STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CROSSLINE LIFELINE TRAINING INC.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: 03/11/2024

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

Osborn Dist #8

Cross Lifeline Training Inc

3700723377

$495.00

--. Date.

Amount

Reissue. WT #

Office of the Maricopa County

Scheol Superintendent

District Name / Number: Osborn School District #8

Contact Name: Yyonne Lopez

Warrant Void/Stop Request

Attachments:

[] Original Warrant
Lost Warrant Affidavit (required for ALL reissues}

[J Vendor Letter (if requesting Vendor reissue)

‘Werrant Number: | Warrant Date
(setting with “377): (mm/dd/yyyy)

Amount.

Payee

: (as Itappears in ‘Check Meonager}

Void
Stop

CROSS LIFELINE TRAINING INC/@® ©

3700723377 | 12/20/2023!$ 495.00

Notes:

District Approver( Lava. ~) . Y alagne

Check was lost in the mail-Please reissue.

Date 2\23\24

For Internal Use Onty

Clerk of Board Date:

Void Report Date:

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.
Cvs es Lielving wing lnc{1), being first sworn, upon oath deposes and says:
On or about December 20\4, 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, 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

ah LAL, in the sum of $ 445,00 (3)
Signed: Z rs op (4)

(5) Subscribed and sworn to before me this ZU day of Februn cA 2024.
C T

NOTARY PUBLIC

My commission expires:
Lf{- {~ Ze

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

Warrant/Check Number ; _ ~
Original Date of Issue a
ane’ fknown) (7) \2\20|\2023
Reason for original issue of Warrant/Check (8):
1 Payroll
&X1 For Services or Goods furnished__Cross LiFe\ine Tai ving lnc.
OO Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice o } 3/ 1 1/ 4

Revised June 2015 ig

Trainin

\
oe
Calla Lifeline
, Inc.
— ‘_ i

March 7, 2024
Attn: Finance Desk
Re: Vendor Letter Request

Good Day!

As of this letter, Cross Lifeline Training Inc has not received payment for services
provided in October 2023, invoice CLT102305.

As per your request, | signed the paperwork to re-issue payment, and it was
notarized at the District Office.

! am the owner of Cross Lifeline Training, Inc.

Thank you,

Colleen Alexy

2/29/24, 10:48 AM VMware Horizon
Warrant (1 - meta) - Warrant number: 3700723377, Stopped
Warrant

|| |

|= 23
ait Warrant | Status | Print | Attachments
+
Maintain New Status | Setup | Attachments | ce _ re
3700723377
| a Warrant header
General Posting
Warrant number: 3700723377 Invoice:
Holden invoice date:
Issued cate: 12/20/2023 12:00:00 am Paid date:
Status: Stopped Bositive pay sent date: 12/21/2023 12:00.02 pm
Exception flags ti Agency details
Exception reason: None Agency voucher number: 6070
Queued for positive pay: 11 Agency claim number:
Agency low origi
Locked forreconcile: |_| Agency PO number:
Registered Agency sub fund:
Date registered!; Agency dept num:
No of days interest: 0
Annual interest rate: 0.00000
4 Warrant Lines |
. t
im Amount : Payee ; Account i

495,00 CROSS LIFELINE TRAINING INC Po

Id oe: fb Pl | eo | oj | Identification of the warrant

https;//horizon.maricopa.gov/portal/webclient/#/desklop 4/1