HomeMy WebLinkAboutS_Check_Request_Cash_Bond_CH1347_LUA14-000241_20230407AP Check Request Form
City of Renton - Finance Department
1055 South Grady Way – 5th Floor
Renton, WA 98057
FinanceAP@rentonwa.gov
Instructions: Use this form for all payment requests including: employee reimbursements, customer refunds, or recording wire or EFT payments
__________________________________________________ ________________________________________
Requestor’s Name Ext. Requestor’s Department/Division
_____________ ___________________________________________________ _____________________
Vendor # Payable To Date
_______________________________________________________________________ _____________________
Check Description Total Check Amount
__________________________________________________________________________________________________
Address for Check City State Zip
Employee Reimbursement
Customer Refund
Wire/EFT Payments (If wire attach instructions)
Wire/EFT Date _______________________
Other ________________________________
Notes/Comments/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
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
Signature Printed Name Date
Check Information
Type of Check Request
Account Numbers (GL format: xxx.xxxxxx.xxx.xxx.xx.xx.xxx)
Approver Authorization (Department Administrator, Director, or designee)
PrintImagesPageIofIU.S.BankConfidentialCommunicationRequestedby:RachealWilliamsLibank.Thischeckimagecontainsconfidentialinformation.Ifyouprintthisimage,pleasestoreitinasecureplacetoavoidunauthorizedusageofthisinformation.Increasedsecurityawarenesswhendiscardingordestroyingthisdocumentisrecommended.A1b8c0rtACIILIC96m5E36ksssin,tID!MacnIdaid,WA98040206.53https://image.us.bank-dns.com/imageIJSP/ReponXI.jsp8/3/2018Item#1AccountNo.:1000263705CheckNo.:SequenceNo.:008358012573Amount:$30346.50RoutinqNo.:12510008Date:08/16/2016Front:Back:WnçInntntBank1347-Sçoü,*A3S2lO.1-1’•-‘;t’’fri.?.r”r-
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SandraPedersenrFrom:SeanHollingsworth\ent:Wednesday,August01,201811:48AMTD:SandraPedersenSubject:SpecialDepositsFundAttachments:TR1S-07-021.pdf;InvoiceRequest-AlbacoreACHLLC,EnclaveatBridleRidgeHammerhead.pdfHeySandy,HerearethetwodocumentsIhaveformovingthe$30,346.50outofthecustodialaccountandintothespecialdepositsfund.Pleaseletmeknowifthisisenoughdocumentationforyourrecords.Thankyou,SeanHollingsworthFinanceAnalystICityofRenton(425)4306953.1
CashTransfrrflDisbursementQJournalEntrvQYcar3OtaPrr}od‘OneUII/1otatOPRnNMOVEINV0cE;32241TOSPECIeSDEPOSITEUT4D.Avat,:TrailsSICepo,ltrd55034650withtIreCitytorrenovaletaIctnoorawbanoterheadin2016,nowngIhIBnow,I1mmtheCEDCLM0dI*IAccounttoDescriptiontliesoi,iiaiiI,,p0141fordWPACAMOUNTREPTYPEACCOUNTNUMBERACCOUNTDESCRIPTiONPRotECTACCOUNTINGLINEDESCRiPTIONDEBITCREDITBO®.QO..237.33.OO.OOOECONOMICDTVELOPMEPITCUSTODIALACCOUNTMoonSno,cei4fl4130340SOB65o.0.I.33,..miO0oCUSTODIALACCOUNTSSPECIALDEPOSITSUpoirInvoice04334330.34650(IC3L34f5330,34130(ITOhi-paredBySeas,IcILrqtind,thIo:y30.20(1
bsdetl.rptGILTrialBalanceDetailReportPage:17130120182:14:26PMPeriods:SthroughaCityorRantenSf112016through813112016060GENERALBeginningflDflUAccountNumberBalanceCubit,CreditsDebit,CreditsSalancaLiabilities237.23.00000ECONOMICDEVELOPMENTCUSTODIALAt33147.54CR0.0000002532.59124.6121344,14754CR8112/2016ar-receiptRC0I-0310130346.50LineDescription:0mitc42237DocumentDescription‘PMT422478/3112016genimat033E16’DS.OOO527.79LineDoscsipt:on:2016-00EASTSIDEElSREVEARNEDocumentDescnption2036.08EASTSIDEEISREVENUEEAI237.23.00CODECONOMICDEVELOPMENTCUSTODIALAI44.14754CR527.7930346.5063,DGD.3O155.1586373.06625CRTotalLIabilities43147.54CR5277931)346.5083,060.38155,1586373.966,25CR•TotalLIabilIties44,137.54CR527.79303465083,06038155.1586373.96625CRTotalGENERAL34.41,54CR52119303465083,06(138155.1586373.968,25CRFundNortoBalancePage:1
.INVOICEREQUESTCityofRentonFinanceDepartmentDateAugust9,2016FromDepartmentCEDCustomerNumberAccountNameAuthorization(Name&:::iaAlbacoreACHLLC%JDeptContact/PhoneoriginalInvoiceCreditMemoDebitMemoForInvoice:JudithSubiax6575InvoiceTitleEnclaveatBridleRidgeHammerheadDescriptionEnclaveatBridgeRidgeFeeforremovalandrestorationofthetemporaryhammerheadatAmount••.‘.237.23..$30,346.50AccountDistributionWorkOrder/FunctionAmount$30,345.50INVOICETOTAL$30,346.50Comments:Please5endanelectroniccopyofinvoicetoJudithAddress:AlbacoreACHLLCAttn:JustinLagers9675SE36thSt,Ste105MercerIsland,WA98040Phone:206-588-1147,253-405-5587SendcompletedformandallbackuptoAccountsReceivable,SandyPedersen,ASD.ext.6859
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Z5CustodialAccounttobeusedicrthefulureremovaloftheHammerhead..SE1/4SECTION14,TOHWSHIP23N,RANGESE,WA1THEENCLAVEATBRIDLERIDGE(ParcelID14023059122&1423059023,at14038156thAveSI.(14204156thAveSE)adjacentparcel1423059013—III!I—---H-
BMEBIGMOUNTAINENTERPRISES,LLCPCBox1001Enumclaw,WA98022Phone:(360)886-5286Fax:(360)886-5287Enclave6_16_15HammerheadRemoval&InstallQuantityUnit$PriceUnit$TotalMobelizatlon115$1,200.00IS$1,200.00Sawcutting45I.ES5,00LF5225.00MassE&Export115$3,500.0015$3500.00RemoveCurb235LF$6,00LF$1,410.00DemoADARamps2EA$450.00EA900.00DemoAsphalt1[5$950.0015$950.00Sidewakw/Prep500SF$4.25SF$2,125.00Curb&Gutterw/Prep115LE$22.00I.E$2,530.00AsphaltPrep1320SF$0.55SF$726.00AsphaltPrepw/6’Rccl1320SF$1.30SF$1,716.00Asphalt4”HMA147SY$22.00EA$3,234.00Plantersw/Sod700SF$2.45EA$1,715.00GrandTotal$20,231.00c1jfJcSOtCec%Oitit&a°,,3ix.1S=-