HomeMy WebLinkAboutS_Check_Request_Wetland_LUA16-000527_20230203AP Check Request Form
City of Renton ‐ Finance Department
1055 South Grady Way – 5th Floor
Renton, WA 98057
FinanceAP@rentonwa.gov
Instructions: This form is to be used for customer refunds, employee reimbursements, recording a payment made via Wire or EFT
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Requestor’s Name Ext. Requestor’s Department/Division
__________________________________________________ ________________________________________
Payable To Date
_____________________ _______________________________________________________________________
Detailed Check Description Total Check Amount
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Address for Check City State Zip
Please check all that apply:
□Employee Reimbursement
□Customer Refund
□Wire/EFT Payments (If wire attach instructions)
□Other
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Check handling instructions:
________________________________________________________
Emergency Check (outside normal check run)
Date Needed __________________________________
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
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Signature Printed Name Date
Finance Accounts Payable Team
Natalie Wissbrod, Accounting Asst. Casaundra Sauls, Accounting Asst.
(425) 430‐6919 (425) 430‐6930
nwissbrod@rentonwa.gov csauls@rentonwa.gov
Jen Hughes, Finance Manager
(425) 430‐6935
jhughes@rentonw.gova
Check Information
Type of Check Request
Account Numbers
Approver Authorization (Department Administrator, Director, or designee)
BILLING INVOICE EG00133075
1055 South Grady Way, Renton, WA 98057
Transaction Date: February 03, 2023
AR:
Eden Invoice:
DEPARTMENT: System Administrator
BILLING CONTACT
Jonathan Bartels
JK Monarch LLC
PO Box 188
Puyallup, WA 98371
REFERENCE NUMBER PAYMENT
METHODFEE NAME TRANSACTION
TYPE AMOUNT PAID
LUA16-000527 Refund Finance APENG - Special Deposit Refund
$(12,250.00)650.000000.000.237.00.00.000
($12,250.00)
SUB TOTAL $(12,250.00)
$(12,250.00)TOTAL
Page 1 of 1Printed On: February 03, 2023 Prepared By: Stacy Tucker
DEPARTMENTOFCOMMUNITYOFANDECONOMICDEVELOPMENT——“‘RentonRECEIPTFORCASHDEPOSITApplicant’sNameandAddressCHelanCreekLLCPERFORMANCEASSURANCEPCBox188PuyallupWA98188TOCITYOFRENTONProjectNo.(PR)/ConstructionPermitNo.fU)ProjectName08-067/U15005174ChelanCreekPUDCashDepositL...UAI527SiteLocation$12,250.00924ChelanAVETheCityofRenton,hereinaftercalledtheCITY,herebyacknowledgesreceiptfromtheabovenamedapplicant,hereinaftercalledAPPLICANT,oftheamountnotedabove.TheAPPLICANTherebyauthorizesthatthesumreferencedabovebekeptondepositwiththeCityofRentonFinanceDepartmentforthepurposeofguaranteeingthattheabove-referencedprojectwillbecompletedinaccordancewithapprovedplansandconditionsandapplicableCitystandardsnolaterthan_______________________________Theseimprovementsinclude,butarenotlimitedto:MaintenanceIMonitoringSeeattachedagreements$8,300.00LandscapeMaintenance$1,500.00PlantingIReplacementIRestorationTOTAL$9,800.00@125%$12,250.00THECONDITIONOFOBLIGATIONisthat:1.UntilwrittenreleaseofthisobligationbytheCITY,thiscashfinancialguaranteemaynotbeterminatedorcancelledbytheAPPLICANTforanyreason.2.TheobligationsoftheAPPLICANTshallnotbedischargedoraffectedbyanyamendmentoftheengineeringplansusedforconstructionoftheproject.3.UponfailureoftheAPPLICANTtoperformanyofthetermsoftheAGREEMENT,theCITYmayusethefundstocompletetheworkandpayoutstandingfeesandotheramounts.TheAPPLICANTshallhavenodutyorrighttoevaluatethecorrectnessorappropriatenessoftheCITY’Sdeterminationthatrequirementshavenotbeensatisfactorilycompleted.AnyunexpendedfundsshallbereturnedtothepartydesignatedbelowuponcompletionofthetermsoftheAgreement.4.TheAPPLICANT’Sobligationtoperformtheworkorpayfeesandotheramountsisnotlimitedtotheamountofthiscashdeposit.111/04/2016
ProjectNo.(PR)/ConstructionPermitNo.(U)ProjectName08-0677U15005174ChelanCreekPUDItistheAPPLICANT’SresponsibilitytonotifytheCITYofanychangeinaddress,telephonenumberorchangeofownershipoftheproperty.ItistheAPPLICANT’Sresponsibilitytoarrangeforreplacementofany/allfinancialguaranteespriortoanychangeofownership.APPLICANT:APPLICANTSMAILINGADDRESS:ChelanCreekLLCPCBox188PuyallupWA98371(PhoneNumber)StateofWashington,CountyofKingIcertifythatIknoworhaveseensatisfactoryevidencethatJb-%z—Lc(APPLICANT)signedthisinstrumentandacknowledgesittobehis/herfreeandvoluntaryactfortheusesandpurposesmentionedinthisinstrument.Dated:__
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_SignatureofNotaryPublic:Title:Myappointmente%ires:I.-t•t)UReceivedforCityofRentonByDateJbNkfl-(PrintName)(NotarySealorStampfor211/04/2016
CASLYWAtLkLock?SECUFTYFATUHESLtSTEOOgACKjDiCATENØTAMpERiNWQRCQPyjNQ:ColumbiaStateBank2100ChelanCreek,LLC34-827/1251PaBox188Puyallup,WA983719/8/2017CftyofRentonIizo.ooTwelveThousandTwoHundredFiftyand00/100**DOLLARSCityofRentoncashwetlandbondChelanCreek,LLC2100CityofRenton9/8/201712,250.00)ColumbiaBankcashwetlandbond12,250.00
RECEIPTEG00074629BILLINGCONTACTJonathanBartelsJKMonarchLLCPCBox188Puyallup,WA98371—“Renton01055SGradyWay,Renton,WA98057TransactionDate:September08,2077REFERENCENUMBERFEENAMELUA16-000527IENG-SpecialDepositTRANSACTIONPAYMENTAMOUNTPAIDTYPEMETHODSUBTOTALTOTAL14DU.UUPrintedOn:March07,2018PreparedBy:DianaHiattPage1of1