L * FORM EORGIA 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 required. This form must be submitted intyped format only. Vendor Information Vendor or Employee Name Date Department Name City of Conyers 5/7/2025 Public Relations If there is a Purchase Order issued for this expense, DO NOT USE THIS FORM. Ifs so, submit invoice with a copy of the PO. Mailing Address City of Conyers, c/o. Jennifer Edwards If payment is to a Vendor, is a W-9 on 901 O'Kelly Street, SE file in the Purchasing Office? Conyers, GA 30012 If No, a completed W-9 MUST be Email Address attached. Email Shervondaells@rockdalecountygagov in our lestoneseA Purchasing Division for a complete New Vendor Packet. Shervondaeli@rockdalerountypagoy EXPENSE/ACCOUNT DETAILS Description (for individuals, Services, Date of General Ledger Account Expense Reimbursements) Service or Amount Invoice Fund Function Account Dept. Co-Sponsorship of Red, White and' Boom 4/21/2025 100 1570 531100 10 $25,000.00 2025 OAE Rek 1nd BUDGETED (x) NOT BUDGETED () ) Total Check Amount $25,000.00 DESCRIBE FULLY THE NATURE OF THE PAYMENT SIGNATURIS/APPROVAIS . Dept. Designee Date Chief Financial Officer/Degigi e Date 5 X CLA - / Ons 5,4.25 Acçounting Officer Datey Senior Prpcurement Manager Date Mad 5/9/ 25 AANR relss 518/25 CHECK HANDLING INSTRUCTIONS 5. Mail 6. Pick Up-Approval by CFO 7.5 Send Inter-Department Mail (Enclose attachments ifr requiredi in letter size Available at the Finance Office Front Desk after Will be placed 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. 207,2077 City of Conyers 901 O'Kelly Street SE, Conyers, GA 30012 Phone 770-483-4411 CITY OF CONYERS INVOICE NO. 1003 DATE 4/21/25 BILL TO INSTRUCTIONS Rockdale County Remit to: City of Conyers, cio Jennifer Edwards 958 Milstead Avenue NE 901 O'Kelly Street, SE, Conyers, GA 30012 Conyers, GA 30012 Attention: Sue Sanders QUANTITY DESCRIPTION UNIT PRICE TOTAL Co-Sponsorship of Red, White and Boom 1 $25,000.00 $25,000.00 2025 SUBTOTAL $25,000.00 TOTAL DUE BY DATE 5/20/25 $25,000.00