STAMPED & REDACTED - FOR AGENDA ATTACHMENT - WESTERN UTILITY CONTRACTORS LLC.PDF

v
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: 7/25/2024

Subject: Affidavit — Replacement of lost warrants

Please find attached 1 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 lost and is stale dated.

Please call Joyce Maurmann at 506-1343 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: Warrant #3010168590 / Western Utility Contractors LLC
Fund 240 — D300 PRM 240000017701

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: Duplicate or [J 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
page 2 of this form.

Western Utility Contractors LLC (4), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 14-Dec-2023 (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, ar 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 $ 1,675.00 (3)

1

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 _<-2.M_day of ieee 20 +,

NOTARY PUBLIC

LEl BRINTON
Notary Public, State of Arizona
Maricopa County
My commission expires: My Commission Expires
| Thal i, dire Jona oe (seal)
Warrant/Check Number ar Ol
sCheck Nu 3010168590
Original Date of Issue
(if known) (7) 14-Dec-2023
Reason for original issue of Warrant/Check (8):
O Payroll
For Services or Goods furnished_
O Treasurer's refund/payment
7/25/24

O Other:

80) a

July 22, 2024
To whom it concerns,

| Brandon Porter, authorize Jill Albin, administrator, to execute and affidavit on behalf of

Wester Utility Contractor, LLC.

Yours truly,

a va
Bfandon Pofter

President

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