CM-2017-1314 - 2/10/2017DocuSign Envelope ID: 0585BF62-E538-4128-ADC3-FCD6BFD5ADD1
Form ROW -R-99
(Rev 07111)
Page 1 or 1
CLAIM FOR ACTUAL MOVING EXPENSES
Print orType
All information
t. Name ofCluimant(s)
Parcel No: 17
County. Williamson
Jami Shaun Smith
ROW CSJ: 0683-01-092
Project No,:
Residence Business Farm
0 Nonprofit Sin ❑ Other
2, Address of Property Acquired by State:
3. Address Moved To:
1002 Glenwood St, Round Ruck, TX 78681
302 Mendowside Drive
Claimant's Telephone No.: 512-7884555
Hutto, TX 78634
4. Occupancy of Property Acquired by State:
5, Distance Moved: 15 Miles
From (Date): To (Date of Move):
1
7. Mover's Name and Address:
May 2015 1/14/17
Dependable Relocation Services. Inc.
2401 Double Creek Drive
Round Rock, TX 78664-3806
Owner/Occu ant 211•enant
6. Controlling Dates Mo. Day Yr.
a. First Offer in Negotiation 110 03 2016
9. Amount of Claim:
it. Moving Expenses
b. Reestablishment Expenses
$3,232.80
S
b. Date Property Acquired
e. Date Required to Move
H. Property Storage (attach explanation)
From (Date): NIA To (Date of Move): N/A
c. Searching Expenses
d. Tangible Property Loss
$
$
Place Stored (Name and Address):
N/A
C. Storage
IF Temnortry Lcidgine
$
_
10. Temporary lodging (attach explanation)
From (Date): N/A To (Date of Move):N/A
g. Total Amount
$3,232.80
11. All amounts shown in lllock 9 were necessary and reasonable and we supported by attached receipts Pay of this claim is requested. I certify that I have
not submitted any other claim for, or received reimbursement for, an item ofexpense in this claim, and that I will not accept reimbursement ar
campensution front any other source for any ncm of expense paid pursuant to this claim. I further certify that all property was moved and irwalicd at the
address shown in Block 3, above, in accordance with the invoices submitted
and agreed terms of the move and that all information submitted herewith or
included herein is true and correct
Claimant
Date of Claim: 7
Claimant
Spaces Below to be Completed by State
I certify that I have exammed 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 Iaw. All items are considered to be necessary reasonable expenses and this claim is recommended for payment m follows
Amount of 53.232.80
DocuSigned by: II
1/30/2017
Dw� CIA.WaA-
----- Date
8DDDF8ED8E-13426... --- __
Rirht of Way Manager
1
Laurie Hadl_P�zCity Manaa-e—
C77y ANAIF41
LM, 20/7-I&J y4
DocuSign Envelope ID: 0585BF62-E538-4128-ADC3-FCD6BFD5ADD1
DEPENDABLE RELOCATION
SERVICES, INC.
2401 DOUBLE CREEK DRIVE
ROUND ROCK, TX 78664-3806
InvolceDate: 1 /1 812 0 1 7
Invoice #: 12893
Order#: ROU -11-7
Customer#: IIWLCIIN
** H.W. LOCHNER
Attn: LMII,I,ER@HWLOCHNER.COM
LAURIE MILLER
9601 AMBERGLEN BLVD
BLDG G, SUITE 119
AUSTIN, TE 78729
Amount Due: $3,232.80
Due Date: 2/17/2017
After 2/17/2017 pay: $3,297.46
Amount Paid: S
Remit To:
DEPENDABLE RELOCATION
SERVICES, INC.
P.Q. Bux 733477
Datlas, TX 75373-3477
r — — — — — — — — — — — r Ncasc detach and return this portion with your payment. Thank you. -'
Remit To:
invoice Dale: 1118/2017 DEPENDABLE RELOCATION SERVICES, DEPENDABLE RELOCATION SERVICES,
lnvulce #: 12893 INC. INC.
Order #: 121193IIWLC, -7 2401 DOUBLE CREEK DRIVE P.O. Box 733477
Customer #: ROU -11 N ROUND ROCK, TX 78664-3806 Dallas,'1'X 75373-3477
Shipper: Smith, Shaun Salesperson: Swader, Tammy Hauled Wt: Milts: 15
From: 1002 Glenwood St To: 302 Meadowside Dr Tariff: Austin Local
Round Rock, TX 1•iutto, TX
United States of America United States of America
Pff
Transportation
Fuel- $25/Day
Packing
Unpacking
Valuation
3rd Party -Origin
3rd Party-Dcst.
$1,385.00
550.00
$1,278.00
$11.00
$127.80
$206.00
S175.00
Amount Due: $3,232.80
Due Date: 2/17/2017
After 2/17/2017 pay: $3,297.46
Thank you for your business and prompt payment! We look funrard Iv sensing you again. j
�Y- City of Round Rock
�1
ROUND SD ROCK Agenda Item Summary
Agenda Number:
Title: Consider approval of a Claim for Actual Moving Expenses for the tenant -
Jami Smith (Parcel 17) for RM 620 project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 2/10/2017
Dept Director: Gary Hudder
Cost: $3,232.80
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: 00371745. PDF
Department: Transportation Department
Text of Legislative File CM -2017-1314
Consider approval of a Claim for Actual Moving Expenses for the tenant- Jami Smith
(Parcel 17) for RM 620 project.
The City is negotiating the purchase of the residence on Parcel 17. The tenant has
vacated the home and The Uniform Relocation act allows for actual moving expenses
to be recovered as a result of this displacement, and the requested amount is
supported by the rules and recommended by the relocation consultant for payment.
Pursuant to the project funding agreement, this payment is 100% reimbursable by
TxDoT.
Cost. $3,232.80
Source of Funds: RM 620 ROW
City of Round Rock Page 1 Printed on 2/912017