HomeMy WebLinkAbout*Other - GRISForm State of Washington
4 'N 0*antlb-, rtqn(r 09in ber
1070 K3919
a19 -1A Invoice Voucher
Health Care Authority
621 8th Avenue SE
Vendor's Certificate. hereby underpenalty ofp that the items and totals listed herein are proper charges for materials, merchandise or services
'�h;reb art! u
h
Olympia, WA 98504
of s
shingto I I d a,,
furnished to the Stat of Washington, that all goods rnl fed and/or s , ices rendered have been provided without discrimination because of age, sex,
marital status, race, eed, color, natio rlgln, handica , re lop, or Vie a era or disabled veterans status.
re 0 r
77 7E m. -,-:: 77 77
BY
Grant County
840 E Plum St
Psion in ink)
Cindy Carter, BOCC Clair 15-2-A
Moses Lake, WA 98837
(title) (date)
TAX IDENTIFICATION NUMBER MONTH/YEAR OF SERVICE
RECEIVED BY
DATE RECEIVED
Apr -21
s
'BAR PRoGRAmAivrMT-rKAME Cs" SmIrmy
10 M
P. 6 PF3 MA , , sok,
F 2018 CE, '_I� su
C �p .30K.,
.Total
11.1 ,Admin
387.39
681.68
434.86 0.00 461.76
21 Community -Based Coordination-Px Community -Based Process
Universal -Indirect
1,865.59
0.00
22.5 Community Coalition Coordinator Community -Based Process
Universal -Direct
0.00
22.5 Community Coalition Community -Based Process
UnIvmal-Direct
0.00
22,5.1 Community Codfien Coordinator- ML Community -Based Process
Universal -Direct
6,669.07
6,669.07
22.5.1 Community Coalition - ML Community -Based Process
Universal -Direct
541.78
541.78
22.1.2 PAX -Good Behavior Game - ML- Program Startup Information Dissemination
Universal -Indirect
0.00
22.2.1 Positive Action - ML Education
Universal -Direct
0.00
22.2.1 Youth Empowerment - ML- Start -Up Education
Universal -Direct
3,500.00
22.1.2 Outreach & Education- ML Information Dissemination
Universal -Indirect
3,600.00
0.00
22.1.2 Talk. They Hear You- ML Information Dissemination
Universal -Indirect
0.00
22.1.2 Under The Influence Of You- ML Information Dissemination
Universal -Indirect
0.00
22.1.2 Character Strong - ML Information Dissemination
Universal -Indirect
22.1.2 You Can - ML Information Dissemination
Universal -Indirect
0.00
0.00
22,6.2 Restorative Justice -ML Environmental
22.6.2 Trauma -Informed Schools - ML Environmental
Universal -Indirect
Universal -Indirect
0.00
0.00
22.7.1 Coalition/Community Training - ML- Other
Universal -Direct
0.00
0.00
22.7.1 Coordinator Professional Development- ML Other
Universal -Direct
22.2.1 Strengthening Families Program - ML Education
Universal -Direct
0.00
0.00
22.5.1 Comm6nity Coalition Coordinator - Q Community -Based Process
Universal -Direct
295.16
4,240.27
4,535.43
22.5.1 Community Coalition - Q Community -Based Process
Universal -Direct
4,328.72
4,328.72
22.2.1 Strengthening Families Program - Q Education
Universal -Direct
4,547.18
4,547.18
22,2.1 SPORT PPW- Q- Education
Universal -Direct
0.00
22.3.1 Healthy Alternatives - Q Alternatives
Universal -Direct
0.00
22.1.1 Youth Development- Q- Information Dissemination
Universal -Direct
0.00
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
0.00
22.1.2 Rx Safe Disposal -Q- Information DfsseminaUcn
Universal -Indirect
1,531.70
1,631.70
22.1.2 Starts With One- Q Information Dissemination
Universal -Indirect
0.00
.22.6.2 Drug Free Parks - Q Environmental
Universal -Indirect
0.00
22.6.2 QHS Disciplinary - Q Environmental
22.7.1 Coalition/Community Training - Q- Other
Universal -Indirect
Universal -Direct
0.00
0.00
22.7.1 Coordinator Professional Development- Q Other
Universal -Direct
115.00
115.00
22.6.2 Px Sustainability Policy - Q Environmental
Universal -Indirect
0.00
22.7.2 Community Education Workshops - Q- Startup Costs Other
Universal -Indirect
991.99
991 99
22.7.2 Community Education Workshops - Q- Supplies Other
Universal -Indirect
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
IM, I'l 'IM -1 M
0.00
_PREPARED
:581-58
0.00 0
0.06 --'b.00 70:60]:, 826,48
BY/ DATE
TELEPHONE
,6,233.73*
Reyna Gonzales 5/2712021
509 764-2660
A19 Effective 711119 through 6130121 REVISED 1012020
CURR DOC NO
DOC DATE
VENDOR NO.
AGENCY APPROVAL:
SWV0002426-00
Sarah Marlani, 360-725-9401, Sarah Marian i(Rhcama.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
r.
is c
i.
It v I I.
2009-11 Biennium Contract Page 1
Rev 7-1-09