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Home My WebLink AboutGrant Related - BOCCGRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: gOCC REQUEST suBnnirTED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Karrie Stockton CONFIDENTIAL INFORMATION: ❑YES MNO DATE: 9/5/2024 PHONE:2937 - - ----------- - --------------- 4 ;j:j ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related El County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders M Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑ Minutes ❑ Ordinances ❑ Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution ❑ Recommendation ❑ Professional Serv/Consultant ❑ Support Letter ❑ Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from Port District #4 Coulee City on the Strategic InfrastructureP-P(- r(,r,,�- (SIP) #2023-05 New Coulee City Medical Clinic, in the amount of $8,154.54. If necessary, was this document reviewed by accounting? ❑ YES documentL8GAL R� � 8VI tW: If this w q wasreview, A w w�i* review p If necessary, was this document reviewed by legal? ❑ YES ❑ NO DATE OF ACTION: �117-1.z5e APPROVE: DENIED ABSTAIN .01 D2: D3: El NO ON/A DEFERRED OR CONTINUED TO: WITHDRAWN: '0 4/23/24 GRAN T_ COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved by Grant County* SIP Project Proposal Number: 2023-.05 41 SIP Funding Recipient: Grant County Port District #4, Coulee City SIP Pro1 *ect Description: New Coulee City Medical Clinic 1y the undersigned, do hereby certify under penalty of peg ury, that the materials have been furnished the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I am authorized to a of $'9u,24a 5,4 is authenticate and certify to, this claim. I also certify that this clamsN. just and due and is an unpaid obligation agam"st 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 hat these funds were expended to assure t toward the p Ject and according to the intent of the proposal. project Signature Printed Name Date Signed ltle Printed Title Completed, signed original certification and invoice are to be mailed -to: Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823 ATTACHMENT 4 tW OULEE CITY Apt ;0 1 X-Vest Main Sweet (309)-0 12-; 1 3 I 1111olle [1.0. Box ON 609)-632�iQ; Fax Coulov Citv, Nv.X 9() 115-0 �(m F-rildid: tcoulec(a OLQE43i TOVIII III ORA11111 COUNT 7 Accou'llt Infon-nation Grant County Port Dist No 4 Cunt 0: 1915 PO Box 537 Date 07/01/2 )024 Due. 07/31/2024 Coulee City, WA 99115 Invoice 14 For: Utility Service Connection Item taxed'. Quantity; Amount Total' Wrater Connection - 2" N' 0.5000-1 4,524.54 2.262.27 Water Connection - 211 N' 0.5000 4.524. 54` 3 162,27; 21— Sewer Connection N� 0.5000 7 ~4000.00. 1,000.00: Sty -veer Connectioll x N' 0.5000. ?,000.00, 1 ,000.00; 18 W. Main - New Service Connections, Non. Taxed: 6,5*24,54! Taxed: 0.00' Tax Ci, 0.00%: 0.00, Payments: 0.004 Total: 6,4524.54 00,00 Grant County Port District #4 61410 0 4 0 9 2 Town of Coulee City 7/1.312024 61524.54 Cash Account water sewer 6,524.54 PRODUCTSSLT104 USE WIT14 91663 ENVELOPE Deluxe Corporation 1-800-328-0304 or www.deluxe.com/shop 1 C52,5951� 24138817009- DNIKU SLKDK03 12/15/2022 07:32 -10- Page 1 of 4 Grant County PUBLIC UTILITY DISTRICT Customer Service PO Box 1519 Moses Lake, WA 98837 Address Service Requested 00000994 TGCSTMNT060724022532 01 100000000 0001684 003 Grant County Port District #4 PO Box 537 Coulee. City WA 99115-0537 40 4 teN 0 0 CD % Service Address: Metered Temp Main St W 218 OH, Coulee City W.A. 99115-0000 Metered Temp Service 06a*rge - OH GWO 223447 Billing Period: 0610612024 - 06/06/2024 Prior Balance $uo Payments $0.00 Balance $0.00 Metered Temp Service Charge - OH $380.00 CURRENT CHARGES $ CURRENT AMOUNT DUE $3:8 !0. 070 Page 2 of 4 98767,63174 0610612024 0710112024 $3115422600 --- --- -- - ----- Customer: Grant County Port District #4 (Continued) • Service Address: 2100 Main St Medical Clinic, Coulee City WA 99115-0000 Construction Charges UG Service GWO 223447 o BON Period: 06106/2024 - 06106/2024 Cy Prior Balance $0.00 Payments $0.00 C) Balance Line Extension Job Charges Electric Job Order Charge - UG $850.00 Fiber Job Order Charge - UG $400,00 C> C) CURRENT CHARGES 17 $31.162.00 o CURRENT AMOUNT DUE 31!162.00 OG 6141004.086 t Grant County poFor,DIsIdr, #4 241388 Om/shop i!5/2022 07*32 -16- 1 -Boo-328-0304 or www-deluxe-c SLKDK03 12 PROD ITH,a,t4\tELOPE 663 F Deluxe Ca oration UOT SSLTJ 04 Usew 2:49 PM 09102124 Type VnecK TOTAL Check TOTAL Check TOTAL Check TOTAL Check f,OTAL Check TOTAL' Check TOTAL Grant County Port District #4 Check Detail July I - 229 2024 Num Date Name 4086 07113/2024 Grant County PUD Item Account Cash Account New Construction Paid Amount -1,630,00 -1,630.00 4087 0711312024 McDonald, Howard Cash Account 513.10 - Commissio... -161.00 -161.00 4088 0711312024 Joy Beardsley Cash Account 513.10 - Commissio.. -161 -00 -161.00 4089 07113/2024 Chris Erickson Cash Account 538.40 - Utilities 138.66 514.10 - Port Secret.. -200.00 1-338.66 4090 0711312024 Boss Public Affairs... Cash Account f 514.40 - Professiona... -1,000.00 -41,000.00 4091 07113/2024 Centurylink Cash Account 538.40 - Utilities -85,46 -85.46 4092 0711312024 Town of Coulee City Cash Account New Construction -6,524-54 -61524.54 Page 1 2:49 PM Grant County Port District ##4 09/02/24 Check, Detail ,duty I e 22, 2024 Type Num Date Marne item Account Paid Amount Check 4093 07113/2024 Ries Law Firm Cash Account 514.40 - Pro€essiona... -70.00 Page 2 GRANT COUNTY PORT DISTRICT#4 2VOUCHER UST GENERAL FUND GRANT P. 0. BOX 537 COULEE CITY., WA �15 WARRANTS: OF PERJURY THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE 1, THE UNDERSIGNED, ®O HEREBY. CERTIFY UNDER PENALTY , CLAIM IS A JUST' DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE , THAT I AI't/! AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. I WARRANT NO. APPROVED: AU DITOR. SIGNED B 1' ' Ff O. PORT DISTRICT COMMISSIONERS