CM-2017-1334 - 3/3/2017DocuSlgn Envelope ID: 686080D5-8D8B-4608-BE37-2BBEOB3B5348
F&M ROW -R-09
(Rev. 0711 i)
Page I of I
CLAIM FOR ACTUAL MOVING EXPENSES
Laurie Hadley, City Manager
6M,� &i -7—/--?3c4
1. Name of Claimartl(s)
Pw-cel No: 17 County; Willionigon
Janif Shaun Snlitb
ROW CSI: 0683-01-092 Project No.:
0 Residence El Business
Farm El Nonprofit sigil Other
2. Address of Property Acquired by State:
3- Address Moved To:
1002 Glen -wood St Round Rock, TX 78681
302 Meadowside Drive
Telephone No.: 512-7884555
Hutto, TX 78634
-Claimant's
4.Occupancy of roperly Acquired by State:
S. Distance Movech 15 Miles
7. Mover's Name and Address:
From (Date): TO (Date of Move):
1
Muv 2015 1114/17
Dependable Relocation Serviem Inc.
2401 Donble Creek Drive
RoundRoi4iTX 78664-3806
0 O%Mewdoccu t NTcn6nt
6. Controlling Dates mo. Day
L Yr.
s. First Mir in Ncgoriation 10 03
2016
9. Amount of Claim:
ft. Moving Expenses
b. Reestablishment Expenses
5195.06
$
b. Date Property Acquired
----
o. Date Rcquired to Move
8. Property Storage (attach explanation)
Prom (Datc):N/A To (Date of Mover): NIA
c. Searching RKpmses
d. Tangible Property Loss
Place Stored (Name and Addrcss):
N/A
C- Storage
f Tepip9MLodS4n
10. Temporary Lodging (attach explanation)
To(Date ofMovLc):NIA
g. Total Amount
$195.06
-Fmra(Dzte):N/A
11. All anumnis, shown in Block were necessary and rcasonahlo and no suppottod by attached receipts. Pay ofthis claim is requested. Icertify that I have
not submitted any other claim for, orreccivod rctmbummeol for, anitem ofaxpwo in this claim, and that wilinol accept reimbumemcot or
compeasatiD11 from any other sour o forany iters of exptz= p3id pursuant to this claim. Ift%orom-fify that all property was moved and histallod at the
address -shown in Block 3, above, in aocordar= with the invoices sobmlitcd and agreed terms oftho =Yo and that all infowmtioji submitted berewith or
Included herein is true and correct.
lairnant
DateofClaim:
Glaimant
leeWify that I have "amiacd this claim and substantiating dotuniumion attached herewith, and have found it to be true and correat and to conform with
the applicableprovisions, ofStatelaw. All items areconsidoced to be necessary reasonable aTenscs and this claim is recommmdec) Forpayment asihRows:
Amount of$195.06
DocuSigned by:
VM4 kawa�
2/22/2017
;V4
Dato
Ili OFIa anagen
Laurie Hadley, City Manager
6M,� &i -7—/--?3c4
DocuSign Envelope ID: 68608OD5-8D8B-4608-BE37-2BBEOB3B5348
F--
n
Z
c6
N
LA
W
M
O
ei
ih
i?
r -I
V1.
a
o
0
U
U
U
LU d
w
0
cu
0
w
C
N
O O
L L
Ln
+, b0
N
� C
�
(�
Z
to
N
WE
w
V)
v O
+-'
tn
a
`u
v v
c
a
Ueo
a
uii
X
cn
m O
LU
LU
41O ++
v,
3
.O
LL
L cu
(9
O
° 0
L
O
`-
v
4'-�
z
E
O
''
_
E
1-
) =
fD
41
v
v
o
m
a CL
m
LY
Y
1--
LU
U
Q
a
O
0
0
a
5
U
'
�
N
�
Gl
=
0
2
OL
LD
WLU
ON
O
O
S
O
CI4
CA
>
m
LOr`
.--I
�
�
DocuSign Envelope ID: 68608005-8D8B-4608-BE37-2BBEOB3B5348
WebBEST Receipt M Page 1 of 1
LU -Haul Safes Item Invoice Sates Items
Contract No.: 00415172 U -Haul Moving & Storage of 1535 Round Rock Ave (512)218-9099
Friday 12/30/2016 12:34 PM Round Rock ROUND ROCK, TX. 78681
(756024)
Part Code
Description
Item Cost Quantity
11"a Cost
SP1615
ROU.,ENVIRO 5UBBLE,5MM 16-X15'
$4.05 2.00 ea.
$8.10
SubTotal:
$8.10
Taxes:
$0.67
Total Charges Including Tax:
$B.77
Account: Approved: Type: Trace: Retrieval #:
XXXXXXXXXXXXXXXX8334 PURCHASE 000024408754
Debit Card Payment:
$8.77
Entry Method: MAG
Account Type: Merchant ID:4445012818112 Term ID:
Net Paid
$8 77
Today:
• I agree to submit all
legal claims In accordance with the U -Haul Arbitration Agreement, incorporated
by reference, and available at
uhaul.com/arbitration
or from my local U -Haul representative.
X
J.J. Ibarra
Customer Signature
U -Haul Signature - (1.1. Ibarra)
WebBest
https:llwbl-uhaul.netlWBReceiptslreceipt.aspx?source=printing_pbjects&saveToWBSQL 1... 12/30/2016
DocuSign Envelope ID: 68608005-8086-4608-BE37-2BBEOB3B5348
ick (P�o,X�,�
-------------------------------------
•#iUTTO
388 EXCHANGE BLVD
HUTTO
TX
78634-9998
4842350682
01/17/2017 (800)275-8T77 8:46 AM
Product Sale Final
Description Qty Price
Misc Rev - $25.00
Other
$25,00
Debi t Card Remit ' d $25.66..
(Card Name:Debit Card)
(Account #:XXXXXXXXXXXX1293)
(Approval #: )
(Transaction #:868)
(Receipt #:006108)
(Debit Card Purchase:$25.00)
(Cash Back:$0.00)
*xxxxxxxxxsrxxxxxxxxxxre*x�xxxxxxxxxxxxx
BRIGHTEN SOMEONE'S MAILBOX. Greeting
cards available for purchase at select
Post Offices.
xx:txxxxxxxxxxxxxxxxxxxxxxscxxxxxxxxxxxx
Order stamps at.usps.com/shop or call
1-800-StamP24. Go to
usps.com/clicknship to print shipping
labels with postage. For other
information call 1 -800 -ASK -USPS.
xxxxxxxxxxxxxr�xxxxxxxxxxxxxxxxxxxxxxxx
Get your mail when and where you want
it with a secure Post Office Box. Sign
up for a box online at
uSps.com/poboxes.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
HELP US SERVE YOU BETTER
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
Go to•
https://postalexperience.oam/Pos
840-578D-0391-002-00008-86416-02
or scan this code with
your mobile device:
or
call 1-800-410-7420.
YOUR OPTWOM COMTS
0s+
Otu-
DocuSign Envelope ID: 68608OD5-8D8B-4608-BE37-2BBEOB3B5348
2/6/2017 Old Navy - BillingAcSvity
Mlchale Freeman I Profile I Messages (0) i Contact Us I Logout 1
SUMMARY ACTIVITY PAYMENTS REWARDS & OFFERS SERVICES
Activity
for Ivavy+st Visa, C;;rd x8g23
Current Balanca Available to Spend Available for Last Payment
Notify Ma ;hen high Notify me when low Cash Advance January 03, 2017
'r:4ay nal reflectreoant transactions
At, tiiat�:r• els
Pending Activity
e tr,rasa .iiuns :fir• t;c: f::' ;+osl d u` :'aur s ".,;o nt or inOw'.0d 'rt !'our :^arrant Boonce but may irrrs aC your Cora in Tiancaceirm
s`.tatet.; �pSt :�ithln �S haat'.•,
lncrc ore no pending transactions at this [into.
Completed Activity Notify me of large amoun.s
January 16, 2017
January 16, 20 17
January 15, 2017
January 15. 2017 .
e
January 15. 2017 -L
M �\
January 14, 2017
January 13, 2017
January 13, 2017
January 13. 2017
January 12.2017
Sort by: AFr. o!. `
January 03, 2017 DTV`DIRECTV HARDWARE 800.3473288 CA
Location DTV'DIRECTV HARDWARE 800.347-3288 CA
Posting Date January 03, 2017
January03, 2017
httpsJlwww3-oniinecreditcenterS.com/eServi ee/Bi llingAcbvityrinitiateBi I lingAcUvityAcUon.acton
1/2
DocuSign Envelope ID: 68608OD5-8D8B-4608-BE37-2BBEOB3B5348
Page 1 of 1
DOM052 ofnsao.al6"AUTO ra01-00278634-514W2 Jnta
�l��tl4�lt��t,tpttp�lpti�lituutill�lt�ttllullhlmllrlr
JAM IS SMITH
302 MEADCWSI06 OR
HUTTO, TX 70634-5149
Dear JAMI SSMITH,
Ihankyou for being a DIRECN customer and laking advantage of theDIREC'N
Movers DeolTM. Novi all yod have to do is 'sake your receivers and remotes with
you. Leave your dish behind and welt do Ih.e rest.
Please take a moment to review the steps below to ensure your move goes
smoothly.
Check your order (This is NOT a bill)-»�--•--gym
Please review your arder. To make a change, call888.DTV_MOVE
1888.380.6683) at least 24 hours before yoorinstails tioa. Chan ges to your
ordermay cause your installation to be rescheduled.
Review your DIRE CTV vid ac installation appointrn erltl
Order date Januar{ 02.2017
Order Cofiirmation N om ber: Z0643605
OIRECTVAcmunt Number. 19257M
YOUR Eaufae ENTSEf.Ecn OilS
City ne, a ;tine
I MoveOIRECTV0Oenia 1DAD
2 OIRECTVd fie,dn Mini R,dnsWt $0.00
1 0 REETVSerNceIn9ta O13h $144110
I OIRECTVS SOmiine Obh $ODa
P4mipa DITabt $I4940
AnnmorALr-EF.s
Your tstaffativadate jsJanuary16,2017,aad )our las llarwillarriva 0cllroy&Hand UMFee $01•139
between Ih00 a.m,- 12 0 p.m Tim 51229
Log ii) Ear6reclvm_rrihnirr.,ntioxi! ,YarafmBrsJe•yvtirg7pgyi;menIor ORDERTaTALPAM' SI612
felt WRT-'o 2188010 si,gn Uft forreal-tit 1p aTiporn mart alerts
40 Reviewyour DIREeWO agreements
Please note thothyaccepting the DIRECNMaters Dea[?",you sea
agreeing to a 24-MONTHSERVICEAGREEMENTwith upgraded equipRient,
ora new 12 -MONTH SMICEAGIREEMENT If you aro moving existing
equipm en t AND your ctirrant service agreemontis less [hen 12 m onlhs. 11
you rcurrenL agreement has more than 12 months relrlaining,you will
remain in that Longer term agreement.
It you decide to can celyour sn:rvio2 early or otherwise fall to maintain your
minimum programming requirement;you will be responsible for afee of
$201mo. for the remainder of your contract lup to $4901
Thankyou for chonsing DIRECN.WE truly value your loyalty an4wish you the
hest in you r n Ew home I
Sincerely,
DIRECN
•Reltedr. Iota[amaaat Y-datthe time of a dnc. This is nuts biL- PL -ase do not send any farm of 027mat to DIRECTY. Ifthe eriartatatvas FA Oodloyomr
01RECWaecomntthetataC, mayappearasV.W.
file:///C:(Users/ssmith/Appl)ata/Local/Microsoft/Windows/Temporary%20Tnternet%20Files... 1/4/2017
January 2, 2017
_r0m0o
-�
NEW TO
so U
GHEWI
RESGHEDt1iE7
Your lemll:20orw10 ARRIVE tetneen,
Log into
6,013AM, 12,00 pm
ditdv.oa ,pp!
CICO
In January 36, 2917
8e8 ANP .1 E
Ihankyou for being a DIRECN customer and laking advantage of theDIREC'N
Movers DeolTM. Novi all yod have to do is 'sake your receivers and remotes with
you. Leave your dish behind and welt do Ih.e rest.
Please take a moment to review the steps below to ensure your move goes
smoothly.
Check your order (This is NOT a bill)-»�--•--gym
Please review your arder. To make a change, call888.DTV_MOVE
1888.380.6683) at least 24 hours before yoorinstails tioa. Chan ges to your
ordermay cause your installation to be rescheduled.
Review your DIRE CTV vid ac installation appointrn erltl
Order date Januar{ 02.2017
Order Cofiirmation N om ber: Z0643605
OIRECTVAcmunt Number. 19257M
YOUR Eaufae ENTSEf.Ecn OilS
City ne, a ;tine
I MoveOIRECTV0Oenia 1DAD
2 OIRECTVd fie,dn Mini R,dnsWt $0.00
1 0 REETVSerNceIn9ta O13h $144110
I OIRECTVS SOmiine Obh $ODa
P4mipa DITabt $I4940
AnnmorALr-EF.s
Your tstaffativadate jsJanuary16,2017,aad )our las llarwillarriva 0cllroy&Hand UMFee $01•139
between Ih00 a.m,- 12 0 p.m Tim 51229
Log ii) Ear6reclvm_rrihnirr.,ntioxi! ,YarafmBrsJe•yvtirg7pgyi;menIor ORDERTaTALPAM' SI612
felt WRT-'o 2188010 si,gn Uft forreal-tit 1p aTiporn mart alerts
40 Reviewyour DIREeWO agreements
Please note thothyaccepting the DIRECNMaters Dea[?",you sea
agreeing to a 24-MONTHSERVICEAGREEMENTwith upgraded equipRient,
ora new 12 -MONTH SMICEAGIREEMENT If you aro moving existing
equipm en t AND your ctirrant service agreemontis less [hen 12 m onlhs. 11
you rcurrenL agreement has more than 12 months relrlaining,you will
remain in that Longer term agreement.
It you decide to can celyour sn:rvio2 early or otherwise fall to maintain your
minimum programming requirement;you will be responsible for afee of
$201mo. for the remainder of your contract lup to $4901
Thankyou for chonsing DIRECN.WE truly value your loyalty an4wish you the
hest in you r n Ew home I
Sincerely,
DIRECN
•Reltedr. Iota[amaaat Y-datthe time of a dnc. This is nuts biL- PL -ase do not send any farm of 027mat to DIRECTY. Ifthe eriartatatvas FA Oodloyomr
01RECWaecomntthetataC, mayappearasV.W.
file:///C:(Users/ssmith/Appl)ata/Local/Microsoft/Windows/Temporary%20Tnternet%20Files... 1/4/2017
City of Round Rock
ROUND ROCK
TEXAS 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: 3/3/2017
Dept Director: Gary Hudder, Transportation Director
Cost: $195.06
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: 00373353.PDF, 00373204.PDF
Department: Transportation Department
Text of Legislative File CM -2017-1334
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. $195.06
Source of Funds: RM 620 ROW
City of Round Rock Page 1 Printed on 3/2/2017