HomeMy WebLinkAboutResolution - 328 - Form 132 Request - TDHPT - Reimbursement, Project 8005-1-1, U.S. 84 - 11/08/1979.- 11 JWF:bs
RESOLUTION
RESOLUTION 4328 - 11/8/79
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCKI-
That the Mayor be and he is hereby authorized and directed to execute for
and on behalf of the City of Lubbock a Form 132 request to the Department of
Highways and Public Transportation for reimbursement from said Department to
said City relating to expenses incurred by said City as set forth in said
form, a copy of which is attached hereto and made a part hereof.
Passed by City Council this Stb day of November 1979.
7�*dhhtfto�
D= WEST, MAYOR
ATTEST :
Evelyn Gaf Aga' ity Se r -
Treasurer
APPROVED AS%TO CONTENT:
Rikfit 6fWay Department
APPROVED AS TO FORM:
Q, 1A
4,
1!
J. W th Fullingim, Assistant i
Cit ttorney
G
STATE DEPARTMENT OF HIGHWAYS AND
T' PUBLIC TRANSPORTATION
)RM Tat REV- 11-75 MONTHLY STATEMENT
BILLING INSTRUCTIONS. To facilitate handling and prompt payment slow Department Order No., Requisition No., and Board of Control
No. In spaces provided. Submit statement M quintuple; sign the original only. ;.
Submit a separate statement for each requisition. Charges for freight or express, if/any, must ba supported by the prepaid freight
or express bill.
Ime of Firm
Cit of Lubbock pafa 9/24 14 79
p ox 2000 Lubbock Texas 79_4_08
(dress
INVOICE DESCRIPTION QUANTITY UNIT PRICE AMOUNT DEIARTtNEO. ORDER
DATE NUMBER
Reimbursement of 50% of forfeited
12 50
bid deposit
Credit for advertising cost for sal
-3 25
of improvements receiving no bids
8005-1-1
Parcel 3
`I
f
DIRK WEST do hereby certify CASH DISCOUNT x DAYS
het I am. Mayor, City of Lubbock and that I am TOTAL
(Title of Person Certifying) 9 25
July authorized to maks this certification REQUISITION NO. BOARD OF CONTROL NO.
:or and on behalf of City Of I,ubbOCk COST DISTRIBUTION
(Name of payee company/Claimant) -fl
I further certify that the attached invoice is correct and that it
Pat. DETAIL COST ACCOUNTING Coots
corresponds in every particular with the supplies and/or services QUIP opt COST
At he ac ount is true, correct, 1 AUTN ACCUMULATION NO 0
tontrected for. I fvrths 0049CT
`d unpaid. sue. 111. 0 0 0 FUNCTION Of 11) AMOUNT
11/8/79 ' NPR RESEARCH JOB NO (1[I EXPENDITURE N
(Dote) (Signature) B PROJtcT PARCEL/ UTILITY NO 0 0 tlo•u tel
DESIGNATOR .
T CO./KING MAY. HIGHWAY No. s[C AB
SPECIAL JOB N
IT CERTIFICATION -400 336 9 25
' FIFY THAT THC ABOVE SERVICES WERE RtND[RtD,OR
�5 YWAT THEY CORRj8pOMD in —
LAR[IWITH THETCONTRACT UNDER W14ICN THEY •ERI ZVCRY � 5 35 0
ED AND THAT TN[ INVOICE Is TRUE. AND UNPAID-
R.O.W. Admin. Assi t.
"AMC TITLt
r1oNs AMC FOOTINGS VtNIFICD--
TINe DOCUMENTS COMPLITtI BY
taae Department of Highways
d Public Transportation
Form DIS-20AB-77
.Caaner%City of Lubbnr-k
TABULATION OF COST AND
REQUEST FOR COUNTY Lubbock
REIMBURSEMENT PROJECT 8005-1-1
HIGHWAY u. s. 84
1.
PARCEL
NO.
2.
GROSS COST
TO
COUNTY/CITY
(Excludes
County/City
Fencing)
3.
REQUESTED
REIMBURSEMENT
FOR
PARCEL COSTS
50%4.
40W NET
CREDIT OR
LOSS FROM
SALE OF
IMPROVEHENTS
5.
TOTAL
REIMBURSEMENT
REQUESTED
(Total of
Columns 3 & 4)
6.
IMPROVEMENTS RETAINED
BY THE GRANTOR
(Item No. From Form D -15-18B)
7.
COUNTY/CITY
MOVING OR
ADJUSTMENT
COST
NOT PAID
TO OWNER
8.
E
T
H C
N O
I D
C E
3
9.25
9.25
I hereby certify that amounts indicated Total Acreage 0
hereon represent amounts as actually dis-
bursed by City of Lubbock , to the I hereby certify the amounts eligible
property owners or in making property ad- for State participation as shown hereon
justments necessitated by the right of way to be true and correct.
taking, that such amounts are eligible
for State cost participation under terms '
of the Contractual Agreement, and the docu-
mentation to this effect is available for
audit by the State.
District Engineer or authorised
representative. R.O.W. Admin. Assist.
Mayor, 11/8/79
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