CM-2019-0305 - 10/11/2019DocuSign Envelope ID: 37041343-4A4A-42E3-B9F5-EDOCIDD51539
Goias Lappet
2. Address of Frapetty �
712 Round RodcAvc,
Round Roc1;, TX 75681
4.0ccupanq• of property
From (Date):
r.anvolling Data
a. �Ofrw 1-1 PC
CLAIM FOR ACTUAL Mov][NC EXPENSES
:d by Stat
To (Date of move);
From {Dale): WA— -Ta r .t..,.uuuvnr
(Rate of Move). NIA
sones (Mame and
WA
25-02 Connty:
.r -^OCR s Moved To:
1308 Round Rord` Ove,
Round Rads, TX 78681
I
Yr.
17 9. Amount of Claim:
Is a a3avirlgExpen= s Io,,;zyq (o �►
L018 b. Re=abllshment E%pM= S
c Searching Ekpcnses g
d. tu-ble Property Lass S
a Swrrgc s
r�w?1POmryLodging (attach e�plan=WA
[. Tcena�..sR• r ., r .:__
NIA To Date of A4ove Total Amount 11. All amoarrns slmsvn in Block 4 uwc ae $- $ R
3 urd retsan drin and ares
not submkied anytallterdaim far, arr¢ ed nimbursemenl far, as item or[ �d b}' attrshed rcaials. Pay ofth)s claim Is
�mpcmatloa from , expense in this claim, and thal I wilt not ucsted I ernily drat I Maes
addressshatvninBlodc3,latm r¢ ��itemnfexpcmapWdpursuanttothisdaily1funhaanti ePtr�mhurse 10tor
induded b vc, Rlaraee with d,e invotca submitted and fY dml all PwPc ty was moved and installed at 11re
herein is true and �d toms of the move and that all ierw=tiOn submitted herewith or
u orcmaza: 4,45
Claimant
Da
- �9
Claimant
prnvisiont of 5tatc faw, p8 items etc
Amoal arS A ax a 9. /_
9/26/2019
Below to be Com ets d b 8ttte
utrerwtion attaehcd haavith, and have round it to be true and
10 be nexssary reasonable exp and Thisclaim is "10Mfeet and to conform rsith
_VZ7
mendrdForpayn tasrallans
[Ice Signed dY•
R-wd
city Mana er
dWr
la-rt-cCfv�
+R991r
WCUSIgn Envelope 10 3713413434MA420-139F5-E00C10Q51539
MEMORANDUM
September 24, 2019
TO: Sheets & Crossfield Texas Department of Transportation
Attn: Lisa Dworaczyk Austin District
Ann.: Shanna Pasemann
FROM: Laurie Miller
SUBJECT: Parcel 25»02 — Taqueria Chapala 2
ROW CSJ — 0683-01-092
Project: RM 620
Claim— Moving Expenses —Request Reimbursement for miscellaneous expenses
It is requested that the attached submission for be handled on a normal basis. In support of this request, please
fwd the following:
Move Expenses
Date Invoice Payee Description Amount Remarks
Number
D$R4718
Chi# a Golden Trknglc
I7lsmxutlim� Rood and
;3,666.04
hi�„re
IJ0 4220$ LLC
crk Goren Ttiaagle
S'"e
Rccomet Hoed a
I~:x fpses
14[ove
mro3ne ,
.Si; 34,04
11104331'8 LI.0
ltexbneet fire splrpresaion
I ,edses
9.
system
0}'127/19
Nlh Taqueria
1:f#esiorage
.67
Ivloyc
616119 _
NIA
Taqueria
Liquor App/Cert fee
$16.00
Move
Chapalla 02
Expenses
616119
NIA
Taqueria
Austin American Statements
$535.14
Move
Chapalla #2
Expenses
616119
#2
Taqueria
Alejandro Zane
57,700.00
Move
Cha alta #2
erases
6119118
899
Carlos Lopez
I Infinity Signs Inc.
$238.15
Move
Carlos Lopez
l:xp uses
Move
7125118
s
NIA
Infinito Signs Inc.
$1,76038
Exnenses
Total
Amount
Paid
To -Date
'1'.'4id
$1 1,0N.,00
Pi dd
$'11,6'70,67
Total SIO 9.67
DocuSign Envelope ID. 37D413434A4A42E3-B9F5-EOOC1OD51539
September 24, 2019
Page 2
Invoices / Proof of Payment
(4) Form ROW -R-99, Claim for Reimbursement of Moving Expenses
(4) Certification of Eligibility
(4) ROW -R-96
(4) W-9 and AP -152
EXPENSE VERIFICATIONS
N ) Comments: The attached packet is a Request for Reimbursement of miscellaneous cost to the move
(Moving Expenses)
The Austin District agreed to assist the City of Round Rock by providing primary oversight of all relocation
assistance submissions. All relocation packager 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 this
process.
1 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.
lA�[/uo
Laurie Miller, R/W NAC, R/W-URAC
Attachments
City of Round Rock
ROUND ROCK
,E_x,e,� Agenda Item Summary
Agenda Number:
Title: Consider approval and execution of claim forms authorizing reimbursement
of miscellaneous expenses in the amount of $10,249.67 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: 10/11/2019
Dept Director: Gary Hudder, Transportation Director
Cost: $10,249.67
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: IAF-00432871.PDF, Claim-00432854.PDF
Department: Transportation Department
Text of Legislative File CM -2019-0305
This is a request for reimbursement payment to a displaced re tenant for miscellaneous
personal property move expenses. This payment is recommended for approval by the City's
relocation consultant, and is 100% reimbursable by TxDoT in connection with the RM620
project.
Cost: $10,249.67
Source of Funds: Round Rock Transportation and Economic Development Corporation (Type
B)
Ckty of Round Rock Page i Pdnted on 1011012019