HomeMy WebLinkAboutGrant Related - BOCC (006)GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
Memo
To: Board of County Commissioners
From: Janice Flynn, Administrative Services Coordinatorf>
Data June 24, 2021
Re: Authorization for Release of Funds, Dept of Commerce., CDBG PSG #20-
62210-005, Reimbursement #6, Subrecipient O/C Request #6
01C has requested reimbursement regarding the above -referenced grant in the amount
of $24,766.39 for May 2021 expenses. Their documentation is attached for review.
I am requesting the release of funds for payment to 01C in the amount of $24,766.39.
Thank you.
Dated. this day of
Board ®f Cotinty Colnini sioners
iUr.,;4
Grant County. Washington
App—riwe DlLa �_ro�ve. Abstain
Dist #I Dist #I Dist #1
Dist 42 Dist #i Dist #2
Dist #3 ..... .... Dist #3 Dist #3
J!_J!�! 2 2021
STATE OF WASHINGTON
DEPT OF COMMERCE
Al"m CDBG PROGRAM
110 BOX 42525
OLYMPIA, WA 98504-2525
COMMUNITY ACTION AGENCY SUBRECIPIENT;
CONTRACT NO:
OIC OF WASHINGTON 20-62210-005
815 FRUITVALE BLVD -REPORT PERIOD,.
`SAKI MA WA 98902 Maym21
REPOW]"NUMBER:
TOTAL AMOUNTREQUESTED THIS PERIOD:
2020 COMMUNITY DEVELOPMENTBLOCK. GRANT - PUBIAC SERVICES GRANTS
CERTIFICATION: I certify that (lie illforinalioll on 11lis 1101,111 is a
true and ficeill'afe report of tile cash sontils and 110 all reported
exnenditnres rip proiacrly
chargeable to tile referenced grow.
sigmalure:
--------------
Printed Name: -D
Title: Chief Financial Officer
Date: 6/21/2021
ro WASHINGTON NATE
---------
DEPARTMENT OF COMMERCE
AGENCY NUMBER _....
IDIS PROJECT NUMBER
Commerce Contrac1&mber
VOUCHE DISTRIBUTION
103
2-62210-005
�� ,r� ,,
-
_
AENCY NAM INSTRUCTION TO VENDOR OR CLAIMANT:
I i DEPARTMENT OF COMMERCE Submit this form la claim payment for materials, merchandise or services::
f AT i'N: CDI3G �hpw com late detail for each item.. _.
PO BOX 42525
p ifj
.<� OLYMPIA, WA 98504-2525 .Vendor's Certificate: I hereby certify under perjury that the Items and totals listed herein are
�t�
I proper charges for materials, merchandise or services furnished to the State of Washington,
� ctrl �a?i
and that all goods furnished andlor services rendered have been provided without
VENDOR OR CLAIMANT (Warrant is to be payable fie:)
discrimination because of age, sex, marital status race, creed, color, national origin,
r handicap, religion or Vietnam era or disabled veterans status.
Pi
,4
GRANT COUNT
i.
i PO BOX 37 B -..
EPHRATA, WA 9$823-0037
: pg9 (SIGN IN BL E INK
1
,
# 5
l"11
F. 3j{� f IG PERIOD: MAY, 202-1 _ (TITLE) (DATE)
i 14 Description QUANTITY AMOUNT
PREVIOUSLY AMOUNT REMAINING
BUDGETREQUESTED THIS INVOICE BALANCE
)5 Public Services
----------- --------
$117,184.00
81 ?855.74
24,766.39
_ $10,561.87
$0.90
'1.A, General Admin
3500.00
3,500.00
$0.00
$0.00
$0.00
$0.00
------------
$0.00
$0.00
TOTAL PAYMENT 40����
$12j$4.0Q
$85;�55 74
I� 766.39
Ev r . 4b W1 l 1 f Commerce
-
FED TAX 10 #PROGRAM APPROVAL (The Individualsigning this voucher warrants theyhave the auiharity to sign this voucher.) DATE
PRINTED NAME: Jeff Hinckle SIGNATURE:
AT _.. __ _
NO. REFERENCE DOC N0. __
FO __ VENDOR NUMBER
CLINRE�1'F DOC.
_ SIMV ## 0002420-03
ACCOUNT NO,
ASD NUMBER _ ,.... ._..... _
VENDOR MESSAGE
......__ ....._..
382x43
CDB #
(N `
SUB
TRANS
0
MASTER
SUB
SUB
GL ACCT
SUBSID
INVOICE
Co.DE..
D
INDEX..
011DBS
_
- AMOUNT
NUMe�R
620F0320
_
N
za- z21 -o0
SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT ----------------------- ------- ------ f -------- -- --------- - ------------
................
DATE . _...._- _ WARRANT TOTAL --
ACCOUNTING APPROVAL FOR PAYMENT
_
DATE