HomeMy WebLinkAboutGrant Related - BOCC (005)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: Kat't"12 Stockton
CONFIDENTIAL INFORMATION: OYES ® NO
DATE:6/28/2024
PHONE:2937
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO •
N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO R N/A
DATE OF ACTION: /�
APPROVE: DENIED ABSTAIN
D1:
P�
D2:
D3: -
4/23/24
DEFERRED OR CONTINUED TO:
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71 -eases
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Reimbursement request from McKay Healthcare on the Strategic Infrastructure
Program(SIP) #2023-01, in the amount of $2,500.00.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO •
N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO R N/A
DATE OF ACTION: /�
APPROVE: DENIED ABSTAIN
D1:
P�
D2:
D3: -
4/23/24
DEFERRED OR CONTINUED TO:
rc`E�IVP
GRANT COUNTY JUN
STRATEGIC INFRASTRUCTURE PROG..... A M 20Z�
a Vty
PROJECT CERTIFICATION��
This form must be signed and returned, with an invoice, for the •approved funding
before reimbursement can be approved by Grant County, 4=71
SIP Project Proposal Number: SIP2023-01
SIP Funding Recipient McKay Hospital & Rehab
SIP Project Description Phase I Architecture and Engineering Site Plan
1, the undersigned, do hereby certify under penalty 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 Pro ect and that •I am authorized to
Pro'
authenticate and certify to this claim. I also certify that this claim of $2,500.00 is just and
due and is an unpaid obligation against Grant County.
Further, according to the SIP Project Funding Policies.
0 , 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
Victor Odiakosa
Printed Name
Date Signed
Administrator/Sqperintendent
Title
Administrator/Superintendent
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement # 11 *in the amount of $2,500.00
ATTACHMENT 4
GSI
GS/ GA Transforming Age Ventures dba GSI
-,WA
R
Bill To
McKay Healthcare
127 2nd Ave SW
Soap Lake WA 98851
United States
Terms Due Date Balance 'Forward
6/1412024 $20,272.30
Invoice
INVOICE NUMBER: INV 122
INVOICE DATE: 5/16/2024
TOTAL
$2,500000
Due Date; 6/14/2.024
Description Quantity Rate Amount
Consulting Services 1 $2,500.00 $2,500.00
The Sizzle Piece Project - 50% deposit
Subtotal $2r500,00
Tax (0%)
$0.00
Invoice Total
$21500.00
Total Ba1a'nce
$22,772.30
11111 11111illill 111111111111 1 of I
INV1 122
McKAY HEALTHCARE
1186U4 W 44 3 bill 1:423206S 61: IS32400201-34iim