Loading...
HomeMy WebLinkAboutInvoices - GRIS (002)ZZ) Form A19-tA State ct WaMirgh 3 Inwice Voucher Health Care Authority 621 8th Avenue SE WA 98504 Grant County 640 E Lake, Moses Lake, WA 98837 9 Agency No. A6reement ID c, Contract Number 1070 K3919 rd�'. rtifier 1 h y certify under penaperjrythat the I endtotals llstdharem —IonWcharges for materiels, merchandise orservicesOlympia, Ne to of Woe d that all Nmish0 n rendered have been proNdad without tlisalminefion because a/ge,' r , ealam at origin, ap bligion, W ere or cisrsabld veterans statusV6NGtMGRCIAA1gVT ` sign In ink) • f)�r �'1 4 (due) (date) TAX IDENTIFICATION NUMBER MONTHlYEAR OF SERVICE """1319 9/112020 SuoplemenW #1 RECEIVED BY DATE RECEIVED BMS PaGGMUAcnYITT XeuE Csxp Is IF—le PFS OMA SOR NCE -a SOR Supp 90R II MHPP ° EBP PP Ganenl Tahal 11.1 Admin G.C, 000 21 Ce mmunayBasad Coordbhauon-Px Community -Based Process Universal-Imd,- 0.00 22.5 Community Coalition Coordinator Community -Based Process Universal -Direct 0.00 22.5 Community Coalition Community -Based Process Universal.Direct G 00 22.5.1 Community Coalition Coordinator -ML Community -Based Process Universal -Direct Goo 22.5.1 Coarxurdty Codillon -ML Community -Based Process UN—.A- irect 709.09 709,09 24 1 2 PAX -Good Behavior Game - ML Information Dissemination Universal -Indirect Goo 22.2.1 Positive Action -ML Education Universal -Divot no 22.2.1 Youth Ernpowennent - ML Education Universal -Direct 0.o0 22.1.2 Oulrah&Education-ML Information Dissemination Universal -Indirect 0.00 22.1.2 Tek. They Hear You ML Information Dissemination Universal -Indirect o.00 24,1,2 Under The Influence Of You ML Information Dissemination Universal -Indirect 0.o0 22.1.2 Ct—W Strong - ML Information Dissemination Universal -Indirect 0.110 22.1.2 You Can -ML Information Dissemination Universal -Indirect o.o0 2284 Restorative Justice -ML Eno—memal Universal -Indirect Goo 22.8.2 Traumalnfor—el Schools - ML Emi—mental UNver-Andirect O.00 22.7.1 CoaliUWCanmunity Trainig - ML Otter Universal -Direct 0.00 22.7.1 Coordinator Professional Development - ML Otter Uniwrs*Dract 0.00 0100 22.5.1 Community Coalition Co'c"nelnr - O CcmmunitNBased Process Universal -Direct 0.00 22.5.1 Conmunity Coalition - O CcmmunityBsed Process Universal -Direct ODD 222.1SaengthenagF 'lies Progratn-0 EducaUon Universal -Deet[ B.w 22.2.1'p°'°°""""""�iv°oo°e101rye'BiM1°'"°" Education Universal-Dkect Goo 22.3.1 HmMy Aft—dies-O Alternatives Universal-DYect o.Do 22.1.1 Information Dissemination Universal -Direct 0.00 22.1.2 You Can - O Information Dissemination UNversal-Indirect om 22,1.2 Under The Influlaxe Of You- O Information Dissomir-an Universal -Indirect 0.00 22.1.2 Rxsw llrpoc°'"o'P'°a""su°u'm luuaeO MM Bap Information Dissemination Universal -Indirect Goo 22.1.2 Starts With Ona O Information Dissemination Universal -Indirect 22.6.2 Drug Free Parks -O Enveerm W Universal -Indirect 22.6.2 OHS Di.iPOnary - O Environmental Universal-Irtdirect 22.7.1 CoalitiaNCanmunily Tratndlg - O OMer Universal-Dnect fl�.owo 22.7.1 Coordinator Praia.." Development- O Other Universal -Di -t 22.8.2 Px Sustainability Policy- O Erni—ental Universal -Indirect 22.7.2 Ocn at Education Workshops- O Other UalvarsA-Indirect o.00 o.00 o.00 0100 o.00 Goo oCo 0 00 709.09 0.00 0.00 0.D0 0100 0.00 0.00 0.00 0.00 0.00 0.00 0.00 709.09 PREPARED BY( DATE Reyna Gorvaks 12/15I2020 TELEPHONE 50978az5so A19 Effective 7l1119 through 6/30121 REVISED 1012020 CURR DOC NO DOC DATE VENDOR NO. SWV0002426-00 AGENCY APPROVAL' Sarah Mariani, 360-725-9401, Sarah.Mariani hca.wa. ov ACCOUNTING APPROVAL FOR PAYMENT/ DATE i>Lu U NT' 1 6 21120 1 pw, N 11-