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Form• State of Washington
Sr
1070 K3919
A19 -1A Invoice Voucher
r%Ks
Health Care Authority
621 8th Avenue SE
Vend ,ate. I hereby certify under penal j * u that the items and totals listed herein are proper charges for materials, merchandise or services
fefrurrn%s�headl
Olympia, WA 98504
fur, shed to a of shingtor an all goo
tat and/or services rendered have been provided without discrimination because of age, sex,
nation , ,
tal statu ace, sed, olor, net,! hanc i religion, or Vietnam era or disabled veterans status.
ic
Grant County
840 E Plum St
BY
J (sign In ink)
Cindy i6artei-,ClairMoses
Lake, WA 98837t
0 r 2,oZl
(date)
TAX IDENTIFICATION NUMBER MONTHNEAR OF SERVICE RECEIVED BY
DATE RECEIVED
1319 May -21
BAR? 24 A dmi _01
R Ag"TTW a. OX", 7 4R; VA
:SO
A,;; "74 EM,
NC ;R��,AQRSijo
Kti
11.1 Admin 368.01 581.58 362.21
247.28 619.10
2,178.18
21 Community�Based Coordination-Px Community -Based Process Universal-Indirect.cy
-g � ------
$121_ ISO N 816.1t , gg -
0.00
22.5 Community Coalition Coordinator Community -Based Process Universal -Direct
22,5 Community Coalition Community -Based Process Universal -Direct
PRO ag
0,00
W 0.00
e.r.A
R � 0-1-0
22.5.1 Community Coalition Coordinator- MLCommunity-Based Process Universal -Direct 4,961.87
.
22.5.1 Community Coalition - ML Community -Based Process Universal -Direct 1,331,61
777���
4,961.87
22.1.2 PAX -Good Behavior Game - ML- Program Startup Information Dissemination Universal -Indirect
RUN=
1,331.61
0.00
22.2,1 Positive Action - ML Education Universal -Direct
i-11
SIMON
22.2.1 Youth Empowerment - ML Education Universal -Direct 336.73
0.00
0.00
336.73
22.1.2 Outreach & Education- ML Information Dissemination Universal -Indirect 2,386.28
22.1.2 Talk. They Hear You- ML Information Dissemination Universal -Indirect
2,386.28
0.00
22.1,2 Under The Influence Of You- ML Information Dissemination Universal -Indirect
22.1.2 Character Strong - MLInformation Dissemination Universal -Indirect
- 0.00
0.00
22.1.2 you Can - ML Information Dissemination Universal -Indirect
Restorative Justice
0.00
22.6.2 -ML Environmental Universal -Indirect
0.00
22.6.2 Trauma -informed Schools - ML Environmental Universal -Indirect
0.00
22.7.1 Coalition/Community Training - ML- Other Universal -Direct 2,877.90
2,877.90
22.7.1 Coordinator Professional Development - ML Other Universal -Direct
NMI,
22.2.1 Strengthening Families Program - ML Education Universal -Direct
Ago= 3,090.97
0.00
22.5.1 Community Coalition Coordinator - Q Community -Based Process Universal -Direct
-
Y 4,227.63 3,527.72
3,090.97
7,755.35
22.5.1 Community Coalition - Q Community -Based Process Universal -Direct 1,288.66
Strengthening Families Program
1,288.66
22.2,11 - Q Education Universal -Direct 3,311.45
2,276.30
5,587.75
22.2.1 SPORT PPW_Q_ Education Universal -Direct
1,685.88
1,685,88
22.3.1 Healthy Alternatives - Q Alternatives UnIversal-Direct
201.25
201.25
22.1.1 Youth Development -Q- Information Dissemination Universal -Direct
0.00
22.1.2 You Can - Q Information Dissemination Universal -Indirect
47.62
22.1.2 Under The Influence Of You- Q Information Dissemination Universal -Indirect
IN -1-1
47.62
0.00
22.1.2 Rx Safe Disposal - Q - Information Dissemination Universal-Indirect0.00
22.1.2 Starts With One- Q Information Dissemination Universal -Indirect
Drug Free Parks - Q
0.00
22.6.2 Environmental Universal -Indirect
22.6.2 QHS Disciplinary - QEnvironmental Universal -Indirect
0.00
0.00.
22.7.1 CoalitiontCommunity Training - Q- Other Universal -Direct
300.00
300.00
22.7.1 Coordinator Professional Development - Q Other Universal -Direct
glum -
0.00
22.6.2 Px Sustainability Policy - Q Environmental Universal -Indirect
22.7.2 Community Education Workshops - Q Other Universal -Indirect
0.00
22.7.2 Community Education Workshops - Q- Other Universal -Indirect
0.00
0.00
0.00
0.00
0.00
0.00.
':*`r
0.00
0.00
NAM
0.00
....... .....
0.00
090 O.W
PREPARED BY/ DATE TELEPHONE
Reyna Gonzales 7/1912021 509 764-2660
'Al 9 Effective q6130121 ective 711119 thr66REVISED 1012010
CURB DOC NO
DOC DATE VENDOR NO.
AGENCY APPROVAL:
SWV0002426-00
Sarah Mariani, 360-725-9401, Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
V
U j
21 Pi, L I �i 1 V' U 101
ANITC01 P
M M IS -3 S 10 NE R, E)
2009-11 Biennium Contract Page 1