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: gOCC
REQUEST SUBMITTED BY: Karrl2 Stockton
CONTACT PERSON ATTENDING ROUNDTABLE: Kat't"I@ Stockton
CONFIDENTIAL INFORMATION: ❑YES ® NO
SATE: 4/15/2025
PHONE:2937
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Reimbursement request from McKay Healthcare & Rehabilitation Center on the
Strategic Infrastructure Program (SIP) 2024-05 Phase 1 Master Planning, in the
amount of $4,160.00.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO R N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO * N/A
DATE OF ACTION: �I Z'Z' � DEFERRED OR CONTINUED TO-
APPROVE: DENIED ABSTAIN
D2:
D3:
WITHDRAWN -
4/23/24
GRANT COUNTY
STRATEGIC INFRASTRUCTUREPROGRAM
PROJECT CERTIFICATION
This form must be signed and returned, with an invoice, for the approved funding,
before reiunbursement can be approved by Grant County,
SIP Project Proposal Number:
SIP Funding Recipient:
SIP Project Description:
2024-05
McKay Healthcare & Rehabilitation
Phase I Master Planning
1, 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 in the
project proposal for the above -referenced SIP Project and that I am authPzed to
�-
authenticate and certify to this claim. I also certify that this claim of $1,160.00 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 assure that these funds were expended
toward the project and according to the intent of the proposal.
IZ4
i�nat�re
Lisa Tellefson
Printed Name
�/ l� goo? 50,
Date Signed
t a
AdMUUS a or Desi
Title
Administrator DesS
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823
Reimbursement# 5 in the amount of $4,1601.0.0 �
ATTACHMENT 4
McKAY HEALTHCARE
586 RiceFerqusMiller
04/03/2025 94988
"Invoice Numb e - r -
Invoice Date
Description
Gross Amount
Discount Taken
Net Amount, Paid
2023052.00-018
03112/2025
Admin - PS - SIP2024-05
$4,160.00
$0.00
$41160.00
$4,160.00
$0.001
.. ...... .. $41160.00
--------------------------- ------ -- ------------ ----- ... ... -- - - ---------- -------------------- - ------ ----- -- - --------------
McKAY HEALTHCARE US 13ANK 6041 094988
127 SECOND AVE SW - PO BOX 819 mW
SOAP LAKE, WA 98851 04/03/2025
(509) 246-1111
PAY TO THE ORDER OF $4j160.00,,e�
lit 6O L, LO 9 4 9813,10 1: 12 3 20 C35164 L532L0020134P
Rlcorgusmp'm.
275 Fifth Street, Suite 100
Bremerton, WA 918337
(360) 377-8773
Public Hospital District No. 4 of Grant County, Washington
P.O. Box 819
Soap Lake,, WA 98851
Victor Odiakosa
Professional services through 02/28/2025
Invoice Summary
Invoice number 2023052.00-018
Date 03/12/2025
Project 2023052.00 McKay Healthcare SNIF Pro -
Design - Master Planning
Contract
Total
Prior
Contract
Current
Description
Amount
Billed
Billed
Remaining
Billed
Scope 1A - Conceptual Design
100y184-00
100,184-00
100,184-00
0.00
0.00
Scope 1A - Schematic Design (Reduced by C07)
66,840-00
66,840.00
66,840-00
0.00
0.00
Scope 113.1 - Site Plan Design (Reduced by
77,200.00
62,200.40
62,200.40
14,999.60
0.00
Change Order 04)
Change Order 02 - Scope I B.2 - Zoning Approval
137728.00
132727.90
13,727.90
0.10
0.00
(Reduced by C07)
Change Order 03 - Phase I Schematic Design
174,600.00
174,500.00
174v500.00
0.00
0.00
Change Order 03 - Phase I Design Development
2133000.00
4s160-00
0.00
208,840.00
4s160.00SIP 2024-05
Change Order 04 - Phase 2 Master Planning
513940.00
0.00
0.00
51,940.00
0.00
Change Order 05 - Phase I CD
Change Order 05 - Phase I CD - RFM
173,540.00
0.00
0.00
173,540.00
0.00
Change Order 05 - Phase I CD - Civil
44w800.00
0.00
0.00
4000-00
0.00
Change Order 05 - Phase I CD - Landscape
283560.00
0.00
0.00
28,560.00
0.00
Change Order 05 - Phase 1 CD - Structural
34,160.00
0.00
0.00
34,160.00
0.00
Change Order 05 - Phase I CD - MEP
72,240.00
0.00
0.00
720240.00
0.00
. .. . ... . ..... Subtotal
353,300-00
0.00
0.00
3537300-00
0.00
Change Order 06 - Phase I Food Service DD - CD
34,496-00
0.00
0.00
34,496.00
0.00
Reimbursable Expenses
4,925.79
4og25.79
4,925.79
0.00
0.00
Total
1,090,113.79
426,538.09
422,378.09
663,575.70
4,160.00
Invoice total 49160.00
Aging Summary
Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120
2023052.00-018 03112/2025 41160.00 4,160.00
Total 4,160.00 4,160.00 0.00 0.00 0.00 0.00
For any questions regarding this invoice please contact A Wolfard at (360) 377-8773 orjwolfard@rfmarch.com
Public Hospital District No. 4 of Grant County, Invoice number 2023052.00-018 Invoice date 03112/2025
Washington