STAMPED & REDACTED MIDSTATE MECHANICAL.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 9/24/2021

Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda

v The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.

v The original warrant(s) have had a stop payment done.

If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)

Thank you.

#02 Riverside Elementary Midstate Energy $3,178.00

RECEIVED

SEP 27 2021

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Latercfliay yal - AE

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.

MIDSTATE ENERGY |\\e.c\sAn\ (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about June 8, 2021 (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 high/her in the sum of $3178.00 (3)
planes Lab, (4)

(5) Subscribed and sworn to before me this l a ay of Agog _ 20 D4 .

NOTARY PUBLIC

TERI ANN CERANSKI

Notary Public - Arizona

My commission expires: 2) Maricopa County
Commission 4 602946
Se” My Comm. Expires Jun 26, 2025 seal)

Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

Warranticheck Number 13700433337 09/27/2021
Original Date of I ,
1912" enon) ()__ (JUNE 10, 2021

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

For Services or Goods furnished !|NSTALLATION OF BACKFLOW
O Other: INSTALLATION OF BACKFLOW

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

iMIDSTATE

MECHANICAL

000000000000000000000000000000000000000000000000000000000000000000000000

© Phoenix, Arizona 85034 e Phone @ Fax

September 21, 2021

ATTENTION: Teresa Solares
Riverside School District #2

Phoenix, AZ 85043
To Whom It May Concern:

Please be advised that Midstate Energy is no longer an active subsidiary of Midstate Mechanical and
therefore is not listed as an authorized recipient of funds for the company. Several years ago, Midstate
Energy was a wholly owned subsidiary of Midstate Mechanical and was engaged in HVAC service
work, which is when the company was originally set up in the system of Riverside School District.
Since Midstate Energy is no longer active, Midstate Mechanical is the company that performs work and
transacts as a business, so all payments should be mode directly to Midstate Mechanical.

Robbie Molnar was the Chief Financial Officer of Midstate Mechanical is authorized to sign the
affidavit on behalf of Midstate Mechanical.

If you have any further questions or concerns, please contact me at the number listed below. Thank
you for your assistance.

Kindest Regards,

Mark Dubyak
Controller
Midstate Mechanical

Direct: (602)

License No.’s: ROC148103 e ROC155427 e ROCO71451 @ ROC133325