HomeMy WebLinkAboutGrant Related - BOCC (003)I
GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
Memo MAY - 3 2022
.... ....... J
To: Board of County Commissioners
From Janice Flynn, Administrative Services Coordinator
Dam April 22, 2022
Re: Authorization for Release of BOCC Approved Funds, Requests #6-8,
SIP #2021-01- GC Hospital #4 — McKay Healthcare, Phase 1 Capital
Improvement Plan
McKay Healthcare has certified the requirements for release of funds in the above -
referenced SIP project, which was approved by the BOCC pursuant to Resolution
No. 21 -013 -CC dated February 16, 2021. The proof of requirements is in the form
of a signed Project Certification form from the Hospital and supporting invoicing of
the project that meets the requested amount.
To that end, I am requesting the release of funds on this SIP project as follows:
(1) 6th -8th installments of the grant award in the amount of Ten
Thousand Four Hundred Twenty Four and 93/100 Dollars
($10,424.93) to McKay Healthcare.
Note: The full grant amount is $350,000. This leaves a balance of $316,156.75.
Thank you.
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
PROJECT CERTIFICATION
This form must be signed and returned, with an invoice, for the approved funding,
before reimbursement can be approved by Grant County.
SIP Project Proposal Number:
SIP Funding Recipient
SIP Project Description
SIP2021-01
McKay Hospital & Rehab
Phase 1 Capital Improvement Plan
1, the undersigned, do hereby certify under penalty of perjury, that the materials have
been furnished, the services rendered, and/or the labor performed as described in the
project proposal for the' above -referenced SIP Project and that I am authorized to
authenticate and certify to this claim. I also certify that this claim of $1,960.86 is just and
due and is an unpaid obligation against Grant County.
Further, according to the SIP Project Funding Policies, I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's
Office and an emphasis audit will be requested to assure that these funds were expended
toward the proje t and ing to the intent of the proposal.
Si na Title
�A �e r
Printed Name
Li•1l•ZZ
Date Signed
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement # 6 in the amount of $1,960.86
ATTACHMENT 4
MCKAY HEALTHCARE
owl 02/10/2022 91571
vv
Invoice Number
Invoice Date
Gross Amount
Discount Taken
Net Amount Paid
3026
—Description
01/26/2022 Admin - PS - SIP Grant
$1,960.86
$0.00
$1,960.86
$1,960.861
$0.001$1,960.86
McKAY HEALTHCARE QVbank. - 96-671 415
127 SECOND AVE SW - PO BOX 819 1232
SOAP LAKE, WA 98851 6041091571
(509) 246-1111
91571 02/102022 $1,960.86
One Thousand Nine Hundred Sixty Dollars and 86 Cents
PAY PCI
To THE 400 S Jefferson, Ste 301 BY
ORDER OF Spokane, WA 99204
BY
AVTHOR f fQ FIE M'
u@604091571on i:L232067L01: L536073695300
,i
.f.../
z
U kdn_qM�CElectlicalcyndElectronICs
ZZSystem Design
I.Grant County] mcKayHeamcareGeneMor.I.Foolacemerit-..
. 3 202
Nate ..-Rdb` 0b
Revised oescnpvon of WOM
11.1 pw
Reimbuirsables
$653.62 $
ffQ'IfIl". �- W�l Man :'•V
Odor
oath
[Design Trip #3 (10/12121) $ 653.62 100% 653.62 100% is C'- , 100%
--653,6-2
Design Trip #4 (1119122) $ 653.62 0.00 100% Is loc)%
CA Trip #1 $ 893.62 - 0.00 Is - 0%
CA Trip #2 $ 893.62 0.00 $ - 00/0
Utility Coordination $ 1.101.121 0.001 $ - - M/0
IL&I Permit Fees $ 920.00 0.00 $ - 0%
ITotal ReimWrsables $ 6.422.84 $ 653-62 $ 1,960.86 $
Pre�nou
$0.00 $
920.00
Total
3.808,36
tem*
MIMS' 6VWd
1
Wirihi % tUrrentTO B1H
Bred
:; Total MM
I
Design Development
S
5,503-99
100%
5,503.89
100%
100%
$5,503.89 $
2
65% Construction Documents
$
8,255.83
100%
8,255.83
100% $
100%
$9,255.83 $
-
3
100% Construction Documents
$
9,478.93.
95%
9,004.981
95% $
9S%
$9,00498 $
473.95
4
gid Phase
$
611.S4
0.00l
$
0%
$0.00 $
611.54
5
Construction Administration
$
6,115.43
0.00
$
0%
$0.00 $
6,125.43
61Prnied
Owe out
$
611.54
0.00
09/4
$0.00's
611.54
11.1 pw
Reimbuirsables
$653.62 $
ffQ'IfIl". �- W�l Man :'•V
Design Trip #1 (4128/21) $ 653.62 0.00 100% $ 653.62 100%
Design Trip #2 (6fl4/21) $ 653.62 0.00 100% Is 653.62 100%
[Design Trip #3 (10/12121) $ 653.62 100% 653.62 100% is C'- , 100%
--653,6-2
Design Trip #4 (1119122) $ 653.62 0.00 100% Is loc)%
CA Trip #1 $ 893.62 - 0.00 Is - 0%
CA Trip #2 $ 893.62 0.00 $ - 00/0
Utility Coordination $ 1.101.121 0.001 $ - - M/0
IL&I Permit Fees $ 920.00 0.00 $ - 0%
ITotal ReimWrsables $ 6.422.84 $ 653-62 $ 1,960.86 $
CONTRACT TOTAL.
Change Wem. -
C -M 0.001
Pro
M000-00
$653.62 $
$653.62 $
$653.62 $
$653-82 $
-
$0.00 $
893.62
$0.00 $
893.62
$0.00 $
1,101.12
$0.00 $
920.00
2,614.48 $
3.808,36
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
PROJECT CERTIFICATION
This form must be signed and returned, with an invoice, for the approved funding,
before reimbursement can be approved by Grant County.
SIP Project Proposal Number:
SIP Funding Recipient
SIP Project Description
SIP2021-01
McKay Hospital & Rehab
Phase 1 Capital Improvement Plan
I, the undersigned, do hereby certify under penalty of perjury, that the materials have
been furnished, the services rendered, and/or the labor performed as described in the
project proposal for the above -referenced SIP Project and that I am authorized to
authenticate and certify to this claim. I also certify that this claim of $473.95 is just and
due and is an unpaid obligation against Grant County.
Further, according to the SIP Project Funding Policies, I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's
Office and an emphasis audit will be requested to assure that these funds were expended
toward the projec and a g to the intent of the proposal.
Signature Title
Printed ame
Date Signed
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement # 7 in the amount of $473.95
ATTACHMENT 4
MCKAY HEALTHCARE
f1IY 1
03/11/2022 91658
JVI
invoice Number
Invoice Date
Description
Gross Amount
Discount Taken
Net Amount Paid
3039
02/28/2022
Admin - PS - Other SIP Grant
73.95
0.00
$473.95
473.95
$0.
$473.25
McKAY HEALTHCARE CMbank. 971 415
1232
127 SECOND AVE SW - PO BOX 819
SOAP LAKE, WA 98851 6041091658
(509)246-1111
Four Hundred Seventy Three Dollars and 95 Cents
PAY PCI
TOTE 400 S Jefferson, Ste 301
ORDER OF Spokane, WA 99204
91658 03/11/2022 $473.95
BY Ar
BY AUTHORIZED SIGNATURE Ar
v6041091658►i' 1:1 2 3 206 7 101: 15360738953011'
Pip,
�� Penne[1 l andtt ectr Inc.
Eiectrlcal and Hectronlcs
�� System Design
400 South Jefferson, Suite 301
Spokane, WA 99204
Public Hospital District #4
of Grant County WA
PO Box 819
Soap Lake, WA 98851
Attn: Erica Gaertner
Invoice
I' Date •
2/28/2022 3039
FAR 0 � Nit,
11Y• ...............
renneu con=agLng Inc-
ffi
Electrical and Electronics r- P,
ar;re,rSystem Deslggn
Kewsea mescwtion v1 rrvric
1 Design Development
$
5,503.89
100%
5,503.89
100%
$ -
100%
$5,503.89"
2 65% Construction Documents
$
8,255.83
100%
8,255.83
100%
$ -
100%
$8,255.83 $
-
3 100% Construction Documents
$
9,478.93
95%
9,004.98
100%
$ 473.95
100%
$9,478.93 $
-
$
611.54
0.00
$ -
0%
$0.00 $
611.54
4 Bid Phase
$ -
0%
$0.00.$
6,115.43
5 Construction Administration
$
6,115.43
0.00
6 Project Close Out
$
611.54
0.00
S -
0%
$0.00 $
611.54
Reimbursables
Design Trip #1 (4/28/21)
$
653.62
100%
653.62
100%
S -
100%
$653.62 $
-
Design Trip #2 (6/14121)
$
653.62
100%
653.62
100°%
$ -
100%
$653.62 $
-
Design Trip #3 (10/12/21)
$
653.62
100%
653.62
100%
$ -
100%
$653.62 $
-
Design Trip #4 (1/19122)
$
653.62
100°%
653.62
100°%
$ -
100°%
$653.62 $
-
$
893.62
0.00
$ -
0°%
$0.00 $
893.62
CA Trip #1
0.00
$ -
0%
$0.00 $
893.62
CA Trip #2
$
893.62
Utility Coordination
$
1,101.12
0.00
$ -
0%
$0.00 $
1,101.12
L81 Permit Fees
$
920.00
0.00
$ -
00/0
$0.00 $
920.00
Total Reimbursables
$
6,422.84
$ 2,61448
$
61 8
3,808. 36
t.': s• :._.:r ,'.,,.A:,`. . ,. t :.t": ..::
..;. . ,<{. ., %j/..,...,. �.': ti? :,',.. }..,,, ,i'- i "�v 't77i:
Z , rL��0.73 )J,.�.��
t � 1
d68i'
Change Orders:
0.00
$ -
0%
$0 00 $
-
CO#1
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
PROJECT CERTIFICATION
This form must be signed and returned, with an invoice, for the approved funding,
before reimbursement can be approved by Grant County.
SIP Project Proposal Number:
SIP Funding Recipient
SIP Project Description
SIP2021-01
McKay Hospital & Rehab
Phase 1 Capital Improvement Plan
I, the undersigned, do hereby certify under penalty of perjury, that the materials have
been furnished, the services rendered, and/or the labor performed as described in the
project proposal for the above -referenced SIP Project and that I am authorized to
authenticate and certify to this claim. I also certify that this claim of $7,990.12 is just and
due and is an unpaid obligation against Grant County.
Further, according to the SIP Project Funding Policies, I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's
Office and an emp asis audit will be requested to assure that these funds were expended
toward the projected a r m to the intent of the proposal.
Signature
Erica Gaertner
Printed Name
LI ,) � . Z_6 z- 2
Date Signed
Administrator
Title
A[k & 111 (-
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement # 8 in the amount of $7.990.12
ATTACHMENT 4
MCKAY HEALTHCARE
04/13/2022 91738
JV
invoice Number
Invoice Date Descri on
Gross Amount
Discount Taken
Net Amount Paid
3054
03/28/2022 Admin -PS -Other (SIP Grant)
$7,990.12
0.00
$7,990.12
$7,990.121
$0.00
7,990.12
1 415-67
t�bank. I 96
MCKAY HEALTHCARE 6-67
;27 SECOND AVE SW - PO BOX 8191932
196041091738
,.
SOAP LAKE, WA 98851
(509) 246-1111
e
91738 04/13/2022 $7,990.12
Seven Thousand Nine Hundred Ninety Dollars and 12 Cents
f
PAY PCI
MTHE 400 S Jefferson, Ste 301 a,
WIDER OF Spokane, WA 99204
BY
e6041091738'I' 1:1232067101: 15360738953011'
a
Pennell
Heti on INnr Inc.
Wpm. !C
Flece cO an nElecfronlcs
400 South Jefferson, Suite 301
Spokane, WA 99204
Public Hospital District #4
of Grant County WA
PO Box 819
Soap Lake, WA 98851
Attn: Erica Gaertner
Invoice
InvoiceDate
3/28/2022 3054 7
RECEIVED MAR 312021
Client Account # .. n. .•
2021.13 McKay Healthcare Generator Rplcmt
Description
Quantity
Rate
Amount
Pre-bid Walk through @ 100%
893.62
920.00
893.62
920.00
L&I Permit Fees
Department of Health Fees
1.1
5,615.00
6,176.50
Vendor #: �--- AmOu
Bars Name 0 W SLD
r
rte.
—��C• IZ
iotat.
pprOVBi:
Dep Head
Please contact Cindy Merrick with questions at (509) 747-1888, or
To#al $7,990.12
cindy.merrick@pennellconsulting-com
fflm VPerer,:ea Consultin9�E7ecM -ofandElecfiOMcS
J `�Csystem Design
/Y �,�y ... .._:..:...�y� t_:..:: ;>;;;t�•L::,;��,,{{, ��:+;.:,y:,y�:,:,:�Y., ,.�;'�: y,� �j�py�i ]ny.� ��,,�y y� .:.r:ntY,
k7i�l��i�, t'' Hk7:7A4 ,il�b{�I�IYi?11181 MC�%••iedit W7Ql1VFy'�f\C i�tie
S2yYu
BiHitlui## 15t�i' ,�?R6ii f .)dbNi�ixlb�r� ;, C
HeWSeQ Vescrrpvvrr VJ vrv�n
.�.'.
1 ` �y _ r .) iitafan+retei
.i'otdt Wl
, r z '3�rel+�du • ,} r, `Brtled ` total efiie+d ' Wr`�jset�
li�r�'� ;;' Desc�Ip�ftlw of 1�11otCc -,� 8udjfet , �'9t :. r P t�reirfou� B1il�d .Current % Curif,E�ttt iE,�-(sill .. .
1 Design Development $ 5,503.89 100% 5,503.89 100% $ 100% $5,503.89 $
2 65% Construction Documents $ 8,255.83 100% 8,255.83 100% $ - 100% $8,255.83 $ -
3 100% Construction Documents
$ 9,478.93
100%
9,478.93 100%
$ -
100%
$9,478.93 $ -
$ 611.54
0.00
$ -
0%
$0.00 $ 611.54
4Bid Phase
$ 6,115.43
0.00
$ -
0%
$0.00 $ 6,115.43
5 Construction Administration
$ 611.54
0.00
$ -
0%
$0.00 $ 611.54
6 Project Close Out
Reimbursables
Design Trip #1 (4/28/21)
$ 653.62
100%
653.62 100%
$ -
100%
$653.62 $ "
Design Trip #2 (6/14/21)
$ 653.62
100%
653.62 100%
$ -
i 00%
$653.62 $ -
Design Trip #3 (10/12/21)
$ 653.62
100%
653.62 100%
$ -
100%
$653.62 $ -
Design Trip #4 (1/19/22)
$ 653.62
100%
653.62 100°x6
$ -
100°�
$653.62 $ -
Pre -Bid Walk Through #1
$ 893.62
0.00 100%
$ 893.62
1000/0
$893.62 $
$ 893.62
0.00
$ -
0%
$0.001$ 893.62
CA Trip #1
$ -
0%
$0.00 $ 1,101.12
Utility Coordination
$ 1,101.12
0.00
$ 820.00
0.00 100%
$ 920.00
100%
$920.00 $
1.81 Permit Fees
2,614.48
3S 62
428 4
$ 4,428-1,994�t.7L}
;$12!
,W42.2I.
T.otal Reimble.s.;..s.
ut',: r.sa.
.6li 4I•/.D -t
,.l-+r.Ss ; sr,,.,h: ,.,». , }l,,y:,i.fri:�:•,r . .. ..: rp't}�"t�i..$.yY. (u41�
k4�_lti�hii..J.,Fd,'y((f
l. Yf?'�"'F ftJr*t<�1
Nrri„g+�.}4z,...s,.,,;: ra,l
I xOPW" �✓
l
$$.. J...8
:,;.,.r.lJ.r,.e.,1NL�'4tr'}
i8y6�1r}�
.
J ybl�
Change Orders:
COM -Dept. of Health Fees
$ 6,176.50
°
0•� 100 �
$ s1 7s.50
'
0
100%
-
.00
$ o $
.. ., ,- .....„,. ".,f": ;'x Yr. ....y�. ,,,. .,,. ;: J ilk .<.. u,:t',., i:.•'�lj.'De
:,n'< '"':., �W k, , r; r r yl:(rklrU J 6 �c
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'� L4 y. jlif i Wf{ S C
$TATE OF WASHINGTON
DEPARTh9ENT OF HEALTH
.G� D(o722.._
March 16, 2022
McKay Healthcare and Rehab Center
127 2nd Ave SW
Soap Lake, WA 98851
Attn: Accounts Payable
Construction Review Services has received the following application for plan review.,
Invoice# CRS -61286205
Project Title: Emergency Generator Replacement
Please remit payment of $5,615M.
To avoid delays: Payments for each project should be submitted as separate payments and should reference
CRSN 61286205
Check via U.S. Postal Service
Department of Health
Revenue Section
111 Israel Road S.E., MS: 1099
Olympia, WA 98507-1099
ACH Payment
Name of financial institution:
Financial Institution Address:
Account Name:
AWRouting #:
Account M.
US Bank
60 Livingston Ave., St. Paul, MN 55107-2292
3030 -DEPARTMENT OF HEALTH
123000848
153910882452
If you have any questlons, please contact our office at 360-236-2944 or by email at crs@doh.wa.gov.
Sincerely, p
o \u
Ricardo Theodore
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