090716 DUPLICATE WARRANTS 9 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
.Maricopa County School-Superintendent's Office
TO: CLERXOE TOE BOARD
FROM: Willie 'Thompson
SUBJECT: Affidavits
DATE: 8/22/2016
Pase find attached 5 AffidavitOotice of Craim(s)for Cost warrants for incrusion on
the next avaira6 Board agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previous()) re-issued.
The warrant(s) have had a stop payment done.
If you have any questions, please contact Mew Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School Einance Division at 4041 9I/: Central Avenue #1200, ( 12 th
(Floor) Thankyou.
#2 RIVEXS'IDE CADILEENA STEN -UMW $1165.77
#2 RIVEWSIVE AXGELA .1\r TOITS $638.03
#2 RIVEWS IDE WOODKOEE CONSTKUCTIOW $44,344.22
#5 ISAAC VICTORDIAZ $498.40
#65 LIT1LET011r WASSP /SAVOATBALOGVX $139.40
_ ED
AUG 2 3 2016
MAR ICO PA COUNTY
CLERKBOARD OF SUPERVISORS
vynia.cf2

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Cathleen A. Stenehjem (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 25, 2015 (iate)(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 $ 1,165.77 .( 3)
Signed: (4)
re me this day of 20 / .
NOTARY PUBLIC
OFFICIAL STAMP
My commission expires: WALTER ALLEN FLOETER
NOTARY PUBUC - OREGON (seal)
COMMISSION NO. 951839
MY COMMISSION EXPIRES .11iNP
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued
Warrant/Check Number 160020927
(if known) (6)
Original Date of Issue September 25, 2015
(if known) (7) ,,, ----, t---1
Reason for original issue of Warrant/Check-(8):
It Payroll
El For Services or Goods furnished uuuNTY
MARICOPA
LI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Angela N. Potts (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about June 03, 2016 (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 $ 638.03 .( 3)
Signed: (4)
(5) Subscribed q aAnd sworn top, .f.?rme me this /.2-4(.. day of 5451- 20 46,.
NOTARY PUBLIC Maria Teresa Solares
Notary Public
MAcommisOon expires:, Maricopa County
(ifft-.1-/ 20 it My Arizona Comm. (seal)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number 160088371
(if known) (6)
Original Date of Issue June 03, 2016
(if knovvn) (7)
Reason for original issue of Warrant/Check (8):
WI Payroll
El For Services or Goods furnished
LI Other:
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

A it;
DATF, A111\2 6 2016
Affidavit
STATE OF ARIZONA K. MARICOPA BT7ArF. COUNTY SCIPrRVISCR 5
) ss.
COUNTY OF MARICOPA
1704 nig; CO 11,541(1)Chek being first duly sworn, upon oath deposes and says:
That on the FORA- day of Tnie- , 20 ( Jo , he presented
to thgleiside 9100 I b;51- Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of -Sone, , said claim being
in the sum oftie .--(thielA0054$41 Dollars ($ litit 341q,; 1° ) in payment
-tke kovfred 4brI y —fv or 4.14/ -hvesay /.1
of which the Superintendent of Schools caused his Warrant No. 7 Via/ 7
To be issued on 0-01‘1 14 , 20 I , drawn on the V40
Fund of IRV65icie...1400/ of Maricopa County, Arizona.
Dr.* 441-
Affiant further says that although he was informed and believes that the above
asti is lost
mentioned warrant was regularly issued
40565 '7lailed-66 torml add-re-5S,
WHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools of said County issued to him a duplicate of said Warrant
No, q71003(,w in the sum of $ WI 3W 2,2. .
Subscribed and sworn to before me this /44 — day of iht5
20 )1, .
Nbtary Pu
My commission expires: ,20/61

WOODRUFF WOODRUFF
CONSTRUCTION CONSTRUCTION
9401 N. 7th Avenue 2710 E. Lakin Dr.
Phoenix, AZ 85021 Flagstaff, AZ 86004
(480) 921-1925 Phone (928) 527-4138 Phone
(480) 446-0825 Fax (928) 527-4139 Fax
August 22, 2016
To Whom It May Concern:
I, Wade Woodruff, Vice President of BWC Enterprises Inc. dba Woodruff Construction am authorized to
sign the lost Affidavit form for Woodruff Construction.
Signature: 2L/ a€ Date
1.0o- cit. Lao 04(v64-
State of Arizona
County of Maricopa
On this 22nd day of August, 2016, before me personally appeared Wade Woodruff, whose identity was
proven to me on the basis of satisfactory evidence to be the person who he or she claims to be, and
acknowledged that he signed the above document.
PAMELA K MORROW
**try PubSe - ASIAN'
Marlow. County Notary Public: / aM,tt< d Xr"), ,v/v7L)
My Commission Swim
AUGUST 3,201$
BWC Enterprises Inc., DBA Woodruff Construction License No's A-263244, B-096802 & B1-096809

7.&
0. pt• R
S
'36140ENI ARIZI5NA• INTEREST FROM DATE MARKED nNSLIFFICIENT FUNDS' DATE
MORA& DATE PLINDS AVAILABLE. (SEC 11438. ARSIDSH) 07/14/2016 2046460
Riverside Elementary District #2
WARRANT AMOUNT••
arty Four Thousand Three Hundred Forty Four end 22/100*** Dollars $44,34412
365 DAYS
a Woodruff Construction
-IE 1825 W. University Dr. #113
RDER Tempe, AZ 86281 pi: Tcatel.d CaVey' -
Superfittendent of Schools
AUTHORIZED SIGNATURES
1111,?000 3 6 9 I: L 2 2 1000 2141: 9 704 394 9 30
-07/14/20/6-Check: -2045460 -E(138,148E- --
IARICOPA COUNTY SCHOOLS • PHOENIX, ARIZONA Al' Run Date 0745-16 470003694
Woodruff Construdfon 07/1412016
Payee I Check Date
AIICILEailM---1320t1dWIESMIN Pit'Mtit
02CTIS14OOK+450101 15573 APP liCk I AW 4.78(120
630T51406:6450SOT 16573 ATV NO: 1 39,5602
PAM
JUL 1 5 2016
BUSINESS SERVICES
VOUCHER: 1129 TO $44,344.22
HAmJam CLARKE MTze42 60126026

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
GOUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
le7(1)( 1)(07, (1), being first sworn, upon oath deposes and says:
ame/C aimant
On or about —7— iq - pot cp (da,e)(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/checyaif issued to him/her in the sum of $ g, .(3)
Signed: ( I C-40 1( 1)102) (4)
(5) Subscribed and sworn to before me this 1 514-1 day of 6A-4-03LA-05t 20
NOTARY PUBLIC --OFFICIAL SEAL —
CONSUELO S. HERNANDEZ I
Notary Public - State of Arizona •
My commission expires: I MARICOPA COUNTY
t, -./07t1 /02,0(90 F.xoTsF.e.esum;
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally Issued
Warrant/Check Number
(if known) (6) 41 — CeO4, tinS
Original Date of Issue
(If known) (7) —1-1 61 -apl & _ _ - Arka Ift
Reason for original issue of Warrant/Check (8):
0 Payroll
0 For Services or Goods fuiAished
Kia Other: -176Wel 1,4e( ixt,rsen leo •E me/ octet
5: \PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clairn.doc
Revised June 2015 A.R.S. 11-632 & 15-999