HomeMy WebLinkAboutReimbursable Work Request - GRIS-*6
100D•1181w/.n Mhc1
Page 1 RNm-
Health Care Authori
PO Box 42691
Olympia, WA 985044M
verdorsc,tflcat, in bycemfy under penalty f peq,q that th, and Wbif, Rated h,,,,n are pmda,,hwge, for rn,tl meadhandius or —A—f1milhad W Me S
Wa install goods Nmisri moll se�.s rendered h— be uided mthwl bodausa, of Ip, san, 11nWl lWaul. MI. Inmed, Cold, ,t,n,f on",
nan=r, . or Via— Mer .1 Meabled 11111111WA
t
77C aIi
"t. of
840 Plub Street IM0505
Lake, WA 98837
TAX IDENTIFICATION NUMBER 91-6001319
7
�'CornmunityCoaftion Coordinator
Kq7,7,W.,Tir,;F7---5-
®Comrn�Coalibon- -Refteshment Supplies -ML
MIND=
A19 Effective 7/1119 through W30121 REVISED 7118t19
-Sarah Mairlairf, 360-725-9401 Sarah. M ariani@hca.wa.gov
100D•1181w/.n Mhc1
Page 1 RNm-