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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 CONTACT PERSON ATTENDING ROUNDTABLE: Kal"1'12 Stockton CONFIDENTIAL INFORMATION: ❑YES A]NO DATE:10/15/2024 PHONE: 2937 IVA ❑Agreement /Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget []Computer Related ❑County Code El Emergency Purchase El Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders ® 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 Renew on the Community Development Block Grant (CDBG) CV2 #20-6221 C-111 in the amount of $6,439.34 for August 2024 expenses. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: i � - �Z` Z� DEFERRED OR CONTINUED TO: WITHDRAWN: APPROVE: DENIED ABSTAIN D1: D2: D3: 4/23/24 &ATE OF WASMN 0 DEPARTMENT OF COMMERCE 99504-2525 Form 19-1A VOUCHER DISTRIBUTION AGENCY Short Code Commerce Contract Number NUMBER CMS Invoice ID: DEPARMENT OF 1030 20-6221C-111 404957 COMMERCE VENDOR OR CLAIMANT (Warrant payable to:) INSTRUCTION TO VENDOR OR CLAIMANT: Grant County Board of Commission Submit this form to claim payment for materials, merchandise or PO BOX 37 services. Show complete detail for each item. EPHRATA, WA98823 Vendor's Certificate: The individual signing this voucher below warrants they have the authority to do so as authorized and on behalf Karrie Stockton --------------------- - ---- - - - - --- -- of the entity identified in the Vendor/Claimant section. The individual (Vendor Contact Person) signing below certifies under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or (509) 754-2011 (Vendor Contact Phone) services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, kstocktona-grantcountywa.aov (Vendor Contact Email) national origin, handicap, religion or Vietnam era or disabled veterans status. 03/27/20 - 06/30/25 (Contract Period) Karrie Stockton Kstockton2) 10/15/2024 8:32:35 AM 08/01/24 - 08/31/24 (SUBMITTED BY) (SUBMIT DATE) (REPORT PERIOD) DESCRIPTION BUDGET REQUESTED EXPENDED TO AMOUNT THIS AWARD AMOUNT DATE INVOICE REMAINING Contract Total $929,365.00 $6,439.34 $508,375.76 $.00 $420,989.24 Non - Match Total: $9299365.00 $69439.34 $508,375.76 $.00 $420,989.24 PROGRAM APPROVAL Date (The individual signing this voucher warrants they have the authority to sign this voucher.) DOC DATE CURRENT REFERENCE DOC NO. VENDOR NUMBER and SUFFIX DOC. NO. SWV0002426 03 ACCOUNT NO. ASD NUMBER VENDOR MESSAGE 39195 TRANS REV MASTER SUB SUB MG MS GL ACCT SUB AMOUNT PROGRAM CODE CODE INDEX OBJ SUB SID INDEX OBJ 622CO320 NZ 6221 C READY to BATCH PREPARER DATE WARRANT TOTAL CREATED BY Karrie Stockton (Kstockton2) DATE 10/15/2024 8:29:42 AM Form 19-1A VOUCHER DISTRIBUTION AGENCY NUMBER Short Code Commerce Contract Number CMS Invoice ID: DEPARMENT OF 1030 20-6221C-111 404957 COMMERCE 0 All Expenses under $1,000 Paid by UBI Paid by Organization Name Paid to Contractor - Paid to UBI Paid to Organization Name Paid to Org Type Expense Type Amount Type Subcontractor Total Sub Subcontractor Total Al VOUCHER FORM Voucher #8 ti F Q T" WASHINGT®N STATE 1 b r DEPARTMENT OF COMMERCE 1 1it19 •. AGENCY NUMBER IDIS PROJECT NUMBER COMMERCE CONTRACT NUMBER A19 VOUCHER DISTRIBUTION 1030 107 20-6221 C-111 AGENCY NAME DEPARTMENT OF COMMERCE ATTN: CDBG-CV PO BOX 42525 OLYMPIA, WA 98504-2525 INSTRUCTION TO VENDOR OR CLAIMANT: Submit this form to claim payment for materials, merchandise or services. Vendor's Certificate: I hereby certify under perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion or Vietnam era or disabled veterans status. VENDOR OR CLAIMANT (Warrant is to be payable to:) GRANT COUNTY PO BOX 37 EPHRATAry WA 98823 0037 (SIGN IN BLUE INK) Grant Administrative S ecialist 10/15/2024 '��''' REPORTING PERIOD: Au -24 (TITLE) (DATE) IDIS Activity ID DESCRIPTION ORIGINAL BUDGET PRIOR AMOUNT REQUESTED AMOUNT THIS INVOICE REMAINING BALANCE Add or delete budget line items as needed. Includes CVi and CV2 as applicable. 8310 21 A General Admin (Grant County Expenses Only) $ 22,190.00 $ - $ 22,190.00 8311 05Q Public Services Admin. Budget (OIC) $ 96,367.84 $ 66,453.96 $ 29,913.88 8311 05Q PS -Subsistence Payments (rent, mortage,utility) (OIC) $ 17500.00 $ 100,290.99 $ 74,709.01 8312 05X PS- Housing Counseling and Admin. Budget (OIC) $ 110,715.59 $ 22,756.19 $ 875959.40 8313 18C - Microenterprise Assistance Admin. (0IC) $ 126,034.57 $ 48,685.88 $ 77,348.69 8313 18C - Microenterprise Financial Assistance. (OIC) $ 50,000.00 $ - $ 50,000.00 8313 18C - Microenterprise Training (OIC) $ 12,000.00 $ - $ 12,000.00 8706 050 - Urgent Need- Mental Health -General Public (Grant Co.) $ 304,900.00 $ 198,136.57 $ 6,439.34 $ 100,324.09 8706 050 - Urgent Need- Mental Health -Tele-Health (Grant Co.) $ 32,157.00 $ 32,157.00 $ - 8706 050 - Urgent Need- Mental Health -County Jail (Grant Co.) $ - $ - $ - Balances $ 929,365.00 $ 468,480.59 $ 69439.34 1 $ 454,445.07 !` ,BELOW THIS E IS F OR DEPTARTM-fNT OF COMMERCE IMA- TRANS CODE M 0 D MASTER INDEX SUB OBJ SUB SUB OBJ GL ACCT SUBSID AMOUNT INVOICE NUMBER CI 622CO320 NZ �i / SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT DATE WARRANT TOTAL CMS Invoice ID: ACCOUNTING APPROVAL FOR PAYMENT DATE Grant Grant Sehav!Qml Health 6 Wetir-ess PO Box 1057 DATE: October 7, 2024 Moses Lake, WA 98837 INVOICE August 31st, 2024 Phone (509) 764-2643 Fax (509) 764-4124 BILL TO: Grant County - CV-2 PO Box 37 Ephrata, WA 98823 FOR: AUA g -2- CV-2 DCR DESCRIPTION Amount Total Amount CV-2 DCR Salary & Benefits $ 6,151.32 $ 61151.32o" Oper Expenses 288.02 $ 288.024 Total 61439.34] M ME a, renl�w. Gr*nt. S*havlor-al H**Ith a Wolin*#* CV-2- DCR 10 8.15 0.00.7 609.5 64.41. 108.150.00.7609.5 64.41.2100 108.150.00.7609-564.41.2200 108.150.00.7609.564.41-2300 108.150.00.7609.5 64.41.2301 108-150.00.7609.564.41.2400 108.150.00.7609.564.41.112,A 108.150.00.7609.564.41.4152 108.150.00.7609.564.41.4204, j 108.150.00.7 609.564.41.42 D 2 ----- --- ----- -- 41851.36 438-08 371.14 345.65 10-26 134.83 �� 6,151.3 157.03V400# 41.2 29A-0? TOTAL BILLING FOR CV-2 JAIL 6,439-34 10/7/2024 7:46 EMP # w4AME IPay source I Say B.EHA'VY'10,R,A.L,HEAI-,,r'.I'H. JOURNAL ENTRIES 8/31/2024 Salaries- Benefits CV-2 GC 0CR-7609 IDEBIT CREDIT 108.150.00.7609.566.51.1100 $4,851.36 108.150.00.7609.566.51.1201 $0.00 108.150.00.7609.566.51.1202 $0.00 108.150.00.7609.566.51.2100 $4. e./•08 108.150.00.7609.566.51.2200 $371.14 198.1, 0.00.7 09.5 6.51 Yiw 00 $345.65 108.150.99.7 09.566. 51. 3+01 $19. 6 108.150.00.7609.566.51.2400 $134.83 108.150.00.0000-564.001100 $4,851.36 108-150-00-0000-564,001201 $0.00 108.150.00.0000.564.001202 $9.Q9 0 .150.99. 000. 64.992199 $438.08 108.150.00.0000.564M2200 $371.14 108.150.00.0000.564.002300 $345.65 108.159,99.9999.5 4.99 301 $10.26 108.150.00.0000.564M24,00 $134.83 $6,151.32 $6,151.32 $0.00 RCS 8/31/2024 Posted By Posting Month Et7tered Posted