HomeMy WebLinkAbout*Other - GRIS (002)Form State of Washington
777,777Number
A19 -1A Invoice Voucher
1070 K3919
Health Care Authority
621 8th Avenue SE
Ven penal'
it f er
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,ijficate. 1 hereby certify under penalt�vf erjury that the items and totals listed herein are proper charges for materials, merchandise or services
Olympia, WA 98504
fulhis'.-tt t, 'jm*s'
goo f
ad t Milk tate of Washington, and th all/ goo furnished and/or services rendered have been provided without discrimination because of age, sex,
,�nod
tal st handi p, religion,
creed, arital st t -a or, national . 9 , handl religion, or Vietnam era or disabled veterans status.
_4 _%R6 77
Grant County
BY
(sign In ink)
840 E Plum St
Moses Lake, WA 98837
D 0_1
f (date)
TAX IDENTIFICATION NUMBER MONTH/YEAR OF SERVICE
RECEIVED BY DATE RECEIVED
**-**''1319 Jun -21
y.,
PqQPR"�AGTIVITYKAMCSAP -;�bF P. 2018
.tt-0-M K s6ft:_ �, ----pf dotal
0 m!s.MH
11,1 Admin
5
ON M NIMP I M_
'
1,965.08 581.62 169.37 976.51 1,349.89
21 Community -Based Coordination-Px Community -Based Process
Universal -indirect
i No 0,
5,042.47
22.5 Community Coalition Coordinator Community -Based Process
Universal -Direct
RN
0.00
22.5 Community Coalition Community -Based Process
Universal -Direct
0.00
" P.0 all
0.00
22.5.1 Community Coalition Coordinator- MLCommunity-Based Process
Universal -Direct
6,836.23 `-i
22.5.1 Community Coalition - ML Community -Based Process
Universal -Direct
2,858.04 }ti f
6,836,23
22.1.2 PAX -Good Behavior Game - ML- Program Startup Information Dissemination
Universal -indirect
6,220.06 &S, 5,697.11
2,858.04
22.2.1 Positive Action - ML Education
Universal -Direct
RW
11,917.17
22.2.1 Youth Empowerment - ML Education
Universal -Direct
250.000.00
22.1.2 Outreach & Education- ML Information Dissemination
Universal -indirect
652.99
250.00
22,1.2 Talk. They Hear You- ML Information Dissemination
Universal -indirect
652.99
22.1.2 Under The Influence Of You- ML0.00
Information Dissemination
Universal -Indirect
0-
R 6,
'
22.1.2 Character Strong - ML Information Dissemination
Universal -Indirect
0.00
22.1.2 You Can - MLInformation Dissemination
Universal-Indirect
0.00
22.6.2 Restorative Justice -ML Environmental
Universal -Indirect
0.00
22.6.2 Trauma -Informed Schools - ML Environmental
Universal -indirect
0.00
22.7.1 CooWorVConvmrdty Tralring - ML. &(Program Start-up Cost 2600) Other
Universal -Direct
7,538.22
0.00
22.7.1 Coordinator Professional Development- ML Other
Universal -Direct
-011
N N
7,538.22
22.2.1 Strengthening Families Program - ML -Start -Up Costs Education
Universal-Direct6,509.25.
�
0.00
22.5.1 Community Coalition Coordinator - Q Community -Based Process
Universal -Direct
2,239.55 2,097.60
6,509.25
22.5.1 Community Coalition - Q Community -Based Process
Universal -Direct
�g-IN,-6,111.68
17.50 19.47
10,448.83
22.2.1 Strengthening Families Program - Q Program Start-up Cost Education
Universal -Direct
1.901.17 7
36.97
22.2.1 SPORT PPW- Q- Program Start-up Costs Education
Universal -Direct
,4E 1,995.00
1,825.51
3,896.17
22.3.1 Healthy Alternatives - Q Alternatives
Universal -Direct
5,382.48
2,223.46
7,207.99
22.1.1 Youth Development- Q- Information Dissemination
Universal -Direct
---
2,223.46
22.1.2 You Can - Q Information Dissemination
Universal -indirect
0.00
22.1.2 Under The Influence Of You- Q Information Dissemination
Universal -Indirect
291.00
61.25
291.00
22.1.2 Rx Safe Disposal - Q - Information Dissemination
Universal -indirect
570.00
-02
631.25
Start
22.1.2 s With One- Q Information Dissemination
Universal -indirect
0.00
22.6.2 Drug Free Parks - Q Environmental
Universal-indlrect
0.00
22.6.2 QHS Disciplinary - Q Environmental
Universal -Indirect
0.00
22.7.1 Coalition/Community Training - Q- Other
Universal -Direct
0.00
22.7.1 Coordinator ProfessionaFDevelopment - 0 Other
Universal -Direct
0.00
22.6.2 Px Sustainability Policy - Q EnvironmentalUniversal-indirect
0.00
22.7.2 Community Education Workshops - Q- Other
Universal-Indirecthl�
u x
0.00
22.7,2 Community Education Workshops - Q- Supplies Other
Universal -indirect
300.00
300.00
0.00
0.00
0.00
0.00
R,
0.00
1M1' a
0.00
0.00
0.00
AT! -
7T, :,Wif-7 W"N g, 0.00
65;60. 1-.6
M58
PREPARED BY/ DATE TELEPHONE
Z20& 0 00,
Reyna Gonzales 8/0412021 509 764-2660
1
Effective 71119 through
A19 E dc6130121 'REVISED 1012020
CURR DOC NO DOC DATE
VENDOR NO. AGENCY APPROVAL:
I
SWV0002426-00 I Sarah Marian!, 360-725-9401, Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
R
E D
EE. %64
A 5 21
,3S 10NE-1 I Q
COUNTY COMMI`�'-;
2009-11 Biennium Contract Page 1 Rev 7-1-09