HomeMy WebLinkAboutGrant Related - BOCC (004)i
1
GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
To: Board of County Commissioners
From: Janice Flynn, Administrative Services Coordinator
Data June 2, 2023
Re: Authorization for Release of BOCC Approved Funds, Dept of Commerce,
CHG Grant #22-46108-10, Hotel Leasing Amendment, Reimbursement #19,
New Hope, Request #13
New Hope has requested reimbursement for the above -referenced grant, per the
contracted guidelines in the amount of $6,840.00 for April 2023 expenses. The invoice
and supporting documentation are attached for review.
I am requesting the release of funds for payment to New Hope in the amount of
$67840.00.
Thank you.
JUN 1 3 2023
F RECEIVED
JUN 0 1 2023
MANT COLJNTY C011AAMISSIONERS
Grantee Name: Grant County
Report Month/Year: Apr 2023
Lead Grantee
Grant County
List Sub Grantee Names Below
New Hope
0.00
Admin
Total
.: 0 00 ,
L Hou in :.:
h r -.Rent Fac,Su ease:...&
CHG; Ot e
Costs
$000
CHG-Rent & Fac support/Lease Costs $0.00
.$0.00
$0.00
...
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MCI7�t�.
$
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-:
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is C l�j �+
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r ions { � � � � . c
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$0:00
u A
.$0.00
2t
.$0.00
$0.00
Mill =0111111111iiiii
$0.00
HotelLeastng/RRI�Ad�n������''"ay�� $1,217.87
$1,217.87
r
Hotel\ Leasi RRHaO $131.70
).<.., : =f,_.
$131.70
t,. t
$228.70
$228.70
> ! .„ "WR: $5,261.73
Re t forrrRa�e=�Ho'us�
$5,261.73
YY;te�.���t,�a3rX�w,w�g��t
>,, g 13��».E�
� • - k > 2 •ti ,vf,� y �eC; \,�c� h� ' \ h.` \ �. � � S `ai a av:yr�t`� , 1.
AdditionalCGFunding�rF,t��$$�pp1�=r;p r` ;t: ;� tt
$0.00
Invoice Total
$6,840.00
MTAALW,kVJ§LwJ=WWwA t q
Grantee Name: Grant County Lead Gra t Sub Grantee Names Bel
Report Month/Year: Apr 2023 Grant county
New Hop(`BUDGET
Admin
$0.00
CHG-Other Rent/Fac Sup:p.Lease
Housing Costs
$0.00
$1,064.00
CHG-Rent & Fac support/Lease Costs
$0.00
$12,017.72
' 3 k 2• # � +.#'.� ��3^ T 1-:T�.rW iSa .fr � Fail'.
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\ ) X 4 a 4 ?kms"(c ,C t" f A. ,,Z *m . F •.�.,F ,'r S�?4 } yi 1s; . �•'LT, ..yl e ! .�v�,. �. �p �"�1.!iti. �,.,'kF>`:
_i,'.� .wt. ," ...f .+ 3; aay it•..,. a, .n}4. Y.,w,. i.� k'y a..' cwy». M.. nS�, .ip,. ?��•r',x:.,,�w,.
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'r:.-': ,_. �..:.: •.i i,._.::1 ,...:_.tp.'.., .; .._l... Y[,.:; _�;_� .�^�i^����.�°-.�„9�".._�.''. �.iksL�`v" _.: il,�`.: ��1G�� .ww.b.�i{'G.kz��.'.�. F"�i^T: i. ���
(
a art
e
$4,453.10
Hotel Leasin RRHtAdmi�n�\=k�,y��,� a {�\ $12.,000.00
\:�z.
a�. '� >
tl`! \
HQtel'Leastn RRI3O e�at�on's#�rs' �� 4 $9,000 00
\tV
Hotel Leasingv,���XaX�xv� k�k�a #" , $15,300.00
�• l �t �. � �' #1; �;t k)xU� �t , �#;��a� $45 000.00
Rent o \ Rapid Re, Hous�r�g AFF 3
i g��R,� d� k
r yr )9 f ;i,.; rs: 1
,412.00
$9.,412.00
n Ga...a .e d....t.nii P .,..... ': Fwh F...X.W..'..ti, �.....14t,4':v::..W�.,k..�.s..•»,a.e..,. .k';kaWZrk. .r .ra,�SA.v,wnv, \1sv,yaX�:t-o �.a e,?li3aw�: `G, ms.��e: �i't;
Jan -23 Feb -23 Mar -23 Apr -23 TOTAL OF
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Invoice Total; $3,178.99 $1,756.65 $5,946.13 $6,840.00 $58,709.56
$90,712.00
BALANCE
REMAINING
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
-$17.72
$8,868.30
$4,336.35
$9,403.51
$9,412.00
$32,002.44
$0.00
$0.00
$1,064.00
$833.63 $833.63
$1,217.87
$12,017.72
$131.70
$131.70
$964.99
$923.02 $659.40
$228.70
$10,963.65
$1,150.00
$4,453.10
$5,261.73
$35,596.49
$0.00
$0.00 $0.00
$0.00
$0.00
Invoice Total; $3,178.99 $1,756.65 $5,946.13 $6,840.00 $58,709.56
$90,712.00
BALANCE
REMAINING
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
-$17.72
$8,868.30
$4,336.35
$9,403.51
$9,412.00
$32,002.44
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Invoice Documentation Form: Goods & Services Worksheet
Grant County New
Agency Name: Hope
Invoicing Period:
April 1-30, 2023
Purchases by Vendor and items
Vendor
GC Human Resources
Best Western Rama Inn
Mario Padilla
Weston Square Apartments
Portfolio Real Estate (Visa)
Ziggy's (Visa)
Items
March HR Services Fee
Emergency Shelter
Client EFA - Rent
Client EFA - Rent
Client EFA - Rent
Client EFA - Window
Repair
Total Charges
Total bill
amount
Total Charged to
I Contract
$ 1,354.67
$
1
$ 228.70
$
228.70
$ 3,350.00
$
2,000.0 ,-
$ 1,890.00
$
71,8 9 0. GQ-
$ 1,133.21
$
1,133.21
$ 238.52 $ C238.5V
$ 81195.10 $ 5,622.13
Page 1 / 1
Invoice 0387162
Date 4/18/2023
County of Grant
35 C STNW
P.O. Box 37
Ephrata WA 98823
Vendor: GRANT CO HUMAN RES
Document Number Purchase Order Number Vendor ID, Shipping Method Payment Terms ID
radfiO23-RR IU(MRS
!NET 30
1 Description:
km cunt
el
Warch HR Service Fee $1,354.671
Subtotal $1,354.67
Misc $0.00
Tax $0.00
Freight $0,00
Trade Discount $0400
Payment
Total Due $1,354-67
R
Grant County Human. Resources
Invoice for Human Recources Services
In advance of summer grant deadlines, Human Resources is
asked to use headcount reports to set a cost-sharing amount for
each non -general fund budgets utilizing HR services,
Department Jew Hope Invoice Date 03/0 1/23
Contact Alyce Barrien#oz Invoice Amount: 1,!l354.67
This invoice will be used for departments to generate vouchers
for revenue payment to Human Resources. Processing questions
should be directed fio the Auditor's Office - Accounting
Department.
CJ
Kirk Eslinger
HR Director
|— lHtbTwn RMIZ¥c," . A 0-
_,
. .
..
.
.
. . . .. .. . .
. ..
. . .
..
.. .. .
.. .
. .
_ .
. _
�§
AS
{ 70.,
1 3-11-3
3 0 S:
1,3S467
0
Invoice
Page 1 /1
Invoice 0386152
Date 415/2023
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: BEST WESTERN RAMA INN
1818 BASIN ST SW
EPHRATA WA 98823 -
Document Number Purchase Order Number Vendor ID Shipping Method Payment Terms ID
R1044798956 BWRIN
.. ...........
Description-, Amoti�i
'Emergency Shelter $99.351
Subtotal $99.35
MISC $0.00
Tax $0.00
Freight $0,00
Trade Discount $0.00
Payment $0.00
Total Due $99.35
0
3sr
i aS__3_�
Best Western Rama Inn Guest Folio
User- NR
Ephrata, Washington 98823
Date. April 01, 2023
Main:5097547111 Fax:5097547171 Time: 10:18 AM
bwephratafd@yahoo.com
New Hope Arrival date: 3/3112023
Departure 4/1/2023
IWA Confirmation R1044798956
Room-, 109 (K)
Folio #.* 5326697
DATE
DESCRIPTION
TYPE
CHARGES
-- -------------- ------
CREDITS
BALANCEI
3/31/23
L: EW HOPE
Direct Bill
-$99.351
-$99.35
3/31/23
Room 109
Room Rent
$89.99
-$9.36
3/31/23
LODGING
$1..80
-$7.56
3131/23
WA SALES TAX
$5.85
-$1.71
3/31/23
GRANT COUNTY
$1,71
$0.00
Guest Signature:
Totals $0.00
Each Best Western @ branded hotel is independently owned and operated.
Shelter/Hotel:
Date In:
V
Program, DV
Hotel
3/31/2023
- ---------- I
Client (First Initial & Last Name):
Year of Birth.- 1988
Case ID:
S
6 econdary #1 YOB*
Secondary #2 YOBIJ
Secondary #3 YOB*
Secondary #4 YOB:
Secondary #5 YOB:
Secondary #6 YOB:
Previous Living Situation?:
Where did client exit to?.
Payment Grant:
Client Shelter Form
Hotel Name/Room in Shelter: Best Western
6
Date Out. 4/1/2023
Review Shelter Guidelines: Yes
Invoice Turned in:
Client ID: GML04493
N CA Trak
Gender:
Gender:
Gender:
Gender:
Gender:
Gender:
Rental by client, no ongoing subsidy
Comments:
-------- -- -
Invoice
Page I/ I
Invoice 0386158
Date 4/5/2023
County of Grant
35 C ST NW
Mise
PA Box 37
Tax
Ephrata WA
98823
Vendor**
BEST WESTERN RAA INN
$0.00
1818 BASIN ST SW
$0.00
EPHRATA WA 98823 -
Document Number Purchase Order Number Vendor 1D Shipping Method, Payment Terms ID
..........- -- - ------- -------------- ----- - -- - - ---------- --
kf X3065 -TD ----—BWRIN
Description: ....... -- Amount
Emergency Shelter $129.35
Subtotal
$129-35
Mise
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$129.35
Best Western Rama Inn Guest Folio
User; NR
Ephrata, Washington 98823 Date: April 04, 2023
Main:50975471 11 Fax:5097547171 Time: 11:06 AM
bwephratafd@yahoo.com
Arrival date: 3/27/2023
Departure 3/28/2023
Ephrata,WA 98823 Confirmation R1044430465
Room: 119 (Q H)
Folio #: 5283203
DATE
DESCRIPTION
TYPE
CHARGES
CREDITS
BALANCEI
3/27/23
Room 119
Room Rent
$89.991
$89.99
3/27123
LODGING
$1.80
$91.79
3/27/23
WA SALES TAX
$ 585
$97-64
3/27/23
GRANT COUNTY
$1.71
$9935
3/27/23
PET FEE
PET FEE
$30.00
$129-35
3/28/23
028112 *********8723, Invoice #
Visa
-$138.19
-$8.84
1
5054847
4/4/23
*********8723, Invoice #
Visa
$138.1.9
$129.35
5128774
1 4/4/2j3CL:NEW
HOPE
Direct Bill
-$129.35
-$0.00
Guest Signature:
0
I-------------- -
Totals 1 40.00 fl
Each Best Western @ branded hotel is independently owned and operated.
I
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor SCHNEIDER HOMES
DBA: THE WESTON APARTMENTS
901 NW SUNBURST CT #R101
MOSES LAKE WA 98837
Document Number urchase Order Number _.__...'VendorlD
04182023-SFVSTAP
t4scri pt j . o . n: .. . .....
Client. EFA
Page 1 /1
Invoice 0387164
Date 4/18/2023
Shipping Method
Payment Terms ID
................. ------ . .........
Amount
$1 P890.00
Subtotal
$1 ,890.00
Misc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
so"00
Total Due
$1 )890.00
EMERGENCY FINANCIAL ASSISTANCE REQUEST FORM
Staff: Sluzr Fode
Pr-
,
Cate Submitted: 4,18,2023
new beginnings. g��y
befter tomorrows.
Amount requested 189
Type OT e rent.
INDV SSA DCVSC 0 YHD
Client ID. GML00201
Client's HordeCity: Moses Labe
..r ,,. � , �.,-� ra, •.,`�_v' -. Y5' �„2.' Y,,t•,yr„V-.,T 1 Q,S •y\SIgC ,. ,,:� �'. �11 '-f^'`. .Y,. ,�,•"` ?Yn, „`:,' r,, ``i�" �",>�".�_'. �\. Y.�.W'L` �a",. `�5''
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Explain:
! Background check -for housing
* Mortgage
Abusive partner controll'ing money, not enough
* Children's needs
Service Q13
. Debt assistance
+ Utilities bills
for rent over next couple months.
* Driver's, license
0 Security Assist
• Education training
0 Dental Assist
Bus fare to return home
far payments
• Cell phone to seek work/housing
Food/Necessities
,
� Family well being
. r v \ \ ,:i .,,,,;., . \ a+, ,><.`" . _ \ ,tet t ,;•: \ .r;,a i� U,t _ g x $.:',�' , ., o: ;� �,r' ,a .
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i ib... ,:•n„N r. . M. 3)- .. .
k. i�
• blousing Authority
Explain:
! Salvation Army
• Serve ML/Quincy
Splitting 3 months rent with parent support.
DSH
VPS
• Family contribution
• Friend contribution
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Include back up documentation: -
Receipt
Copy of check
W9, if applicable
Updated: 2/11/2020
GRANT COUNTY
New�Hope/Kids Hp
eope
PROMISE TO PAY
Date 04/17/2023
Claimant: Weston Square Apartments
Post Office Address:901 NW Sunburst Court Moses Lake, W 98837
---------------
Month ----- Day Purpose -dollar Cents
05 01 May Rent 1260. 00
------------
.06 1 01 1/2 June Rent 630, 00
All bills must be itemized in detail on this blank or itemized list attached her. When submitting claims for
rent be sure to specify dates claim is intended to cover.
For Submission for Payment -
ISSUED: Return Voucher To:
SuZiFode Grant County
NewHope/Kids Hope
New Hope/Kids Hope Advocate 311 W Third Avenue Moses Lake,
WA 98837
1 hereby Certify on Honor, that the goods, merchandise, material or service charged for in the above bill have been
furnished as her'ein charged.
DAIT': 04/1712023
CANNOT BE USED FOR ALCOHOL,,. TOBACCO,
PRE -PAID OR GIFT CARDS.
[%TZTX 11 OR vqaoj1U=_7__
Printed Claimant Name
Signature
Check one: Mail pa anent to above address
Claimant will vick up, payment at
Vouchers received by 12:00 pm Wednesday will have payment available the following Thursday.
— --------------
EMERGENCY FINANCIAL ASSISTANCE FORM
SIGNED? YES [Z] NOE]
FUNDING: 7611
Weston Square Apartments
901 NW Sunburst Court - Office - Moses Lake, WA 98837
(509) 765-3887
1 LEASE RENEWAL and Change in Lease Terms
1.1 EXTENSION OF LEASE ADDENDUM
----- ----- . .... ..
Then, in accord iance with your lease the OWNERS AGENT may, upon 30 days prior written notice, make Chang- res in, or additions to, the
Rules and Regulations stated herein.
LATE CHARGE/RETURNED CHECK CHARGE: LESSEE understands that if the totzil rent is not received by m1daight of the sixth (6th)
day of the month there will be a ONE -HUNDRED dollar ($100.00) late charge.
Thj.o,,LytPna I ion nr Lease Adderidum is part of the Lease/Rental Agreement daLed, between Weston Apartments (Owner/Agent) and
I -
--or the premise located at
901 NW Sunburst Court
Moses Lake, A 98837
1. Your lease, is hereby rene'vved for a term of 12 months . Beginning 05/01/2023 end.ing 04/30/2024
2, Al.t terms, provisions and covenants of the described Lease above shall remain in full force for the duration of the extended term, except
as noted.
3. In con,nection with this renewal, monthly fees shall be:
NEW MONTHLY RENff S$1,260.00
IN WITNESS WHEREOthe parties hereto Nave executed this agreement.
By signing below}cru acknowtedge and acrree to the terms in Section 1 .
0 , y C� .
X_
Lessee NMI IP *A(dress: 24.54.101.149
0210912023 08:17pm PST
Weston Square Apartments
901 NW Sunburst Court - Office * Moses Lake, WA 98837
(509) 765-3887
2. Sian and Accept
I*w
2.1 ACCEPTANCE OF LEASE
This is a legally binding document, by typing your name, you are consenting to use electronic -means to (1) slop tads contract, (H) accept
addenda. You can access and doWnload this contract at any timemi your portal.'
x
IP Address-, 24.54.101.149
0210912023 08:18pm PST
x VO& cowlchir*
Lessor IP Address: 174,31.58.93
0.2/10/202,3 09.1 lam PST
a
2
County of Grant
35 C ST NW
P.O. Box 37
Ephrata WA 98823
Vendor: PADILLA, MARIE
10281 BASELINE E RD
MOSES LAKE WA 98837
Document Number Purchase Order Number
i04182023 -SM i� .� _M . _ w. . _ _....�w . , x M.., ..
Description:
Client EFA - SM
. . ........ ....... ..........
ADILM
Page 1 /1
Invoice 0387161
Date 4/18/2023
VendorID, Slipping Method Payment Terms ID
Amount
$3)350.00
Subtotal
$3;350.00
Misc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0.00
Payment
$0.00
Total Due
$31?350.00'
---------------
EMERGENCY FINANCIAL
4
Staff: )ara Mill
.Y
Date Submitted: 411l4=23
new beginnings. better tomorrows. Amount requested $33-60
Type of client:
#ofC
OOV OSA 0 -Cy
Client . GML28201 Client's Home Cit: Moses Lake
AAI As istance,,-(EFA) tzmer9enCVRnanca
--req"es foe?t:
-------- - ---
Explain:
Client resides in single parent home, parent is on disability and client
Children's needs
* Mortgage has recently incurred traumatic head injury. parent has been
Debt assistance a utilities bills transporting client to several medical appointments each week and is
• Driver's license # S urity Assist unable to worR date to disability ty and time needed to transport and
Education training 0 Rental Assist
• Bus fare to return homy tend to client. Client parent has fallen behind on rent and is struggling
Cell phone to seek work/housing w to finance current bills. Request €�r EFS to overdue rent and two
Family SII being Food/Necessities�
months' rent to reduce parental stress and ensure client remains
sheltered with basic and medical needs meta
-: ..
Indic -a e w hath. s ror Mo
rsu� �',
".
PPQ-,
0.
Housing Authority Explain.
Salvation Army
Sawa I" l,,.l uincy
CPS
Family contribution
Friend contitbutton
Supervisor Signature:- f 0 Approved 0 Denied
WN!,
Date: 4Z1.q-,/s;2
M .. tidy
.+ CRAlM CIDSKS 000A USA CICVSC UYKQP
METHOD F PAYMENT: OCheck OPetty Cash Mebit Card OCr drt Card
.. wrcwwMwr
include back cep documentation:
Receipt
Updated: 2/1112020
Date 4/18/2023
Claimant: Mario & Cindy Padilla
Post Office Address: 306 Beech Street Moses Lake, WA 98837
Month Day Purpose Dolls n1_5
05 01 $650.00 remaining April Rent, May Rent $1350.00 2000 00
wnwww=
06 01 June Rent1350. 00
.
Total Amount $3350-00
All bills must be itemized in detail on this blank or itemized list attached herewith. When submitting claims for
rent be sure to specify dates claim is intended to cover.
For Submission for Payment -
ISSUED.-,- Return Voucher To:
Sara MacDonald Grant County
New Hope/Kids Hope
New Hope/Kids Hope Advocate 311 W.Third Avenue Moses Lake,
WA 98837
1 hereby Certify on Honor, that the goods, merchandise, material or service charged for in the above bill have been
furnished as herein charged.
4/18/2023
01 --ft,
wee-Attached.Lea ..Aar me t
Printed Claimant Name
Signature
CANNOT BE USED FOR ALCOHOL, TOBACCO, Check one: Mail p2cyment to above address
PRE -PAID OR GIFT CARDS. Claimant will pick up p4yment at
New,Hope
Vouchers received by 12:00 pm Wednesday will have payment available the following Thursday,
EMERGENCY FINANCIAL ASSISTANCE FORM
SIGNED? YES [Z] NOE]
FUNDING: 7611
GRI,.... NT COUNTY
New Hope/Kids Hope
!tLls Hope
bow kmxx�..
T
+�,���ISE O PAY
Date 4/18/2023
Claimant: Mario & Cindy Padilla
Post Office Address: 306 Beech Street Moses Lake, WA 98837
Month Day Purpose Dolls n1_5
05 01 $650.00 remaining April Rent, May Rent $1350.00 2000 00
wnwww=
06 01 June Rent1350. 00
.
Total Amount $3350-00
All bills must be itemized in detail on this blank or itemized list attached herewith. When submitting claims for
rent be sure to specify dates claim is intended to cover.
For Submission for Payment -
ISSUED.-,- Return Voucher To:
Sara MacDonald Grant County
New Hope/Kids Hope
New Hope/Kids Hope Advocate 311 W.Third Avenue Moses Lake,
WA 98837
1 hereby Certify on Honor, that the goods, merchandise, material or service charged for in the above bill have been
furnished as herein charged.
4/18/2023
01 --ft,
wee-Attached.Lea ..Aar me t
Printed Claimant Name
Signature
CANNOT BE USED FOR ALCOHOL, TOBACCO, Check one: Mail p2cyment to above address
PRE -PAID OR GIFT CARDS. Claimant will pick up p4yment at
New,Hope
Vouchers received by 12:00 pm Wednesday will have payment available the following Thursday,
EMERGENCY FINANCIAL ASSISTANCE FORM
SIGNED? YES [Z] NOE]
FUNDING: 7611
-
TMS AGREE PT s made �i day . �...
Z) C'
":�Zw betwe
heremafter designated the Lessor or Lan(flo.
LILLA here A-
Omaroteres",tamthe-
THR
e
�e
a
intheCityof ))17
CMW
State of , 7
..� of whit the real estate is described as followi"(Iegal desaiptim, of propaq
s
itpon
thefbllo. anti
'arxx leased, for €off tax
at
01 the day of to Indaxdly dweafter.
i, pay tl the �unt of per� Mo�� � ate, �. dae� ` c mouth in ads L=&There shall �� a e c . r o Yfor tay remt palmant mreivedafter ths .� day of the mouth.
,. shaU pa for serce and u .fie supped to Ow prtanim. waspt ^ will be %ndsW bi Lilt
4. Suhlet. The ' oft Wee not to sahiot said primas nor assign this leaw n= aAy part thereof mahout the pwior Witten consent of Landlor&
S,: Us's l%Lessem
a � � prom s in a. ole and sauftaq condition:.
FropeAy dispose of rui* garhap and waste iu a ctean and sanitary ntTmff at re and regWar intervals and to assume aU casb of ederminationaud hudga
for infestedm caused by
reg° y anctOPOM10 an electrical, gas, heating, p%Nngfiwilffies, fttam avid apphancw,
(dj Not hatentiDIMIly or ntly destm. WWOW o,'bvwr or rMove any patt ofto pmmisfts their a a a :es, fatties* equipment, eta" €a. fungshings,
appliances. nor to Vit any member of his fi d, invitee. Rcensee € r, other person acting under his ccratrol to do sm,
W Not to pmt a nice or commca Via.
6. Maina of 'remis"t Lessee qjew to maw 4nd at the gr s avA lawn., and keep dwjam. lawn, flims and shrubbery y thexao lim good ordora d con&tIou,,and to
the sfdowtilk so Ouaing said premises free axed clear of all o t ns to replace in a meat and worbumUke wan,€�er an gl*" anct Boars broken duxaug aCCUPWWY thex
to e dqe precaufioa a InA f� of watax or wade exp" and etoppoge of 2mme - about said prem Mis md that ME case water or waste pipes, are hozen or heoome co
mon of negleat of Lessee. " Les shall reps the saga at kis awn axpawa as well as all damW caused thereby,
Herat o w Le=ee ams not to mak alterations or do or cause to be dona my painting or wallpapwing to said PrMnises without the prior written mment oftandlord
8. Use of rewis�. Lessee sWI not use sacl pramit" for maypurpow oto thm that of a residence and h&U not use said premises or any pa thereof for buy Wept purp
moa agreoo to conibrm to mmicipal, county and state, codes statutes.. 4ordinancesand ululations � ee;ni the x and �x ati of gid. promises. watt spa. u�.
the mitis a s lista da coidomanwith all applicable provisions f � � cmmt; and state cam, statutes, ord1=16ces and flat us Mainteuaac
`
Opefttiou of sU , prowisw.
-9_ Lis Oblaox Less= shad:
(a) I=xnediatrAnote texnant" by Cert - mail or updated posting. of any chamges as to the person or add of mad
Mann n all s ural canpoamts MI good rem:
(CI Keep conaan arm r°a orably cieva gid. safe fxm d at"�cu increuing the hands of fin or accident;
(d) Provide a reasona ,ate program for the coutwl of infestation. by inseets, rodents, and ether peau at the hAtiadon. Gf the tenancy, pr vidad however, that Landlmd sit
be held mponsible whae infes4ation is caused by TewmL
x •- ♦ .0 .. » v w .. •. r.rY ,.. 4. i• 0.M $ rt Y r > Y `ME Z t r Vl
c) T *apply r iceS4 or
To exhibit m display the premises to prospective or aw l purchaws. wortgagees, tenants, *mtm or couh-artors.
Access shall be at enable ties except in me of emerge=y or abantt.
1. Surrender of Premises: In. the event of r t .% yu ofany mta: t *front or at the expiraWn of said term o th lei, Lasses wiH qvitandsurreaderthe
to Landlor& It this lease is for an inaefinito time, tomminadm simll bo b'Etta uodw Ofat lead t (20) days, Preceding "and of any such nv=thl 'rental
Oxy tither party tom oth". �; k
12- Coda ant Attorney's Fem If, by ream afany dafiwtt orbmch on the partafelther paw` In the perfornm.e ofany of the provisious a t�� agreement., a legO 'I
the loses Party, Wa4s to pay alL mu le costs and a ttamsy`s fi�ft Ia cowtection thmwith. It eed the the venue of any 4al aeon lwoug6t uAdor the terms
nu . - the county in t.c prams am Aw ted.
13. sad Damage Npasit:'the Uses hos d . ited the sums
as
sclaiowlWged. which aur shall be dep9sited by LAndlord in a bust accuumt wM
licamsets... __ ��branch, who" addr
lntm�st ate: the d"sit stall holmig to OerAndlord 0 tans <
All or a porticynsuch deft may be retained by Landlar& and a refer of any pian ofsu&per is wnditioned as fallowt.-
(a)shall fully
am_ ohligagans heteund
Chapter SS.1a Wised Go& o WashiDgto, or" such maybe ss' ameudW
Lesh* ot=py said pmnisw for tam age to Wive-.
Lessee: sh&11 rJean. ropy -%r Fmd restme said r a, and row tb*- samo to mW -d in itsni� omdou, exert forru wear r and tear. the t r-
thi �a and on a r : a . edfi itemt. � the co ttou of the r s% at commowemont of the t.mumc. is on E o rsveme
see a ll sun -ender W Lmdlord the keys to prem
Any refundfrom deposit, as bylitemizedstatement Shawn to be due t % A&H be reed to wither: fourteen 1 &s after tenuipatian o this tonancy a
of Ow prenulses.
14., Non.,RefimdablP. Ffts- The sum of $ isto be reWned by the Landlord as a am -returnable res, for !L�Oor
and is to addilUen to the socurity ant 4wags depoak but rwt a p -
:. dual T It any. attsca veto or oxthe reverse side hereof, am'mude it pat € f this agreement by refere=e and am descaiW as follows:
fix*
vt
b
n LO
'. � � _ .. : �. "ilii '..
to lowis .dor over one 1 year, an a ki�1W cant by, the ctd/lessor est to
IN WITMSS WITMOF, the Lessee(s)andLessor,,or-this agent., each hereunto segs hfs hand.
BY
��►-�, 11�r a
RoOdeadd Lease Agrftment And Security Deposit Kecelipt
Washington Leo 8twik, Inc., lssaqu , WA FO No. t .
MATERIAL ,AL N(AY NOT BE REPRODUCEDIN WHOLE OR IN p Vr IN ANY ORMWHA SOFVFUL
8. Furture.:
9 Appliances*..
I-O.Plumbuil.gy Iteatuixg, electrical:
I acknowledge recolipt of a copy hereoL
)d1ord
Land. I' en i -11t(s)
STATEMEW Of CONDITION
AND CLEANUNFSS AND EXISTING
DAMAGETO-PREMISES D UMNISHINCA
The pramises c .. the follovning defects, damages and physical condition at the n meat of the tenaut
ca, �.
s
Walls:
G
.3. Cowitertops:
�1
k
• ° x
a .qr kOtA
' k
5. Drapes:
/107
6. Windows:
.m-
County of Grant
35 C ST N -W
P.O. Box 37
Ephrata WA 98823
Vendor: WASHINGTON TRUST BANK..
PO BOX 2127
SPOKANE WA 99210-2127
Document Number
M39- 03/2023
;1 Description.
Visa Statement 03/2023
Page 1/1
Invoice 0386182
Date 415/2023
-------- — - - ------- -----------
Purchase Order Number 'VendorlD Shipping Method Payment Terms ID
WTBCC NET 30
Amount I
$
i 57990,641
. .. .......
Subtotal $5,990.64
Misc $0.00
Tax $0.00
Freight $0.00
Trade Discount $0.00
Payment $0.00
Total Due $5,990.64
� � i i 33.ai
1146 LWG 3 7 1 230402 0 PAGE I OF 2 1 0 4a33 0030 . CX48 01 ACI 146
Cardholder Name and Account Number Page 1 of 2
ALYCE BARRIENTOZ VISA
GRANT COUNTY
4"X.)=-XXM-XJ=-7139
01Was40 hingtonTrust 1Mocht'vr FDIC
Due back to 4S=t
41 - ,,14.12.2023 by 12pm
-- ---- AccoutA Information
---------
1 1. . Account Summary
Transactions
Statement Closing Date
04/02/2023
Previous Balance
10.00
Credit Limit
$7,500-00
Payments and Credits
$0.00
Available Credit
$7,456.00
+/-Fnance Charge(net)
$0.00
Cash Credit Limit
$0.00
+ Purchases
$0.00
Available Cash
$0.00
+ Cash Advances
$0.00
$35.00
03/10
+ Other Charges,
$0.00
SKAUG BROTHERS GLASS MOSES LAKE WA
$16.26
New Balance
$0.00
243323925000QNRE8
ACRANET- CBS BRANCH 509-3241249 WA
PqTent Information
03/12
Payment Due Date., 0412712023
24431062SW5XHNYMG
Minimum Payment Due: $0.00 New Balance: $0.00
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127 SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please include your a=unt
number on your check,
New address, phone number or e-mail?
Check the box to the left and print Change$ on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Mail Inquiries To:
P.O. BOX 2127 SPOKANE, WA 9921G-2127
We appreciate your bus nasal
Questions?
CaH Customer Service: WO -788-4578
Lost or Stolen Card- 800-788-4578
Payment Due Date
April
-S M T T
Account Number X)=.XX)O(-XX)(X-7139 F S
New Balance $0.00 3 14 5 6 8
9 loll -1.12 13 14 115
22
Minimum Payment Due NONE 16 17h8 I � '- I
23— 2 . -, *-8
30
Amount
Enclosed $
ALYCE BARRIENTOZ
GRANT COUNTY
ATTN MICHELE JADERLUND
PO BOX 37
EPHRATA WA 98823-0037
000000000000000041295700310271393
Transactions
Post Pate
Trans Date
Reference 71
Description
Amount
03/03
03/01
24943001XLKW3G7QB
HOLIDAY INN EXPRESS SPOIL SPOKANE WA
$157.35---
03/07
03/05
249430021 MOE I RADX
HYATT REGENCY WASHINGTON 888.5872877 DC
$1,003.50--,-
03/09
03/08
2,449216240TVIZG62
AF*WINDERMERE PROPERT. 509-765-5691 WA
$35.00
03/10
03109
2400959248ROKHVXR
SKAUG BROTHERS GLASS MOSES LAKE WA
$16.26
03/10
03/09
243323925000QNRE8
ACRANET- CBS BRANCH 509-3241249 WA
$45.00
03/12
03109
24431062SW5XHNYMG
CONFLUENCE HEALTH 509-662-1511 WA
$140.40
03/12
03/10
2443106252DYMYAW8
GRANT PUD 509-758-2508 WA
$102.00
03/14
03/13
244921528RTGQX12S
PAYPAL *ARIZONASTAT 402-935-7733 AZ
$20040
03114
03/13
244921528RTGQ942B
PAYPAL *ARIZONASTAT 402-935-7733 AZ
$200.00,.-
03/16
03/15
24492152BOTWFOHDQ
AF*WINDERMERE PROPERT. 509-765-5691 WA
$35.00
03/16
03/15
24492152BOTWFFTK3
AF*WINDERMERE PROPERT, 509-765-5691 WA
$35.001�
03/20
03/19
24011342EO014T3DA
ZOOM.US888-799-9666 WWW.ZOOM.US CA
$1,137.44
03/22
03/21
249O6412G4Y9XV7DD
Trupanion trupanion.comWA
03123
03/22
244921523OTSXMLK8
AF*PORTFOLIO REAL EST. 509-764-6600 WA
$1,1
$1'1
03/24
03/23
24492152JMHO82VWW
SO *RICAS FRUTALETA OTHELLO WA
29,33.27'
0 2
03128
03/22
244450O2N5SB6Z1DV
WALMART.COM 8009666546 BENTONVILLE AR
$4930
03128
03/26 -
24755422NM8MJ7JZY
HILTON HOTELS CHICAGO 312-9224400 IL
$253.58 --'--
Remit Payment to:
WASHINGTON TRUST BANK
PO BOX 2127 SPOKANE, WA 99210-2127
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Please include your a=unt
number on your check,
New address, phone number or e-mail?
Check the box to the left and print Change$ on back.
WASHINGTON TRUST BANK
PO BOX 2127
SPOKANE, WA 99210-2127
Mail Inquiries To:
P.O. BOX 2127 SPOKANE, WA 9921G-2127
We appreciate your bus nasal
Questions?
CaH Customer Service: WO -788-4578
Lost or Stolen Card- 800-788-4578
Payment Due Date
April
-S M T T
Account Number X)=.XX)O(-XX)(X-7139 F S
New Balance $0.00 3 14 5 6 8
9 loll -1.12 13 14 115
22
Minimum Payment Due NONE 16 17h8 I � '- I
23— 2 . -, *-8
30
Amount
Enclosed $
ALYCE BARRIENTOZ
GRANT COUNTY
ATTN MICHELE JADERLUND
PO BOX 37
EPHRATA WA 98823-0037
000000000000000041295700310271393
146 i_W G 3 7 1 230402 4 PACE 2 4F 2 1 0 4333 0030 CX48 01AC1146
Cardholder Name and Account Number Page 2 oft
A..YCE BARRIENTOZ 111SA
GRANTy ��YYJyy�C`+/YO U NT/e 1��Vhr�/�(�y Nj/� 1 •/jay
Finance Charge Calculation
Transactions (continued)
Post Date
Trans Bate
Reference
Description
anount
03/28
03/26
24755422NM8MJ7K0G
HILTON HOTELS CHICAGO 312-9224400 IL
$253.58`-
03128
03/26
24755422NM8MJ7PPA
HILTON HOTELS CHICAGO 312-9224400 IL
$253.68' "
03/28
03/26
24755422NM8MJ7PPJ
HILTON HOTELS CHICAGO 312-9224400 IL
$253.58.,,---
03/28
03/27
24692162N2X4AON9
WALMART.COM 800-960-6646 AR
$126.26
03/28
03/27
24801972PBMOBPBHG
IGGY'S MOSES LADE 013 MOSES LADE WA
~ $238.52"
03/29
03/28
24431062RLQ'TWRHFK
WA FINANCE OFFCRS ASSOC 206-625-1300 25.1300 WA
$75.00
03/29
03/28
24692162P2XS2J5E9
SO *CASITA DE CAFE Warden WA .,.
$40.00
03/31
03/30
24226382SBLH1Y2JY
' AL -MART #2007 MOSES LAKE WA -
$'10.0
04/02
03/30
24610432SO3R2WN9A
ROSS STORES #1636 MOSES LAKE WA
$44t41
04/02
04/02
OOOOOOOOOOOOCOMPC
TOTAL PURCHASES $5,990.64
TOTAL $5,990.64
TOTAL FEES FOR THIS PERIOD
TOTAL INTEREST FOR THIS PERIOD
Finance Charge Calculation
Annual Percentage late (APR) is the annual interest rate on your account.
Type of Balance APR Average Dally
Finance Charge Remaining
% Balance
Balance
Purchases 17.74% $0.00
$0.00 $0.00
Cash Advances 20.74% $0.00
$0.00 $0.00
Clays in Billing Cycle: 0 M = Variable Rate
See reverse side of page one for explanation of Finance Charge calculation.. Credit Purchases
calculated using Method G. Cash
Advance Charges calculated using Method A.
FOR REBATE PROGRAM QUESTIONS, CALL 800-788-4578.
Notes of Interest
Privacy Notice -Federal lave requires us to tell you how
we collect, share, and protect your personal information.
Our privacy policy has not changed, and you may review
our policy and practices with respect to your personal
information at watrust.+cdm or we VA411 mail you a free
copy upon request if you call us at 800.788.4578.
ype of client:
DV SA X CVSC 0 YHDP
Whathe-,, -..is -Emergen+
• Background check for housing
• Children's needs
• Debt assistance
• Driver's license
• Education training
• Bus fare to return home
• Cell phone to seek work/housing
Family well being
Date Submitted: 0/14/2023
Amount requested 4-1;�
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# of Children: t
Client's Home City: Moses Lake
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Explain: Rental Assistance
• Mortgage
• Service D
Utilities bills
Security Assist
• Rental Assist
Car payments
Food/Necessities
Updated: 2/11/2020
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ype of client:
X DV SA CVSC 0 YHDP
• Background check for housing
• Children's needs
• Debt assistance
• Drivers license
• Education training
• Bus fare to return home
Cell phone to seek work/housing
Family well being
# Mortgage
# Service DVPO
* Utilities bills
* Security Assist
#
Rental assist
Car payments
Food/Necessities
Staff: D. Long
Date Submitted: 003/21/23
Amount requested $220-.04 ,'a "$ . =�,.
# of Children: 3
Client's Home City: Moses Lake
Explain: Window Replacement
Updated: 2/11/2020
EMERGENCY FINANCIAL ASSISTANCE REQUEST FORM
Include back up documentation:
Receipt
Copy of check
W9, if applicable
Updated-, 2/11/2020
Invoice Address
NEW HOPE
311 W 3RD AVE
MOSES LAKE, WA, 98837
1013 Moses Lake
1520 East Wheeler Road
Moses Lake, Washington 98837
Phone: (509) 765-7300
Delivery Address
NEW HOPE
311 W 3 RD AVE
MOSES LAKE, WA, 98837
Order No 2119220
Order Date 03/27/2023
Customer
16720
Contact Name R DEBBIE LONG
Contact Number
-4.69 OR 509-764-8402
Job
-----
220.04
Your Ref
Authorization #
Delivery
By 03/27/23
Taken By
Janine Zieflow
Sales Rep
HOUSE
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1 EA 220.04
EA
-----
220.04
************7139
Authorization #
027047
-----------
Amount Outstanding
$0.00
Goods received in good condition
Print name
Signature
Payment Method
Amount Received
Visa
$238.52
Merchant #
191165472884
Account #
************7139
Authorization #
027047
-----------
Amount Outstanding
$0.00
Subject to our terms and conditions of sale posted at store and Ziggys.corn
$0.00
$220.04
$18.48
$238.52