CM-2020-212 - 8/21/2020DocuSign Envelope ID: 2715E912-D8F5-4312-BB58-9D89E2B4C45D
7/16/2020
To: TxDOT & City of Round Rock, Tx
I am requesting the Fixed In -Lieu of Payment for my move of my business. 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 has helped me search and have taken me to see vacate possible sites, but
they were either too much money, too big or just too faraway. If I were to rebuild my business at anew
location it would tape at too long to establish new customers. The first two years at the location that has
been sold to the state and city, I struggled to get customers. The third year my business started to pick
up until customers started hearing that we. would have to move because the road out front was going to
be widened and they would not be able to park and because the construction would make traffic more
difficult than it is already. This has hurt my family terribly financially and I have decided that I cannot
start over again
I was put into 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,
(A' '4L�c
Pearl (Hai Zhen) lames
�i-Z62o-z1 Z
DocuSign Envelope ID: 2715E912-D8F5-4312-BB58-9D89E2B4C45D
Form ROW-R-102
(Rev. 07/11)
Page 1 of 2
FIXED MOVING EXPENSE PAYMENT -
R1 NINV.RS- FARM OR NONPROFIT ORGANIZATION
Print or Type All Information - Read Rules on the Reverse Side
1. Applicant's Name:
Parcel No.: 1 I
County: Williamson
Wynn Foot Spa (Pearl James, a/k/a Hai Zhen James)
ROW CSJ: 0683-01-092
Project No.: N/A
2. Applicant's Address:
1 Name and Address of Business, Farm or Nonprofit Organization:
2601 La Fronlera Blvd. # 22434, Round Rock, TX 78681
Wynn Foot Spa
1205 Round Rock Ave, Ste.
Telephone No.: 512400-8396
Round Rock, TX 78681
4. Occupancy of Property Aec
ired by State
From (Date):
I'o (Date Required to Move):
❑ Owner Occupied ® Tenant Occupied
2/1/2015
10/5/2019
5. Type Operation
Business ® Farm ❑ Nonprofit ❑
Will Business, Farm. or Nonprofit be: Yes No
a. Discontinued7 Z ❑
b. Continued at a new location? ❑
c, If a business or nonprofit organization, is it part ❑
Type of Business, Farm or Nonprofit Organization
Foot & Body Massage
of an enterprise having not more than three (3 )
otherestablishments being acquired by the State,
and which is en in the same or similar activitv7
Dates r i n
From:
To:
1
2/ 1 / I S
10/5/20.19
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. l certify that all information attached hereto or included herein is true and
correct.
. 99
Signature of Applicant
7/20/2020 __ _ Business Owner
Title or Position
Sonce Below to be Completed hX State
I certify that I have examined the records made available by the above applicant(s) and have found the earnings to be as follows:
2017, $32,990.ft 2018 $0 00 Average Annual Net Earnings: $16,495.00
Year Year
7nnnr2nDate Ri -- - -
gbi of Way Agent
I certify that I have examined this request for Determination of Entitlement and supporting documentation and
® Recommend a payment of $16,495.00
❑ Find that payment cannot be authorized because
(List reasons payment cannot be authorized Use care page if necessary) oocusigned by: !!
8/10/2020 i 444 CtA�VVaA
LWIG W . 6DDDF6EME13426...
4U�U6 A�4 -
City Manager ApprovW
* R 1 0 2*
DocuSign Envelope ID: 2715E912-D8F5-4312-BB58-9D89E2B4C45D
Form ROW-R-101
(Rev. 07111)
Page 1 of 1
CLAIM FOR PAYMENT FIXED MOVING EXPENSE -
BUSINESS, FARM OR NONPROFIT ORGANIZATION
Print or Type
All Information
I. Applicant's Name:
Parcel No.: I I
County: Williamson
Wynn Foot Spa (Pearl James. a/k/a Hai 7.hen James)
ROW CSI: 0693-01-092
Project No. N/A
2. Applicant's Address:
3. Name and Address of Business. Farm or Nonprofit Organization:
2601 La Frontera Blvd. 8 22434, Round Rock, TX 78681
Wynn Foot Spa
1205 Round Rock Ave., Ste.
Round Rock, TX 78691
Telephone No.: 512-400-8396
4. Address Moved'fo (If Applicable4
5. Controlling Date
Mu.
Day
Yr.
N/A
a. First Offer in Negotiations
03
30
2017
b. Date Property Acquired
08
28
2019
c. Date Acquired Property Vacated
it. Date Required to Move
10
09
05
30
2019
2019
6. Amount of Claim S 16.495.00
7. Payment of this claim in the amount shower 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 prcviuusly
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 (his claim, and
that I will not accept reimbursement or compensation from any other source for any item of expense paid pursuant to this claim.
By: '� 'C �iYi►�� Q3� eyet x h t4
Applicant's Signature
7/20/20 Business Owner
Date of Claim Title or Position (Owner, Manager. Etc.
Space Below to be Completed by State
I certif}- that I have examined this claim and the Request for Determination of Entitlement and have t'ound it to be true and correct and to
contorm with the applicable provisions of State law. This claim is recommended for payment.
Doousgned by:
8/10/2020 AaMd RAWA.!
E
Date eooDF6ED6E13426... It Of Way Manager
City Manager Wroval
DocuSign Envelope ID: 2715E912-D8F5-4312-BB58-9D89E2B4C45D
W
d
Form ROW-R-CE
(Rev. 03/16)
Page i of 1
CERTIFICATION OF ELIGIBILITY
ROW CSJ: 0683-01-092
Parcel: 11
Displaeee: W m Foot Spa - Pearl (Hai Zhen) James
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,
Date: lfl4o/
_V �1 aClaimant t 7
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 -PW( 0 �Date:
Claimant
DocuSign Envelope ID: 2715E912-D8F5-4312-BB58-9D89E2B4C45D
Parcel 11
Project: RM 620
CSJ#: 0683-01-092
Parcel: 11
Displacee: Wynn Foot Spa
Year: 2017
Fixed In -Lieu of Move
Breakdown
1. Net Income or Loss (11205 Line21) $32,990.00
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
5. TOTAL FOR YEAR (Total lines 1-4) $32,990.00
Year: 2018
6. Net Income or Loss (11205 Line21) $0.00
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) $0.00
11. TOTAL LINES 5 & 10 $32,990.00
12. DIVIDE LINE 11 by LINE 2 :2
13. AVERAGE ANNUAL NET EARNINGS $16,495.00
14. FIXED PAYMENT (Minimum $1,000 - Maximum $40,000) $16,495.00
Wynn Foot Spa
City of Round Rock
ROUND ROCK
TEXAS 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 $16,495 for the
Wynn Foot Spa 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: 8/21/2020
Dept Director: Gary Hudder, Transportation Director
Cost: $16,495.00
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: LAF-00452680.PDF, Claim form-00452684.PDF
Department: Transportation Department
Text of Legislative File CM-2020-212
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 RM620 project, and the claim has been reviewed and approved by TxDoT.
Cost: $16,495.00
Source of Funds: RR Transportation and Economic Development Corporation (Type B)
City of Round Rock Page 1 Printed on 812012020