1RELOCATION CLAIM PACKAGE COVERSHEET
BB 2025
4/1/2026 City of Fresno BNSF Grade Separation Project 446-232-36 DATE AGENCY PROJECT APN(S)DISPLACEE: Genuine Parts Company RESIDENTIAL NON-RESIDENTIAL CLAIM TYPE: MOVING EXPENSES Documents should be in order with this cover sheet first.All Claims Require Proof of Vacancy-- Unless Agency Has Approved Advance Payment PAYMENT REQUEST DOCUMENTS:1.Claim for Relocation Assistance Payment (RW 10-02 or 10-30)2.Vendor Authorization Form3.W-9Request for Taxpayer ID Number & CertificationPAYMENT JUSTIFICATION DOCUMENTS:4.Vacancy Certification5.Spreadsheet of Moving ExpensesRAP ELIGIBILITY DOCUMENTS:6.Notice of Eligibility (RW 10-39, 10-41, 10-43, 10-46, 10-47, 10-49 or 10-50)7.Owners Certification of Tenants (RW 10-01)8.Certificate of Occupancy (RW 10-25)9.Certificate of Legal Residency (RW 10-44)The above checked documents are included in the following claim package.4/1/2026Barbie Barnes, SR/WA, RW-RAC DateProject Manager, Universal Field Services Rent Differential Payments Require: Purchase Differential Payments Require: Lease Agreement Purchase Contract RHV Report RHV Report Computation of Rent Differential Payment Estimated Closing Cost Statement Decent, Safe & Sanitary Report Decent, Safe & Sanitary Report Self-Move Payments Require: Fixed Move Payments Require: Inventory List and/or Photos Certificate of OccupancyBid Approval Page Move Cost ScheduleIn-Lieu Payments Require: Reestablishment Payments Require:IRS Tax Transcripts Calculation Explanation Page Displacement & Replacement Leases
Claim for Relocation Assistance - NonresidentialRW 10-30 (Rev 01/2019) Page 1 of 2 3/27/2026 446-232-36DATE PARCEL/APN(S) 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, whicheveris later.DISPLACEE (sole proprietor, corporate officer, or all partners): Date Vacated Displacement Property: 6/13/2025 Genuine Parts Company Date Occupied Replacement Property: 6/1/2025 dba NAPA Auto Parts Final Date to file all Claims: 12/13/2026 DISPLACEMENT PROPERTY Address: 1632 N. Blackstone Avenue Fresno, CA 93703 REPLACEMENT PROPERTY Address: 2701 N. Blackstone Avenue Fresno, CA 93703 A. Nonresidential Moving Expenses (Supporting documentation attached)1. Transportation of displaced person and personal property within 50 miles $ 2. Packing, crating, unpacking and uncrating of the personal property $ 3.Dismantling, disconnecting, reassembly and reinstallation (Reconnection of Data lines) $741.79 4.Utility and Service line reconnection (including telephone) $9,340.00 5. Connection to available nearby utilities from the right-of-way to improvements at the replacementsite. $ 6. Modifications to personalty (with prior approval) $ 7. Physical changes at the replacement property to accommodate the personalty $ 8. Storage for _______ months (not to exceed 12 months; prior approval needed) $ 9. Replacement Value Insurance and/or damaged, lost or stolen property $ 10.Licenses, permits and certifications fees for the business operation $2,599.79 11. Relettering signs and replacing stationary on hand at time of displacement made obsolete due todisplacement $ 12.Loss of tangible personal property/substitute property (Paint Booth)$28,505.98 13. Cost to sell personal property not relocated $ 14. Search fees ($2,500 maximum) $ 15. Self-Move (per attached Self-Move Agreement) $ 16. Feasibility surveys, soil testing and marketing studies (prior approval needed) $ 17.Professional services performed (Electrical Services for Paint Booth) $33,689.35 18 Low value / high bulk $ 19. Impact fees or one-time assessments for anticipated heavy utility usage (prior approval) $ 20.Other: Replacement Shelving (Sub Pers Prop)$55,118.28 B. Nonresidential Reestablishment* Expenses (Maximum $25,000 for Items B1 through B12)(Supporting documentation attached)1. Repairs or improvements required by federal, state, local law, code or ordinance $ 2. Modifications to accommodate the business operation (Prior approval) $ 3. Construction and installation cost for exterior signage to advertise the business $ 4. Redecoration or replacement of soiled or worn surfaces at replacement site $ 5. Licenses, fees and permits not paid as moving expenses based on useful life of permit, license, etc. $6. Advertisement of replacement location $ 7. Estimated increased costs of operation during the first two years at the replacement site for lease orrental charges, personal and property taxes, insurance premiums, and/or utility charges (excludingimpact fees) $ 8. Other items considered essential for reestablishment:$ TOTAL CLAIM $129,995.19 Claim for Relocation Assistance - Nonresidential RW 10-30 (Rev 01/2019) Page 1 of 2 3/27/2026 446-232-36DATE PARCEL/APN(S) OR in lieu of A and B above (IRS Tax Transcripts verified by Agent)In-Lieu Payment based on average annual net earningsTax Year for $ andTax Year for $ TOTAL IN-LIEU CLAIM _____N/A_______________ 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 FRESNO 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.DATEDATEI CERTIFY that I examined this claim and substantiation documentation and found it to conform to the applicable provisions ofState and Federal law and the Code of Federal Regulations, Title 49, Part 24. This claim is approved for a moving payment of $129,995.19for eligible moving, moving related and reestablishment expenses (not to exceed $25,000), or for an in-lieu payment of $ N/A .DATEBARBIE BARNESProject ManagerUniversal Field Services, IncDATE GEORGEANNE A. WHITECity ManagerCITY OF FRESNO 3/27/2026
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