CM-2020-166 - 6/12/2020DocuSign Envelope ID: OBEBE537-DB9A-4C8D-BB50-4F63171C2CEC
Form ROW-R-102
(Rev. 07/11)
Page 1 of 2
FIXED MOVING EXPENSE PAYMENT -
BUSINESS, FARM OR NONPROFIT ORGANIZATION
Print or Type All Information - Read Rules on the Reverse Side
1. Applicant's Name: Parcel No.: I County: Williamson
Arrow Cleaners, Inc. (Hung Nguyen)
2. Applicant's Address:
16620 Barrhead Cove, Austin, TX 78717
Telephone No.: 512-944-8853
4. Occupancy of Property Ac uired by State
From (Date): To (Date Required to Move):
09/1994 1 10/5/2019
5. Type Operation
Business ® Farm ❑ Nonprofit ❑
Type of Business, Farm or Nonprofit Organization
Dry Cleaners
Dates of
ROW CSJ: 0683-01-092
L Name and Address of ]
Arrow Cleaners, Inc.
1205 Round Rock Ave, Ste.
Round Rock, TX 78681
❑ Owner Occupied
Project No.: N/A
Farm or Nonprofit Organization:
® Tenant Occupied
Will Business, Farm, or Nonprofit be:
Yes
No
a. Discontinued?
®
❑
b. Continued at a new location?
❑
c. If a business or nonprofit organization, is it part
❑
of an enterprise having not more than three (3)
other establishments being acquired by the State,
and which is enaaated in the same or similnr Arr. th,v
From: To:
09/1994 10/5/2019
6. Determination of entitlement for payment in lieu of moving expense and the amount to which the business, farm or nonprofit
organization named above may be entitled to, if any, is requested for the reason(s) outlined in the attached statement. I understand this
request and the attached documents shall become part of any claim for payment; and that other records needed for determination of
eligibility shall be made available on request of the State. I certify that all information attached hereto or included herein is true and
correct.
, Signatur Appli
4/30/2020 B lainess Owner
Date of Request Title or Position Owner Man er Etc.
Space Below to be Completed by State
1 certify that I have examined the records made available by the above applicant(s) and have found the earnings to be as follows:
2017, $47,005,00, 2018, $36,619.00; Average Annual Net Earnings: $41,812.00
Year Year
snnozo
I certify that I have examined this request for Determination of Entitlement and supporting documentation I
® Recommend a payment of $40,000.00 .
❑ Find that payment cannot be authorized because
(List reasons payment cannot be auth Docuaigned by: wry)
!
6/3/2020 �A�A.I(kA.yy�clU,
Date _ SDDDF6EDSE13426... nfwa
bq 202 i?-/(,r 4v
City Manager
*R102*
DocuSign Envelope ID: 0BEBE537-DB9A-4C8D-BB50-4F6317lC2CEC
Parcel 11 Fixed In -Lieu of Move
Breakdown
Project: RM 620
CS1#: 0683-01-092
Parcel: 11
Displacee: Arrow Cleaners - Hung Nguyen
Year: 2017
1. Net Income or Loss (11205 Line21) $47,005.00
2. Wages paid to Spouse and/or Dependents $0.00
3. Guaranteed Payments to Partners (1065 Line 10) $0.00
4. Wages paid to Owners of Corporation (11205 Line 7) $0.00
S. TOTAL FOR YEAR (Total lines 1-4) $47,005.00
Year: 2018
6. Net Income or Loss (1120S Line21) $36,619,00
7. Wages paid to Spouse and/or Dependents
8. Guaranteed Payments to Partners (1065 Line 10) $0.00
9. Wages paid to Owners of Corporation (11205 Line 7) $0.00
10. TOTAL FOR YEAR (Total lines 6-9) $36,619.00
11. TOTAL LINES 5 & 10 $83,624.00
12. DIVIDE LINE 11 by LINE 2 :2
13. AVERAGE ANNUAL NET EARNINGS $41,812.00
14. FIXED PAYMENT (Minimum $1,000 - Maximum $40,000) $40,000.00
Arrow Cleaners
DocuSign Envelope ID: OBEBE537-DB9A-4C8D-BB50-4F63171C2CEC
Form ROW-R-101
(Rev. 07111)
Page 1 of 1
CLAIM FOR PAYMENT FIXED MOVING EXPENSE -
BUSINESS, FARM OR NONPROFIT ORGANIZATION
Print or P,pe All Information
1. Applicant's Name:
Parcel No.: 11
County: Williamson
Arrow Cleaners, Inc. (Hung Nguyen)
ROW CSJ: 0683-01-092
Project No.: N/A
2. Applicant's Address:
16620 Barrhead Cove, Austin, TX 78717
3. Name and Address of Business, Farm or Nonprofit Organization:
Arrow Cleaners, Inc.
1205 Round Rock Ave., Ste.
Telephone No.: 512-944-8853
Round Rock, TX 78681
4. Address Moved To (If Applicable):
5. Controlling Date
Mo.
Day
Yr.
N/A
03
30
2017
a. First Offer in Negotiations
b. Date Property Acquired
c. Date Acquired Property Vacated
d. Date Required to Move
10
09
05
30
2019
2019
6. Amount of Claim $ 40,000.00
7. Payment of this claim in the amount shown in Block 6 above is requested. I certify that I am the owner or authorized representative of
the business, farm or nonprofit organization named above. I understand this claim for payment is based upon information previously
submitted to the Texas Department of Transportation and that all such information is true and correct and part of this claim. I further
certify that I have not submitted any claim for, or received reimbursement or compensation for, any item of expense in this claim, and
that I will not accept reimbursement or compensation from any other source for any item of expense paid pursuant to this claim.
Apeicant's gna %e
4/30/2020 Business Owner
Date of Claim Title or Position (Owner, Manager, Etc.
Space Below to he Completed by State
I certify that I have examined this claim and the Request for Determination of Entitlement and have found it to be true and correct and to
conform with the applicable provisions of State law. This claim is recommended for payment.
Docuftned by:
6/3/2020Date
Ev8DDDF8ED8E13426
... .ht of Way Manager
DocuSign Envelope ID: OBEBE537-DB9A-4C8D-BB50-4F63171C2CEC
MW
9
atn.ian
Form ROW-R-CE
(Rev. 03/16)
Page i of 1
CERTIFICATION OF ELIGIBILITY
ROW CSJ: 0683-01-092
Parcel: 11 '
Displacee: Arrow Cleaners
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:
Citizens or Nationals of the United States
or
❑ Aliens lawfully present in the United States
* If an Alien lawfully present in the United States, supporting documentation will be required.
�?rL Date: 111151- A01%
laiman
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 laws and authorized to conduct business within the United States.
Date: �f�% �7
ClAihnt
DocuSign Envelope ID: OBEBE537-DB9A-4C8D-BB50-4F63171C2CEC
12/15/2019
To: TxDOT & City of Round Rock, Tx
I am requesting the Fixed In -Lieu of Payment for my move of my dry cleaning store. I have looked for
several months to find a place that was close to my current store so that I will not lose my customers. I
have not had any luck and Laurie Miller and Darren Quick have helped me search and have taken me to
see vacate possible sites, but they were either too much money, too big orjust too far away. If I were to
rebuild my business at a new location it would take at least 3 years to establish new customers. This
would hurt my family terribly financially.
I have been at my location for 25 years. I am to old to start over, but I am not old enough to retire. I am
a situation of not knowing what to do but the landlord made his decision to have us move so the
decision was made for me.
Please accept my request to do the Fixed In Lieu of Move.
Thank you,
Hung Nguyen
City of Round Rock
J UND ROCK U 5 Agenda Item Summary
Agenda Number:
Title: Consider approval and execution of claim forms authorizing reimbursement
of fixed personal property move expenses in the amount of $40,000 for the
Arrow Cleaners due to displacement of the business caused by acquisition
of right of way on the RM 620 project (Parcel 11).
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 6/12/2020
Dept Director: Gary Hudder, Transportation Director
Cost: $40,000.00
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: Claim-00447927.PDF, LAF-00447931.PDF
Department: Transportation Department
Text of Legislative File CM-2020-166
This is a request for reimbursement payment to a tenant for actual re-establishment expenses.
The tenant is allowed to recover a fixed move cost based upon annual income which is
documented through tax returns. This payment is 100% reimbursable by TxDOT in connection
with the RM 620 project, and the claim has been reviewed and approved by TxDOT.
Cost: $40,000.00
Source of Funds: RR Transportation and Economic Development Corporation (Type B)
City of Round Rock Page 1 Printed on 611112020