FORM GEORGIA FIN1510-01 For Accounts Payable Use Only Vendor Number CHECK REQUEST FORM - Use this form to arrange for payment to individuals or businesses when a Purchase Order or P-card is not'rèquired. This form must be submitted in typed format only. a Vendor Information A Vendor or Employee Name Date Department Name Envelopes & Forms, Inc / Surebill 4/17/2025 Ift there is a Purchase Order issued for this expense, DO NOT USE THIS FORM. If 50, submit invoice with a copy of the PO. Mailing Address 2505 Meadowbrook PKWY IF payment is to a Vendor, is a W-9 on Duluth, GA 30096 filei in the Purchasing Office? If No, a completed W-9 MUSTI be Email Address attached. Email Shervonda.ells@rockdalecountygagoy in our oacsasmon Purchasing Division for a complete New Vendor Packet. Shervondp.eliserocklalecoumypoy EXPENSE/ACCOUNT DETAILS Description (for individuals, Services, Date of General Ledger. Account Expense Reimbursements) Service or Amount Invoice Fund Function Account Dept. Mailing service of Notice of Assessments 3/5/2025 100 1550 523200 08 $24,482.80 BUDGETED (x- - NOT BUDGETED ( ) Total Check. Amount $24,482.80 DESCRIBE FULLY THE NATURE OF THE PAYMENT Setup and Mailing of 39,000 Notices of Assesments to all property owners within the county SIGNATURES/APPROVAIS Dept, Designee, Date Chief Financial Officer/Designee Date 2 4/17/2025 well lws4 Q o) Accoynting, Officer Date Senior Procurement Manager Date Ciboyd 441825 CHECKI HANDLING INSTRUCTIONS 5.Mail 6. Pick Up-Approval by CFO 7.5 Send Inter-Department Mail (Enclose attachments ifr required in letter size Available at the Finance Office Front Desk after Will be placedi in mailbox after 2:00 p.m every Friday envelope) 2:00 pme 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. Ar-20A Envelopes & Forms incSurebll-Postage INVOICE 2505 Meadowbrook Pkwy Invoice Number: 10188P Duluth, GA 30096 USA Invoice Date: Apr 17, 2025 Page: 1 Voice: (770) 623-5140 Fax: (770) 623-5141 BITO 1* Ship, to: S : ROCKDALE BOARD OF ASSESSORS ROCKDALE BOARD OF ASSESSORS ATTNWILL BARKLEY ATTN:WILL BARKLEY PO BOX 562 PO BOX 562 CONYERS,GA 30012 CONYERS,GA 30012 CustomerID Customer PO Payment Terms ROCKDALE BOARD OF Net Due Sales Rep ID Shipping Method Ship, Date Due Date US Mail 4/17/25 Quantity Description 28 UnitPrice Amount 38,800.00 POSTAGE 0.63100 24,482.80 As we move into 2025 we wil need update Subtotal 24,482.80 Resale certificates, tax exempt certificates Sales Tax and W'9's, Please remit with with yournext Freight payment or send directly via email to Tma@epew.bmean Thank Total Invoice Amount 24,482.80 you foryour continued business. Payment/Credit Applied TOTAL 3 - 24,482,80 Check/Credit Memo No: