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HomeMy WebLinkAboutGrant 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: Karrle Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kafrl2 Stockton CONFIDENTIAL INFORMATION: DYES 8 NO DATE: 1 /3/2025 PHONE:2937 111111111ag 1!22iMIA91k_&U1 KU11 LIU so j jU:j:j Will ❑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 ❑ 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 of Royal Slope on the Strategic Infrastructure Program (SIP) 2019-10 Water Line Extension in the amount of $26,000 for the year of 2025, 1 payment remaining. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 8 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO © N/A DATE OF ACTION: i �'Z� DEFERRED OR CONTINUED TO- APPROVE: DENIED ABSTAIN D 1: D2: D3: WITHDRAWN - 4/23/24 GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM INSTALLMENT 4 OI' S PROJECT CERTIFICATION FORM For the fourth release of $26,600.00 (from a $133,000.00 Grant) 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: 2019-10 SIP Funding Recipient: Port of Royal Slope SIP Project Description: Waterline Extension East to Eldorado Stone L the undersigned, do hereby certify under penalty of perjury, that the materials have been ftimished,, the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I aln authorized to authenticate and certify to this claim. I also certify that this claim is just and due, and is an unpaid obligation against 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 to ass -Lire that these Rinds were expended toward the project and according to the intent of the proposal. Signature Printed Name V3 / 26a-r Date Signed EX I --- lr_e� Title '.4.0 � i ,r GC 44V Printed Title Completed, signed original certification and invoice are to be mailed to: Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823 Grant County StraLig|c|nfrastructune Program Administrative Services Coordinator PDBox 37 Ephrata, VVA98823 Due Date 1/31/2025 PORT OFROYAL SLOPE P.D.Box l47 4572Road l3.GSVV Royal City, WA 99357 SIP Project Number: 20I9-10 SIP Recipient: Port ofRoyal Slope SIP Project Description: Water Line Extension East toEldorado Stone Grant 2019-10 Total Amount Remaining $ 53200.00 Fourth of Five Installments in the amount of: Remaining Amount 2019-10 $ 26,600.00 Phone: 509-3/6-2317bva|entine@portofroyaicomWebsite:www.po|.com