STAMPED & REDACTED - FOR AGENDA ATTACHMENT - THE COLIBRI COLLECTIVE.PDF

Office of the Maricopa County
School Superintendent

Steve Watson

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (ANDIE DE LA ROSA)
SUBJECT: AFFIDAVITS -REPLACEMENT OF LOST WARRANTS

DATE: 05/03/2024

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

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

The original warrant(s) have had a stop payment done.
If you have any questions, please contact the MCSS Finance Desk at 602-372-4833 (Option 1) or

via e-mail at FinanceDesk@maricopa.gov. Approved Affidavits may be routed back to the
Superintendent of Schools - Finance Desk at 4041 N. Central Ave #1100.

Thank you

District Payee Warrant # Amount

Roosevelt Dist #66 The Colibri Collective 3700724011 | $15,000.00

: Date

» Amount

Reissue WTH

Office of the Maricopa County

School Superintendent

Warrant Void/Stop Request

Finance Desk
mm 20201016

District Name / Number: Roosevelt Schoo! District 66 Attachments:

Contact Name: Gabriela German

eS

EC] Original Warrant

Lost Warrant Affidavit (required for ALL reissues)
Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee zs 2 @
(eertg we “7") (mm/dd/yyyy) {est appears in Check Mente) s é ; 3

: : ”. 3
370072401 1| 12/20/2023} 15,000.00 The Colibri Collective ©O

© OU)

©OU

©OL)

N

District Approvér:

otes: Requesting a reissue. Vendor never received payment.

Date: 3/28/2024

For Internal Use Only e
Clerk of Board Date:

V

Void Report Octe:

Schools Affidavit/Ctalm Form

Application for a Duplicate Warrant/Check {dofinitions ara on page 2)

STATE OF ARIZONA Note: Numbers on this form correopond to numbers on the
COUNTY OF MARICOPA {natruction shaet which is page 2 of this form.

The Collbri Collective (1), betng first sworn, upon oath deposes and says:
“Tena aa —
On or about 12/20/2023 (date)(2) @ warrant/check was Issued to the

above named person/entity In the amount as stated below. Such warrant/check was
either never tecelved cr was subsequently Inadvertently lost or destroyed and there Is
no reasonable probability of its belng 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 aim Is correct
and the amount shown Is due and owing, and the applicant requests that a replacement

Oe Oe ae ee sum of ¢15000 (3)
Signed: (4)
Ze

c
(5) Subscribed and swom to before mathis__Z- __ day of havi 2074.

NOTA

[ MN Koken, exres: ,

2\ FERNANDA OYUK? GARDEA YANEZ
NOTARY PUBLIC - ARIZONA
MARICOI

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

Maran faamia (3700724011

Oran time’ [12/20/2023

Reason for originat Issue of Warrant/Check (8): |
C1 Payroll

4 For Services or Goods furnished
O Other:

S:\PROCESSES\Warvants « Duplicate cr Stale\02 Forms\Schiools\Schoots-Warrants Checks notice of datmatioc
Revised Juna 2015 ARS. 11-692 & 15-299

RECEIVED
5/3/24
- ai APR 93 2024

Business Services

04/02/2024

Dear Roosevelt School District Accounts Payable,

Reference: Invoice 1858

(hope this letter finds you well. We are writing to inform you that our office has not yet received check
#3700724001, Issued for the amount of $15,000 corresponding to invoice 1858.

According to your records, the check was purportedly mailed to our office at 1425 North ist, Suite 100,
Phoenix, AZ 85004 on December 20, 2023. Regrettably, the check has not been received.

In light of this, we kindly request your office to re-issue the aforementioned check once all necessary
steps have been taken from our end,

We sincerely value the collaboration between our organizations. Should you require any further
information or assistance, please do not hesitate to contact us.

Sincerely,

aby Cardenas
CEO/Owner
The Colibri Collective

The Collbrl a

4117124, 9:02 AM VMware Horizon
Warrant (1 - meto) - Warrant number 3709724011, Stopped

| Warrant | ;
i pt FY

Print | Attachments

i

Warrant | Status
x

Maintain New Status | Setup | Attachments
3700724011
a Warrant header eee —_
General Pasting
Werrant number: 3700724011 Invoice:
Holder Invoice date:
Issued date: Paid date:
Status: Stopped Positive pay sent date:
Exception flag: Pl Agency detaits
Exception reason; Nene

Agency voucher number 2051
Agency claim number
Agency lov orig:

Queued for positive pay: {|

Locked ferreconcite | |

Agency PO number:
Registered Agency sub find:
Date registered: Agency dept num:
No of days interest: 0

Annual interest rate: 0.00000.

4 Warrant Lines - . \
oO Amount ; Payee Account

i

2 | 2) | Mdentitication of the warrant

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