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Home My WebLink AboutGrant Related - BOCC (008)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 SUBMITTED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Karrie Stockton CONFIDENTIAL INFORMATION: DYES R NO oare:6/10/2024 PHONE:2937 If necessary, was this document reviewed by accounting? ❑ YES Fw-1 NO ❑ N/A If necessary, was this document reviewed by legal? ❑ YES ® NO ❑ N/A DATE OF ACTION: C � • Tq APPROVE: DENIED ABSTAIN D1: D2: D3: 4/23/24 DEFERRED OR CONTINUED TO: ❑Agreement /Contract ❑AP Vouchers ❑Appointment /Reappointment ❑ARPA Related El Bids /RFPs /Quotes Award ❑Bid Opening Scheduled ❑Boards /Committees El Budget ❑Computer Related ❑County Code ❑Emergency Purchase ❑Employee Rel. ❑Facilities Related ❑Financial El Funds ❑Hearing ❑Invoices /Purchase Orders BGrants —Fed/State/County ❑Leases El MOA / MOU ❑Minutes ❑Ordinances El Out of State Travel ❑Petty Cash F1 Policies El Proclamations El Request for Purchase El Resolution El Recommendation ❑Professional Sery/Consultant ❑Support Letter ❑Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from McKay Healthcare & Rehab on the Strategic Infrastructure Program (SIP) Grant #SIP2023-01 in the amount of $10,345.00. If necessary, was this document reviewed by accounting? ❑ YES Fw-1 NO ❑ N/A If necessary, was this document reviewed by legal? ❑ YES ® NO ❑ N/A DATE OF ACTION: C � • Tq APPROVE: DENIED ABSTAIN D1: D2: D3: 4/23/24 DEFERRED OR CONTINUED TO: GRANT COUNTY STRATEGIC INFRASTRUCTURE PRO GRAM Thi's form must be signed,.and returned, fth n *nv i e din wi 9 We , for the approved foll 91 before reimbu, rse'm en't can, be ap��r�w�d. b Grant Count . yo , y SIP, Project ProDosal Number: SIP2023-01 SIP Funding Reci I p . ler t McKay H6spital & Reha b SIP PtoJectDe§c`nptlon Phase 1Architecture -and Engineering e Plan 1, the undersgned do hereby certify under penaltv of p eri that the mat rials have uryen been, fivnished, the services rendered, -and/or the lab or performed as described ill the project proposal for .the. above-kefefenked SIP Pect and that I am auth ze r0"i or"d to l authenticatd And certify to this claim. I also certify that Of this claim 2,�345.00,i$ just G a coltmty and due, and is anb ,p,a't*(I,o,bligaiio.naga.inst t. Further,accordingtoo the SIP Proje 'Fundiniz Pol"cies, I attest -that at the ndxt,audk of. ' ct i ray on o wasMo- - t State Auditorls entity, this projectshall becalled, to the attenti f the , ng on, .sure fun Office and an exhphAsis audit Wi 11be requested,to ass that the - e S. ds e expended tow-afd the00 f -l. project and ac, rding to the ifttento I the rooosa p , 1. , -. I -------- Signature Victor diakosa Printed Name Pate, Signed - tratoi/S _A AdmLws uvennten-dent Title Aftmlsttator/Sub erintendent PAntea Tial:e- Hed to: Comerpleted, sianed original certification andnv ice are to be m 1 0 a' i Administrative Services Coordinator, PO Box 37, El phrat a, WA '98823 Reimbursement # 10 in the amount of $10,345.00 MWIN I ill 0 � I ATTACHMENT 4 McKAY HEALTHCARE 586 RiceFergusMiller 05/30/2024 94013 ------------ Invoice Number Invoice Date Description Gross Amount Discount Taken Net Amount Paid .2023052.00-008 05/08/2024 Admin - PS - SIP2023-01 $10,345.00 $0.00 $10,345.00 . ... ....... $10,345.001 $0.001 $1 Ot345.001 5offill * MC AY HEALTHCARE USBANK' 6041 094013 127 SECOND AVE SW - PO Box 819 98-66111232 soAp LAKE, WA 9MI 05/30/2024 PAY TO THE ORDER OF $10,345.00 ': .. Ten Thousand Three Hundred Forty Five Dollars and 00 Cents DOLLARS RlceFergusM*Iller'*- - .275 Fifth Street; :quite 100 V_,4ar .:Bremerton, WA 11160tiV394013111 146L2320GSLGia 4 S 3 2 100 20 L 3 �111 RIC i./ gUSMI LLER 275 Fifth Street. Suite 100 Bremerton. WA ?8337 (360)377-8773 Public Hospital District No. 4 of Grant County,. Washington P.O. Box 819 Soap Lake, WA 98861 Victor Odiakosa Professional services through 04130/2024 SIP Grant 2023-01 Invoice number 2023052.00-008 Date 06/08/2024 Project 2023052.00 McKay Healthcare SNP Pre- DesIgn - Master Planning Invoice total 10,345.00 Aging Summary Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120 2023052.00-007 04/10/2024 40,603.11 40,603.11 2023052.00-008 05/08/2024 10x345.00 10,345.00 "amik .... ... ... Total 60,948.11 50j948.11 0.00 0.00 0.00 0.00 For any questions regarding this invoice please contact Jill Wolfard at (360) 377-8773 oriwolfard@rfmarch.corn 1 4: M 0 BCode ,ars 3a ke - rs P rov -a %cag,t. I-letac.1 AP Public Hospital District No. 4 of Grant County, Invoice number 2023052,00-008 Invoice date 0510812024 Washington Contract Total Remaining Current Description Amount Billed Contract Billed Scope IA -Conceptual Design 100184.00 943360.00 51824.00 0.00 Scope 1 A -Schematic Design 78,936.00 54,296.00 24,640.00 41207.50 Scope 1 B.1 -Site Plan Design 871280.00 543800-00 32,480.00 61137.50 Total 266l40O.00 203,456.00 62,944.00 10,345.00 Invoice total 10,345.00 Aging Summary Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120 2023052.00-007 04/10/2024 40,603.11 40,603.11 2023052.00-008 05/08/2024 10x345.00 10,345.00 "amik .... ... ... Total 60,948.11 50j948.11 0.00 0.00 0.00 0.00 For any questions regarding this invoice please contact Jill Wolfard at (360) 377-8773 oriwolfard@rfmarch.corn 1 4: M 0 BCode ,ars 3a ke - rs P rov -a %cag,t. I-letac.1 AP Public Hospital District No. 4 of Grant County, Invoice number 2023052,00-008 Invoice date 0510812024 Washington