11/23/2021 Resolutions 2021-330Do not recreate, revise, or copy this form. Revisions, recreations, and copies wili not be accepted.
Caiendar Year 202i. Documents inctude ihe ori inal Signing Resalution, Year-�nd Certifir.,atit�n(s), and a capy of
documentation of the appointment(s) of the City Street Superintende�t(s). These must be received at the NDOT bv December
31.2021.
RESOLUTION
SIGNING OF THE
YEAR-END CERTIFICATION OF CITY STREET SUPERINTENDENT
2021
Resolution No. 2021-330
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 31 � 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., empioyed, 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 Chairpe�son.
Be it resolved that the Mayor� Village Board Chairperson � of citv of (;rand T sl an�
(Check one box) (Pnnt Name of Muniupalityy
is hereby authorized to sign the attached Year-End Certification of City Street Superintendent completed form(s).
Adopted this 23rd day of November
(Date) (Monfh)
, 20 21 at Grand Island , Nebraska.
City CouncilNillage Board Members
Councilmember Nickerson Councilmember Stelk
Councilmember Mendoza Councilmember Fitzke
Councilmember Guzinski Councilmember Scott
Councilmember Conley
Councilmember Haase
Councilmember Paulick
Councilmember Minton
City CouncilNillage Board Member Paulick
Moved the adoption of said resolution
Member Fitzke Seconded the Motion
Roll Call �_ Yes � No Abstained _� Absent
Resolution adopted, signed, and biHed as adopted.
Attest, �� � ��u�
(Signature of Clerk)
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Do not recreate ar revise this document. Revisions and recreations wiA not be accepted. Copying this form is acceptable; see (3)
below. Faiture to comnlete and return the necessary documents �rer ins#ructions wi11 result in,�qur municip�li�,r not receiuiny
an Incentive Pa�ment for Calendat Year Z021. Dtrcumsnts inc3ude !he vri irial Signin�g Resolutian, Year-End C�rtificatit�n(s), and
a copy of documentation of the appointment(s) of the City Street Superintendent(s). These must be received at the NDOT �
t7ecember 31. 2021.
Year-End Certification of City Street Superintendent
For Determining Incentive Payment
January 1, 2021 to December 31, 2021
*(1)(a) Certification ofthe municipality of Grand Island �at; Shannon Rose Callahan was
the appointed City Street Superintendent from January 1 , 2021 to December 31 �, 2021,
(b) the above listed individual is not ❑ or is a Licensed City Street Superintendent, License Number S- 1485 Class A
(Check th�s box �s the above lisled mdividual �s not licensed (A o� 8)
(c) the above listed individual is not ❑ or is a Licensed Engineer in Nebraska, License Number E-
(Check ihis box is the above Irsted �ndiv�dual is not hcensed
(d) the superintending services of the above listed individual were provided by: (Cl�eck one box)
� Employment
with this
Municipality
❑ Contract
(consultant)
with this
Municipality
(e) the above listed individual assisted in the following: Reference Neb. Rev. StaL §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. Devefoping an annual budget based on progwammed projects and activities,
4. Submitting such plans, programs, and budgets to the local governing body for approval; and
5. Implementing the capital improvements and mainienance activities provided in the approved plans, programs, and budgets,
-OR-
, 2021 this municipality did not have
(Date)
an appointed City Street Superintendent. ,.�--�y-�
� '�C
Signat of Mayor � Village Board Chairperson ❑
"(3) If your municipality had a licensed superintenderrt 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 superirrtendent who is licensed or exempted from licensure under
the Superintendents Ad; (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 Certifcation(s), Signing Resolufion, 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.
(2) From , 2021 to
(�onth) (Date)
Return the completed original resolution and certification(s), and a
copy of the documentation of appointment(s) by December 31, 2021 to:
❑ Contract (interlocal agreement) between this
Municipality and the following listed Municipality(ies)
and/or Counfy(ies)
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
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meetinQs minutes Some may involve mayoral appointments, or interlocal agreement (relinquishment of funds},
Call 402-479-4436 if you have any questions about what ta submit for documentation.
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