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Home My WebLink AboutGrant Related - BOCC (002)Ft 9fopeSource 700 E. Mountain View Ave Suite 501 Ellensburg,, WA 98926 Phone: 509-925-1448 Fax: 509-925-1204 HopeSource # of Days Description Post -Occupancy Rate [_r56N Current Expense 31 # of Days/ Month in Jan 22 25 Beds funded by Shelter Program $4,340.00 496 # of Bed nights from HMIS - Jan 22 $27,,776.00 Request for Payment $32,116.00 700 E. Mountain View Ave. Suite 501 Ellensburg, WA 98926 0 Phone (509) 925-1448 0 Fax (509) 925-1204 110 Pennsylvania Ave, Cle Elum, WA 98922 • Phone (509) 674-2375 • Fax (509) 674-5187 r r 5 j 1 f r i. i ftp t J ,C I.. 1'..} L '�`�,� �. ..�.. ,. '� ._ i. ..,i �'Y „"? .�.. � �.t�.��4 �f•4 .y $�6s�;.�.� ap�f ts,l.,Sl ws �s �,. cy; .�.'� �} v�-��. t a�.L� �� ,; �.i Form 19-1A VOUCHER DISTRIBUTION AGENCY Short Code Commerce Contract Number NUMBER CMS Invoice ID: DEPARMENT OF 1030 21-4610C-104 344538 COMMERCE VENDOR OR CLAIMANT (Warrant payable to:) INSTRUCTION TO VENDOR OR CLAIMANT: Grant County Board of Commission Submit this form to claim payment for materials, merchandise or PO BOX 37 services. Show complete detail for each item. EPHRATA, WA 98823-0037 Vendor's Certificate: The individual signing this voucher below warrants they have the authority to do so as authorized and on behalf Brittany Rang (Vendor Contact Person) of the entity identified in the Vendor/Claimant section. The individual signing below certifies under penalty perjury of 'u that the items and totals listed herein are proper charges for materials, merchandise or (509) 754-2011 ext 2937 (Vendor Contact Phone) services furnished to the State of Washington, and that all goods furnished and/or services ' ices rendered have been provided without brang@grantcountywa.gov discrimination because of age, sex, marital status, race, creed, color, (Vendor Contact Email) national origin, handicap, religion or Vietnam era or disabled veterans status. 08/01/20 - 06/30/23 ..._...ii. ,-x.._.i-._.._:i;..x:._>:R.. /.U.:';. /d.>. i,:]a.�S>. .l._../. N:i%.l:z. ✓.. r.,. ., ,._,. .. ,_moi __ i _-__ (Contract Period) Brittany Lutz (belutz) 3/8/2022 3:47:50 PM 01/31/22 (REPORT PERIOD) (SUBMITTED BY) (SUBMIT DATE) DESCRIPTION BUDGET REQUESTED EXPENDED TO AMOUNT THIS AWARD AMOUNT DATE INVOICE REMAINING Shelter Program APre- Occupancy - Unassigned $435,461.00 $.00 $435,460.63 $.00 $37 Shelter Program A Post - Occupancy Operations - $273,375.00 $32,116.00 $136,528.00 $.00 $136,847.00 Unassigned Non - Match Total: $708,836.00 $325116.00 $571,988.63 $.00 $136,847.37 PROGRAM APPROVAL - Date (The individual signing this voucher warrants they have the authority to sign this voucher.) DOC DATE CURRENT REFERENCE DOC NO. VENDOR NUMBER and SUFFIX DOC. NO. SWV0002426 03 ACCOUNT NO. ASD NUMBER VENDOR MESSAGE 190.001.00.7605.334042000 38753 TRANS REV MASTER SUB SUB MG MS GL ACCT SUB AMOUNT PROGRAM CODE CODE INDEX OBJ SUB SI® INDEX OBJ 465TO350 NZ 4610C 465TO450 NZ 4610C 465TO250 NZ 4610C READY to BATCH PREPARER DATE WARRANT TOTAL CREATED BY Brittany Lutz (belutz) DATE 3/8/2022 3:46:44 PM Form 19-1A VOUCHER DISTRIBUTION AGENCY Short Code Commerce Contract Number NUMBER CMS Invoice ID: DEPARMENT OF 1030 21-461 OC -104 344538 COMMERCE ® All Expenses under $1,000 Paid by U131 Paid by Organization Name Paid to - Type Paid to U131Organization Paid to Organization Name Paid to Org Type Expense Type Amount Subcontractor Total Sub Subcontractor Total Agencies 0 Agencies A, Clients Univ Programs P Enrollment Enrollments I Enrollments I Programs F Enrollment Reimbursable Amount Grant Cour HopeSourc 78A6AE94� HPGMLES 941456 2021-12-15 4576 31 1736 Grant Cour HopeSourc E8902OB6E HPGMLES 932740 2021-12-03 4576 31 1736 Grant Cour HopeSourc 37B8719EC HPGMLES 932742 2021-11-22 4576 31 1736 Grant Cour HopeSourc CEOF58720 HPGMLES 932742 2021-11-22 4576 31 1736 Grant Cour HopeSourc 90CC1AOCF HPGMLES 932742 2021-11-22 4576 31 1736 Grant Cour HopeSourc AIMC457f HPGMLES 932742 2021-11-22 4576 31 1736 Grant Cour HopeSourc 809511F85 HPGMLES 932331 2021-11-12 4576 31 1736 Grant Cour HopeSourc 5CE37D69; HPGMLES 932331 2021-11-12 4576 31 1736 Grant Cour HopeSourc 28D5E8E1E HPGMLES 932331 2021-11-12 4576 31 1736 Grant Cour HopeSourc 66BB016BE HPGMLES 926970 2021-11-09 4576 31 1736 Grant Cour HopeSourc 2AO5383 F4 HPGMLES 926970 2021-11-09 4576 31 1736 Grant Cour HopeSourc 3001FA1CC HPGMLES 918461 2021-10-12 4576 31 1736 Grant Cour HopeSourc 9816EF98F HPGMLES 918328 2021-10-08 4576 31 1736 Grant Cour HopeSourc B720373AS HPGMLES 911796 2021-09-10 4576 31 1736 Grant Cour HopeSourc AC20E871S HPGMLES 906938 2021-08-23 4576 31 1736 Grant Cour HopeSourc 533E47CO4 HPGMLES 905882 2021-08-13 4576 31 1736 boLAY N11S o e-�' COMPLETE GREEN CELLS Number of beds in shelter HMIS project prior to bed Number of beds funded by inventory added by Shelter Count of bed nights Shelter Program Grant Program Grant I Days in Month from HMIS report 25 ;; Maximum operating amount that can be billed to Shelter Program Grant (bed nights of new beds funded by grant plus up to Vacancy Rate 10% vacancy rate) 36% $ 32,116 TOTAL I 496 $ 32,116