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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: BOCC REQUEST SUBMITTED BY: KaCI"I@ Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kai"1"I@ Stockton CONFIDENTIAL INFORMATION: DYES ONO oarE: 10/25/2024 PHONE:2937 N N ❑Agreement / Contract ❑AP Vouchers - - --------- ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related ❑County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders *Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑Minutes ❑Ordinances ❑Out of State Travel El 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 Infrastructure Program (SIP) #2023-05 New Coulee City Medical Clinic, in the amount of $3,996.90. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO * N/A If necessary, was this document reviewed by legal? El YES ❑ NO DATE OF ACTION: DEFERRED OR CONTINUED TO: APPROVE: DENIED ABSTAIN D 1: AL�J_ D2: D3: WITHDRAWN: 0 N/A 4/23/24 V 111� III' IIIII rp I PROJEC ERTIFICATION This form must be signed and retu ed, with an invoe, for the approved funding, before reimbursemeniTtan. be approved by Grant County. SIP Project Proposal Number. 2023-05 SIP Funding Recipient: Grant County Port Distriet #4, Coulee City SIP Project Description: New Coulee City Medical Clinic 1, the undersigned, do hereby cerdfy nder penalty of perjury, that the materials have p"el been furnished, the services rendere and/or the labor performed as described M' the 0 project proposal for the above -I need SIP Project and that I am t qnzed to authenticate and certify to this claim. I also certify that this claim of $,!90 just and due and is an unpaid obligati against Grant County. Further, according to the SIP Project ding Policies, I attest that at the next audit of my entity, this project shall be called t the attention of ft Washington State Auditor" s Office and an emphasis audit will be quested to assure that these funds were expended toward the project and according to t a � intent of the proposal. 4 lv+�L V VISA Lentnc Printed Name Date Signed Completed, signed original Grant Administrative Sp Printed Title Lion and invoice are to be maned to: PO Box 37, Ephrata, WA 98823 AITACEMENT 4 GENERAL FUND.. .... . . ...... ...... *_.__'�'_� ............... P. 0. BOX 537 DATE: � .� COULEE CITY, WA 99115 WARRANTS: % A=v - 11 THE UNDERSIGNED, DO HEREBY CERTIFY UNDER. PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. li I WARRANT No. APPROVED: --- AUDITOR SIGNED B PORT DISTRICT CO=MMISIONERS a�- TOTAL W a .. W Check 4129 1011812024 Boss Public Affairs... Cash Account 514.40 - Professiona... -11069.80 -1 j059.80 TOTAL Check 4130 1011812024 Gray & Osborne, Inc. Cash Account Professiona... -1 Ye� 614-40 - 1312-60 A ,312.60 TOTAL Check 4131 1011=024 All American Plum... Cash Account 546.40 - Repairs Mis... -480.59 -480-59 TOTAL Check 4132 1011812024 Leone & Keeble, Inc. Cash Account Capital Projects -415,905.58 TOTAL V00001 Page 2 Invoice September 09, 2024 Grant County Port District No. 4, Project No: 20840.00 ti P.O. Box 537 Invoice No., 22 Coulee City, WA 99115 P"'_"ect Coulee City r0A - - edical linic Prof ess1onal.§e-rYLc.es,. from ..,AugU-st_1,1 to Se -ember fl" 02A24 Professional Personnel Hours Rate Amount P., Manager Meskimen, Michael 4�00 20-3.98 815,92 Qvil Env, Guzman, Zara 2,00 152,16 304.32 Totals 6.00 1,120.24 Total Labor 12120.24 Reimbursable Expenses Mileage 40.20 Total of urs e 1 "o times 40-20 40.20 Billing Limits C rent Prior To -Date Total Billings 1,1 0.44 2671066,81 268,227.25 Limit 294t0001.00 Remaining 25,772.75 Total this invoice $1.160.44 Invoice M") N 8 LTING ENCUNEERS Grant County Port MsWict No. 4 October 07, 2024 P.O. Box 537 Project No- 20840.00 Coulee City, WA 99115 Invoice No: 23 is Project 20840.00 Coulee City ical Clinic .08, Professional Services from, Septe Lilber2024 to tober 06, 2024 f. p r6festfohaf drsonnea ��__Houm Rate Amount Civil Engr'. Guzman, Zara 1.00 152.16 152.16 Totals 1.00 152.16 i. Total Labor Billing Limits Cur nt Prior To -Date Total Billings 15 16 269,227.25 268,379.41 Limit 294,000,00 Remaining 25,620,59 A^ Total this Invoice 1152922 1130 Rainier Avenue S.,, Suite 300 Seattle, i. 1. ashinglon98144 (206)2"0860 Fax (206)283.3206 im ARRIVALTIME 25 r All American Plumbing Services, C 16063 Stratford Rd NE Moses Lake, Wa. 9883 Tel: (509)761-1195 Work Order/Invol . ce, E OF ORDER HOMETEL.'.. ORD R TAKEN BY WORK TEL. C S WTOM-A EORDRD ERNIF [j DAYWORK 0'.QONTRAC 13.:0(T-0A" STARTING DATE OVERTIME- t.. - OTH TO"B"NAME i N 0, JOB LOCATION ATE B T INVONCE r JQEL. DEPARTURE TIME t. C/o- 0 --- ---- - --- 77,77. 77. ■ F119 it,'& n d01L01rV0'_ AP To - ----------- ---- -- Total Materials • Total Labor Tax 3(0 -V ®dash $ 13 0heck OAMOUnt 9; Total CARD 0 EXP. DATE VER. CODE I hereby acknowledge the satisfactory completion of the above descri ed work. Date - -- ---- ic. Ttfank You! *ffia Co Printed In UM by WwPdn1it41e33X0M 000-370-659!f .......... GENERAL FUND GRANT COUNTY PORT DISTRICT #4 P. 0. BOX 537 COULEE CITYt WA 99115 �CjU�CHER LIST DATE.Q ��f WARRANTS: vj THATTHE MATERIALS HAVE BEEN FURNISqHE C THE SERVICES RENDERED OR THE THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. WARRANT NO. �aJ- q �-� APPROVED: AUDITOR PORT DISTRICT COMMISSIONERS ---------- I-n-voice Grant County Port District No. 4 P.O. Box 537 Coulee City, It 99115 Project 20840.00 fes . Sion Fsi�'Nldes from" J01i Professional Personnel Civil Engr, Guzman, Zara Totals Total Labor Billing Limits Total Billings Limit Remaining ALIqUSt 12, 2024 Project No,, 20840.00 Invoice Na; 21 Coulee City ledical Clinic 2416" Ap�* 2024 Hours Rate Amount 3.50 152,16 532-56 3,50 532,56 532466 CL rent P ri o r To-DM6 5 2.56 266,534,25 2671066.81 294,000.00 26,933,19 Total this Invoice ,532.56 F-,x t42-0`6t 1-i", 1.01 50 98 4 f"s All American gnu L mull amm B I N An DEPARTURE TIME ---------- 4