HomeMy WebLinkAboutGrant Related - BOCC (003)E
GRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: BOCC
REQUEST susMrrTEo BY: Karrie Stockton
DATE: 1/19/2024
PHONE:ext. 2937
CONTACT PERSON ATTENDING ROUNDTABLE: Karrie Stockton
CONFIDENTIAL INFORMATION: DYES ®NO
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Request from Port of Royal Slope regardingStrategic Infrastructure g Program (SIP) 2019-10
Waterline Extension to East Eldarado Stone Pro' •
sect, for release of fund installment
3 of 5 in the amount of $26,600.00.
DATE OF ACTION: I � 30 , ?"-q
AP ROVE: DENIED ABSTAIN
D1:
D2:
D3:
DEFERRED OR CONTINUED TO:
GRANT -COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
INSTALLMENT 3 OF 5
PROJECT CERTIFICATION FO,7 � i,� .,� { � =._�
For the it release ofk .: r� , :r^
_�26960� 900 ,: ,w , ppa ; u
(trom a $1339000.00 Grant)
This form must be signed and returned, •with an invoice for the approved funding,
before reimbursement can be a proved by'
p Grant County,
SIP Project Proposal Number: 2019-10
SIP Funding Recipient: Port of Royal Slope
SIP Project Description: Waterline Extension East to Eldorado Stone
1, the undersigned, do hereby certify underpenalty of perjury, that the materials have been
furnished, the services rendered, and/or the laborperformed as described in the project
proposal for the above -referenced SIP Project and that I am authorized to authenticate and
certify to this claim. I also certify that this claim isjust and due, and is an unpaid obligation
against Grant County.
Further, according to the SIP Project Funding Policies , I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's Office
and an emphasis audit will be requested to assure that these funds were expended toward
the project and according to the intent of theproposal.
Signature
Printed Name
Date Signed
Title
�ec u�, J � `� r.r ec_�v
Printed Title
Completed, signed original certification and invoice •are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Grant County
Stratig|c Infrastructure Program
Administrative Services Coordinator
POBox 37
Ephrata, \NA98823
Due Date
SIP Project Number:
SIP Recipient:
5|P Project Description:
PORT OFROYAL SLOPE
pO.Box l47
4572Road 13.63VV
Royal City,.VVA 99357
1/31/2024
2Ol9-lO
Port ofRoyal Slope
Water Line Extension East to Eldorado Stone
Grant 2019-10 Total Amount Remaining
Third of Five Installments in the amount of:
Remaining Amount 2019-10
Phone/ 509-346-2317 bvalentine@portofroyal.com
$ 79,800.00
$ 26,600.00
$
Website: www.portofroyal.com