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 DATE: 1/30/2025
REQUEST SUBMITTED BY. Karrie Stockton PHONE: 2937
CONTACT PERSON ATTENDING ROUNDTABLE: Karrie Stockton
CONFIDENTIAL INFORMATION: ❑YES ® NO
❑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 *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
'Who What
'..a .
Reimbursement request from Community Services of Moses Lake (Moses Lake
Food Bank) on the United States Department of Agriculture (USDA) Grant No. K5556
in the amount of $34, 182.00 for November purchases.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 7 N/A
l Wg l t ti��I� tr-d RE - : « : -=�T�TRV1! «! r 1 E Lei ■ ATAMU, l .plff e»I• �! 0:
If necessary, was this document reviewed by legal? ❑ YES ❑ NO
- - --------- -11= i=IaIi
DATE OF ACTION: DEFERRED OR CONTINUED TO-
WITHDRAWN -
APPROVE. DENIED ABSTAIN
D1: 1<;1kL
D2: �.
D3:
0 N/A
4/23/24
WASHINGTON STATE
AGENCY USE ONLY
DEPARTMENT OF AGRICULTURE
AGENCY NUMBER
AGREEMENT NUMBER
4950
K-5-556
FORNIA19-IA CSFRF COUNTY INVOICE VOUCHER
Instruction to Vendor or Claimant: Submit this form to claim payment for materials,
AGENCY NAME: DEPARTMEN"I'OF AGRICULTURE
I I I I WASHINGTON ST SE,2nd FLOOR
merchandise or services. Show complete detail for each item,
P.O. BOX 42560
OLYNIPIA, WA 98504-2560
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.
VENDOR OR CLAIMANT (Warrant is to be payable to:)
Subrecipient Name and Address:
e--
Grant County
PO Box 37
Ephrata Wa 98823
(SIGN IN INK - ANY COLOR EXCEPT BLACK)
0
Grant Admin Specialist 01/07/2025
Statewide Vendor Number: FSVJ 0002426-59
(Title) (Date)
SUBRECIPIENT INVOICE VOUCHER REIMBURSEMENT REQUEST
EXPENDITURE DETAIL Total Budget Expenditure Period: I i 1 24 to I I 4
$ 75054.29
Remaining Funds
Z!�
for November Expended this
Billing Net Amount
$ 75,054.29 Period
Salaries & Benefits
Adjustment Requested
S -
Pass -through Awards _S 34,182.00
34,182.00
Food Purchases
Distribution & Transportation
Indirect Costs
$
Other
$ -
Total This Period $ 34,182.00
$ S 34,182.00
E`I_0;w'A(7rR ILTURE USE'O
FED TAX ID 14 PROGR_k�l APPROVAL DATE
DOC INPUT DATE
CURRENT DOC. NO.
REFERENCE DOC NO.
VENDOR NUM13ER
SUFFIX
ACCOUNT NO.
ECMLS CON-rRACT#
VENDOR MESSAGE
TRANS
FUND
FUND
APPN
PROG"RAM
SUB
SUB
INVOICE
CODE
SOURCE
(ACcr)
INDEX
INDEX
OBJ
SUB OBJ
AMOUNT
NUINIBER
ACCT APPROVAL FOR PAYMENT
DATE
$
AGRAXXX (N/10/21)
Community Services of Moses Lake, Inc.
Grocery Outlet
Date Type Reference
11 /21/2024 Bill
WA Trust - CHKG I nv 42012111
Original Arnt-
341182.00
11/21/2024
Balance Due Discount
34,182.00
Check Amount
16393
Payment
34,182.00
34,182.00
341182.00
#111 Change to Store Name
GIR CEn't UUTLET
New 60 Mobile pp
Mgt) LIPS got $5 coupon,.
Scan QR code*
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FROZEN JURKEY 34182,00 F
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BALANCE DOE 34-182.00
SUB 101AL 34162,00
TOTAL IV 0,00
MAL 34182,00
Manual Check $34182.00
CANGE OV00
Cash ler. Name: Flerm
Cashier 4.0208 Store: 0111
POS 1*9 003 T ransat%A1" on; 0004
[' 17 AM r i day , 22 November", 2024 08 *
1HANK YOU 1-OR SHOPPING W11H L13141
Questlons please call (509) 766-76b()
1177 N Stratford Road
Moses Lake, WA 9883*7
Returns are gladly awepte.d with a
Receipt within 30 days, of PLO -Chase f01-
A f U l l cash reftlfld tor credit to the
applicable credit or EV (J-drd)
CSFP
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