CM-2016-1256 - 12/19/2016 Form ROW-R-99
(Rev.07111)
Page 1 of 1
CLAIM FOR ACTUAL MOVING EXPENSES
Prlat or Type All InformaWn
1.Name of Claimants) Parccl No: 19 County:Williamson
Lisa Peers ROW CSJ: 0683-01-092 Project No.:
Resldcnce Business Farm D Nonprofit Si Other
2.Address of Property Acquired by State: 3.Addres:,Moved To: Vw t.T_
403 Brentwood Street,Round Rock,TX 78681 (a 0-5 C=• D (2r7f,LA1< l r` ht r T'' WU(1V
Claimant's Telehone No.:512-507-7525
4.Occupancy of Property Acquired by State: 5.Distance Moved_ Miles
From(Date): To Date of Move): 7.Mover's Name and Address:
May 2007 to—I-
Owner/Oceu ant Tenant
6.Controlling Dates Mo. Day Yr.
a.First Offer in Negotiation 09 09 2016 9.Amount of'Claim:
b.Date Property Acquired o. Moving Expenses S 7 y 00
c.Date R aired to Move b. Reestablishment Expenses $
8.Property Storage(attach explanation)
From(Date):N/A To(Date of Move):NIA C. Searching Expenses $
Place Stored(Name and Address): d. Tangible Property loss S
NIA
C. Storage S
10.Temporary Lodging(attach explanation) f. Tcmppmry I,odging $
From(Date):N/A To(Dale of Movc):N/A g. Total Amount J S ,
11.All amounts shown in Block 9 were necessary and reasonable and arc supported by attached receipts.Pay of this claim is requested.t certify that I have
not submitted any other claim for,or relived reimbursement far,an item of expense in this claim,and that I will not accept reimbursement or
cnmpcnsuli from any other soutec for any item of expense paid pursuant to this claim.I further certify that all property was moved and iaslalled at the
address s Black 3,above,in accordance with the invoices submitted and agreed temu of the move and that all information submitted herewith or
include c i frac and rarrect.
Claimant
Date or Claim:
Claimant
Spaces Bdow to be Com eta by Steele
I certify that I have examined this claim and substantiating documenauion attached herewith,and have found it to be true and correct and to conform with
the applicable provisions of Stalc law All items arc considered to be necessary reasonable expenses and this claim is recommended for payment as follows
Amount of S yy
DateL— _ - Ri iofwa,—
1 try/ro�'
lm h/ ,
Laurie Hadley, City Manager
20( 1250
Form ROW-R-100
(Rey 07/11)
Page 1 of 2
CLAIM FOR FIXED MOVING EXPENSE PAYMENT-INDIVIDUALS AND FAMILIES
1. Name of Claimant(s): Parcel No.:19 Con:Williamson
ROW CS3: 0683-01-092 Project No.:
Lisa Peers
4.Occupancy of Property Acquired by State
From(Date):May 2007 To(Date of Move): 12/1/2016
5,Controlling Dates Mo. Day Yr.
a.First Offer in Negotiations 09 09 2016
2. Address of Property Acquired by State: b.Date Property Acquired
c.Date Required to Move
403 Brentwood St. 6.Dwelling:(house,apartment,etc.)
Round Rods,TX 7868I Single Detached Home
®Owner-occupied n Furnished
A t,No. Tenant ® Unfamished
3. Address Moved To: (1)Number of Rooms: 9
605 E.Oak Stre&41, (2)Payment Schedule Amount S
Round Rock,TX 78664
(3)Total Amount of Claim: $2,050.00
Apt.No.:
7.Payment of this claim in tite amount shown in Block 6(3)is requested.I certify that i have not submitted any other claim
for,or received reimbursement or compensation for,any item of expense pursuant to thi claim.I further certify that all
information shown above is true and correct.
z'(` I , W t ' ialman[
late of Cleim
--- _-Claimant � ---------
5 aces Below to be Com feted by State
8.Type occupancy and number of rooms verified prior to 9.Vacancy verified on:
move on:Tenant with 9 rooms of personal property
Date:8124/16 Date:12/1/2016
r
By: fvj� By:
Si .start
Signature -
I certify that I have examined this claim and found it to conform to the applicable laws and regulations governing relocation
assistance payments.I further certify the computation of the payment and the information as shown herein is correct.This
claim is recommended for payment.This claim is recommended for payment as follows:
Amount of$2,05 z/
/ .5` /-
'14 ' /
------------
Date AAL
121 1 of Wa M er
- , n S��ser
t
Laurie Hadley, City Manager
+ R 1 +w
City of Round Rock
IROUCS NDROCK Agenda Item Summary
Agenda Number:
Title: Consider approval of two (2) Claims for Payment of moving expenses in
the amount of$2,050 and $44 for the RM 620 ROW Project- Parcel 19-
renter Lisa Peers.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 12/16/2016
Dept Director: Gary Hudder
Cost: $2,094.00
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: LAF, Claim 1, Claim 2
Department: Transportation Department
Text of Legislative File CM-2016-1256
Consider approval of two (2) Claims for Payment of moving expenses in the amount of
$2,050 and $44 for the RM 620 ROW Project- Parcel 19- renter Lisa Peers.
The tenant living in the residence on Parcel 19 is displaced because of the proposed
right of way acquisition. The Uniform Relocation act allows for actual moving expenses
and utility reconnection fees to be recovered as a result of this displacement, and the
requested amounts are supported by the rules and recommended by the relocation
consultant for payment. Pursuant to the project funding agreement, these payments are
100% reimbursable by TxDoT.
Cost: $2,094
Source of Funds: RM 620 ROW
Staff recommends approval.
City of Round Rock Page 1 Printed on 1211312016