CM-2017-1329 - 2/24/2017DocuSign Envelope ID: CDEE5AB3-29EE-4BF8-85DB-A3A28CAOF1BB
Form ROW -R-99
(Rev. 07/11)
Page 1 of 1
OCLAIM FOR ACTUAL MOVING EXPENSES
Print or Type All Information
1. Name of Claimant(s)
Parcel No: 12
County: Williamson
Billy & Beverly Ketchum
ROW CSI: 0683-01-092
Project No.:
® Residence ❑ Business ❑ Farm ❑ Nonprofit ❑ Sign ❑ Other
2. Address of Property Acquired by State:
3. Address Moved To:
403 Briarwood Street, Round Rock, TX 78681
1206 High Chaparral Dr., Leander, TX 78641
Claimant's Telephone No.: 512-296-5381
4. Occupancy of Property Acquired by State:
5. Distance Moved: 19 Miles
From (Date): ro (Date of Move):
1
7. Mover's Name and Address:
1993 12/6/2016
Dependable Relocation Services, Inc.
2401 Double Creek Drive
Round Rock, TX 78664
® Otvner/Occu ant ❑ Tenant
6. Controlling Dates
Mo.
Day
Yr,
a. First Offer in Negotiation
09
09
2016
9. Amount of Claim:
a. Moving Expenses
b. Reestablishment Expenses
$99.00
$
b. Date Property Acquired
11
01
2016
c. Date Required to Move
01
07
2017
8. Property Storage (attach explanation)
From (Date): N/A To (Date of Move): N/A
c. Searching Expenses
d. Tangible Property Loss
$
$
Place Stored (Name and Address):
N/A
e. Storage
f Temporary Lofting
$
$
10. Temporary Lodging (attach explanation)
From (Date): N/A To (Date of Move):N/A
g. Total Amount
$99.00
11. All amounts shown in Block 9 were necessary and reasonable and are supported by attached receipts. Pay of this claim is requested. I certify that I have
not suhtni titer c for, or received reimbursement
for, an item of expense in this claim, and that I will not accept reimbursement or
ntiai
cosali0 onm ) any 011ie source fo any iteof expense paid pursuant to this claim. I further certify that all property was moved and installed at the
a ress utvn in Block 3, a Ove, ccordance with the invoices submitted and agreed terms of the move and that all information submitted herewith or
I et cin is true and rtec �—
,Claimant
DatV(Clainr
Claimant
Spaces Below to be Completed by State
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 $ 99.00
2/17/2017
DocuSigned by: II
PA)AJ
CtA� att,
Date
RiehU6 anaeer
J:�� 0 2-2
Laurie Hadley
City Manager
DocuSign Envelope ID: CDEE5AB3-29EE-4BF8-85DB-A3A28CAOF1BB
at&t
�'A Account Charges
Other Charges and Credits
Account Activity _
1. Internet Equipment Fee
Credited from 12105 -12125
BEVERLY KETCHUM
1206 HIGH CHAPARRAL OR
LEANDER TX 78641-3611
OnfL-Time Ch_ aiges
- Date heseIlan
2. 12/06 Installation of AT&T Internet
Surcharges and Other Fees
3. State Cost -Recovery Fee
Government Fees and Taxes
4. TX City District Sates Tax
5. TX Local Sales Tax
6. TX State Sales Tax
Total Government Fees and Taxes
Totat Other Charges & Credits
4.90CR
99.00
Page: 2 of 3
Bill Cycle Date: 11/26/16 -12/25/16
Account: 127040351
Visit us online at: www.att.com
Other charges and Credits
Account Activity
2. Internet 12 Stand-alone
Credited from 12105 - 12125
3, Intemet 12 Stand-alone (12 Month Promotional
Price)
Charged from 12105 - 12/05
4. Internet 24 Stand-alone (12 Month Promotional
Price)
Charged from 12/06 -12/25
Total Acrount Activity
Data Usage Summary
0.52 Total 1,024GR Internet Usage Allowance
Plan GB 1,024
GB Used 20
.1.00
0,90
5.91
7.81
102.43
Total Account Charges 102.43
® Internet
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and incbntes hunt -In wireless home netwoiking capabitlty,
access to the entire national AT&T WI -Fl flat Spot netwaik,
11 emitl accounts, photo storage, AT&T Security Suite
powered by fdcAtee% pop-up blocker, anti Parental controls.
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learn more.
Total 1,024GB Internet Usage Allowance - Your total Internet
IIs --(9,1 allowance can consist of your 1 terabyte plan usage
allovrmce Pius any additional offers. Exceeding your total
Internet usage allowance Will result in a charge of $10 far
each addilianal 50 gigabytes of data even it less Lhau 50
gigabytes Is consumed. Visit rnnvwalt.com/internet-usage to
VIEW details of your internet data usage.
Monthly Charges - Dec 26 th_ru Jan 25
1, Internet 24 Stand-alone (12 Month Promotional 50.00
Price)
Surcharges and Other Fees
S. State Cost -Recovery Fee
Government Fees and Taxes
6. TX City District Sales Tax
7. TX Local Sales Tax
8. TX State Sales Tax
Total Government Fees and Taxes
Total Other Charges & Credits
Totalinternet
i News You Can Use
39.90CR
1.67
33.33
4.90CR
0.10
0.52
0.12CR
1.26
1.66
3-14CR
46.86
BILLING DURING YOUR MOVE
When your service is moved between your regular bill dates, you
will see a credit for unused services for any full days you were
without service during your move. These credits will be In the
"Other Charges and Credits" section of your bill. If you added new
services, they will show as "Charged" or if you discontinued a
service it will show as "Credited",
YOUR BILL HAS A NEW LOOK
Notice anything different about your AT&T bill?
We redesigned it so it's easier for you to understand.
Go to www.atLcom/billsummary to learn more.
WE'RE HERE FOR YOU!
We hope you're enjoying your service. If we can do anything to
help make it even better, call us at 877-407-1505. When you call,
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City of Round Rock
/
ROUND TEXNROCIC Agenda Item Summary
Agenda Number:
Title: Consider approval of a Claim for Payment of Incidental Expenses on the
Purchase of Replacement Housing for Ketchum -Parcel 12 on the RM 620
project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 2/24/2017
Dept Director: Gary Hudder
Cost: $99.00
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: 00372940.PDF, 00372938.PDF
Department: Transportation Department
Text of Legislative File CM -2017-1329
Consider approval of a Claim for Payment of Incidental Expenses on the Purchase of
Replacement Housing for Ketchum -Parcel 12 on the RM 620 project.
The City has purchased the residence on Parcel 12 and landowners have purchased a
replacement home. 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: $99.00
Source of Funds: RM 620 ROW
City of Round Rock Page 1 Printed on 2/23/2017