HomeMy WebLinkAboutReimbursable Work Request - GRIS (002)it -Io -L., AV C,-'1
F«m slate of W ash'nglon
A19 -!A Invoice Voucher
�'cyna�
Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
vE,-IxlR aacLnnu�-r
Grant County
840 E Plum St
Moses Lake, WA 98837
Agency No. Agrwment 10 «contract Numl»r
1070 K3919
Vendor's Certacala. I hereby certify underpenaey ofp&7wy that the item and totats listed herein are proper chaTm / materials, merchandise w services
misnedenaar services rerMered nave been provided ximout disciiminerion because Drage, sex,
marcal status, race, peed, color,, �natiioonal origi/n, handicap,Vietnam We or disebled v s atatus.
fwm.+ned to the Srete ofwachingran, and mat aN goads N24"
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9:
(sign in ink)
// 77� �7��
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(tide) (deb)
TAX IDENTIFICATION NUMBER
^' 1319
MONTH/YEAR OF SERVICE
Aug -20
RECEIVED BY DATE RECEIVED
6-1 PROORAYac-NAYE
COR19MATEGYIOY
9-G OFS pFS P18 ffs DMA Stift NCE WR We Supp suit 11 MHPP
Camyova EBP PP General
Total
11.1 Ad-
0.00 581.58 20274 1.093.32
1,877.64
21 C«nmundyBased Coo cl or-Px
Community -Based Process
Universa -Indirect
0.00
22.5 Community Coalton Coordinator
CommunilyB-ccl Process
Universal -Direct
0.00
22.5 Community Coalition
Community -Based P,w-
Universal -Direct
0.00
22,5,1 Community Coalition Coordinata-ML
Communi Based Process
Universal -Direct
7.062.95
7,062.95
22.5.1 Caaoxaly COW'- - ML
Community -Based Process
Unser ---/-Direct
48C 00
480.00
22,1+2 PAX40A Bal,svior Gam -ML
Information Disseminatbn
Universal -Indirect
0.00
22.2.1 Positive Action - ML
Education
Universal -Direct
0.00
22.2.1 Youth Emp-erment - ML
Education
Uniwrsal-D-t
O.DO
22.1.2 Outreach 8 Etlucetion- ML
Information, Dissemination
Universal -Indirect
0.00
22.1.2 Talk. They Hear Yon ML
Information Disseminatbn
UniversaFlrMimt
0.00
721,2 Under The Influence Of You -ML
Informed -Dissemination
Universal -Indirect
0.00
22.1.2 Character Strong - ML
Information Dissemination
Universal -Indirect
0.00
22,1,2 You Can - ML
Informstlon Dissemination
Universal -Indirect
0.00
22.6.2 Restara6ve Justice -ML
EnA--W
Universal -Indirect
0.00
Y242 Tracm.1 mod Schools - ML
Em,im mental
Universal -Indirect
0.00
22.7.1 Caalilion/C«mmuney Training - ML
Othar
Universal -Direct
0.00
22.7.1 Coordinator Professional Development - ML
Ogler
Universal -Direct
0.00
0.00
22.5.1 Community Coalition Coordinator- O
Community -Based Process
Universal -Direct
2.089.88 6444.62
8,534.50
22.5.1 Community Coalition - Q
C«mmunil Based Process
Universal -Dred
444.38
444.38
22.2.1 Stragthening Families Program - Q
Education
Uni er kDirecl
0.00
22.2.1 SPORT PPW-Q
Education
Universal -Direct
3.58142
3,581.42
22.3.1 Healthy Alternadves - Q
Alternatives
Universal -Direct
0.00
22.1.1 Youth Development- Q
Information Dissaninadon
Universal -Direct
0.00
22.1.2 You Can - O
Information Dissemination
Universal -Indirect
0.00
22.1.2 Undo The Influence Of Yon Q
Information Dissemination
UniversaPlndireol
0.00
22,1.2 Rx Safe Disposal - Q
Information D-sminabm
Universal -Indirect
0.00
22.1.2 Starts With Ons -Q
Information Disssminutkn
Un-rsaWndirect
0.00
22.6.2 Drug Fres Parks - Q
Enwonmonlai
Universal -Indirect
0.00
22.6.2 OHS D-4Ainry-0
Environmental
Universal -Indirect
0.00
22.741 CoelitioruCommunty, Training- Q
Other
Universal -Direct
0.00
22.7.1 Cocrdlnaa Prafessiad Developn,anl-Q
Ogles
Universal -Dred
OAO
22.8.2 Px Suala-uny Perky - Q
Environmental
Universal -Indirect
0.00
22,7.2 Community Education Workshops - Q
Other
Universal -Indirect
3,640.41
3,840A7
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7,542.95 581.58 2,73701 1 0.00 r 0.00 0.00 0.00 0.00 14.759.77 t 000 0.00 0.00
25,621.31
PREPARED BY/ DATE
Rayne GorvAks 1012812020509
TELEPHONE
764-2660
A79 Effective 711/19 through 6/30/21 REVISED 10/2020
CURR DOC NO
DOC DATE
VENDOR NO.
SWV0002426-00
AGENCY APPROVAL:
Sarah Mariani, 360-725-9401, Sarah.Mariani hca.wa. ov
ACCOUNTING APPROVAL FOR PAYMENTI DATE
NOV - 5 2020
Pepe 1 Rev r-1-ce