Rahficationge FORM G EORG 31 FIN1510-01 For Accounts Payable Use Only Vendor Number CHECK REQUEST FORM 6 54636 Ch Use this form to arrange for payment to individuals or businesses when a Purchase Orderor P-card is not required. LaI This form must be submitted in typed format only.L- Vendor Information Vendor or Employee Name Date Department Name SAFEbuilt Georgia, LLC 2/24/2025 Planning and Development Ift therei is a Purchase Order issued for this expense, DO NOT USE THIS FORM. if S0, submit invoice with a copy of the PO. Mailing Address P.O. Box 88135 If payment is to a Vendor, is a W-9 on Chicago, IL 60680-1135 file in the Purchasing Office? If No, a completed W-9 MUST be Email Address attached. Email Shervondaell@rocktalecountygagoy in our AR@safebuilt. com Purchasing Division for a complete New Vendor Packet. RSSE EXPENSE/ACCOUNT DETAILS Description (fori individuals, Services, Date of General Ledger Account Expense Reimbursements) Service or Amount Invoice Fund Function Account Dept. SAFEbuilt Inspection Services October 10/31/2024 100 7410 521200 39 $17,736.95 SAFEbuilt Inspection Services November 11/30/2024 100 7410 521200 39 $16,285.76 SAFEbuilt Inspection Services - December 12/31/2024 100 7410 521200 39 $19,801.97 + Cenelal find BUDGETED (X) NOT BUDGETED ( ) Total Check Amount $53,824.68 DESCRIBE FULLY THE NATURE OF THE PAYMENT Professional services contract for inspections, plan review, and building official services. SIGNATURES/APPROVAIS Dept. Designee Date Chief Financial Officer/Designee Date Sas1bas Accoupting offiper Dête Senior Procurement Manager Date 1. &4 2 lo CH AECK HANDLING INSTRUCTIONS 5.Mail X 6.F Pick Up-Approval by CFO 7.5 Send Inter-Department Mail (Enclose attachmentsi ifr requiredi in letter size Available at the Finance Office Front Desk after Willl be placedi in mailbox after 2:00p p.m every Friday envelope) 2:00p pm every Friday Revised 1/17/25 Please send this form with attachments to the Department of Finance. Each check request received Monday-Friday will be processed the following Friday. 905-153 Page: 1 Invoice Invoice Number: 866550 - SAFEbuilt. Invoice Date: 10/31/2024 Terms: Net 30 Days Rockdale, GA, County of Due Date: 11/30/2024 958 Milstead Avenue Conyers, GA 30012 Customer #: 03-ROCKDAL Customer PO #: Stam Code Description Quantity Price Amount Building Inspection Building Inspection 147.50 $83.22 $12,274.95 10/8/2024 Building / Brian Gardiner 8.00 $83.22 $665.76 10/9/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/9/2024 - Building / Robert Coliom 5.00 $83.22 $416.10 10/10/2024 - Bullding / Robert Collom 5.00 $83.22 $416.10 10/11/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/3/2024 - Building / Robert Collom : 6 residential, 2 commercial 3.00 $83.22 $249.66 10/3/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/4/2024 - Building / Robert Collom : 10 residential, 1 4.00 $83.22 $332.88 commercial 10/4/2024 - Building / Brian Gardiner 4.00 $83,22 $332.88 e: 10/7/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 Eul 10/11/2024 - Building / Andrew Brumbalow 3.00 $83.22 $249.66 10/15/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/15/2024 - Building / Robert Collom : 13 residential, 5 6.00 $83.22 $499.32 commercial 10/16/2024 * Building / Robert Collom : 33 residential, 8 6.00 $83.22 $499.32 commercial 10/16/2024 * Building / Brian Gardiner 4.00 $83.22 $332.88 10/16/2024 M Multiple Licenses / Leandro Ruiz : 3909 Daniel's, 2.00 $83.22 $166.44 430 Birch, 3637 Cherry Creek 3030 & 3020 Edwards Dr 10/17/2024 - Building / Robert Collom : 31 residential 4.00 $83.22 $332.88 10/18/2024 - Building / Andrew Brumbalow 1.50 $83.22 $124.83 10/18/2024 - Building / Robert Collom : 33 residential, 4 4.00 $83.22 $332,88 Gommersial- 10/21/2024 - Building / Robert Collom : 28 residential 4.00 $83.22 $332.88 10/21/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/22/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/22/2024 - Building / Robert Collom : 42 residential 5.00 $83.22 $416.10 10/22/2024 - Multiple Licenses / Leandro Ruiz : 2971 Stone 1.00 $83.22 $83.22 Bridge, 701 Jefferson 10/23/2024 - Building / Robert Collom : 22 residential 4.00 $83.22 $332.88 10/24/2024 - Building / Robert Collom : 2 commercial, 16 6.00 $83.22 $499.32 residential 10/24/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 Rockdale, GA, County of Invoice Number: 866550 Invoice Date: 10/31/2024 Page: 2 Building inspection 10/25/2024 - Building / Robert Collom : 68 residential, 1 6.00 $83.22 $499.32 commercial 10/28/2024 - Building / Robert Collom : 18 residential 6.00 $83.22 $499.32 10/28/2024 - Bullding / Brian Gardiner 4.00 $83.22 $332.88 10/29/2024 - Building / Robert Collom : 31 residentlal 4.00 $83.22 $332.88 10/29/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/30/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 10/31/2024 - Building / Robert Collom : 17 residential 4.00 $83.22 $332,88 10/31/2024 * Building / Brian Gardiner 4.00 $83.22 $332.88 Plan Review Plan Review 50.00 $109.24 $5,462.00 10/10/2024 - Building / Brian Gardiner 6.00 $109.24 $655,44 10/11/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/1/2024 - Bullding / Brian Gardiner 8.00 $109.24 $873.92 10/2/2024 Building / Brian Gardiner 4.00 $109.24 $436.96 10/3/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/4/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/14/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/15/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/24/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 10/25/2024 - Building / Brian Gardiner 2.00 $109.24 $218.48 10/29/2024 - Bullding / Brian Gardiner 2.00 $109.24 $218.48 10/31/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 Please remit to: SAFEbuilt LLC Lockbox #88135 Net Invoice: $17,736.95 PO Box 88135, Chicago, IL 60680-1135 Freight: $0.00 444 N. Cleveland Ave, Ste 444/ /Loveland, CO 80537 Phone: (866) 977-4111/ Fax: IBImwiwEEeN Sales Tax: $0.00 Invoice Total: $17,736.95 Page: 1 Invoice Invoice Number: 975713 SAFEbuilt. invoice Date: 11/30/2024 Terms: Net 30 Days Rockdale, GA, County of Due Date: 12/30/2024 958 Milstead Avenue Conyers, GA 30012 Customer #: 03-ROCKDAL Customer PO #: Item Code Description Quantity Price Amount Bullding Inspection Building Inspection 136.00 $83.60 $11,369.96 11/1/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 11/1/2024 - Bullding / Robert Collom : 2 commercial, 5 residential 4.00 $83.22 $332.88 11/4/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 11/4/2024 m Building / Robert Collom : 32 residential 6.00 $83.22 $499.32 11/5/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 11/5/2024 - Building / Robert Collom : 12 residential, 4 6.00 $83.22 $499.32 commercial 11/6/2024 - Building / Robert Collom : 7 commercial, 18 6,00 $83.22 $499.32 residential 11/6/2024 - Multiple Licenses / Leandro Ruiz : 2800 Union 1.00 $83.22 $83.22 Church 11/7/2024 Building / Brian Gardiner 3.00 $83.22 $249.66 11/7/2024 - Building / Robert Collom : 47 residential 6.00 $83.22 $499.32 11/8/2024 - Building / Robert Collom : 2 commercial, 8 residential 6.00 $83.22 $499.32 11/8/2024 - Building / Brian Gardiner 3.00 $83.22 $249.66 11/12/2024 * Building / Brian Gardiner 4.00 $83.22 $332,88 11/12/2024 * Building / Robert Collom : 4 commercial, 6 6,00 $83.22 $499.32 residential 11/13/2024 - Building / Robert Collom : 1 commercial, 42 6.00 $83.22 $499.32 residential 11/14/2024 - Bullding / Robert Collom : 18 residential 2.00 $83.22 $166.44 11/15/2024 - Building / Robert Collom : 62 residential 6.00 $83.22 $499.32 11/18/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 11/19/2024 - Building / Robert Collom : 16 residential 6.00 $83.22 $499.32 11/19/2024 - Building/Brtan Gardiner 4.00 $83.22 $332.88 11/20/2024 - Building / Robert Collom : 50 residential 4.00 $83.22 $332.88 11/20/2024 - Building / Brian Gardiner 3.00 $83.22 $249.66 11/21/2024 - Building / Robert Collom : 70 residential 5.00 $83.22 $416.10 11/21/2024 - Building / Brian Gardiner 2.00 $83.22 $166.44 11/22/2024 - Building / Robert Collom : 35 residential, 1 5.00 $83.22 $416.10 commercial 11/22/2024 - Building / Brian Gardiner 4,00 $83.22 $332.88 11/25/2024 - Building / Brian Gardiner 3.00 $83.22 $249.66 Rockdale, GA, County of Invoice Number: 975713 Invoice Date: 11/30/2024 Page: 2 Building Inspection 11/25/2024 - Building / Robert Collom : 8 commercial, 43 3.00 $83.22 $249.66 residentlai 11/25/2024 - Multiple Licenses / Leandro Ruiz : 2221 1.00 $83.22 $83.22 BRIARWOOD CIRCLE 11/26/2024 - Building Official / Andrew Brumbalow 2.00 $109,24 $218.48 11/26/2024 - Bullding / Robert Collom : 46 residential, 4 4.00 $83.22 $332.88 commercial 11/26/2024 - Building / Brian Gardiner 3.00 $83.22 $249.66 11/27/2024 - Building / Robert Collom : 45 residential 5.00 $83.22 $416.10 11/27/2024 - Multiple Licenses / Leandro Ruiz : 38 LANDOLA 1.00 $83.22 $83.22 DR. Plan Review Plan Review 45.00 $109.24 $4,915.80 11/1/2024 - Building / Brian Gardiner 2.00 $109.24 $218.48 11/5/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 11/6/2024 - Building / Brian Gardiner 2.00 $109.24 $218.48 11/7/2024 - Building / Brian Gardiner 3.00 $109.24 $327.72 11/8/2024 - Building / Brian Gardiner 5.00 $109.24 $546.20 11/12/2024 Building / Brian Gardiner 4,00 $109.24 $436.96 11/13/2024 - Building / Brian Gardiner 4.00 $109,24 $436.96 11/19/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 11/21/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 11/22/2024 - Building / Brian Gardiner 4.00 $109,24 $436.96 11/26/2024 - Building / Brian Gardiner 5.00 $109.24 $546.20 11/27/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 Please remit to: SAFEbuilt LLC Lockbox #88135 Net Invoice: $16,285.76 PO Box 88135, Chicago, L 60680-1135 Freight: $0.00 444 N. Cleveland Ave, Ste 444/Loveland, CO 80537, / Phone: (866) 977-4111/Fax: 877120-2704/www.SAFEbui.com Sales Tax: $0.00 Invoice Total: $16,285.76 Page: 1 invoice Invoice Number: 1130810 SAFEbuilt. Invoice Date: 12/31/2024 Terms: Net 30 Days Rockdale, GA, County of Due Date: 1/30/2025 958 Milstead Avenue Conyers, GA 30012 Customer #: 03-ROCKDAL Customer PO #: tem Code Description Quantity Price Amount Building Inspection Building Inspection 166.50 $84.16 $14,012.25 Minimum per Day - BDS Building Official Date: 12/2/2024 - 1.00 $109.24 $109.24 Minimum: 2.00 Actual: 1.00 12/2/2024 - Building Officiai / Andrew Brumbalow 1.00 $109.24 $109,24 12/2/2024 Building / Brian Gardiner 4.00 $83.22 $332.88 12/2/2024 - Building / Robert Collom : 1 commercial, 30 8.00 $83.22 $665.76 residential 12/3/2024 - Building / Robert Collom : 29 residential 4.00 $83.22 $332.88 12/3/2024 Building / Brian Gardiner 4.00 $83.22 $332.88 12/4/2024 - Building / Robert Collom : 21 residential, 1 6,00 $83.22 $499.32 commercial 12/5/2024 - Building / Robert Collom : 1 commercial, 18 3.00 $83.22 $249.66 residential 12/5/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/5/2024 - Multiple Licenses / Leandro Ruiz : 1726 FARMER 2,00 $83.22 $166.44 RD., 2239 MCDANIEL MILL RD. 12/6/2024 - Building / Robert Collom : 22 residential, 1 5.00 $83.22 $416.10 commercial 12/9/2024 - Building Official / Andrew Brumbalow 2,00 $109.24 $218.48 12/9/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/9/2024 - Building / Robert Collom : 1 commercial 2.00 $83.22 $166.44 12/10/2024 - Building / Robert Collom : 34 residential 6.00 $83.22 $499.32 12/10/2024 - Building / Brian Gardiner 4.00 $83.22 $332,88 Minimum per Day BDS - Building Official Date: 12/11/2024 - 1.50 $109.24 $163.86 Minimum: 2.00 Actual: 0.50 1271172024 - Building Official7 Andrew Brumbalow 0.50 $109,24 $54.62 12/41/2024 Building" Robert Collom +58 residential; 4 -4:00 $83:22 $332.88 commercial 12/11/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/12/2024 - Building / Robert Collom : 1 commercial, 32 6.00 $83,22 $499.32 residential 12/12/2024 - Multiple Licenses / Leandro Ruiz : 3637 Cherry 1.00 $83.22 $83.22 Creek 12/13/2024 - Building / Robert Collom : 73 residential 6.00 $83.22 $499.32 12/16/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/16/2024 - Building / Robert Collom : 25 residential, 1 8.00 $83.22 $665.76 commercial 12/17/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 Rockdale, GA, County of Involce Number: Invoice Date: 12/31/2024 Page: 2 Building Inspection 12/17/2024 - Building / Robert Collom : 9 residential, 5 6.00 $83.22 $499.32 commercial 12/18/2024 - Building / Robert Collom : 30 residential 5.50 $83.22 $457.71 12/18/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/19/2024 - Building / Robert Collom : 39 residential, 5 5.00 $83.22 $416.10 commercial 12/19/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/20/2024 - Building / Robert Collom : 1 commercial, 30 3.00 $83.22 $249.66 residential 12/20/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/23/2024 - Building / Robert Collom : 4 commercial, 1 2.00 $83.22 $166.44 residential 12/26/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/26/2024 - Multiple Licenses / Leandro Ruiz : 2135 AVALON, 4.00 $83.22 $332.88 2051 HWY 138 12/27/2024 - Building / Brian Gardiner 8.00 $83.22 $665.76 12/27/2024 Multiple Licenses / Leandro Ruiz : 2264-2274 1.00 $83.22 $83.22 ASHTON DRIVE 12/30/2024 - Building / Robert Coliom : 1 commercial, 37 3.00 $83.22 $249.66 residential 12/30/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 12/31/2024 - Building / Robert Collom : 64 residential 6.00 $83.22 $499.32 12/31/2024 - Building / Brian Gardiner 4.00 $83.22 $332.88 Plan Review Plan Review 53.00 $109.24 $5,789.72 12/3/2024 - Building / Brian Gardiner 2.00 $109.24 $218.48 12/4/2024 Building / Brian Gardiner 4.00 $109.24 $436.96 12/5/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 12/6/2024 Building / Brian Gardiner 6.00 $109.24 $655.44 12/10/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 12/12/2024 - Building / Brian Gardiner 8.00 $109.24 $873.92 12/13/2024 - Building / Brian Gardiner 8.00 $109.24 $873.92 12/17/2024 - Building I Brian Gardiner 4.00 $109.24 $436.96 12/19/2024 - Building / Brian Gardiner 4.00 $109.24 $436.96 12/20/2024 - Building / Brian Gardiner 4.00 $109.24 $436,96 12/23/2024 - Building / Brian Gardiner 3.00 $109.24 $327.72 Mnimumperoay-BDSt Plan Review-Date: 12/31-/2024 1:00 $109.24- $109.24 Minimum: 2.00 Actual: 1.00 12/31/2024 - Building / Brian Gardiner 1.00 $109.24 $109.24 Please remit to: SAFEbuilt LLC Lockbox #88135 Net Invoice: $19,801.97 PO Box 88135, Chicago, IL 60680-1135 Freight: $0.00 444 N. Cleveland. Ave, Ste 444/Loveland, CO 80537 /Phone: (866) Sales 977-4111 / Fax: (877)203-2704 /www.SAFEbuil.com Tax: $0.00 Invoice Total: $19,801.97 Rockdale County BOC Check Number: 178798 To: SAFEBUILT GEORGIA LLC 54638 Date: 02/26/2025 Invoice Number Date Description PO Number Paid Amount 866550 10/31/2024 INSPECTION SVCS $17,736.95 975713 11/30/2024 INSPECTION SERVICES $16,285.76 1130810 12/31/2024 INSPECTION SERVICES $19,801,97 TOTALS: $53,824.68 Rockdale County BOG United Community Bank 178798 (770)2 278 -7555 1000 GA. Hwy 138 SE 061112843 POE BOX 289 Conyers, GA 30013 CONYERS, GA3 30012 Pay FATheeT Thousalndl ElghtHundred TwentyFour Ddlarst and 68 Cents. DATE AMOUNT to the Order of: Feb 26, 2025 $53,824.68 SAFEBUILT GEORGIA LLC LOCKBOX 88135 PO BOX 88135 CHICAGO, IL 60680-1135 Rockdale County BOC (770) 278 -7555 PO BOX 289 CONYERS, GA 30012 SAFEBUILT GEORGIA LLC LOCKBOX 88135 PO BOX 88135 CHICAGO, IL 60680-1135