CM-2018-1909 - 10/15/2018MEMORANDUM
October 3, 2018
TO: Sheets & Crossfield Texas Department of Transportation
Attn: Lisa Dworaczyk Austin District
Ann.: Shanna Pasemann
FROM: Laurie Miller
SUBJECT: Parcel 25-02 — Taquerin Chapala 2
ROW CSJ — 0683-0I-092
Project: RM 620
Payment Request — Gold Triangle Company LLC
It is requested that the attached submission for be handled on a normal basis. In support of this request, please
find the following:
(4) Payment Request in the amount (s) of S7,333.3 for disconnect and reconnect at replacement
site and reinstall the fire system -- Under Moving Cost. The remaining balance of the $11,00,00 Invoice.
(4) Payment Request in the amount (s) of $5,000.00 to cut the walk in cooler at replacement site and
remove the remaining part, reconnect electric and coolant run for the cooler refrigeration core —
Because the walk-in cooler is too big for the restaurant as it is now. Under Re-establishment Cost
(4) Pictures of Hood and Walk in cooler
(4) Certification of Eligibility
(J) W-9
(q) R-99-' Claim Form
EXPENSE VERIFICATIONS
(�) Comments: The attached packet is a Request for Direct payment to Vendor. The same Vendor for
both invoices but one is considered a moving expense and the other is a reestablishment expense.
The Austin District agreed to assist the City of Round Rack by providing primary oversight of all relocation
assistance submissions. All relocation packages are sent to Texas Department of Transportation for
approval then sent to the City of Round Rock for payment. Signature lines for approval will reflect thin
process.
We approve and recommend that the attached submission be processed at your earliest convenience. if
additional information is needed, please contact Laurie Miller of this office at (512) 4134012.
1461-ra AM -
Laurie Miller, R/W-NAC, R/W-URAC
cc:
Attachments
r....
Form ROWR-49
(Rev. 0711 I)
Page t of 1
CLAIM FOR ACTUAL MOVING EXPENSES
Print orType All Information
1. Name ofClainmant(s)
Parcel No' 25-02
County: Willimnson
Carlos Lopez
ROW CSJ: 0681-01-092
Project No.: NIA
El Residence x nusiness 0 I anti ❑ Non rolil Sin Other
2. Address of Property Acquired by State:
3. Address Moved To:
712 Round Rock Avc,
1308 Round Rock Ave.
Round Ito& TX 76681
Round Rock.1 X 78681
Claimant's Ielc hone 512-663-6674
.1.
•I.Occupancy nfi'roperly Acquired by Slate:
5. Distance \•loved: I Miles
Front (Date): •I'o (Date of klovt:):
7. `lover's Name and Address:
2002 August 3. 20I8
❑ 0w•mCr1OCQl ant X Tenant
6. Controlling pates Mo. Day Yr.
a. First Offer in Negotiation 2 24 17
9. Amount of Clnim:
a, Moving E:spenses
b, Reeslublishment Expenses
S7,334.00
S '5.0()0.00
h• late Property Acquired G 30 i8
c. Date Required to Move 8 3 2018
R. Property Storage (attach explanation)
From (bale): NIA To (hate of Move): NIA
c. Searching fxpcnses
d. Tangible Property Loss
S
5
Place Stored (Name and Address):
NIA
c. Slortlgc
f.. l-emporary Lodging
S
S
10. Temporary Lodging (attach csplanalion)
From (mate): NIA To (Date of Move):N/A
g. Total Amount
S12,334.00
11. All amounts shoo%n to Block +1 ware necessary and reasonabic and arc supported b)' a palled receipts, Pay of this claim is requested. I certml} that I have
mm sub+nitled any other claim for, or rcec' cd reitnbutscalcut far, an item of expense it, this claim. and that I will not accept reintburscmcmt or
cotmhpcnsatian from ml}' other Boum 111 ly item of expense paid pursuant to this claim_ I further cenify that all property was moved and installed at the
address shown in Block J, above, i rdance with tIle invoices submitted and named tants of llmc move and that till information submitted herewith or
included herein is tnic and co
Claimant
iinie of taaim:
Clnimu;un
Spaces Below to be Completed by State
I certify that I leave ceamincd this claim and substantiating documcnlation allached hencrith, and have found it to be true and cortct and to conform niih
the applicable provisions of State law. All items arc considered to he necessary; rcasonablu expenses and this claim is reeontmcnded for payment as folio%%;
Amount ors 12,334,00
Date a 10 ght of Way hiana LF
6M-'-w-1qCq
S
CityManager
GOLD TRIANGLE COMPANY LLC.
16509 FM 1325
Austin, Tx 78728 Ph: (512)-317-6956
f un�r....rar
Name
620 Forest
Address
1308 round rock Ave
City
Round Rock
Phone
11_— B__._.!.
NIA
UU-11. —1—,
State Texas
ZIP 78665
Invoice No. 444119
INVOICE
Misc
Date mldly July -12-2.018
Order No,
BY Sa_mer
Spp Type Maintenance
Qty
Description
Unit Price $
TOTAL $
0.00
0.00
0.00
0.00
0.00
0.00
Labor Charges
LS
Cut the walk in cooler and remove the remaining part with
run the cooler refrigration core
5000.00
5,000.00
Total Material 0.00
Payment Tax Rate(s) 8.25% 0.00
Check via mail to our P_O.Box or pickup Total labor 5,000.00
Comments TOTAL 5000.00
Name Gold Triangle LLC
CC # Archive
Expires
GOLD TRIANGLE LLC.
AC, Electrical & Commercial Kitchen
16509 FM 1325
Autin, TX 78728
- goldtdangleco@gmail.com
GOLD TRIANGLE COMPANY LLC.
16509 FM 1325
Austin, TX 78728 Ph: (512)-317-6956
Customer
Name 620 Florest
Address 1308 round rock Ave
City Round Rock State Texas ZIP 78665
Phone N1A
Ite Served Hood {
Invoice No. 444121
INVOICE
Misc I
Date mldly July -12-2018
Order No. _
BY Samer _
Spp Type Maintenance
m
Qty
Description
Unit Price $
TOTAL $
0.00
0.00
0.00
0.00
0.00
0.00
Labor Charges
LS
Remove the hood and re -installed in specified location and
11000.00
11,000.00
install fire system
Total Material
0.00
Payment Tax Rate(s) 8.25%
6._Wol
Check. via mail to our P.O.Box or pickup Total labor
11,000.00
r.nmments TOTAL
{ 1000.00
Name Gold Triangle LLC
CC # Archive
Expires
-NAWA.nD
Q_ -7,3 5 N, drD
GOLD TRIANGLE LLC.
AC, Electrical 8 Commercial Kitchen
16509 FM 1325
Autin, TX 78728
goidtriangleco@gmail.com
The undersigned displacee hereby agrees that payment for relocation services identified on the attached
scope of work 4viil be made to Gold Triangle Company LLC. This agreement is void without a signed
scope of work attachcd. The Teras Department of Transportation reserves the right And responsibility of
detennining the "reasonable and necessary" charges for the move as is customary in the indwstry. Carlos
Lopez understands anything not included in the attached scope of %vurk inust be pre -approved by
TaDOT in order to ensure its eli-ibility for reimbursement. Vendor understands that the Texas
Department of Transportation %Hill not be able to make any reimb=ernents for the pre-approx•ed scope
ofservices until displace authorizes release of the payment.
�isplacet s Sian - � � Ua1c
r
I lipfacrc's : °�1n1c {Printrdl `
6 =` G,C - O t'
Vendor's Signatuse DaT:
Vendor's Nramc ( Printed)
TxDOT Project Manager 3ipauuL Dare
i xi3C)"I I'rajcct Atanagcr Name (Printed)
Perm ROW -R -MV
(1011)
Roplacas Fora RUN-R.D?1.1
?age 1 of S
AGREEMENT FOR DIRIXT PAYMENT TO VENDOR
County.
Williamson
IZOW CSI:
0681-01-092
flidlnray:
PUM 620
Parcel:
75-02
The undersigned displacee hereby agrees that payment for relocation services identified on the attached
scope of work 4viil be made to Gold Triangle Company LLC. This agreement is void without a signed
scope of work attachcd. The Teras Department of Transportation reserves the right And responsibility of
detennining the "reasonable and necessary" charges for the move as is customary in the indwstry. Carlos
Lopez understands anything not included in the attached scope of %vurk inust be pre -approved by
TaDOT in order to ensure its eli-ibility for reimbursement. Vendor understands that the Texas
Department of Transportation %Hill not be able to make any reimb=ernents for the pre-approx•ed scope
ofservices until displace authorizes release of the payment.
�isplacet s Sian - � � Ua1c
r
I lipfacrc's : °�1n1c {Printrdl `
6 =` G,C - O t'
Vendor's Signatuse DaT:
Vendor's Nramc ( Printed)
TxDOT Project Manager 3ipauuL Dare
i xi3C)"I I'rajcct Atanagcr Name (Printed)
Form ROW -R -CE
(Rev. 03116)
Page 1 of 1
CERTIFICATION OF ELIGIBILITY
ROW CSJ: 0683-01-092
Parcel: 25-2
Displacee: Taqueria Chapala 42
Individuals, Families and Unincorporated Businesses or Farming Operations
I certify that myself and any other party(ies) with a financial interest in this relocation assistance claim
are either:
Ef Citizens or Nationals of the United States
or
❑ Aliens lawfully present in the United States
* if an Alien lawfully resent in the United States, supporting documentation will be required.
Date: 6
`laimant
Date:
Claimant
Incorporated Business, Farm or Nonprofit Organizations
I certify that I have signature authority for this entity and such entity is lawfully incorporated under the
applicable state's 1 and authorized to conduct business within the United States.
Date:
Claimant
City of Round Rock
1:
ROUND ROCK
TCxAs Agenda Item Summary
Agenda Number:
Title: Consider approval and execution of claim forms authorizing partial payment
of a moving expense in the amount of $12,334.00 for the Taqueria Chapala
due to displacement of the business caused by acquisition of right of way on
the RM 620 project (Parcel 25).
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 10/12/2018
Dept Director: Gary Hudder
Cost: $12,334.00
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: 00411181.PDF, 00411127.PDF
Department: Transportation Department
Text of Legislative File CM -2018-1909
Consider approval and execution of claim forms authorizing partial payment of a moving
expense in the amount of $12,334.00 for the Taqueria Chapala due to displacement of the
business caused by acquisition of right of way on the RM 620 project (Parcel 25).
This is a request for (1) payment of $7,334 remaining on an initial $11,000 move estimate,
and (2) payment of an additional $5,000 reestablishment expense for the new business
location. The first $3,666 direct partial payment to Vendor for actual moving expenses was
approved and paid on 8110118. The work has now been completed, and these additional
claims include actual moving costs associated with reinstallation of the fire system, and
re-establishment costs associated with the refrigeration system, at the replacement site.
These payments are 100% reimbursable by TxDoT in connection with the RM620 project.
Cost: $12,334.00
Source of Funds: RR Transportation and Economic Development Corporation
CltyolRoundRock Page t Printed on 10/11/2018