STAMPED & REDACTED - FOR AGENDA ATTACHMENT - SAFE SITE, LLC.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: 02/26/2024

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

Isaac Dist #5 Safe Site LLC 3700706229 | $4,320.00

= MCESA Stop/Cancel/Void F
School District Esaae Schoof Pot Matieops Conny ep/Lance Ol orm

cS: Education Service Agency Attachments: J~ Original Warrant
District #: - f , © affidavit

{7 Void Report

Voucher Number | @UORG 5057 I~ Other

Fund meee wee wumber Amount Warrant Date System Generated Warrant# Payee
loot [[aalooeay [W350 00 [lope Bas [s70070eBaa — [Sade Site LOT
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Reason for Stop, Cancel or Void: check here ifto be reissued by MCESA

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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.

Sate Sife LI] . C (1), being first sworn, upon oath deposes and says:

On or about [O [96 [303.3 _ (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 ofiperjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/chéck be issued to him/her in the sum of $. { ri 3 20 : oO (3)
Signed: SW be (4)

(5) a bovoey to before me this _|{gT day of Tins 2024 ,
aan |

NovARY PUBLIC =” eae aca, =
Notary Public State of Arizona

Maricopa County

wparalyn Ann eraidva0a
Commission Nu

My co! ion expires:
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Loz] (seal)

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

Warrant/Check Number | 27. 007106 IQ

Original Date of Issue

(if known) (7) lo We I9023

Reason for original issue of Warrant/Check (8):
yroll
For Services or Goods furnished

O Other:

SAAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\School
Revised June 2015. “ ° 2/26/24

“THE PROFESSIONAL CHOICE”

To whom it may concern,

I, Tim Story, the owner of Safe Site Utility Services, LLC, verify that Sarah Bruno is an authorized
representative and was allowed to sign the affidavit.

‘Thank you,

a

Tim Story
President & CEO

Ph: ox:

AZ-ROC211956 NV-0078575

2/16/24, 10:56 AM
Warrant (1 - mcto) - Warrant number: 3700706229, Stopped
| Warrant |

bait Warrant | Status | Print | Attachments

VMware Horizon

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Maintain New Status | Setup | Attachments
3700706229
"4s Warrant header —_ 7
General Posting
Warrant number: 370706229 Invoice:
Holder: Invoice date;
Issued date: 10/26/2023 12:00:00 am Paid date:
Status: Stopped Positive pay sent date; 10/26/2023 09:00:13 am
meter flag: ld Agency details
i son:
ception rea on None Agency voucher number, 5057
Queued for positive pay: |} Agency clainy number:
Agency low orig:
Locked forreconcite; | | Agency PO numben
Registered Agency sub fund:
Date reyistereds Agency dept num: |
No of days interest: 0
Annual interest rate! 0.00000
4 Warrant Lines
O Amount : Payee Account

4,320.00 KC LOCATELLC

lq qo b& bl | we | P) | identification of the warrant

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