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. Cl. EL, MARICOPA COUNTY Z.10 114 A r:i) OF SUPER 'f .'1S01;`S C.) li ICOP A COUNT V Department of Finance 301 West Jefferson, Ste 960 2019 MAY -7 AM 12: 59 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: May 7, 2019 To: Clerk of the Board From: Kathy Baskom Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavit for lost warrant to be included on the next available Board Agenda. • The attached item has been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please call me at 506-0572 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: Department 640 ID:19*9533 Fund: 234 Unit: 6440 Appr Unit: 1548 Object: 8122 Detail:TSYS Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is paae 2 of this form. Arizona Public Service (I), being first sworn, upon oath deposes and says: Name/Clalmant On or about 26 -0ct-2018 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrant/check was either never received or was subsequently inadvertently lost or destroyed and there is no reasonable probability of its being found or presented for payment, or it was not presented for payment within one year after the date of issuance. Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing, and the applicant requests that a replacement warrant/check be issued to him/her in the sum of $29,043.00 i(3) Signed: (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this 1!---?` day of IllavC)/1 20 (VI . NOTARY PUBLIC . PADFIELD -- My commission expires: Notary MARICOPACOUNly Public- Stet° of Artzon9 (voki,e,v 2- 0, 2.0Z-0 MY Commission Expires I (seal) Soptembor 20, 2020 Warrant/Check Number 3010018184 (If known) (6) Original Date of Issue 26-Oct-2018 (if known) (7) Reason for original issue of Warrant/Check (8): Ilhnovii For Services or Goods furnished LI Treasurer's refund/payment 0 Other: P.O. Box 53999 aps Phoenix, AZ 85072 aps.com April 19, 2019 Maricopa County Department of Transportation 2901 W. Durango Street Phoenix, AZ 85009 SUBJECT: Disbursed Check for Invoice AR0480006137 To Whom It May Concern, Our records show that we did not receive warrant/check 3010018184 issued on or about October 26, 2018 for $29,043. The check/warrant is for APS invoice AR0480006137. Esteban Corral is authorized to sign the affidavit on behalf of APS. Please re-submit payment. Sincerely, Michael Owen Team Leader — T&D Accounting michael.owen@aps.com 602-250-3386 DashBoard Page 1 of 1 Warrant Number -3010018184 Status Issued Account # 210100-200-2000-2768-20198-4100---- Paid Date Issued Date 10/26/2018 Registered Date Payee ARIZONA PUBLIC SERVICE Amount $29043.00 Interest $0.00 Claim # Sub Fund Dept # PO # LowOrig Voucher hups://treasurer.maricopa.gov/AgencyWeb/Dashboard 2/12/2019 aps 3/15/2019 MARICOPA COUNTY 2901 W DURANGO ST PHOENIX AZ 85009 United States Dear Valued Customer: Please note the item(s) listed below are now past due. These item(s) need your immediate attention for payment. Please remit payment within the next five days to avoid additional late fees being assessed to the referenced item(s). If you have items that are more than 60 days past due, your account is now in delinquent status. If payment is not received within the next five days for these item(s), your account will be turned over to our Collections Department. To avoid further action, please process payment immediately and include the Item ID with your remittance. If you have items that are more than 90 days past due your account may be turned over to a collection agency. We value you as a customer and appreciate your prompt attention to this matter. If you have already remitted your payment of the listed item(s), please disregard this notice. If you have any questions and/or concerns, please contact us immediately. Business Unit: AR048 Customer: 101134 MAR ICOPA COUNTY Item Line Entry Entry Reason Remaining Overdue Charges Due Date Accounting Days Type Balance Date Late AR0480006137 0 IN SVC 29,043.00 USD 0.00 7/26/2018 6/26/2018 232 29,043.00 USD 0.00 Sincerely, ESTEBAN CORRAL 602/250-2428 Please remit payment to and include Item ID: Arizona Public Service Company P.O. Box 53920, Sta. 9996 Phoenix, AZ 85072-3920 Statement Number: 328 Statement Date: 03/31/2019 as p Account Number: 101134 _ Rec Type: 01 Business Unit: AR048 MARICOPA COUNTY 2901 W DURANGO ST PHOENIX, AZ, 85009 USA Due date Item ID Entry Type Amount Due Item Activity Payment Discount 07/26/2018 AR0480006137 Invoice 182,819.00 0.00 Line Description Customer Ref Line Notes 1 12kV Overhead Relocation WA400653 07/26/2018 AR0480006137 Invoice -153,776.00 3010008600 0.00 Line Description Customer Ref Line Notes 1 12kV Overhead Relocation WA400653 Future 0 - 30 31 - 60 61 - 90 Over 90 Total No. of Items 0.00 0.00 0.00 0.00 2.00 2.00 Amount 0.00 0.00 0.00 0.00 29,043.00 29,043.00 USD We appreciate your business. If you have questions about your account, please call ESTEBAN CORRAL 602/250-2428 RETURN THIS STUB WITH YOUR REMITTANCE Statement Date: 03/31/2019 Account Number: 101134 Rec Type: 01 Business Unit: AR048 Make Checks Payable and Mail To: Item Number Entry Type Due Date Amount AR0480006137 Invoice 07/26/2018 29,043.00 Arizona Public Service Company P.O. Box 53920 Mail Station 9996 Phoenix, AZ 85072-3920 Item Total: 29,043.00 Total for MARICOPA COUNTY 29,043.00 Page 1 of 1