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HomeMy WebLinkAboutGrant Related - BOCC (004)GRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT.. BOCC DATE - REQUEST suBnnirrED BY: Janice Flynn CONTACT PERSON ATTENDING MEETING: Janice Flynn CONFIDENTIAL INFORMATION: ❑YES ®NO 10/19/2023 PHONE: Ext 2937 kedu &MIJUA91JEEL11 ate► 110111111111111111 A iii:ll!lil� A A ed or ❑Agreement / Contract FAP Vouchers ❑Appointment / Reappointment ❑ARPA Related El Bids / RFPs / Quotes Award ❑Bid Opening Scheduled ❑Boards / Committees ❑Budget ❑Computer Related ❑County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders 0 Grants — Fed/State/County Ell -eases ❑ MOA / MOU ❑ Minutes ❑ Ordinances ❑Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution El Recommendation El Professional Sery/Consultant ❑Support Letter ❑Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from New Hope on the Department of Commerce Commerce Consolidated Homeless Grant (CHG) No 24-46108-10, in the amount of $3,969.86 for September 2023 expenses. ,ZAP PROVE v� ❑DENIED ❑TABLED/DEFERRED/NO ACTION TAKEN: ❑CONTINUED TO DATE: ❑OTHER DATE OF ACTION: I U 1/24 --�3 L ub'_Grantee Names Invoice Month/Year Grantee Name IM S-- Total $3,969.86 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 County of Grant 35C ST NW P.O. Box 37 Ephrata WA 98823 Vendor: DAVID GUTIERREZ 14214 S. HANEY RD KENNEWICK WA 99337 Document Number �9062b-i �-DL. Description: Client EFA Page 1 /1 Invoice 0396553 Date 9/7/2023 Purchase Order Number Vendor ID Shipping Method Payment Terms ID GUTID Amount $170001,00 subtotal $i jow,00 Misc. $0.00 Tax $0,00 Freight $0.00 Trade Discount $0.00 Payment $0.00 Total. Due $1.,000.00 Updated: 2/11/2020 Staff*- D. Long Date Submitted: 09/06/2023 now beginnings. better tomorrows. Amount request: $1,000 Type of client: # of Children: 3 DV SA X CVSC OYHDP 600%lient ID: AOT23188 Client's, Home City: Moses Lake ti NVE Explain: Rental * Background check for housing Mortgage o Children's needs •Service SVPO e Debt assistance Utilities b4lis * Driver's, license Security Assist e Education training Rental Assist Bus fare to return home • Carpayments Cell phone to seek work/housing Food/Necessities • Familywell being MWI.�,5`.. .r <. t'+- ,..L !>.'x> �� "?-k.N LI LUM. iaLM,. 'ie*S}�f��FW. ,:.:� �� "�Y>;V.-rv�.rr-..5�'. _ , .<.:."i .. �4 .. ,�i; it(RyYiFSy� ,Ci.. "Yq"�,_ �. ... Fi!. ,...i�.F�. Utx <4�. „� _ 'E�t'.-r�. ..1. ':%. +:3ldN �} j> • Housing Authority Explain: Employment • Salvation Army 0 Serve MIJQuincy 0 DSRS 0 CPS 0 Family contribution Friend contribution k .",-"S- �` �Y. n t e, r eme d 'UP.fit z n MI _eV sbf,-, 19 r N At N.- Ak: gg -A G 0 AN, 3-OSK"" HDP NOW', 01, KA_ F 4 A -Y,, k -C --b", -OD`:� MENT� UP as Updated: 2/11/2020 GRANT CM4,NTY Neer t o e/K i J Hopeo PROMISE't,` 1`0 PAY CIBI111,1111 Qav I&P� LIli Io -re? J– — vost 011icc Addre4o* 442,N,5I-Itanc% Rd k WIN NIC)IIII, DaN Purpos.c Dollar CCtIts 09 01 September Rent 1,000 00 - ------------- t 1)111C- a W-24)-2. I - Total Amount $ All hill's num K- ili:tiwed in detailon.l.his blatils or iwowvd list atwelied licrew ith W[witsubmitting claints tor wit he sure to spCCIN dill esc lo Im. is tIIICII&d to COOT ISSUED Debbie G Wn� Neu I knpe/K . ids Hop: Advocatc p For'subliussion for Pay"ICIII - RCIUM VOUCIICT 10 G, raill County NI'm Hopc/K ids I lope 31 l W Third Avenuc Moses Lake. NVA 98837 I licrdik Caffy on I lonor. that the goods. mc(chandise, oiatimil (v set%, ice dlarVd f()r III IN: aNiN 4: hill havc k4en futniNfied as 11crelf) charged DAIE 11f inted Clatinmit Nara: CA INNOIB I US ED I'M A LCO110L, TOBACCO, PRE -PA I D OR CHF-freMDS :_mcnt lo ah_q\�c a�dgrg�m,.0 aL. will, LC \ �vf Vvudwn, ri:u.I�vd IV), 12 v tit) I\ uill hay c a� "'Icorav. 3' 144c the to , I pm 1:X1FRGJNN('Y HNNANCIAL ASSISIANCI- 1. IN11\10 FUNDINIG 7611 Id— N ONO% Page 1 /1 Invoice 0396432 Date 9/6/2023 County of Grant 35 C ST NW P.O. Box 37 Ephrata WA 98823 Vendor: HOUSING AUTHORITY OF GRANT COUNTY UNITED MARKETING P.O. BOX 3080 BELLEVUE WA 98009 ww Document Num �er Purchase Order Number VendorlD Shiin& Method Payment Terms ID PP �91 GC . .............. ........ Description: Amount Client EFA $1,990.00 Subtotal $1$990.00 ,disc $0.00 Tax $0.00 Freight $0.00 Trade Discount $0.00 Payment $0.00 Total Due $1 A 990. 00 Vendor: Post Offi it qn-V ,� � GRANT COUNTY • New Hope/Kids Hope Rids Hope PROMISE TO PAY Date— q 1 11-2623 Total Amount $ Nqa. 0 D 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 - SUED: Return Voucher To: Grant County New Hope/ {ds Hope Hope/Kids Hope Advocad 3 11 W 'Third Avenue Muses Lake, WA 98837 I hereby Certify on Honor, that the goods, 'Merchandise, material, or servi.ce charged for In the above bill. have been furnished as herein charged. DATE: /V Printed Vendor Name S-1-0—i—atu, re ❑ Mail 12MMent to above address Check one: CANNOT BE USED FOR ALCOHOL, TOBACCO, PRE -PAID OR, GIFT CARDS. lul claimant will pick, qppgyMend at Ne Vouchers received by 12:00 pm Wednesday will have payment available the following Thursday. Staff: Date Submitted: (� � � �..�;,��, Amount requested $ IqqV - 0 C) Type Of pl i ek n t 0 DV XSA OCV 0 CAC # of Children: Client 11): Ce-ASP3010 What s the Emergency * Background check for housing * Mortgage * Children's needs * Service DVPO * Debt assistance # Utilities fties bills * Driver's license * Security Assist * Education training * Rental Assist • Bus fare to return home * Car payments Cell phone to seek work/housing * Food/Necessities Family well being Explain: Form RD 3560-8 USDA - RURAL DEVELOPMENT Form Ai)Droved (Rev. 08-11) JEN&II-GERIIENATE212 OMB No. 0575-0189 Effective M M D Q Y Y 1. Data 1 02/01/23 HOUSEHOLD INFORMATION Initial Certification Certification Expired Recertification di-,clos-c certain inforniation may cleliv the processing of your cligibility or rejeaion. R14S will not den .1 . I I Y & Eviction in Process Modify Certificafian 0 Designate 60 Day 0 Coteflant to Tenant (enter code) Absence [] Assign/Remove. RA End 60 Day Absence 0 Vacate a Unit contribution rbrr�ntl-lowcvcr, the information collecwd nmy be relcw�ed to appropriatc Fedoral, StW, and Tenant Transfer PART I - PROJECT AND UNIT IDENTIFICATION I2. Project Name 3. Borrower ID and Project Number 4. Unit Type 5. Unit Number Beverly Lane 772065345,034 N2 I 1 1 21 WARNING STATENIENT. Section 1001 of Title 18, Unit d 8vates Code provides, "Wboever, in any mottcr within the jurisdiction of any departmew oragency of the United Stat knowingly and *x. Ilifully faisifies, conceals or covers up by defy trick, scheme, or device a inatexial fact, or makes any fabse, fictitious or fraudulent statements or representations, or makes or uses any fillse writing, or document knowing the same to Ontain any fiflqe, fictitious or fr-audulent stateMetit or elitry, shall -be fined under thii title or finprisoned not more than five v=-,, or both," PART 11 -TENANT S'TATE.kir-.NTRI-'Q[JlRr-t)BYTHI--PRI'Vtk(YACI': Tide V of the Housing Actor 119419 authorizes R11S. to HOUSEHOLD INFORMATION collect t4v information on this form. Your disclosure orthe information iq voluntafy. However, failure to 6. Tenant Subsidy Code di-,clos-c certain inforniation may cleliv the processing of your cligibility or rejeaion. R14S will not den .1 . I I Y eligibility if y6u r6use todi&Close your Social Security Number. (enter code) El This inrormation Is coltcc-tcd principally to detemlinc-ctigibility r6r occupalicy anti to, determilic Your tenant 0No DMp Tonal &jbsid, y I Ranhal Astisiallm (RA) contribution rbrr�ntl-lowcvcr, the information collecwd nmy be relcw�ed to appropriatc Fedoral, StW, and 2Project Swied 12�'-ion a 4 Othee OKRAi., a ill a cics,, crWit burcaus and wrvicing -agzk`nts w1wo rclevant to civil, Cri initial or rcgulatcr - proccWings 5- Pmtsie RA G - HIM V"Kher or to cnforcc rc-QuIations by manual or autoinatcd verification proccilures. 11 Minor, 14.Elderly, I - oft, -Typos at it Ren, Round Lill flionetary figuitu up lo the nearest drdlai- ai —10 and abotv. 0?he!'S0b1$&Y INN' Wor (teave dOnktr none, PParW tr F -Ful) 0010 SUbSidy AN,Wht (For'Parbd) S i 2a. Race Disabled, Disabled -- ----------- ----- -- Handicapped or Hindi - 7. Social Security No. S. HouseholdMember Name. 9. SEX 10. Date of Birth 11 Race 12, Ethnicitv btermina- or Full -Time capped tion Code Student18 (Last..., First and Middle) M M D D Y Y (Complete -------- --- ----------- or Older 'this only 5 C (Complete when ........ --------- ----- C th s only ...... housohotd --------- ................ ... when C1 C M hwsehold 0 a - - ------ - — — ------- - --- G ineml>er. "renent..or isnot CO-Tenantl the Tqnant .. .......... ...... . .. ........... ------ or$ (Check ...... ....... . ... ...... ........ . CO -Tenant) below when coded ------ ------------- — — - - ------ ----------- above) Choice$ for ROM are, I-Aawdcanindfarior 8a, Number of Foster Children (if any) Chaides for Race Det. Code . EDTotal Elderly Alaman NaWe C- Customer Provided E - Employee Obsefved 0. ne 13). Status 2 - Mian 3 - Oar* brAftican PART III - ASSET INCOME American 4 - Native HawWilan or Paclfit;Wander 15.NetFami - IvAssets (NOTE: If Line '15 is less than S5,000, enter zero on Line 16.) S 393 5 - White 16. Imputed Income from Assets (Bank Passbook Savings Rate U6%) x Une 15- I 0 Chotces foe Ethrkity are: a - IT Income from Assets S 0 b - N00- nidLatlno --- PART IV- INCOME CALCULATIONS 18. Income a. Wages, Salaries, etc. b. Soc. See., Pensions, etc. c,. Assistance d. Income ConVibuted by Assets (G -eater , f er of Line 16 or One 17) e. Other f. Annual Income g. Household Has Exempt Income 0 MUIIIMMMMIIMO0 01 $ 0 S 20462 $ 20462 10. Adjustments to Income a. $480 x total of Line 13 b. $400 if elderly status c. Medical .exceeding 3% of Line 18f W --lde c - tly, handicappvd or dfsaNed) d. Child Care e. Total Adjustments 20Adiusted Annual Income ft. ne 181 mi.nus Line 19Y0) PART V - INCOME LEVELS ---------- 21. Number of Household Members 23. Date of Initial Project Entry M 1 04111/22 22. Current Eligibility Income Level (Enter Code) 24, Eligibility Income Level at Initial Project Entry (Enter Code) El - - - - - -- - --- -- ---------- ------ ---- - ---------- - ------- -- ---- "I -------- PART %n - CEIRT11FICATION BY TENANT I earthy and acknooAedse ffmt -if thev Agency prwidas unauthtAted. ussistarice to the bo77VZa'*rZrY't't'7fami1y housing proWA mw*r fcx my benefit based on arroneotis or frauddent informallon provided In Nt; teriant ce0fication, I wit rekrburse tm Agency for that unaui.Wzed amount If I do not, the Agent y may tise all ri�medliews* availat4e to colk-cL4, including thtn. a under flie Debt Collectior A(A, to recover tot Federal debt dire -Ay from me. in xuxtianc.- with the tequirerinon% o( the Privacy Act of t 974, which protecmy cruillden"- re=ds frorn unauthcrized telease. I authorize the Agwivy to re4oase lnWmaifon :.ollwed in this tem3nt Axcomhagto tete Papttr%vork RtiludioaA0 of 1995. ria) pcvso" arc ic4unrit to fcNmd voill:,3ion 01 laforaw.oa lutk4-A it 6ipikys a vaW 01MB a;rxatd vur,&. 'rhe raild oivu vit-I-)i auwIvr llwthlli mil'"Putia;1 w-MICC'4011 8 Tbt: Wrx mcu cd to wtopleft: thii -uA'Vt;r4V.0 -30 truwatcl pet it")-qsc. lixtudingthc bilks: fi3r rCV14W;r--8 ilvtndcdom< . 'icachi'Ju VXiAtwe 1-iL3 &)d 'na-inlAining dackWA4 ncedat. eine conipirfing and rutin wing the colimflon cif infunmuit"a. PART x'11- PRELIMINARY CALCULATIONS 25. Adiusted Monthly Income (Line 20 / 12) 26. Monthly Income (Line 18.f / 12) 29. Gross Basic Rent a. Basic Rent b. Utility Allowance C. (Line 29.a + Line 29.b) a. $ 1495 x .30 a. $ 1705 X .10 800 $ 61 8 1 27. Designated Monthly Welfare Shelter Payment 28. Highest of Line 25,b, Line 26.b, or Line 27. 30. Gross Note Rate Rent a. Note Rate Rent b. Utility Allowance c. (Line 30,a + Line 30.b) = b, $ 449 = b. $ 171 $ 0 449 MMMYYYYMMYw $ 857 $ 51 $ 908 - ------------ -- --- PART Fill - DETERMINING GROSS TENANT CONTRIBUTION (GTC) Decision (check one) A- If, tenant receives rental assistance (RA) enter Line 28 on Line 31 below, If Line 28 exceeds Line 29.c., go to Decision B since this Teriant will not receive RA. B. If tenant does not receive RA and this project receives Plan 11 Interest Credit, enter the greater of Line 28 or Line 29,c. (but not to exceed Line 30.c.) on I inp'41. hAnw C. If tenant does not receive RA and girls project is a Plan 1, Full Profit or Labor Housing project, complete Lines C.I. thru 0.3. and enter Line C.3 on Line 31. 1. Enter Line 30.c $ 2. Add Plan I Surcharge (if any) $ 3. Total (enter cin .Line 31) PART IX - DETERMINING NET TENANT CONTRIBUTION (NTC) 31. GTC (From PART ''VI II) $ 449 49 3Z Utility Ailowance (Line 29.b. or Line 30.b.) $ 51 33. Final NTC (Line 31 minus Line 32) $ 98 (Amount Tenant pays Borrower for rent. If Line 33 is negative, Borrower pays the difference to Tenant for tifififies 1 3918 PART X - CERTIFICATION BY BORROWER 1 certify that the information on this form has been verified as required by federal law and the tenant household Eis eligible to live in the unit, or I I has been granted ineligible occupancy by RHS. a. Date Signed M M D D Y Y b. Signature of Borrower or Borrower's Representafive -7- Updated: 07/27/2023 Staff. Date Submitted:. mon�M!yb y�UAY11y�tt�■�f `�yjr Amount ■ '... new begrnni better M ,, f yple OT c ne nt:, _ SA OCV 0 /:C y,(j�� of e w. --------- --- I .01 e n t I D: LO 1 Clients Home City: <:'•-,,. , ,.. ,,, .9 i' ;}ir _ ,.. , >._ .. ,. .. ,... ,. r s.....,e.. , ,. 1,.. .�, .J ^4 _. > a. _ . - <ts ..:. .-�....n .. ✓, .. .A* x. f v r. < ,. .""?i_... 1. .s�''�„✓ �... 'L- t. Y - Y .'1=tte.. Via.. �.ice isxe. .'r ':. ., ,,. J _ ,-.. ,... c,. . ,. '., v. .. 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'. e .v{%' Sr •itG` - r C, :+ } r "i`3 -.y >ty.: i .,,� s�. n... r ?� L,� �f• h- f. � Nt. ,�- tt' :,y c: r3 - ..^a' �.., t,) ':�' �r„=i �^. --"s,'9J'�'"" ,Y,. �� 3.. �<•R- : �' `? g� 3 -�:.. :%�-.:P'. .:"�-. Explain: * Background check for housing * Children's needs Mortgage YVii l 0 Service DP Debt assistance 0 Utilt fie4s bills _ -- -...w�}xfr{(YVM * Education training fare Security Assist #�'Y.y.�, yiT}M� Assist d •"A�f,E{�i �}�al�.e:r�tal 0--vA(k--�,:, �,krs. 'fm• .B�y�,us tv return home ,� �a� agents . [T ,f�/�nil�: phone t•✓ MYeil work/housing f.S/1tt�M.l4 ■� 'MVV/ Family well being, e FoodCecessite t• X rti .v- hr .. .- ,. ... ,.. ,,,. ..< ,.. ,. .... :. sb •- A _. .:.-b..r .. y, a-«_.. J :hi':,v, .. ✓ R . y .. .... J. f.. .'.1•,r\ :_..s...am. �..,�_..s...:.-.h.,.:,- _. . 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S\< cta ?'. `-a is \.:f -.r sr ... u...,. .... ,.... ,, .....::. .v ,.< .. .. , . .. _-,.. ... . s.. ,.;;Yrt f . ,a , .t - ?:t. �.� _•:4.. ..fix. .. \. .. , t O L , A. ,_ \.. .., .i .3'.. a ...,[ :. •..r -`,v , t.. .., .-:- ,.. - V3 ? - i„ : c4 f r k 5, •t- ,r D'OPPAYME s r 77777P Updated: 07/27/2023 CHG Voucher Detail Month September 1-30, 2023 Vendor Code Descriptioi Amount charged to the grant David Guiterrez 565504580 Rent 1000 Housing Authority 565504580 Rent 1990 National Real Estate (Visa) 565504580 Rent 979.86 Total 3969.86