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HomeMy WebLinkAboutPOMEROY, WILLIAM & GOCHICOA, AVELINO & STELLA -2005 A-2005-140 PAGE 1 OF 2 ~ fW(k (t.JcvS~1 BUSINESS SELF-MOVE AGREEMENT It is hereby understood and agreed by Dr. William Pomeroy DDS and A velino Gochicoa and Stella Gochicoa ("Claimant") and the City of Santa Ana ("City") that the amount to be paid to the claimant for the relocation of all equipment, stock, inventory, and other items of personal property located at 119 S. Bristol Street (also known as 117 & 123 S. Bristol Street) is Thirty Thousand Seven Hundred Fifty and 00/100 dollars ($30,730.00). The terms are as follows: I. Payment shall be paid by the City to William Pomeroy, DDS upon: verification that all personal property has been relocated to a replacement site; and the claimant signs and returns to the City, the attached Exhibit "A" forms. 2. The claim for payment must be submitted within eighteen (18) months of the date of moving from the acquired premises. Specific disbursements for relocation benefits will be as follows: Searching Expense: $2,500.00 Moving Expense: $18,230.00 Re-establishment $10,000.00 3. Neither the City or any employee, officer, or agent thereof shall be responsible for any damage or liability occurring by reason of anything done or omitted to be done by Claimant under or in connection with the agreement. It is also understood and agreed that the Claimant shall fully indemnifY and hold the City and their designated representative harmless for any liability imposed by injury or damage to property occurring by reason of anything done or omitted by Claimant in connection with this agreement. 4. All notices, requests, demands and other communications required or permitted to be given under this Agreement shall be in writing and shall either be delivered in writing personally or be sent by regular or certified first class mail, postage prepaid, deposited in the United States mail, and properly addressed to the party at its address set forth below, or at any other address that such party may designate by written notice to the other party: To City: City of Santa Ana Clerk of the Council Public Works Agency 20 Civic Center Plaza M-30 Santa Ana, CA 92702 With copy to: L Eugene Hallsted Attorney at Law 10101 Slater Avenue, Suite 103 Fountain Valley, CA 92708 .' Pomeroy, DDS & Gochicoa Business Self-Move Agreement Page 2 of2 5. This Agreement may be executed in counterparts, each of which shall be deemed an original, and, when taken together with other signed counterparts, shall constitute one Agreement, which shall be binding upon and effective as to all Parties. IN WITNESS WHEREOF, the parties to this Agreement have executed this Agreement as of the date first written above. FOR: Dr. William Pomeroy, DDS Denta Offices IPS Tax ill Number Date Tax ill Number Date Tax ill Number Date CI~Y OF f2~t2 BY. ..____ David N. Ream, City Manager Dated ?0~~ / Patricia E. Healy Clerk of the Council APPROVE Joseph City BY: ORM: '- 1 Y EXHIBIT "A" Dr. Pomeoy, DDS "Business Self-Move Agreement" ~ CITY OF SANTA ANA PUBLIC WORKS AGENCY BUSINESS, FARM OR NONPROFIT ORGANIZATION CLAIM FOR ACTUAL REASONABLE MOVING EXPENSE ~ PERSONAL INFORMATION NOTICE Pursuant to the Federal Privacy Act (P.L.93-579) and the Information Practices Act of 1977 (Civil Code Sections 1798, et.seq.), notice is hereby given for the request of personal information by this form. The requested personal information is voluntary. The principal purpose of the voluntary information is to facilitate the processing of this form. The failure to provide all or any part of the requested infonnation may delay processing of this form. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977. Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual y\byan identifying particular. Direct any inquiries on information maintenance to your IPA Officer. ALL CLAIMS MUST BE FILED WITHIN 18 MONTHS AFTER: (a) For tenants, the date of displacement; or (b) For owners, the date of displacement or the date of the final payment for the acquisition of the real property, whichever is later. CITY OF SANTA ANA Dist Co Rte KP(P.M.) Exp Auth PUBLIC WORKS AGENCY AR Parcel No. Federal Project No. 1. FULL NAME OF CLAIMANT(S): Date of Move: Dr. Pomeroy and A velino and Stella Gochicoa 2. DISPLACEMENT PROPERTY 3. REPLACEMENT PROPERTY 119 S. Bristol Street, Santa Ana, CA 4. ACTUAL REASONABLE MOVING AND RELATED EXPENSES BEING CLAIMED The following items may be reimbursable as actual reasonable moving and related expenses. Documentation in support of each claimed item is attached. Amount Claimed: A. Packing, crating, disconnecting, dismantling, removing, transporting, Unpacking, uncrating, reassembly and reinstallation of personal property $ 18.230.00 B. Utility and Service line reconnection $ C. Telephone reconnection $ D. Modification to personal property $ E. Physical changes at new location $ F. Storage $ G. Insurance $ H. License, permits and certification fees $ I. Damaged, lost or stolen property $ J. Professional services $ K. Re-lettering & reprinting $ L. Loss of tangible personal property $ M. Resale costs $ N. Substitute personal property $ o. Search fees $ P. Other moving expense payments, specify: $ 2.500.00 Total Amount Claimed $ 20.730.00 BUSINESS, FARM OR NONPROFIT ORGANIZATION CLAIM FOR ACTUAL REASONABLE MOVING EXPENSE (Cont.) Page 2 of2 Payment of this claim in the total amount shown in item #4 is requested. I CERTIFY that I have not submitted any other claim for, or received reimbursement or compensation fOf, any item of expense in this claim, from the City of Santa Ana Public Works Agency nor from any other public agency or private company, and that I will not accept reimbursement or compensation from any other source for any item of expense paid pursuant to this claim. I further certify that all information submitted herewith or included here is Ime and correct. I understand that only lawful U.S. residents are entitled to claim relocation benefits. I understand that, in addition to the penalty provided by Penal Code Section 72, falsification of any item in this claim as submitted herewith may result in forfeiture of the entire claim. (NOTE: Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city, district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claims, bill, account, voucher, or writing is guilty of a felony.") Date of Claim Claimant's Signature(s) ITEMS BELOW TO BE COMPLETED BY THE CITY OF SANTA ANA PUBLIC WORKS AGENCY I CERTIFY that I examined this claim and substantiation documentation and have found it to conform to the applicable provisions of State law and the California Code of Regulations, Title 25, HCD Guidelines (as amended). This claim is approved and payment in the total amount shown in item #4 is hereby authorized. Authorized Signature Date I ADA Notice For individuals with disabilities, this document is available in alternate formats. For information call (916) 654-5413 Voice, CRS: 1-800-735-2929, or write Right of Way, 1120 N Street, MS-37, Sacramento, CA 95814 EXHIBIT "A" to Dr. Pomeroy, DDS "Business Self-Move Agreement" BUSINESS, FARM, OR NONPROFIT ORGANIZATION CLAIM FOR REESTABLISHMENT EXPENSES Page 1 of2 PERSONAL lNFORMA TION NOTICE Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices Act of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal information by this form. The requested personal information is voluntary. The principal purpose of the voluntary information is to facilitate the processing of this form. The failure to provide all or any part of the requested information may delay delay processing of this form. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IP A of 1977. Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual by an identifying particular. Direct any inquiries on infonnation maintenance to your IPA Officer. ALL CLAIMS MUST BE FILED WITHIN 18 MONTHS AFTER: (a) For tenants, the date of displacement; or (b) For owners, the date of displacement or the date ofthe final payment for the acquisition of the real property, whichever is later. City of Santa Ana Public Works Agency Dist Co Rte KP(P.M.) Exp Auth 20 Civic Center Plaza M-36 Post Office Box] 988 Santa Ana, CA 92702 AR Parcel No. Federal Project No. I. FULL NAME OF CLAIMANT(S): Date of Move: Dr. William Pomeroy and A velino and Stella Gochicoa 2. DlSPLACEMENTPROPERTY 3. REPLACEMENT PROPERTY 119 S. Bristol Street, Santa Ana 4. REESTABLISHMENT EXPENSES BEING CLAIMED The following items may be reimbursable as reestablishment expenses. The total amount claimed cannot exceed $10,000. Documentation in support of each claimed item is attached. They are: A. Repairs or improvements required by law, code or ordinance. B. Modifications to accommodate the business operation. C. Exterior signing to advertise the business. D. Extending utilities from right of way line to improvements. E. Redecoration or replacement of soiled or worn surfaces. F. Licenses, fees and permits not paid as moving expenses. G. Feasibility surveys, soil testing and marketing studies. H. Advertisement of replacement location. 1. Professional services for purchase/lease of replacement. J. Estimated increased costs of operation during the first two years at the replacement site for lease or rental charges, taxes, insurance, and/or utility charges (excluding impact fees). K. Impact fees or one-time assessments for anticipated heavy utility usage. L. Other items considered essential for reestablishment, specify: Amount Claimed: $ $ $ $ $ $ $ $ $ $ $ $ 10.000.00 Total Amount Claimed $ 10.000.00 " .' 'BtJSINESS, FARM, OR NONPROFIT ORGANIZATION CLAIM FOR REESTABLISHMENT EXPENSES (Cont.) Page 2 of2 Payment of this claim in the total amount shown in item #4 is requested. I CERTIFY that I have not submitted any other claim for, or received reimbursement or compensation for, any item of expense in this claim, from the City of Santa Ana nor from any other public agency or private company, and that I will not accept reimbursement or compensation from any other source for any item of expense paid pursuant to this claim. I further certify that all information submitted herewith or included herein is true and correct. I understand that only lawful U. S. residents are entitled to claim relocation benefits, I understand that, in addition to the penalty provided by Penal Code Section 72, falsification of any item in this claim as submitted herewith may result in forfeiture of the entire claim. (NOTE: Section 72 of the Penal Code provides: "Every person who, with the intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city, district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claims, bill, account, voucher, or writing, is guilty of a felony.") ANY AMOUNTS paid pursuant to this claim shall not be duplicated in any compensation otherwise paid to or awarded to the owner of the business being relocated. Any or all amounts paid hereunder may be deducted from any payment paid, or to be paid by the State pursuant to Section 1263.510, Code of Civil Procedure (Compensation for Loss of Goodwill). Date of Claim Claimant's Signature(s) ITEMS BELOW TO BE COMPLETED BY THE CITY OF SANTA ANA I CERTIFY that I examined this claim and substantiation documentation and have found it to conform to the applicable provisions of State law and the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (as amended). This claim is approved and payment in the total amount shown in item #4 is hereby authorized. Authorized Signature Date ADA Notice For individuals with disabilities, this document is available in alternate formats. For information call (916) 654-5413 Voice, CRS: 1-800-735-2929, or write Right of Way, 1120 N Street, MS-37, Sacramento, CA 95814.