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Home My WebLink AboutGrant Related - BOCC (003)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 . Kat'I'I@ Stockton CONTACT PERSON ATTENDING ROUNDTABLE. CONFIDENTIAL INFORMATION: EIYES ®NO DATE -8/1/2024 PHONE:2937 111110:1 RENNIE= I= ElAgreement / Contract EIAP Vouchers ElAppointment / Reappointment EIARPA Related ❑ Bids / RFPs / Quotes Award E]Bid Opening Scheduled El Boards / Committees El Budget El Computer Related E]County Code F Emergency Purchase 0 Employee Rel. El Facilities Related F71 Financial ❑ Funds El Hearing El Invoices / Purchase Orders ® Grants — Fed/State/County E]Leases El MOA / MOU 7 Minutes ElOrdinances El Out of State Travel OPetty Cash El Policies 7 Proclamations [I Request for Purchase F-1 Resolution El Recommendation ❑ Professional Serv/Consultant El Support Letter ElSurplus Req. E]Tax Levies ❑Tha.nk You's DTax Title Property OWSLCIB "fi e -0 �.' 0" va T� - ------------ - - ---- - ---- --- -- Reimbursement request from McKay Healthcare on the Strategic Infrastructure Program (SIP) #2023-06 Engineering & Outdoor Facilities in the amount of $47,272.80. If necessary, was this document reviewed by accounting? 0 YES ❑ NO Fm -1 N/A If necessary, was this document reviewed by legal? 0 YES ❑ NO Fm -1 N/A DATE OF ACTION: ► �7ii APPROVE: DENIED ABSTAIN D1: D2: D3: 4/23/24 DEFERRED OR CONTINUED TO: WITHDRAWN: I GRANT COUNTY STRATEGIC INFRASTRUCTUREPROGR' AM PROJECT CERTIFICATION This form must be signed and -returned, with ani invoice, I*-ce,, for the approved funding, before reimbursement can by Grant rant County. SIP Pt, � ect Proposal Number- IP2023-06 SIS` u'n. n Rewp ent McKay Hospital & Rehab SIP Project Description Engineefln, and Outdoor F i g acilitiesProjects 11 the utid si , ' d, do h - of -per'ur er gne ere�y certify- under penalty -a he materift1s. have. that t been furnished,the: sorvic .es rendered, and/or the labor ,peifort-ried as� described i the pam authorizrojectreject , Ahd that. 1 ed to proposal ior the above -referenced SIP P authenticate and, certify to this claim. - Lats-0, c orltif� that. this claim of $35,1421*80 is jus, C and due And i*s':an* unpaid obligation againstantouItNe Further, according tq.t . he SIP Project'undidnj4 Policies, I attest that at the next .chit of my etitity, this project shall -be called to the attention of the Washington State Auditor's Office and -an emphasi's audit Will be requ ted to ure . - s- that these funds were expended .es "toward the project anal .aoeordmg to the intent of the propo,sal, ---------- .............. ............. Sign Victor Odiakosa. Printed.Name Date Sig ed Adn--*iii'lstrator/Superintendent Title Administidor/Su De-ri . nten'dent Prffited'Title Completed, signed original certification and *invoice are to be mailed to: Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823 Reimbursement # 3 in the amount of �35,427.80 ATTACHMENT4 0 ,off 01 -son '4 INVOICE grete 01. iConstrwl. Scorpion Concrete construction scorpionccOO-@yatioo.com LLC +1 (509.) 237-0767 LLC 4038 RD 7.8 NE Moses Lake, WA 98837 Bill to ship to MO KAY HEALTHCARE MC KAY 'HEALTHDARE 127,Second ave SW 127 Second. ave SW APKE, WA 98837 SO.LAKE, WA 9883 7 SOAP L-A - United States UIted StateS- Invoice details Invoice no.: 1014 Torms: Net 30 lh.vo"16e date, 06/02/2024 Due date: 07/02/2.024 # Pate Product or service Descriptibn Qty Rate mount ....... .... ....... . ..... ............... . ................... .. - .... ------- ............ ---- ............. . . ....... ........ ........ ---- ------ — ............. ------- .......... . - Services Contract #2024-3. Sidewalk ,curb & psi 1 $690100.00 $693,100.00 repairing 2. Services change order 1 $3*18,0.00 $3,780.00, Total $72,880.00 :Ways to pay VISA 13ANK r tw Pa ment -$37,452.2 Y Note to customer Balance due $35o427,80 progress payment requested $37,462.20 NO TAX on this 'Invoice < WAC 458-20-171 provided it by the customer 77-7771 Vi ew I nvw'ce MoKAY HEALTHCARE 622 Scorpion Concrete Construction LLC 07/11/2024 94155 Invoice Number Invoice Date bescriptionI Gross Amoulnt Discount Taken Net Amount Paid 1014-2 106102/2024 Admin - PS - SIP2023-06 $35t4E27,80 $0.001 $35,427.801 $351427.801.1-1- $0.001 $35,427.80] . ........ f7 US 13ANK.. McKWHEALTHCARE" 6041 094155 127 SECOND AVE SW - PO BOX. 619 SOAP LAKE, WA 98851 07/11/2024 (509) 246-1111 PAY TO THE ORDEROF '$35,427.80 Thirty Five.. Thousand Four -Hundred Twenty.Seven Dollars and 8.0[fegds .... .............. .... . ... .... ........ ........ . .......... Scorpion ConcretO -Constru i -4038 RD 7.8 NE. ...'mo*ses Lake, WA 98837 .Pr AT cm to.4� 'e MEMO * AU PR RE 111 60 L, 10 q t, I S SEI" 1: L 2 3 20 LG4 L S 3 2 100 20 L 3 4V GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This - form mush besigned andreturned with an. invoice, the approved funing, before reimbursement can be approved by Grant Co- unty# SIS" P rol-a 6 Propos.al Number, IP.023-.4 .1 1.11 1. SIP Funding Recipient McKay Hospital & Rehab .81P Ptoj ect Descript ion Engineering and Outdoor Facilities Pro-jcots I the under " gried, d -0 hereby certif d' of p at the materials 'have sy un . er penalty orjury, Ih_ ered, tm -or the or, perfo -*b to imed as descn ed 'in the been furnished the service.9 d/ bc r0j P, Pt os for the ahoveferenced SIP roject- and that, I a m aotho'fizod to t e-�r authenticate and certify to this claim. I also certify that: this C.'Aaita of $11A45.00 -i dust ani du and is an unpaid o'bligation 'against aht. Gouty. Pt tt r st that,,, the next audit of .he, Aocot og to the -SIP Pr 'ect. Fundina Policies - late at MY di qj .entity, t . project shall be called,. to the attention of the Washington- State Auditor's. Off 0 emphasis -audit, - i e and an will be requested to assure, that these f4t __.dse� W., e - or, ended toward theprofect and. -according to the inte'- hift 'of the,prc��osal..'..pro 'Victor Odiakosa. Printed Name Aw*"% J Date Si'66ned Adm'i'n,*Ist-i-atot/Su',oerinten,deftt- 'Title Administrator/SWerintendent. Printed Title Completed, signed original curt icat ion and -invoic, are to be %#iled to: Administrativ I e Services Coordinator,, PO Box 37, E phrata, WA 98823 Reimbursement # 4 'in the amount of $11,845,00 ATTR CHM ENT 4 �� Nelson Geotechnical Associates, Ina, to,, 17311 135th Ave NE Suite A-600 Woodinville, WA 98072, United States Tel; 425-486-1669 info@nelsongeotech.com nelsongeotech,com RECEIVED JUN09'L* Victor Odlakosa McKay Healthcare & Rehabilitation Center Public Hospital DIstrict No. 4 of Grant County Washington Soap Lake, WA 98851 V(4ndov';6.t: (V 2L( cizars Code 11c reel &1 2)5 Alt ID e p A I A p p r o v a INVOICE INVOICE DATE: 6/7/2024 INVOICE NO-. 1474523 13ILLING THROUGH: 6/7/2024 Aniourit- McKay Healthcare Geo -Inf Soap Lake -147451- 3 Managed By: Chris Ward -Guthrie Billing for geotechnical engineering evaluation services regarding the Mckay Healthcare and Rehabilitation Center located at 127 SW 2nd Ave, Soap Lake, Washington. A report dated June 4, 2024, has been issued as a part of this ...biffin . . .... . .......................•............ .. . ........ . . ... .... PROFESSIONAL SERVICES . . . ...... .. ..... ...... -AmoUNT ACTIVITY Geotechnical Evaluation $11,845.00 TOTAL SERVICES• $11,845.00 SUBTOTAL $111845.00 NT DUE THIS INVOICE .45.00 This invoice is due on 717/2024 ACCOUNT SUMMARY TLAST �Ny..�MT PR4V'P NPAID AMT Sr INV. No .:'LAST INV DATE.. AST PAY AM $11,845-00 $0.00 T. -D -INCLUDING: THIS. INVOICE..: RETAINER SUMMARY :RSCEIVE P $0.00 $0.00 $0.00 ......... Page I of 2 McKAY HEALTHCARE 624 Nelson Geotechnical Associates, Inc. 0612012024 94090 lr�Gross Amount Discount Taken'Net Amount Paid voice Number 'Invoice Date Oescription 0 1474523 0610712024 Admin - PS - SIP2023-9lo $11,845.00 $0.00 $11,845-00 ------ $11,845.00 $0.00 $11,845.00. US BANK McKAY. HEALTHCARE6041 094090 127 SECOND AVE SW - 1:)o BOX 819 SOAP LAKE, WA 9 06/20/2024 (60 D) 246-1.111.. PAY TO THE $1 1$845.00 ORDER OF Eleven Thmsand Eight Hundred Forty Five DoIlars G and 00 entsE)OLLARS ........ .. .. A Nelson Geotechnical As 'ociates,nc. 17311 135th Ave NE Suite A-500 Woodinville, WA Ord MEMO AUTKQR I) ISIG A4m s4A. .. .. ...... 111160 4 10 9 40 90,16 1:L232065IGs L532100201340