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Home My WebLink AboutS_Check_Request_LUA14-000708_20221213AP 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 __________________________________________________ ________________________________________ Requestor’s Name Ext. Requestor’s Department/Division __________________________________________________ ________________________________________ Payable To Date _____________________ _______________________________________________________________________ Detailed Check Description Total Check Amount __________________________________________________________________________________________________ Address for Check City State Zip Please check all that apply: □Employee Reimbursement □Customer Refund □Wire/EFT Payments (If wire attach instructions) □Other _____________________________________________ 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 _______________________________________________________________________ _____________________ 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 EG00131885 1055 South Grady Way, Renton, WA 98057 Transaction Date: November 16, 2022 AR: Eden Invoice: DEPARTMENT: System Administrator BILLING CONTACT Bob (Robert) Wenzl Tuscany Construction LLC PO Box 6127 Bellevue, WA 98008 REFERENCE NUMBER PAYMENT METHODFEE NAME TRANSACTION TYPE AMOUNT PAID LUA14-000708 Refund Finance APENG - Special Deposit Refund $(569.18)650.000000.000.237.00.00.000 ($569.18) SUB TOTAL $(569.18) $(569.18)TOTAL Notes: Created By Date Note Stacy Tucker 11/16/2022 Per project manager, Brianne Bannwarth refund landscape cash surety Page 1 of 1Printed On: December 13, 2022 Prepared By: Stacy Tucker DEPARTMENTOFCOMMUNIWANDECONOMICDEVEWPMENTjr7TVoCASHSURETYDEPOSIT—APPLICANTNameandMailingAddress(pleaseprintclearly)MAINTENANCEASSURANCEName:RobertWenzlAddress.P0Box6127,Bellevue,WA98008Address2:PhoneNumberProjectNo./PermitNo.ProjectName1U1,14-000708/MairShortPlatCashSuretyDepositSiteLocation$569.1813606156thAveSETheCityofRenton(the“CITY”),herebyacknowledgesreceiptfromtheabove-namedAPPLICANT,whohaspaidthecashsuretydepositamountnotedabove.TheAPPLICANTherebyauthorizesthatthesumreferencedabovebekeptondepositwiththeCityofRentonFinanceDepartmentforthepurposeofguaranteeingthattheabove-referencedprojectwillbemaintainedinaccordancewiththeMaintenanceandDefectAgreementLttnclscapc,-Oitiii1tnance/altodtrij(“AGREEMENT”)fortheproject.THECONDITIONOFOBLIGATIONisthat:i.untilwrittenreleaseofthisobligationbytheCITY,thiscashfinancialguaranteemaynotbeterminatedorcancelledbytheAPPLICANTforanyreason.2.TheobligationsoftheAPPLICANTshallnotbedischargedoraffectedbyanyamendmentoftheengineeringplansusedforconstructionoftheproject.3.uponfailureoftheAPPLICANTtoperformanyofthetermsoftheAGREEMENT,theCITYmayusethefundstocompletetheworkandpayoutstandingfeesandotheramounts.TheAPPLICANTshallhavenodutyorrighttoevaluatethecorrectnessorappropriatenessoftheCITY’Sdeterminationthatrequirementshavenotbeensatisfactorilycompleted.Anyunexpendedfundsshallbereturnedtotheabove-namedAPPLICANTuponcompletion,totheCITY’Ssolesatisfaction,ofthetermsoftheAGREEMENT.4.TheAPPLICANT’Sobligationtoperformtheworkorpayfeesandotheramountsisnotlimitedtotheamountofthiscashsuretydeposit.,//APPLICANT:/7ItistheAPPLICANT’SresponsibilitytonotifytheCITYofanychangeinaddress,telephonenumberorchangeofownershipoftheproperty.ItistheAPPLICANT’Sresponsibilitytoarrangeforreplacementofany/allfinancialguaranteespriortoanychangeofownership.(Date)Page1o12Published:2/1/2018 CASHSURETYDEPOSIT-MAINTENANCEASSURANCE(CONT’D)IProjectNo/PermitNo.ProjectNameLUA14-000708/MairShortPlat(ChooseOne)INDIVIDUALACKNOWLEDGEMENT:StateofWashington1CountyofKing:/2—-2IcertifythatIknoworhaveseensatisfactoryevidencethat/ie/L—/1;Z(APPLICANT)signedthisinstrumentandacknowledgesittobehis/herfreeandvoluntaryactfortheusesandpurposesmentionedinthisinstrument.StaSaufWasNngtanrCowzW-QLKinw—IcertifythatIknoworhavesatisfactoryevidencethat).k1fl4fl’Cof____ ____ __-,aWashingtonlimitedliabilitycompany/corporation(APPLICANT),a&iThcknowledgedthisinstrumenttobethefreeandvoluntaryactanddeedofsaidlimitedliabilitycompany/corporation,fortheusesandpurposesthereinmentioned,andonoathstatedthathe/shewasauthorizedtoexecutethisinstrumentonbehalfofsaidlimitedliabilitycompany/corporation.(NotarySealorStamp)Dated:—c(i—______—_ _____ _____ _pp——n—Signature:_ _ _ _ _ _ ___ __ _______ _ _ _ __STEVEVU-——-INOnPub.:PrintedName:-MAppointn,entExpesMyappointmentexpires:-—-(‘42*2—O—-IDeclO2020-IReceivedfortheCityofRentonBy:(PrintName)(Signature)(Date)Page2of2PubIshed:2/1/2018 RECEIPTEG00085854—‘Renton01055SGradyWay,Renton,WA98057TransactionDate:March05,2018BILLINGCONTACTRobertWenzlP.O.Box6127Bellevue,WA98008REFERENCENUMBERFEENAMETRANSACTIONPAYMENTAMOUNTPAIDLUA14-000708ENG-SpecialDepositFeePaymentCreditCard$569.18650.000000.000.237.0O.0O.000$569ThSUBTOTAL$569.18TOTAL5569.16PrintedOn:March05,2018PreparedBy:LeshShermanPage1ofI