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STATE OF NN'ASHINGTON
DEPT OF COMMERCE
ATTN: CDBG PROGRAM
PO BOX 42525
OLYMPIA, WA 98504-2525
COMMUNITY ACTION AGENCY SUBRECIPIENT:
CDBG amount requested for these program activities thisperiod: $16,656.38
Description of service program how low- and moderate -income (LMI) persons were served this period: Housing
CONTRACT NO:
OIC OF WASHINGTON
19-62210-005
815 FRUITVALE BLVD
REPORT PERIOD:
YAKIMA WA 98902
Apr -20
CDBG amount requested for these 2rogram activities thisperiod: $3,918.03
REPORT NUMBER:
administration expenses associated with managing energy assistance and asset development activities oversight and
10
TOTAL AMOUNT REQUESTED THIS PERIOD: $20,574.41
2019 COMMUNITY DEVELOPMENT BLOCK GRANT - PUBLIC SERVICES GRANTS
CERTIFICATION: I certify that the information on this form is a
trne, .. -orate report of the cash status and that all reported
expenditures are properly chargeable to the referenced grant.
Signature:
Printed Name: Dereje Mekuria
Title: Chief Financial Officer
Date: 5/27/2020
I. Name of Service Program: Asset Development 75
CDBG amount requested for these program activities thisperiod: $16,656.38
Description of service program how low- and moderate -income (LMI) persons were served this period: Housing
counseling, credit coaching, foreclosure services, business start-up, financial education workshops and high school
classes. Free tax -prep.
2. Name of Service Program: Energy Assistance 82
CDBG amount requested for these program activities thisperiod: $0.00
Description of service program how low- and moderate -income (LMI) persons were served this period: Energy
assistance and conservation education.
3.Name of Service Activity: Asset Develop/Energy Develop/EnergyAssist Admin -Indirect Admin
CDBG amount requested for these 2rogram activities thisperiod: $3,918.03
Description of service program how low- and moderate -income (LMI) persons were served this period: General
administration expenses associated with managing energy assistance and asset development activities oversight and
assessments. Indirect admin.
Dated this/ day of
Board of County Commissioners
Grant County, Washington
Approve Disapprove Abstain
Dist #1 Dist # 1 Dist # 1
Dist #2Dist # 2 Dist Al 2
_
Dist #3 Dist # 3 Dist # 3
WASHINGTON STATE
DEPARTMENT OF COMMERCE
AGENCY NUMBER
1030
IDIS PROJECT NUMBER
30
Commerce Contract Number
19-62210-005
A19 VOUCHER DISTRIBUTION
AGENCY NAME
DEPARTMENT OF COMMERCE
ATTN: CDBG
PO BOX 42525
OLYMPIA, WA 98504-2525
INSTRUCTION TO VENDOR OR CLAIMANT:
Submit this form to claim payment for materials, merchandise or services.
Show complete detail for each item.
Vendor's Certificate: I hereby certify under perjury that the items and totals listed herein are
proper ch r materials, merchandise or services furnished to the State of Washington,
and tha II good nished and/or se 'ces re dared have been provided without
discri nation be a s of a e, sex, m al stat s, race, creed, color, national origin,
handic p, reli io alV'e a era or di I v rans status.
VENDOR OR CLAIMANT (Warrant is to be payable to:)
GRANT COUNTY
PO BOX 37
EPHRATA, WA 98823-0037
REPORTING PERIOD: APRIL 2020
By:
IG E INK)
`
Gi
TITLE) (DATE)
Description QUANTITY AMOUNT
IDIS
Activity ID
PREVIOUSLY AMOUNT REMAINING
BUDGET REQUESTED THIS INVOICE BALANCE
7945
05 Public Services $117,558.00 54,711.82 20,574.41 $42,271.77
$0.00
$0.00
7946
21 A General Admin 3,500.00 3,500.00 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL PAYMENT REQUEST $121,058.00 $58,211.821 20,574.411 $42,271.77
Everything below this line is for Dept of Commerce
FED TAX ID #
PROGRAM APPROVAL (The individual signing this voucher warrants they have the authority to sign this voucher.)
PRINTED NAME: Jeff HInckle SIGNATURE:
DATE
DOC DATE
CURRENT DOC. NO.
REFERENCE DOC NO.
VENDOR NUMBER
SWV0002426-03
ACCOUNT NO.
ASD NUMBER
VENDOR MESSAGE
CDBG #
M SUB
TRANS 0 MASTER SUB SUB
CODE D INDEX OBJ OBJ
GL ACCT
SUBSID
INVOICE
AMOUNT NUMBER
629FO320 NZ
15152
SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT
DATE
WARRANT TOTAL
ACCOUNTING APPROVAL FOR PAYMENT
DATE
Contract 19-62210-005
Submitted to GC by: OIC OF WASHINGTON
Request for Reimbursement No. 10
APRIL 2020
Grant County's Subrecipient Checklist:
State Auditor's Office Audit Procedures for Testing Activities Allowed
And Not Allowed, As Published In 2007
Questions to ask before submitting a payment request
Was the expenditure or cost:
X Made for an allowable activity under the grant guidelines?
X Authorized (or not prohibited) under state or local laws or regulations?
X Approved by the federal awarding agency, if required?
N/A Allowable per Circular A-87 (June 2004 version), Attachment B, items 1-43?
For payroll transactions:
X Does the employee's time and effort documentation meet the requirements of
Circular A-122?
X Allocable to the program? (i.e., was the dollar amount charged to the program
relative to the benefits received by the program? Is the federal grantor being
charged its fair share of the cost?)
X Based on actual costs, not budgeted or projected amounts?
X Applied uniformly to federal and non-federal activities (i.e., is the federal
government being charged the same amount as if non-federal funds were being
used to pay the cost)?
X Given consistent accounting treatment within and between accounting periods?
(Consistency in accounting requires that costs incurred for the same purpose, in
like circumstances, be treated as either direct costs only or indirect costs only
with respect to final cost objectives).
X Calculated in conformity with generally accepted accounting principles, or
another comprehensive basis of accounting, when required under the applicable
cost principles?
X_ Not included as a cost (or used to meet cost sharing requirements) of other
federally -supported activities of the current or a prior period?
X Net of all applicable credits? (e.g., volume or cash discounts, insurance
recoveries, refunds, rebates, trade-ins, adjustments for checks not cashed, and
scrap sales).
N/A Not included as both a direct billing and as a component of indirect costs?
N/A Properly classified (e.g., some costs may be incorrectly claimed as a direct cost
instead of being incorporated as part of the indirect cost rate).
X Supported by appropriate documentation? (e.g., approved purchase orders,
receiving reports, vendor invoices, canceled checks, and time and attendance
records.) Documentation may be in an electronic form.
X Correctly charged to the proper account code and grant period?
I:\DATANONSHARED\ACCOUNTING\ingrid's stuff\CDBG\CDBG ML 265 2019-20\Subrecipient Checklist 2019-20.docPage
General Ledger System
OIC OF WASHINGTON
For User: INGRID FRANK
Fund Expenditure report for: 265 - CDBG PS 7/1/19-6/30/20 (Fund status: Active)
Report year: 7/1/2019 thru 6/30/2020 Period ending: April 2020
------Monthly--------------------
Account Budget Expenditures Pct Budget
5999 NON PERSONNEL ADM. ALLOC. $233.00 $440.31 188.97% $2,330.00
Total for sub program ---
Total for program 02 ----->
> $1,942.00 2
3,763.16 1 3.78% $19,420.60
$1,942.00 $3,763.16 193.78% $19,420.60
Total for department 009 ---->
Department: O�ROGRAM _
Total for sub pro --- $6,670.00 61,�6�56;;*'249.72%
Sub program: �54ENERGY ASSISTANCE
5311 SALARIESGES.EXP_ RSE__.-- --J
5351 FICA,OIC EXP
5352 LAND I,OIC SHARE
5353 STATE UCI(ES),OIC EXP
5355 PAID FAMILY MEDICAL LEAVE
Program: 25 PROGRAM SUPPO&T='
5311 SALARIES, ES
$1,942.00 $3,763.16 193.78%
Q � C'
�110
$3,803.00
$9,790.25
257.43%
EXPENSE
5351
FICA,OIC EXP
5352
LAND I,OIC SHARE
5353
STATE UCI(ES),OIC EXP
5355
PAID FAMILY MEDICAL LEAVE
5360
DISABILITY OIC EXPENSE
5361
MEDICAL INSURANCE,OIC EXP
5362
LIFE INSURANCE,OIC EXP
5363
PENSION,OIC EXP
5364
ACCRUED PTO EXP
5399
FRINGE
5500
TRAVEL
5507
OUT OF STATE TRAVEL
5910
INSURANCE
5950
TESTING CHARGES
$1,942.00 $3,763.16 193.78%
Q � C'
�110
$3,803.00
$9,790.25
257.43%
$295.00
$694.17
235.31%
$34.00
$99.34
292.18%
$84.00
$218.32
259.90%
$16.00
$39.21
245.06%
$71.00
$159.86
225.15%
$1,068.00
$3,961.41
370.92%
$20.00
$63.62
318.10%
$283.00
$686.14
242.45%
$0.00
$904.40
0.00%
$497.00
$0.00
0.00%
$166.00
$0.00
0.00%
$283.00
$0.00
0.00%
$0.00
$39.66
0.00%
$50.00
$0.00
0.00%
$19,420.60
$38,030.00
$2,950.00
$340.00
$840.00
$160.00
$710.00
$10,680.00
$200.00
$2,830.00
$0.00
$4,970.05
$664.00
$1,132.00
$0.00
$200.00
$63,706.05
-To Date --------------
Expenditures Pct
$1,865.76 80.08%
$15,159.76 78.06%
$15,159.76 78.06%
$15,159.76 78.06%
$36,734.69 96.59%
$2,661.15 90.21%
$350.47 103.08%
$819.18 97.52%
$149.76 93.60%
$518.21 72.99%
$11,087.73 103.82%
$205.91 102.96%
$2,620.73 92.61%
$3,382.43 0.00%
$0.00 0.00%
$20.00 3.01%
$910.70 80.45%
$95.87 0.00%
$0.00 0.00%
$59,556.83 93.49%
Page:
Page 2 of 3
Date:
5/27/2020
Time:
11:06:27 AM
Annualbudget
Unexpended
$2,797.00
$931.24
$23,311.60
$8,151.84
$23,311.60
$23,311.60
$45,644.00
$3,540.00
$412.00
$1,012.00
$195.00
$859.00
$12,825.00
$251.00
$3,405.00
$0.00
$5,975.05
$1,000.00
$1,700.00
$0.00
$300.00
$77,118.05
$8,151.84
$8,151.84
$8,909.31
$878.85
$61.53
$192.82
$45.24
$340.79
$1,737.27
$45.09
$784.27
($3,382.43)
$5,975.05
$980.00
$789.30
($95.87)
$300.00
$17,561.22
$975.00
$0.00
0.00%
$9,750.00
$0.00
0.00%
$11,704.00
$11,704.00
$72.00
$0.00
0.00%
$720.00
$0.00
0.00%
$875.00
$875.00
$9.00
$0.00
0.00%
$90.00
$0.00
0.00%
$115.00
$115.00
$20.00
$0.00
0.00%
$200.00
$0.00
0.00%
$243.00
$243.00
$3.00
$0.00
0.00%
$30.00
$0.00
0.00%
$46.00
$46.00
General Ledger System
OIC OF WASHINGTON
For User. INGRID FRANK
Fund Expenditure report for: 265 - CDBG PS 7/1/19-6/30/20 (Fund status: Active)
Report year: 7/1/2019 thru 6/30/2020 Period ending: April 2020
Account
To Date
5360
DISABILITY OIC EXPENSE
5361
MEDICAL INSURANCE,OIC EXP
5362
LIFE INSURANCE,OIC EXP
5363
PENSION,OIC EXP
5399
FRINGE
Total for sub program 54 -->
Total for program 25 --a
Total for department 010 -->
------Monthly--
To Date
---
Budget
Expenditures
Pct
$16.00
$0.00
0.00%
$132.00
$0.00
0.00%
$4.00
$0.00
0.00%
$67.00
$0.00
0.00%
$107.00
$0.00
0.00%
$1,405.00
$0.00
0.00%
$8,075.00
$16,656.38
206.27%
$8,075.00
$16,656.38
206.27%
$14,050.35 $0.00 0.00%
$77,756.40 $59,556.83 76.59%
$77,756.40 $59,556.83 76.59%
Page: Page 3 of 3
Date: 5/27/2020
Time: 11:06:28 AM
Annuaibudget
$193.00
$1,592.00
$57.00
$815.00
$1,288.35
$16,928.35
$94,046.40
$94,046.40
Unexpended
$193.00
$1,592.00
$57.00
$815.00
$1,288.35
$16,928.35
$34,489.57
$34,489.57
Fund Totals $10,033.00 $20,574.41 205.07% $97,337.00 $75,286.23 77.35% $117,558.00 $42,271.77
To Date
---
Budget
Expenditures
Pot
$160.00
$0.00
0.00%
$1,320.00
$0.00
0.00%
$40.00
$0.00
0.00%
$670.00
$0.00
0.00%
$1,070.35
$0.00
0.00%
$14,050.35 $0.00 0.00%
$77,756.40 $59,556.83 76.59%
$77,756.40 $59,556.83 76.59%
Page: Page 3 of 3
Date: 5/27/2020
Time: 11:06:28 AM
Annuaibudget
$193.00
$1,592.00
$57.00
$815.00
$1,288.35
$16,928.35
$94,046.40
$94,046.40
Unexpended
$193.00
$1,592.00
$57.00
$815.00
$1,288.35
$16,928.35
$34,489.57
$34,489.57
Fund Totals $10,033.00 $20,574.41 205.07% $97,337.00 $75,286.23 77.35% $117,558.00 $42,271.77
General Ledger System
OIC OF WASHINGTON
For User: INGRID FRANK
Page:
Page 1 of 3
Fund Expenditure report for: 265 - CDBG PS 7/1/19-6/30/20 (Fund status: Active)
Date:
5/27/2020
Report year: 7/1/2019 thru 6/30/2020
Period ending: April 2020
Time:
11:06:26 AM
----Monthly-------
----To
Date ------
Account
Budget
Expenditures Pct
Budget
Expenditures
Pet
Annual budget
Unexpended
Department: 008 DIRECT ADMIN-
an
Program:
Program: 83 COO/ I.T.
5311 SALARIES,WAGES EXPENSE
$0.00
$0.00 0.00%
$0.00
$284.09
0.00%
$0.00
($284.09)
5351 FICA,OIC EXP
$0.00
$0.00 0.00%
$0.00
$21.39
0.00%
$0.00
($21.39)
5352 LAND I,OIC SHARE
$0.00
$0.00 0.00%
$0.00
$1.57
0.00%
$0.00
($1.57)
5353 STATE UCI(ES),OIC EXP
$0.00
$0.00 0.00%
$0.00
$6.34
0.00%
$0.00
($6.34)
5355 PAID FAMILY MEDICAL LEAVE
$0.00
$0.00 0.00%
$0.00
$1.14
0.00%
$0.00
($1.14)
5360 DISABILITY OIC EXPENSE
$0.00
$0.00 0.00%
$0.00
$3.38
0.00%
$0.00
($3.38)
5361 MEDICAL INSURANCE,OIC EXP
$0.00
$0.00 0.00%
$0.00
$26.91
0.00%
$0.00
($26.91)
5362 LIFE INSURANCE,OIC EXP
$0.00
$0.00 0.00%
$0.00
$1.45
0.00%
$0.00
($1.45)
5363 PENSION,OIC EXP
$0.00
$0.00 0.00%
$0.00
$19.89
0.00%
$0.00
($19.89)
5364 ACCRUED PTO EXP
$0.00
$0.00 0.00%
$0.00
$21.59
0.00%
$0.00
($21.59)
5500 TRAVEL
$16.00
$152.95 955.94%
$160.00
$152.95
95.59%
$200.00
$47.05
5601 DEPRECIATION EXP BLDG.
$0.00
$0.00 0.00%
$0.00
$0.67
0.00%
$0.00
($0.67)
5602 DEPRECIATION EXP EQUIP
$0.00
$0.00 0.00%
$0.00
$0.12
0.00%
$0.00
($0.12)
5611 SPACE
$0.00
$0.00 0.00%
$0.00
$14.57
0.00%
$0.00
($14.57)
5630 UTILITIES
$0.00
$0.00 0.00%
$0.00
$6.06
0.00%
$0.00
($6.06)
5640 BUILD. REPAIR/MAINT.
$0.00
$0.00 0.00%
$0.00
$1.54
0.00%
$0.00
($1.54)
5910 INSURANCE
$0.00
$0.00 0.00%
$0.00
$0.50
0.00%
$0.00
($0.50)
5912 LIABILITY INSURANCE
$0.00
$0.00 0.00%
$0.00
$1.53
0.00%
$0.00
($1.53)
5960 COMMUNICATION
$0.00
$1.92 0.00%
$0.00
$3.95
0.00%
$0.00
($3.95)
Total for subprogram -a
$16.00
154.87 967.94%
$160.00
$569.64
356.03%
$200.00
($369.64)
Total for program 83 -->
$16.00
$154.87 967.94%
$160.00
$569.64
356.03%
$200.00
($369.64)
Total for department 008 -a
$16.00
$154.87 967.94%
$11600.00Q
$569.64
356.03%
$200.00
($369.64)
Department: 009 INDIRECTADMIN
CCw�
Program: 02 ADMIN. POOL -BASE
7
5312 SALARY ADM. ALLOCATION
$1,204.00
$2,256.92 187.45%
$12,040.60
$8,865.56
73.63%
$14,453.60
$5,588.04
5354 P/R TAX 8 BEN. ADM ALLOC.
$505.00
$1,065.93 211.08%
$5,050.00
$4,428.44
87.69%
$6,061.00
$1,632.56
OIC OF WASHINGTON
For User: INGRID FRANK
RW Expenditure report for: 265 - 265 CDBC
Report year: 7/1/2019 thru 6/30/2020
Account
Admn Admin - Asset Dev/Energy Asst
Asst Asset Development
Ener Energy Assistance
Report Totals
General Ledger System
Page: Page 1 of 1
Period ending: April 2020
5/27/2020
Time:
-- ---Y------
Monthl
-------To Date-------
Unexpended
Budget
Expenditures Pct
Budget
Expenditures
Pct
$1,958.00
$3,918.03 200.10%
$19,580.60
$15,729.40
80.33%
$6,670.00
$16,656.38 249.72%
$63,706.05
$59,556.83
93.49%
$1,405.00
$0.00 0.00%
$14,050.35
$0.00
0.00%
$10,033.00
v $20,574.41 205.07%
$97,337.00
$75,286.23
77.35%
Page: Page 1 of 1
Date:
5/27/2020
Time:
11:06:55 AM
Annual budget
Unexpended
$23,511.60
$7,782.20
$77,118.05
$17,561.22
$16,928.35
$16,928.35
$117,558.00 $42,271.77