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Home My WebLink AboutGrant Related - BOCC (004)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: Kat"fl@ Stockton CONFIDENTIAL INFORMATION: ❑YES ® NO DATE: 1 /3/2024 PHONE: 2937 1321 711EI-52"IN711��„ .. ❑Agreement / Contract DAP Vouchers ❑Appointment / Reappointment DARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related El County Code ❑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 rlz_,_� Reimbursement request from Port District No.4 Coulee City on the Strategic Infrastructure Program (SIP) 2023-05 in the amount of $1,823.31 for expenses in August 2024. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO Im-1 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: �-1 -�S'-- DEFERRED OR CONTINUED TO: APPROVE: DENIED ABSTAIN D1: D2: � D3: 4/23/24 WITHDRAWN: GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before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 SIP Funding Recipient: Errant County Port District #4, Coulee City SIP Project Description: New Coulee City Medical Clinic I. the undersigned, do hereby certify under penalty of perjury, that the materials have been furnished, the services rendered, and/or the labor performed as described M' the project proposal for the above -referenced SIP Project and that I am authotized toI i authenticate and certify to this claim. I also certify that this claim of $ NR2i� V'�k s 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 wM be requested to assure that these funds were expended toward the project and according to the intent of the proposal. Signature .... ....... Printed Name Date Signed Title Pnnt_ed Title Completed, signed original certification and invoice are to be mailed to: Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823 ATTACEWMNT 4 GENERAL FUND GRANT COUNTY PORT DISTRICT #4 P. O. BOX 537 COULEE CITY, Wt 99115 W HER LIST DATE:�q WARRANTS: I, 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. SIGNED BY: �Q WARRANT NO. �� APPROVED: AUDITOR LJ_� PORT DISTRICT COMMISSIONERS err J�6-,Vi �:oe�c�h- a�v �5�¢,�( ViG lluL, cGr hardAelrl'' 3hOCJc�" e✓"s QeS�/DOiyc �i� olati'z� �7 tl 0� ��e� �'s;,�§ 1,�esj, ��;� jf)�51JLIPA.) 05ee) P�o",Jti- y✓ 1�aS �o55pcP i�5�ec8��/ i cl c e�, 5�% o �"r t� CJ�t-se. f `�'�V SD. �o y�,gN °J Wei aJc�t� �te��r/ 9,�e5� �3iS`� 0.`J �� SG as � � 6141004107 All American Plumbing Cash Account Grant County Port District #4 All American Plumbing Cash Account PRODUCTSSLT104 USE WITH 91663 ENVELOPE Deluxe Corporation 1-800-328-0304 or www.daluxe.com/shop 8/17/2024 C24--ee-* 8/17/2024 6141004107 M .:""� .il. mow. `a;i. � "'�:�'. �-. ..�'.:.i � �. � � b � ti 1.: � � ..rTk ii �'R `A1 Invoice July 15, 2024 Grant County Port District No. 4 Project No, 20840M P.O. Box 537 Invoice No: 20 COLIlee City, WA 99115 Project 20840.rOO Coulee City Medical Clinic Professional Ser vices from June 16,-2 24 to J u 1 13, 2024 Professional Personnel Hours Rate Amount Civil En9r, Guzman. Zara 1.00 152.16 152,16 Totals 1.00 152.16 Total Labor 152.16 Billing Limits Current Prior To -Date Total Billings 152,16 266,382.09 266,534.25 Limit 294to9o-00 Remaining 27,465.75 Total this Invoice Grant County Port District #4 8/1712024 6141004106 Gray & Osborne, Inc. 152.16 152.16 Cash Account PRODUCT SSLT104 USE WITH 91663 ENVELOPE Deluxe Corporation 1-800-328-0304 or www.deluxe-oorn/shop f