CM-13-03-058ROUND ROCK, TEXAS
PURPOSE PASSION. PROSPERITY.
Item Caption:
C,M-('-°3° RECEIVED
MAR 202013
City Manager Approval Form
Consider approving Claim For Actual Moving Expenses for Ben's Barber Shop (Ben Salazar) regarding the
Main Street Parking Project.
Approval Date: March 22, 2013
Department Name: Legal
Project Manager:
Assigned Attorney: Don Childs
Item Summary:
Consider approving Claim For Actual Moving Expenses for Ben's Barber Shop (Ben Salazar) regarding the Main Street Parking
Project.
Mr. Salazar was a business tenant on the property acquired from Mellownie Johnson for construction of City parking facilities.
This reimbursement is authorized under the Texas Property Code and Uniform Relocation Act.
No. of Originals Submitted: 1
Project Name: Main Street Parking Tract
Cost: $353.93
Source of Funds: General Self -Financed Construction
Source of Funds (if applicable): Select Source Fund
Account Number:
Finance Director Approval: LO for C. Delaney Date: 03-20-2013
Department Director Approval: Date:
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP I I I I Budget
N/A OK N/A OK
Purchasing
Ell El
N/A OK
Accounting
El ❑
N/A OK
ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL
REV. 6/20/11
Crossland MEMORANDUM
ACQUISITION, INC.
TO: Don Childs
Sheets & Crossfield
FROM: Laurie Miller
SUBJECT: Ben's Barber Shop — Ben Salazar
City of Round Rock
Downtown Parking Project
0(12.12.-/L.
DATE: March 14, 2013
Originating Office
Crossland Acquisition, Inc.
Relocation Office
It is requested that the attached submission for be handled on a normal basis. In support of this
request, please find the following:
Payment Request in the amount (s) of $353.93
Form ROW -R-99, Claim for Actual Moving Expenses.
Form ROW -R-100, Claim for Fixed Moving Expense Payment Individuals and Families.
Form ROW -R-101, Claim for Payment Fixed Moving Expense Business, Farm or
Nonprofit Organization.
Form ROW -R-102, Fixed Moving Expense Payment Business, Farm or Nonprofit
Organization.
Form ROW -R-103, Request for Authorization Storage of Personal Property and/or
Temporary Lodging.
Form ROW -R-105, Claim for Payment of Rent Supplement.
Form ROW -R-110, Property Owner's Claim for Payment Incidental Expenses of Transfer
of Real Property to the State.
Form ROW -R-113, Claim for Payment of Housing/Down Payment Supplement.
Form ROW -R-116, Replacement Housing Inspection.
Form ROW -R-118, Property Owner's Claim for Payment Incidental Expenses of
Purchase of Replacement Dwelling.
Form ROW -R-119, Negotiated Self -Move Request in excess of $2,500.
Form ROW -R-119, Negotiated Self -Move Request (Approved by the District).
Notarized Affidavit for Temporary Storage.
Certified Inventory of Personalty (Photo Inventory).
Certified Copies of 19 and 19 IRS Returns. (Presented by CPA or Owner)
Affidavit (must accompany IRS returns not certified by IRS).
Commercial Moving Estimate (s) prepared by and
Departmental Cost Finding prepared by of this office.
Certified Copy of the Settlement Statement.
Certified Copy of the Warranty Deed.
Certified Copy of the Promissory Note.
Certified Copy of the Earnest Money Contract.
Letter Requesting Hardship Payment.
Letter Requesting Direct Payment.
Letter from displacee requesting approval of an II Phase move.
C,M- \ '-D3-oSS
Don Childs
March 14, 2013
Page 2
Letter Requesting Fixed Moving Expense Payment (Business).
Moving Plan for moves in excess of $20,000.00.
Paid Receipts for expenses incurred.
Written verification for cash payment to mover.
Invoice Requesting Payment.
Itinerary for Searching Expenses.
Copies of Lease Agreement for Replacement and Displacement Properties.
Texas Application for Payee Identification Number.
Letter approving II Phase move.
Certification of Eligibility
Personal Property Move Time / Log Sheet
Move Plan
Release of Property
EXPENSE VERIFICATIONS
(1)
We hereby certify that the amount (s) and service (s) indicated on the attached receipt (s)
and/or itemized statement (s) reflects the correct amount and service performed.
Comments: Mr. Salazar has completed his move. Mr. Salazar and John W.
Kesselring, a friend of Mr. Salazar moved all the personal property out of the
acquired property. Mr. Salazar paid Mr. Kesselring in cash for his help and has
provided a receipt signed by Mr. Kesselring. Previously, Mr. Salazar requested
storage but the storage is not needed.
I do not expect any additional claims for this displacee.
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) 401-8868.
Laurie Miller, RW/RAC
Attachments
cc:
turu
OfT .
orn,opwrtmoo
Form 132
(Rev. 9/90)
(Electronic version GSD-EPC Word 97)
Page 1 of 1
BILLING STATEMENT
BILLING INSTRUCTIONS: To facilitate handling and
copies. Charges for freight or express, if any, must
processed for payment without a valid payee ID numb
Name of Payee: Ben Salazar
Address: 14 Lake Drive
DELIVERY DATE: March 14, 2013
LINK
S
prompt payment show the information in the spaces provided below. Submit three
be supported by the prepaid freight or express bill. This statement cannot be
er.
Date: March 14, 2013
City & State: Round Rock, Texas 78665
PAYEE ID NUMBER:
w
INVOICE
DATE
NUMBER
FY
S
SOURCE
UNIT
DESCRIPTION
QUANTITY
3/14/13
IAC or MISC
CONTRACT NO.:
CARD CODE 3 INFORMATION
LINK
SEQ
DIST
OR
DIV
SEG
ID
26
DETAIL
13
Moving Expenses
Ben Salazar - Ben's Barber Shop
City of Round Rock Downtown
Parking Project
Williamson County
CASH DISCOUNT
SDHPT
REQ. NO.: 601
AMOUNT
S
PURCHASE
ORDER NO.:
DHT ITEM NO
EQUIPMENT
NUMBER
DAYS
TRADE-IN
ALLOWANCE
DATE:
TRADED
EQUIP NO
1
UNIT PRICE
$353.93
AMOUNT
$353.93
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL
M
0
D
$353.93
09
10
DETAIL
AMOUNT
MOD.
70
THRU
79
DETAIL
AMOUNT
FUNC
OBJ
OF
EXP
STGY
DHT ITEM NO
EQUIP NO
MMIS Tracked
Functions Only
COST CENTER
EQUIP NO
TASK/
WORK
ORDER
SFI
STGY
HIGHWAY
CO
SYS
NUMBER
S
U
F
CL
REF.
MARKER
15 16 17
18 19 20
2122
23 24
25 41
42
53
54
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 ' BEG END
AMT. OF
WORK
PERF.
W
0
R
K
U
N
T
Agency Verification/Audit has been performed, the services rendered and/or goods received, and the invoice(s) correctly corresponds with the authority
under which procurement was made. The invoice(s) is (are) true and unpaid.
By
Date
Form ROW -R-99
(Rev. 07/11)
Page 1 of 1
CLAIM FOR ACTUAL MOVING EXPENSES
1. Name of Claimant(s)
Ben Salazar (Ben's Barber Shop)
❑ Residence
Print or Type All Information
® Business 0 Farm
2. Address of Property Acquired by State:
107 East Liberty Avenue
Round Rock, TX 78664
Claimant's Telephone No.: 512-452-8686
Parcel No:
ROW CSJ:
County: Williamson
Project No.:
0 Nonprofit 0 Sign
0 Other
3. Address Moved To:
Personal property moved to several different locations
4. Occupancy of Property Acquired by State:
From (Date): I To (Date of Move):
1993 March 14, 2013
0 Owner/Occupant Tenant
5. Distance Moved: 0 Miles
6. Controlling Dates
a. First Offer in Negotiation
Mo.
Day
Yr.
7. Mover's Name and Address:
Self -Move
10
16
2012
b. Date Property Acquired
2
15
2013
c. Date Required to Move
3
17
2013
8. Property Storage (attach explanation)
From (Date): N/A To (Date of Move): N/A
Place Stored (Name and Address):
N/A
10. Temporary Lodging (attach explanation)
From (Date): N/A To (Date of Move): N/A
11. All amounts shown in Block 9 were necessary and reasonable
not submitted any other claim for, or received reimbursement for,
compensation from any other source for any item of expense paid
address shown in Block 3, above, in accordance with the invoices
included herein is true and correct.
Date of Claim:
.
//1/,.9_4o15
mant
9. Amount of Claim:
a. Moving Expenses
b. Reestablishment Expenses
c. Searching Expenses
d. Tangible Property Loss
e. Storage
f. Temporary Lodging
8 -
Total Amount
$353.x3
and are supported by attached receipts. Pay of this claim is requested. I certify that I have
an item of expense in this claim, and that I will not accept reimbursement or
pursuant to this claim. 1 further certify that all property was moved and installed at the
submitted and agreed terms of the move and that all information submitted herewith or
Claimant
Spaces Below to be Completed by CTRMS
I certify that I have examined this claim and substantiating documentation attached herewith, and have found it to be true and correct and to conform with
the applicable provisions of State law. All items are considered to be necessary reasonable expenses and this claim is recommended for payment as follows:
Amount of $ 353.413
_
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Date
City of Round Rock Representative
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Description of Activity
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Description of Activity
Name
I Date
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Date: 3I l9 % X%4
1, John Kesselring, received Jed. Vb cash from Ben
Salazar for helping vacate Ben's Barber Shop in Round Rock.
PHOTO's
Initial Interview / Inventory
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I certify this to be a true and correct Inventory of
Personalty taken March 4, 2013
Crossland Acquisition, Inc.
Parcel: Ben's Barber Shop
ROW CSJ:
County: Williamson County
Project: City of Round Rock — Downtown Parking Project
CERTIFICATE OF INVENTORY
I hereby certify that the items included in the attached photographs are located at the
subject property which is 107 East Liberty Ave., Round Rock, TX 78664 and
represents personal property owned by Ben Salazar.
isplacee
Relocation Agent
Date
Lease
There is not a copy of a lease agreement. The agreement for Mr. Salazar to lease the
property was done with a hand shake 20 years ago with the owner, Mr. Johnson; who has
since passed away.
PHOTO's
Vacate Photo's
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Supporting Documents
Certification of Eligibility
Move Plan
Release of Property
re
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Form ROW -R -CE
Rev. 5/2003
GSD -EPC
Page 1 of 1
CERTIFICATION OF ELIGIBILITY
ROW CSJ:
Parcel: Ben's Barber Shop
Displacee: Ben Salazar
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.
If an incorporated business, farm or non-profit organization, I certify that I have signature authority for
this entity and such entity is lawfully present in the United States.
Date: S /ri,Qf&( X/5
Claim t
Date:
Claimant
'Nauss
Dept"Imsnt
Form ROW -R -MP
(12/11)
Pace 1 of 1
Displacee Move Plan
Displacee's Name:
Ben Salazar
ROW CSJ:
Parcel No:
Ben's Barber Sho
Displacement Address:
107 E. Liberty Avenue
Round Rock, TX 78664
❑ Own Square Footage:
a V05(2
$ / 9 5.00
/ / Rent Lease Amount:
Replacement Address:
Special moving equipment needed:
❑ Pallet Jack ❑ Crane
❑ Forklift 0 ❑ Other
❑ Flatbed
Distance of move:
Date move to begin:
Time needed for move: 3
Storage required:
Special utility requirements for replacement site:
(:)( A.
Hazardous or Regulated materials to be moved:
(\/0.\
Zoning considerations:
10/k
Regulatory issues:
tq Ac
Permits needed:
4.(locc U Lige,
1 �O , S�� 14 *
1 ` �"
Contractors needed:
MElectrician
Plumber
❑ Equipment Technician
❑Security System Technician
❑ Other ,
Date of personal property
inventory (attached): 3. y. .901_3
Date of merchandise for
resale inventory (attached):
�.
Other special requirements (attach additional sheets if necessary):
Displacee's Signature:
entitled on request to he informed
Displacee's Name (printed): VQ..t\ 5., II��
Displacee's Title/Position: 6 u3 eii .�
_ ^
Relocation Agent's Sign `_/��rt `r i�Q (
The Texas Department of Transportation maintains the information collected through this form. 11YUm few exceptions, you are
about the information that we collect about you. Under Sections 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this
information. Under Section 559.004 of the Govemment Code, you are also entitled to have us correct information about you that is incorrect.
*RMP*
City of Round Rock
Project: Downtown Parking Facility Project
County: Williamson County
Parcel: Ben's Barber Shop
MOVING PLAN
Displacement Site: 107 East Liberty Avenue, Round Rock, TX 78664
Owner / Tenant:
Address:
Tenant, Mr. Ben Salazar
Type of Activity: Commercial, Barber Shop
Occupancy Date: ?98
Replacement Site: t1/43/k
Distance of Move:
When and how the move is to be performed: cS, F - Mc o -e.
Attach inventory and/or photographs of tangible personal property to be moved.
Items requiring the following:
Special Handling: INVa
Packing/Crating:
Removal/Reinstallation:
Move performed by: {3ec\ nala Z& c
Outline the work specifications and requirements for each of the following:
Utility reconnections: /h
Telephone (business): nAl,
I agree to perform my move using recognized sound moving principles and in accordance
with the requirements of the attached Chapter 10 General Provisions, TxDOT 06/2012.
Business Owner
Crossland Acquisition, Inc.
5 ,i 0g
Date
3/5/I 3
Dat