STAMPED & REDACTED - FOR AGENDA ATTACHMENT - TSA CONSULTING GROUP, 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: 02/14/2024

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

Liberty Dist #25 TSA Consulting Group, Inc 3700698148 | $3,800.00

Date

Amount

Reissue WT #

Office of the Maricopa County

School Superintendent

District Name / Number: Liberty Elementary School District #25 Attachments:

Contact Name: Addison Dunlap

Finance Desk
monn 20201016

Warrant Void/Stop Request

L] Original Warrant
Lost Warrant Affidavit (required for ALL reissues)

v¥ Vendor Letter {if requesting Vencer reissue)

Warrant Number Warrant Date | Amount Payee x aq o
(storting with "37") (mm/dd/yyyy) (as it eppears in Check Maneger} 2 2 3
3700698148! 10/2/2023|$ 3,800.00] TSA CONSULTING GROUP, INC |O @
©oUu
@©O0
OO
Notes:

District Approver: Retnfbrathhe.

Vendor has not received check. As of 01/11/2024 check has not been received or cashed.

Date: et {GY

For Internal Use Only

Clerk of 8card 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.
TSACG
I OA (1), being first sworn, upon oath deposes and says:

‘Name/Claimant

On or about ! o/ 02/2023 (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

warrant/check be Issued to him/her in the sum of $3, 800.00 3)
mare “< (4)

bed and sworh.to before me this __* ~ da of Racamloe 2004.
ol

om LESLIEW, STEVENSON

My commission expires: ‘ I “erm Mann 200

OF Bonded Thru Budge} Holary Services (seal)

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

Warrantfcheck Mumber | 310009 8148 = .

Original Date ofisue | 10/02/2023
Reason for original issue of Warrant/Check (8):
0 Payroll
pf For Services or Goods furnlshed__ —_
O Other:

2/15/2024

‘S:\PROCESSES\Warrants « Duplicate or Stale\02 Forms\Schoo ee
Revised June 2015

OMNI&TSACG

| Compliance Services Services

Cassandra Burris Gabrielle Mounts

CME Opt ee

By signing, this letter I certify that I am an authorized representative of the plan sponsor, and duly authorized to execute this letter
on behalf of the plan sponsor with respect to the 403(b) and/or 457(b) plan.

Please contact me if you have any questions,

Sincerely,

(ensckwnoot a

Lana K. Woodring
Sr. Vice President, Client Services

OMNI&TSACG

Compliance Services

To Whom It May Concern:

Please update the following individual(s) as authorized signers and contacts for U.S, OMNI & TSACG Compliance Services.
Further, please reflect this list of individuals as those from whom your office can take plan sponsor direction, grant access to plan
and participant information, and who are authorized to sign for these specific plans sponsored activities on behalf of our firm’s

clients;

= QDROs
® — Distributions

© Financial Hardship Withdrawal
© Required Minimum Distribution

© Cash Distribution
= Rollovers
= Contract Exchanges
= Loans

Brad Hope
Ala

Janet Williamson

A Gane WI ULErrear

Robert Ard
Kevin Hensley
b. Ve
<
Justin Rollins
Eric Miller
Beth Bish
“p> -
ae .
Denise Stouder
Alina Marquez

Ho fiers

Janis Boutin

a ae .

Vale ie Longshore

Tipe

Alisa Barrera

gt y

Lana Woodring

(ares,

Shelly Tibbs

Andrea Garner

Lian Lf Murra)

Rachelle Davis

Thomas Siren

(Homa AS

Kimberly Johnston

Ys Al

Luiberly Qebvator
Kimberly Porter

Jeannette Ament
f

Anna Tindell

Cnn ford é

tm,
—

OMNI&TSACG

Compliance Services

Alan Brents

Sherrie Taylor
SAT KA
Edith Torres
7
Krystyna Adantic

Pypupatynas Glare

Russell Clark

Susan Barnett

uaan Bait

Leslie Stevenson

Jennifer Santiago

Prom

Debra Watson

Walra. Work

Sandi Moors

Senda Mocs

Gary McCay
bun My “
Danielle Williams

Rob Perez

LOA SOE

Nicole Baxley

“Note UL Bad

Emilie Eusea

(a i

Eduardo t L De _
Glimeris Causit
~ >

(ACR

ae
Sadie Beck

1 :
Haleigh Ellis

‘Toni Shepard

Sou. Stapard

Stephanie Humpert

he LAW LLY Newmpek 7

‘Tamara Hoglen

Gace 4 tf

Roger Cooper

pox

Jennifer Maines

(pecs Magn

Laurah Rhodes

Curast Rod

Melissa Steinfeldt

7 Yalan A dtend, lath

118/24, 8:21 AM

|| Warrant |

ARivti | 48

Warrant (1 - mcto) - Warrant number: 3700698148, Stopped

tid Warrant | Status | Print | Attachments

VMware Horizon

__. Maintain |New | Status | Setup | Attachments - ——
3700698148
“, Warrant header —— —_
General Posting
Warrant number: 3700698148 invoice;
Holder: Invoice date:
Issued date: Paicl date:
Status: Stopped Positive pay sent clate:
Exception flag: l | Agency details
Exception reason: Mone

Queued for positive pay: | |

Locked for reconcile: ||
Registered

Date registered:

No of days interest: 0
Annual interest rate: 0.00000

Agency voucher number 1009
Agency claim number

Agency low orig:

Agency PO number

Agency sub fund:

Agency dept num:

4 Warrant Lines

Oo Amount | Payee
3,800.00 TSA CONSULTING GROUP, INC

Account

If oi. & Pl | “o | oy | Identification of the warrant

hitps://horizon.maricopa.gov/portal/webclient/#/desktop