STAMPED AND REDACTED 3010210882 - ADAMS AND WENDT INC.PDF

MAR COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9% Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 12.23.25

Subject: Affidavit - ADAMS AND WENDT INC.

Please find attached one Affidavit for a Stale Dated 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.

e The original warrant is presumed fost.

Please call Marcia Anderson at 506-7291 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: FUND 506 ~ D880 ENVIRONMENTAL SERVICES — GAX1D 25*16998 — Refund OWR2500589
FY25 4/142025 MCESD Reason for Refund: No inspection needed, no septic on property

L
MA R) COPA Application for a Duplicate or Stale Dated

COUNTY

Warrant/Check Affidavit/Claim Form

This application is for Duplicate or [] Stale-Dated (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

Adams and Wendt, INC

Note: Numbers on this form correspond to the numbers
on the instruction sheet which is page 2 of this form

(1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 25 April 2025

(date) (2) a warrant/check was issued to the above named

person/entity in the amount 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

- 3)
(4)

Signed: i
Print Name: (required) _@reyou 3. Oozen
Note: Please attach a copy of the warrant/check if available and/or any other evidence that a
warrant/check was originally issued.

\ 20.22 _,

(5) Subscribed and sworn to before me this day of DECEMYEIe
NALLY fe

NOTARY PUBLIC

waitin
Notary Publle State of Arizona
Maricopa County ev.”
Kori Charisse Lee * +

2) My Commigelon Exaires 4/10/2026
Commis Gea er 683360

My commission expires:

AN0\20:324

Warrant/Check Number
(if known) (6)

3010210882
Original D f | i
area [25 Apri 2025

12/24/25

Reason for original issue of Warrant/Check (8):
C Payroll

CJ For Services or Goods furnished

[1 Treasurer’s refund/payment
Other: Refund - permit not needed / GAX1D D880 25*16998 / Fund 506

SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc Revised
100518

Adams

and

Wendt

December 10, 2025

Maricopa County

Office of Budget & Finance

301 W. Jefferson St., 9 Floor

Phoenix, Arizona 85003

RE: Affidavit/claim for re-issuance of a lost or stale-dated check (warrant)

To Whom it May Concern:

|, Aaron L. Wendt, authorize Greg J. Dozer, Project Manager, to execute an affidavit on behalf of
Adams and Wendt, Inc.

fi
TI anks,

: d
Vice President.

Environmental Consulting ¢ Project Management
460 South Greenfield Road, Suite 1 Mesa, Arizona 85206 ¢ Phone 480.924.7144