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Home My WebLink AboutGrant Related - BOCC (003)GRANT COUNTY BOARD OF COUNTY COMMISSIONERS L1J1=i1_L�•� To: Board of County Commissioners From: Janice Flynn, Administrative Services Coordinator Data February 8, 2022 Re: SIP No. 2021-02 Reimbursement Request Attached is a signed Project Certification and reimbursement request for SIP Project #2021- 02: Grant County Hospital #1 — Samaritan Healthcare — Infrastructure Support for Replacement Public Hospital. The Hospital's received a grant in the amount of $50,000.00. The invoices submitted are dated prior to the effective date of the grant award on February 16, 2021, but appear to be for the designated project. I am requesting approval of this reimbursement to Grant County Hospital #1 in the amount of $50,000.00. Thank you', SAMARITAN EALTH CARE All of us, for each of you, every time. February 2, 2022 Grant County Strategic Infrastructure Project Attn: Administrative Services Coordinator PO Box 37 Ephrata, WA 98823 RE: Strategic Infrastructure Project Recommendation - SIP No. 2021-02 This letter is sent in response to the February 19, 2021 Award Letter issued to Samaritan Healthcare regarding Strategic Infrastructure Program funding. Included in this response is the following: (1) Project Certification Form signed (2) Invoices for project reimbursement up to $50,000 as follows: ._Samar_itan--Healthcare I-nvoc.e-Sumnlar_y_ — _-- --- --- _ _--- - -- _ -- Invoice No. Firm Focus Date Amount 1 DCI Engineers Design of the infrastructure for the new 12/12/2019 $175100.00 hospital 2 DCI Engineers Design of the infrastructure for the new 01/22/2020 $145250.00 hospital 3 DCI Engineers Design of the infrastructure for the new 02/13/2020 $115400.00 hospital 4 DCI Engineers Design of the infrastructure for the new 03/20/2020 $2,850.00 hospital 5 DCI Engineers Design of the infrastructure for the new 04/14/2020 $5,150.00 hospital TOTAL $50,750.00 Samaritan Hospital Samaritan Clinic on Pioneer Samaritan Clinic on Patton 801 E. Wheeler Road 1550 S. Pioneer Way 8420 Aspi Blvd Moses Lake, WA 98837 Moses Lake, WA 98837 Moses Lake, WA 98837 509.765.5606 509.793.9770 509.793.9781 Fax: 509.764.3236 Fax: 509.764.3246 Fax: 509.764.3281 SamaritanHealthcare.com GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved by Grant County, SIP Project Number: 2021-02 SIP Funding Recipient: Grant County Hospital District No 1, Samaritan Healthcare SIP Project Description: Infrastructure Support for Replacement Public Hospital I, the undersigned, do hereby certify under penalty of perjury, that the materials have been furnished, the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I am authorized to authenticate and certify to this claim. I also certify that this claim is just and due, and is an unpaid obligation against Grant County. Further, according to the SIP Project Funding Policies, I attest that at the next audit of my entity, this project shall be called to the attention of the Washington State Auditor's Office and an emphasis audit will be requested to assure that these funds were expended :toward the project and according to the intent of the proposal. o Signature 7h&reS,q1&111*yAA Printed Name OA100, Zo2-Z Date Signe Title Ch�e��xc�u�e Oor�r Printed Ti e Completed, signed original certification and invoice are to be mailed to: Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823 ATTACHMENT 4 December 12, 2019 Invoice No: 140583 Project 19042-0015.00 Samaritan Healthcare Moses Lake Civil Engineering Services ZGF Project Name: Samaritan Healthcare - Moses Lake Replacement Hospital ZGF Project Number: 524451 Erofe5,Sigj3g1 $Oryi 0- hrough November 30,.2019 Total Fee Total this Phase Total this Invoice 17olOO.00 $17,100.00 1 ;OOXT Invoices not disputed within 30 days are considered due and payable, A finance charge will be applied on accounts 30 days and older at a rate of 1 119 percent per month. We accept Visa and MasterCard (processing fee applies). Contract Percent Billed to Previously Current An nt melee Bifled- 004ed Date &0 1000 - Master Planning 95000.00 100.00 90000.00 9,000.00 0.00 1100 - Schematic Design 39,000.00 100.00 39lOOO-00 39,000.00 0.00 1200 - SEPA / Entitlements 15,000.00 0.00 0.00 0.00 0.00 2100 - Design Development 57,000.00 50.00 280500.00 11,400.00 17,100.00 3100 - Construction Documents 103,000.00 0.00 0.00 0.00 0.00 6100 - Construction,Ad ministration 57o0O0-00 0.00 0.00 0.00 0.00 Total Fee 280j000-00 76,50.0.00 59,400.00 17,100.00 Total Fee Total this Phase Total this Invoice 17olOO.00 $17,100.00 1 ;OOXT Invoices not disputed within 30 days are considered due and payable, A finance charge will be applied on accounts 30 days and older at a rate of 1 119 percent per month. We accept Visa and MasterCard (processing fee applies). Invoices not disputed within 30 days are considered due and payable. A finance charge will be applied on accounts 33 days and older at a rate of 1 1/2 percent per month. We accept Visa and MasterCard (processing fee applies). e t" 1 G I !'~'"l E 7= E -O R 818 Stewart Street, Ste 1000 Seattle, WA 98101 (P) 206-332-1900; (F) 208-332-1600 ZGF Architects 925 Fourth Ave Sutie 2400 Seattle, VILA 98105 January 22, 2020 Invoice No: 142307 Project 19042-0015.00 Samaritan Healthcare doses Lake Civil Engineering Services ZGF Project Name; Samaritan Healthcare .. Moses Lake Replacement Hospital ZGF Project Number: 524451 awksSional-Serylaa tht=cough Decernber �`8_.�1,.2019, Contract Percent Billed to Previously Current t oust---- --C-amplete- -----Dat%e milted ---13111-1e€ , - 1000 - Master Planning 91000.00 100.00 91000.00 91000.00 0.00 1100 W Schematic Design 39,000.00 100.00 39,000.00 39,000.00 0.00 1200 - SEPA / Entitlements 15,000.00 0.00 0.00 0.00 0.00 2100 - Design Development 57,000.00 75.00 420750.00 28,500.00 14,250.00 3100 _ Construction Documents 1030000.00 0.00 0.00 0.00 0.00 6100 - Construction Administration 57,000,00 0.00 0.00 0.00 0.00 Total Fee 280,000.00 40 90,750.00 78,504.00 14,250.00 Total Fee 140250.00 Total this phase $14,250.00 Total this Invoice f.a '14,,250.00 Invoices not disputed within 30 days are considered due and payable. A finance charge will be applied on accounts 33 days and older at a rate of 1 1/2 percent per month. We accept Visa and MasterCard (processing fee applies). i r 818 Stewart Street, Ste 1000 Seattle, WA 98101 (P) 206-332-1900; (F) 206-332-1600 ZGF Architects 925 Fourth Ave Sutie 2400 Seattle, WA 98105 February 13, 2020 Invoice No: 143072 Project 19042-0015-00 Samaritan Healthcare Moses Lake Civil Engineering Services ZGF Project Name: Samaritan Healthcare - Moses Lake Replacement Hospital ZGF Project Number: 524451 sl!o1lal Services -1 11 Februor Willing Phase 1000 - Master Planning 1100 - Schematic Design 1200 - SEPA / Entitlements 2100 - Design Development 3100 - Construction Documents 6100 - Construction Administration Total Fee Contract Percent Billed to Previously Current ----)VMPratt— ---- feteFate Billed - 90000.00 100.00 90000.00 91000.00 0.00 39,000-00 100.00 390000.00 39,000,00 0.00 150000.00 0.00 0.00 0.00 0.00 57,000-00 95.00 54,150.00 42,750-00 11 j400.00 103l000-00 0.00 0.00 0.00 0.00 57,000.00 0.00 0.00 0.00 0.00 280,000-00 A 102j150-00 90,750.00 11,400.00 Total Fee 11,400.00 Total this Phase $11,400.00 Total this Invoice$14►O: a Invoices not disputed within 30 days are considered due and payable. A finance charge will be applied on accounts 30 days and older at a rate of 1 1/2 percent per month. We accept Visa and MasterCard (processing fee applies). 818 Stewart Street, Ste 1000 Seattle, WA 98101 (P) 206-332-1900; (F) 206-332-1600 ZGF Architects 925 Fourth Ave Sutie 2400 Seattle, WA 98105 March 20, 2020 Invoice No: 144971 Project 19042-0015.00 Samaritan Healthcare Moses Lake Civil Engineering Services ZGF Project Name: Samaritan Healthcare - Moses Lake Replacement Hospital ZGF Project Number: 524451 Professional Services throu,q February 29, 2020 Fee Contract Percent Billed to Previously Current _81ilUng-Phase— ------Amount _—Complete- Date---- _131.11le-d—Rilled 1000 - Master Planning 91000.00 100.00 0,000.00 99000.00 0.00 1100 - Schematic Design 39oOOO.00 100.00 39sOOO.00 39,000.00 0.00 1200 - SEPA / Entitlements 15,000.00 0.00 0.00 0.00 0.00 2100 - Design Development 57p000.00 100.00 57,000.00 54,150.00 2,800.00 3100 - Construction Documents 103t000.00 0.00 0.00 0.00 0.00 6100 - Construction Administration 57lO00.00 0.00 0.00 0.00 0.00 Total Fee 280,000.00 105,000.00 102,150.00 2,850.00 Total Fee 21850.00 Total this Phase $2,850.00 Total this Invoice f"Oft 00 I Invoices not disputed within 30 days are considered due and payable. A finance charge will be applied on accounts 30 days and older at a rate of 1112 percent per month. We accept Visa and MasterCard (processing fee applies). 818 Stewart Street, Ste 1000 Seattle, WA 98101 (P) 206-332-1900; (F) 206-332-1600 ZGF Architects 925 Fourth Ave Sutle 2400 Seattle, WA 98105 April 14, 2020 Invoice No: 146436 Project 19042-0015.00 Samaritan Healthcare Moses Lake Civil Engineering Services ZGF Project Name: Samaritan Healthcare - Moses Lake Replacement Hospital ZGF Project Number: S24451 Professional. Services -through -April 4,2020 Fee —13fling-Phases 1000 - Master Planning 1100 - Schematic Design 1200 - SEPA I Entitlements 2100 - Design Development 3100 - Construction Documents 6100 - Construction Administration Total Fee Contract Percent Billed to Amount Compiete-- Date - 91000.00 100.00 90000.00 39y000.00 100.00 39oO00.00 15,000.00 0.00 0.00 570000.00 100.00 57pO00.00 103l400,00 5.00 51150.00 57s000.00 0.00 0.00 2800000.00 110,150.00 Total Fee Previously Current -- B-1110.01 - 131111led 91000.00 39,000.00 0.00 57,000.00 0.00 0.00 105,000.00 Total this Phase Total this Invoice 0.00 0.00 0.00 0.00 51150.00 0.00 5,150.00 51150.00 $5,150.00 Invoices not disputed within 30 days are considered due and payable. A finance charge will be applied on accounts 30 days and older at a rate of 11/2 percent per month. We accept Visa and MasterCard (processing fee applies).