DISTRIBUTED - - 2263 35 2024' FORM ORGI FIN1510-01 For Accounts Payable Use Only Vendor Number CHECK REQUEST FORM 6280 Use this form to arrange for payment to individuals or businesses when a Purchase Order or P-card is not required. This form must be submitted in typed format only. Vendor Information Vendor or Employee Name Date: 02/20/2025 Department Name Water Resources Core & Main Ift there is a Purchase Order issued for this expense, DO NOT USE THIS FORM. If sO, submit invoice with a copy of the PO. Mailing Address P.O. Box 28330 If payment is to a Vendor, is a W-9 on St. Louis, , MO 63146 file in the Purchasing Office? If No, a completed W-9 MUST be Email Address attached. Email Shervonda.elis@rockialecountypagov in our Purchasing Division for a complete New Vendor Packet. Shervondaelis@rocktalecountypagoy EXPENSE/ACCOUNT DETAILS Description (for individuals, Services, Date of General Ledger Account Expense Reimbursements) Service or Amount Invoice Fund Function Account Dept. 3/4x60 soft copper K tubing V297659 505 4440 531100 44 $10,062.00 1x60 soft copper K1 tubing 505 4440 531100 44 $12,708.00 walp à teupese ws &l BUDGETED (V ) NOT BUDGETED ( / Total Check Amount $22,770.00 DESCRIBE FULLY THE NATURE OF THE PAYMENT 3/4 x60 and 1x60 Soft Copper K tubing used to connect and repair water service lines SGNATURIS/APPOVAES Dept. Designee Date 02/21/2025 Chief Financial Officer/Designee Date - 2-25 UAAm 303085 Accounting Officek Date Senior Procurement Manager Date I 2125 - E G. GsVuL 22625 CHECK HANDLING INSTRUCTIONS 5.Mail 6.Pick Up-Approval by CFO 7. Send Inter-Department Mail (Enclose attachments if required in letter size Available ati the Finance Office Front Desk after Will be placedi in mailbox after 2:00p p.m every Friday envelope) 2:00 pm every Friday Revised/17/25 - 2.26.6 22/ 25 g Please send this form with attachments to the Department of Financê! ach sheck request received Monday-Friday will be processed the following Friday. p05-191 Invoice # V297659 CORE&I MAIN Invoice Date 12/05/24 INVOICE Account # 162540 Sales Rep CONYERS HOUSE Phone # 770-860-9988 Branch # 153 Conyers, GA 1830 Craig Park Court Total Amount Due $22,770.00 St. Louis, MO 63146 Remit To: CORE & MAIN LP PO BOX 28330 ST. LOUIS, MO 63146 92SP0.970 E0009 0067D13722803256: S21 P10597790 0008:0009 lMMIe Shipped to: ROCKDALE COUNTY WATER & ENV SV 2420 TATUM RD NE CONYERS GA 30013-1218 CUSTOMER PICK-UP - Thank you for the opportunity to serve you! We appreciate your prompt payment. Date Ordered Date Shipped Customer PO # Job Name Job # Bill of Lading Shipped Via Invoice # 7/22/24 8/09/24 JEREMY WILL CALL V297659 Quantity Product Code Description Ordered Shipped BIO Price UM Extended Price 08107S060K 3/4X60 SOFT K COPPER IMP 1800 1800 5.59000 FT 10,062.00 PER FOOT 08110S060K 1X60 SOFT K COPPER TUBE IMP 1800 1800 7.06000 FT 12,708.00 PER FOOT e Manage billing online e Reprint invoices Retrieve proof of deliveries Online Be suspicious of emails requesting Wire transfers or paymentsto Core & Mainusing updated remittance ADVANTAGE information. For tips about how to identify bad actors, visit aNwas.aA Freight Delivery Handling Restock Misc. Subtotal: 22,770.00 Other: 0.00 Tax: 0.00 Terms: NET30 Ordered By: JEREMYS STEELE Invoice Total: $22,770.00 This transaction is governed by and subject to CORE & MAIN's standard terms and conditions, which are incorporated by reference and accepted. To review these terms and conditions, please visit: htps.lIcoreandmain.comlerms-olsale. 0008:0009 Page 1 of 1