REDACTED - FOR AGENDA ATTACHMENT - ASU-SIRC SOUTHWEST INTERDISCIPLINARY.PDF

MAR COPA.
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9" Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 8.17.23

Subject: Affidavit — ASU SIRC-Southwest Interdisciplinary

Maricopa.gov

Please find attached one Affidavit for a stale dated to be included on the next
available Board Agenda.

e The attached itern has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

e The original warrant is presumed lost.

Please call Marcia Bulanda at 506-7291 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: STALE DATED - FUND 232 — D640 TRANSPORTATION — |.N. 22*33493 -TEO59 LOOP
107 MOBILITY PROJECT - ASU MODELING TASK

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form

This application is for: Cl Duplicate or [A stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA : numbers on the Instruction sheet which is

page 2 of this form. .
ASU SIRC-SOUTHWEST INTERDISGIPLINARY (1) being first sworn, upon oath deposes and says:
Name/Claimant

On or about 01-Feb-2022 (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 ahd owing, and the applicant requests that a replacement

warrant/check be issued to hip/her in the sum of $9,230.76 (3)

fut. ipo ;

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

Signed:

(5) Subscribed and sworn to before me this x day of Avus7 20 23,

DEIRDRE EGAl
Gstery Public - State of Arizon®
NOTARY PUBLIC Eommiesicn 6 set0r8
My commnisgion expires: ,
/ of G/249 (seal)

Warrant/Check Number 13949498824

(if known) (6)

Original Date of Issue
(if known) (7) 01-Feb-2022

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

C2 For Services or Goods furnished

[] Treasurer's refund/payment
Other: STALE DATED -D640 TRANSPORTATION - FUND 232 - TE059 LOOP 101 MOBILITY PROJECT - ASU MODELING TASK

county exrensewarrant - TREASURER OF MARICOPA COUNTY — WARRANT NUMBER

PHOENIX, ARIZONA 3010108824
DATE
94-2224
Five Thousand Two Hundred Thirty And 76/160 Dollars
$5,230.76
neu TO THE ORDER OF AMOUNT
SIRC - SOUTHWEST INTERDISCIPLINARY
Void After
365 Days

For Questions - 602-506-1379 or emnil AP@MAIL MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE,

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

VERE RE
VOR RECORDS

ASU 3010108824 02/01/2022 $5,230.76
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
C|-0061594 ci-0061594 PDI3 D640 220000003553 | 220000020228 5,230.76

| Knowledge
Enterprise

Arizona State University

Maricopa County Office of Budget and Finance
Attn: Marcia Bulanda

301 W. Jefferson St, 9% Floor

Phoenix, AZ 85003

August 16, 2023

RE: Returned Affidavit for Stale Dated Warrant 3010108824 - $5,230.76 (ASU Invoice Cl-
0061594)

Hello Marcia,
This is response to your request for authorization. Please accept this letter as
authorization for Brandon Wildemann to sign the affidavit in your possession. Thank you

for working with us on this matter.

If you have any questions or concerns regarding this matter, please contact me at

ames Obenour
Grant & Contract Officer, Sr.
Cash Management Team Lead

Post Award Services/Fiscal Oversight

Signature: JAMES ObGnOUr

James Gbenausr (Atig 26, 2023 14:22 PBT)

Email: james.cbenour@asu.edu

Knowledge Enterprise Research Operations
686 S. Mill Avenue, Tempe, AZ 85281
htipsiresearchadmin.asu.edufl

‘Knowledge
Enterprise
Arizona State University

Maricopa County Office of Budget and Finance
Attn: Marcia Bulanda

301 W. Jefferson St, 9 Floor

Phoenix, AZ 85003

August 3, 2023

RE: Returned Affidavit for Stale Dated Warrant 3010108824 - $5,230.76 (ASU Invoice CI-
0061594)

———-Hello Marcia: 7

Enclosed is the affidavit that you asked us to complete and return to you. Thank you for
working with us on this matter. I would like to ask if your finance team would please send
the duplicate warrant to the following address to ensure that we receive the warrant and
are able to deposit in a timely manner.

Arizona State University

Research Operations, Fiscal Oversight
Attn: Cash Management

P.O, Box 876011

Tempe, AZ 85287-6011

If you have any questions or concerns regarding this matter, please contact me at

ames Obenour
Grant & Contract Officer, Sr.
Cash Management Team Lead
Post Award Services/Fiscal Oversight

Knowledge Enterprise Research Operations
660 8, Mil Avenue, Tempe, AZ 86284
hitps:researchadmin.asu.edul