municipality
❑ Contract (interlocal agreement) between this
Municipality and the following listed Municipality(ies)
and/or County(ies)
(e) the above listed individual assisted in the following: Reference Neb. Rev. Stat. §39-2512
1. Developing and annually updating a long-range plan based on needs and coordinated with adjacent local governmental units,
2. Developing an annual program for design, construction, and maintenance,
3. Developing an annual budget based on programmed projects and activities,
4. Submitting such plans, programs, and budgets to the local governing body for approval; and
5. Implementing the capital improvements and maintenance activities provided in the approved plans, programs, and budgets,
-OR-
(2) From 2021 to 2021 this municipality did not have
(Month) (Date) (Month) (Date)
an appointed City Street Superintendent. 1�
Signature of Mayor U Village Board Chairperson ❑
* (3) If your municipality had a licensed superintendent for a portion of the year; had two or more successive licensed superintendents;
and/or did not have an appointed street superintendent for any portion(s) of the calendar year, complete a separate Year -End
Certification form for EACH appointed city street superintendent AND for any period without an appointed city street superintendent.
Copy this form as needed to account for these separate periods.
(4) The payment amount will be computed based on (a) your most recent Federal Census as certified by the Tax Commissioner;
(b) the number of full calendar months served by the appointed superintendent who is licensed or exempted from licensure under
the Superintendents Act; (c) class of license, A or B; and (d) if the appointed City Street Superintendent assisted with the required
duties in (1)(e) above. Reference Neb. Rev. Stat. §§39-2302 and 39-2511 through 39-2515.
(5) Failure to return the Year -End Certification(s), Signing Resolution, and a copy of documentation of the appointment(s) of
the superintendent(s) per the instructions will result in your municipality not receiving an Incentive Payment.
Return the completed original resolution and certification(s), and a
copy of the documentation of appointment(s) by December 31, 2021 to:
Highway Local Liaison Coordinator
Boards -Liaison Services Section
Local Assistance Division
Nebraska Department of Transportation
PO Box 94759
Lincoln NE 68509-4759
Page 2 of 3