HomeMy WebLinkAboutGrant Related - BOCCGRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
To: Board of County Commissioners
I"
From: Janice Flynn, Administrative Services Coordinator
Data June 8, 2023
Re: Authorization for Release of BOCC Approved Funds, Dept of Commerce,
CHG Grant #22-46108-10, Hotel Leasing Amendment, Reimbursement #24,
Renew, Request #10
Renew has requested reimbursement for the above -referenced grant, per the contracted
guidelines in the amount of $329.78 for May 2023 expenses. The invoice and supporting
documentation are attached for review.
I am requesting the release of funds for payment to Renew in the amount of $329.78.
Thank you.
P �VE
LF
A`
PRU
JUN 2 0 2023
CONSENT' ,
RECEIVED
GRINNU ("P'OUNTY 001AM",11,11STONERS
Grantee Name: Grant County
Report Month/Year: 05/23
Lead Grantee
Grant County
Renew
List Sub Grantee Names Below
Total
Admin
- $0.00
$0.00
CH h r F L _ H rn
G Ot a .Rent ac Su ease & :. ous
pp
. .. Z.
. t . .:':. ...
$0.00
CHG-Rent & Fac support/lease Costs
$0.00
$0.00
O -=--IONIC
gil mines=0.
$0.00
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\\ \\ �\ \ \\��\\M \ \\\\ \ i\\\\\\ \ .\ \ \ \\
Hoel Leasing,RR�I�Adrninv,���,�v,��vvvTv�:,v�`;�vvvvv�v,�;,v
\� 2443
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$24.43
o42.63
Motel\ Leasing ai. ,.,,,,•��,.,
3$42.6/R
Hotel 26272
262.7
Re `t for a �d\ Re Hous'
0.00
305.35
Invoice Total
$329.78
00*
0
UI w
Grant Behavioral Health 6 Wellness
Project #
Hotel Leasing Grant
CONTRACT # 22-46108-10
Date: Account Staff
May -23 108.150.00-0000.564.00.1100 27.66
108.150.00.0000.564.00.2100 2.87
108.150.00.0000.564.00.2200 2.00
108.150.00.0000.564.00.2300 9.90
108.150.00-0000.564.00.2301 0.06
108.150.00.0000.564.00.2400 0.14
108.150.00.0000.564.00.2599 -
RGCHB1277
Salary & Benefits
42-63
108.150.00.0000.564.00.4502
108.150.00-0000.564.00.4502
108.150.00-0000.564.00.4503
93.83
88.31
80.58
Total Operating Exp
262.72
Total SALARY/BENEFITS-0
305935
ADMIN 8%
24.43
sent
61812023 0:00
*00
is
erenew
HOTEL L GRANT
May-23
BAR Acct.
HMIS,
TOTAL EXPENSES GP LEDGER Departing
108.150.00.0000.564.00.1100
SALARY- Employees did not enter their time o
$
27.66
108.150.00.0000.564.00.2100
Retirement
$
2.87
108.150.00.0000.564.00.2200
SSI
$
2.00
108.150.00.0000.564.00.2300
Medical
$
9.90
108.150.00.0000.564.00.2301
FMLA
$
0.06
108.150.00.0000.564.00.2400
L&I
$
0.14
$
42.63
108.150.00.0000.564.00.4502
12531586 1762881221$
93.83
108.150.00.0000.564.00.4502
12539364 930937033
$
88.31
108.150.00.0000.564.00.4503
12544882 9C361BA66
$
80.58
$
262.72
5 \1 ,_...0 .. .: S , ,::.:.. 7 ..:: p • ' R -...1 ,.. 3 '-\ ' 2
,l� a l 1.
.:.. ... i f.: $, " �1_: '.�:
V��' .?d: S4i\k .it1-Y £F1,.A i R" N '4 `':. ,5'J. S, 'k 't•..:5 \ Y T h; r l
�RrA:H.O;`TE-LLEASING
,.TOTAL\BILLING vF
::: . .. :. ..._ \ .i,:. .-. i ••.. - •\ .
1
DONE
Admin 8%
$
24.43
fiotal Billed
$bF,
329.78
est Schavloml Hoolth G Woffrms*
'Oug
I I
$ 42.63
- ---- ----------- - - ---- ----------- -
8-
108.150.00.0000.564.00.4502 12531586' 176288122
108.150.00.0000.564.00.4502 -12,539364
930937033 $ 88.31
108.150.00.0000..564.00.4503 125448812 9C361BA66 80.58
262.72
z!o,
71, "if,
5"T 'Tot'
xJ "ALIS -11- L UP( uPAS.'
DONE
Admin 8% 24.43
Departing
May -23
;BAAt
R -c
'HMI
TOTAL
EXPENSES GP LEDGER
108.150.00.0000.564.00.1100
SALARY- Employees did not enter their time o
$
27.66
108.150.00.0000.564.00.2100
Retirement
$
2.87
108-150.00-0000.564.00.2200
SSI
$
2.00
108-150.00.0000.564.00.2300
Medical
$
9.90
108-150-00.0000.564.00.2301.
FMLA
$
0.06
108.150.00-0000.564.00.2400
L
0.14
$ 42.63
- ---- ----------- - - ---- ----------- -
8-
108.150.00.0000.564.00.4502 12531586' 176288122
108.150.00.0000.564.00.4502 -12,539364
930937033 $ 88.31
108.150.00.0000..564.00.4503 125448812 9C361BA66 80.58
262.72
z!o,
71, "if,
5"T 'Tot'
xJ "ALIS -11- L UP( uPAS.'
DONE
Admin 8% 24.43
Departing
r t
11
]HEALTH
ElTTWES
5/3./2023
alari '' .:B' e'fit GG .- Hote1 ,,LeC
DEBIT
SDI
108.15 .00.00V0.5`•,f4.4 .1100
$27.66
-108.150-00.0000.564.44.1201
$0.00
108.150.00.0000.564.44.1202
$0.00
"10c1�15000000 '...:... .'.::
$2.87
M-641lts t/I MVI.
, ,
-00 .
;
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$9.90
108.150.00.0000.564.44.2301
0406.
108.' 50.00.0000.564.44.2400
0;14
108 ,150.00.0000.564.44.2500
O f 00
�` � .�> �"i �" 3E- � � 1 *�ykt v'•`fr,* �� �i ,,� 9s \S i� �.�rkS{y%�t��°ii ,�`�'��F�-a-.
$27
108.150.00.0000.564.44.1201
$0.00
108.150.00.0000.564.44.1202
$0.00
.. 0. aM3 "M �+b w4�c� r�'"I;. `a `� lr'• :'4/t+�:.4'"S Yx�`'-. iv; `"23 Sy�`'�'+:-.
$2.87
.%9`4
�dS:
$2.00
X 'fid }��� 1 �-)'- '� wifLj��]■{4� P L.�. :� C�:�..:F�, ti. .A.' `f� !� r'a JY hr4 4tNll�gi�k, 6 l�?o `kllt'ba'�.'+�k��'li KL++��rr��,t _
§!0-.11/ i .
:::' 1., '. ,-.., .>.. ,.- �`' r-�_.: i..i ..-......r. c"E.<.:::L�. R.:, XGa�+«::r',>'u ;,eL`C{'l: •':. - . 911i§.'.1+.4�.. Y3r'�. •yr •A•.��?r" -a.-1-n.:'Y.�a:i.�i'14�.c$'k.��-�!4'ta. .yr`�': ' Y$` ;•'tie�5,
$9.90
� '
tY < ! L � Y.� ,t3ytly�' '`i•�*T 7 t��Z! N4T'.l ?+ „V�,�y�k F x�1'i �'�.r�y (�Fs�i• � i.`�t�y'E` 25��
W 11I RN� k�L�
�...,:..al.. ..o... ... .....
$0.06
..:...�}�`' •F f ti' :. � 1 xP�:.�.... �� .'L ::. S a7 ytF°L 4 p4, 'f+Yd �. -CyS K y i -t 2 4, '�,',;g)i Y:. �-,i �
�
"- ' � � ,+y_, � � .�. � r• t .�.�} tW U .k.S' .. ' .r.i"
.
$0 .00
,0.00
RG 5/3112023
Posted By Posting Month Entered Posted
0
Thomas E. Mitchell
From: Inn On 3rd Ave <messenger@ messaging.squareup.com >
Sent: Monday, June 5,,2023 4:10 PIVI
To: Thomas E. Mitchell
Subject: Receipt from Inn On 3rd Ave
Let Inn On 3rd Ave know how your
experience was
2 Bed Double Queen Weekday
Purchase Subtotal
Sales Tax (10.4%)
1
q 3 0 13
X68.31
8a.sfr
q ab"._-a.� a
$84.99
$84,99
$8.84
Total
Inn On 3rd Ave
509-765-1170
Visa 4212 (Swipe)
GMS CRISIS
$93.83
May 18
2023
at 3:52
PM
jX A
Auth
code:
018186
Return Policy: No refunds
By signing this you acknowledge you are financially
responsible for all damage to your room
WI FI: redsparrow447
Policies:
-Check out is at 11 am
-NO VISITORS after 10 pm, you will be charged for
extra occupants if you have unregistered guest
staying longer than 15 minutes.
-Damage of or rearranging of room fixtures and or
furnishings will not be tolerated and will result in
removal from the property.
-Threatening behavior towards employees or other
guest will result in removal from the property without
refund.
-illegal activity of any kind will result of removal from
property with no refund.
This property is privately owned and the
management has the right to refuse service to
anyone.
-The owners of this property will not be held
responsible for accidents or injury to guest or guest
of guest or for any loss of money, jewelry, or
2
4W, Washington State
IS 4 Department of
"04,01 Commerce
October 2022
Conso. Ild-cited Homeless Grant
Self -Declaration Form
Complete this form to document housing status or income., when applicable, I
EyHomelessness — in the narrative Include information about household's primary nighttime residence (where they sleep the
majority of the time) and if exiting a system of care narrative must also include information on homelessness prior to
system of care entry.
If fleeing violence, indicate in the narrative "fleeing violence." No additional information is required.
At Risk of Homelessness — Refer to Verification of Household Eligibility and Income Recertification Form for information
that needs to be included in narrative based on housing situation,
F1 Chronic Homelessness — Client must attest to chronic homelessness. *In addition, the case manager MUSt provide written
documentation of the living situation and duration1frequency, and the steps taken to obtain the standard evidence
allowable for chronic homelessness. This additional documentation must be in the client file.
Income — In the narrative include details on source of income, income amount, and frequency of Income. In addition, case
manager must document attempts to obtain written and verbal verification. This additional documentation must be in the
clientfife.
[] No Income — Indicate in the narrative "no income."
obtain signature atfirst in-person Zeeting with client.
L-N&U-Iff- TFL#F1WL1VU UVUVt:' U(JU
Chronic Homelessness*(see additional documentation required from case manager above)
Client Attestation
have experienced being homeless for the last 12 months in which I lived in
place not meant for human habitation or in an emergency shelter, or on at least four separate occasions in the last
-three years, I was homeless for a total of at least 12 months,
Client Signature
Case Manager Signature
Let Inn On 3rd Ave know how your
experience wets'-,
1 Bed Queen Nightly Weekend $79.99
Purchase Subtotal $79.99
Sales Tax (10.4%) $8.32
'total $88.31 '
Inn On 3rd Ave
509-765-1170
Visa 421 (Swipe)
May 14
VISA 2023
iS CRISIS at 4:25
Pm
- #h7
Ruth
code:
014232
Return Policy: No refunds
By signing this you acknowledge you are financially
2
NJ
d
TPi
Let Inn On 3rd Ave know how your
experience wets'-,
1 Bed Queen Nightly Weekend $79.99
Purchase Subtotal $79.99
Sales Tax (10.4%) $8.32
'total $88.31 '
Inn On 3rd Ave
509-765-1170
Visa 421 (Swipe)
May 14
VISA 2023
iS CRISIS at 4:25
Pm
- #h7
Ruth
code:
014232
Return Policy: No refunds
By signing this you acknowledge you are financially
2
Covnsoflrdad Hot-neless Gran -t
SeIr'-D.n.darat-lon Form
-41k, '01a shington Stalke
Ma Depari-men, of
VW 6. 1
,V49iP Commerce
October 2022
12 UL4
;Co
mple this form to document housing status or income, when applicable.
Homelessness — In the narrative include information about household's primary nighttime residence (where thesleep the
Y
majority of the time) )and if exiting a system of care narrative must also include information on homelessness prior to
system of care entry.
If fleeing violence, indicate in the narrative "fleeing violence." No additional information is required.
El At Risk of Homelessness — Refer to Verification of Household' Eligibility and Income Recertification Form for information
that needs to be included in narrative based on housing situation.
Chronic Homelessness — Client must attest to chronic homelessness, *In addition, the case manager must Provide written
documentation of tyre Yving situation and duration/frequeticy and the steps taken to obtain the standard e 1
vidence
allowable for chronic homelessness, This additional documentation must be in the. client file.
income — In the narrative include details on source of income, income amount, and frequency of income. In addition, case
manager must document attempts to obtain written and verbal verification. Thl's additional documentation, must be in the
client file.
[:] No income — indicate in the narrative "no income."
Client Name
FlMis Client Identifier
Date
Narrative
Client Signature* 101
eq
'ZI
26;
C,
�a-rc.v� is Cur elk
A
VL
kit
*If intake is conducted remotely incl fi ni signaturw dYb�-1 mediate
e canna e Yin ly obtained, case manager should notate client narrative above anal
obtain signature at first in-person meeting with client.
Chronic Homelessness* (see additional documentation required from case manager above)
Client Attestation
la have experienced being homeless for the last 12 months in which I lived in
place not meant for human habitation or in an emergency shelter, or on at least four separate occasions in the last
,-,Lhree years, I was homeless for a total of at least 12 months.
Client Signature f
Case Manager Signature
MOTEL 6 - MOSES LAKE
2822 DrIggs Drive, Moses Lake 98837 USA
Date: May 239 2023
•
Hoom Numb,131
6097660260
m64365bo@6franchise.com
Receipt
IA-
9cg-u 15"
W -
Card Type
VISA
Confirmation No 4365AEA942
11asked'Card Nurnber xxxxxxxxxxxxx4212
Guest Name 03RIS CRISIS
r. -Wry Mode
Chip Read
Transaction Type CREDIT
Approval Code
023937
Status AP
Total Amount
AID AOOOOO00031010
Mode: Issuer
TVR 8000008000
Trarisactlon Type., Sale
JAD 06011203AOBOOO
Terminal ID., 2541265001
TSI 6800
;)ay above, total arnount acxord-ing 11.-o card issuer a g rr..Jenne, fit,
aqra'.)erne1nt if Credlt.y Voul-,.,her-)
Pr1.
-el.*ailf'l this copy 'JR)" Your recoirds.,
g P"t'WU
N
-0
MIn
.......... ....... - - - - -
Washington State
Department Of
C61 -
July 2022
... Consolidated Homeless Grant
Third Parti Verbal Verification dorm
Complete this form to document housing status or income, when applicable.
Homelessness — In the narrative include details of the phone -call to the temporary housing provider verifying
applicant's temporary housing or system of care representative verifying applicant is exiting and was previously -
homeless.
At Risk of Homelessness — In the narrative include details -of the phone•call to the relevant party. Refer to Verification
of Household Eligibility and Income Recertification Form for specific informatiori to include and who to contact.
Chronic Homelessness -- In the narrative include details of where they were living and specific months.
Iff
F] Earned income — In the narrative include name of employer, pay amount and'frequency, average hours worked per
week, amount of any additional compensation.
R Other Income— In the narrative include name of income source, income amount, and frequency of income.
t�hl It �,���e •. ,. r� .i'.�i .a�.• :� __ ._ ____.._.. __.__�_-
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