HomeMy WebLinkAboutGrant Related - BOCC (005)GRANT 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: Karrie Stockton
CONTACT PERSON ATTENDING ROUNDTABLE: Kal'I'I@ Stockton
CONFIDENTIAL INFORMATION: DYES ® NO
DATE: 4/23/2025
PHONE:2g37
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i !'l •' !a s •
Reimbursement request from Renew on the Community Development Block Grant
(CDBG) CV2 #20-6221 C-1 1 in the amount of $11,464.02 for March 2025 services.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A
DATE OF ACTION: .S`l.�"`..�,J DEFERRED OR CONTINUED TO:
APPROVE: DENIED ABSTAIN
D2:
D3:
WITHDRAWN:
4/23/24
f ,
DEPARTN4ENT OF COMMERCE
Form 19-1A
VOUCHER DISTRIBUTION
AGENCY
Short Code
Commerce Contract Number
NUMBER
I
I
CMS Invoice ID:
DEPARMENT OF
1030
20-6221 C-111
421451
COMMERCE
VENDOR OR CLAIMANT (Warrant payable to:)
INSTRUCTION TO VENDOR OR CLAIMANT:
Grant County
Submit this form to claim payment for materials, merchandise or
DBA BOARD OF COMMISSIONERS
services. Show complete detail for each item.
PO BOX 37
EPHRATA, WA 98823
Vendor's Certificate: The individual signing this voucher below
warrants they have the authority to do so as authorized and on behalf
Karrie Stockton
of the entity identified in the Vendor/Claimant section. The individual
(Vendor Contact Person)
signing below certifies under penalty of perjury that the items and
totals listed herein are proper charges for materials, merchandise or
(509) 754-2011
(Vendor Contact Phone)
services furnished to the State of Washington, and that all goods
furnished and/or services rendered have been provided without
discrimination because of age, sex, marital status, race, creed, color,
kstockton7a"rantcountywa.gov
(Vendor Contact Email)
national origin, handicap, religion or Vietnam era or disabled veterans
status.
03/27/20 - 06/30/25
(Contract Period)
Karrie Stockton (Kstockton2) 4/23/2025 3:39:21 PM
03/01 /25 - 03/31 /25
(SUBMITTED BY) (SUBMIT DATE)
(REPORT PERIOD)
DESCRIPTION
BUDGET
REQUESTED
EXPENDED TO
AMOUNT THIS
AWARD
AMOUNT
DATE
INVOICE
REMAINING
Contract Total
$929,365.00
$113464.02
$749,695.18
$.00
$179,669.82
Non - Match Total:
$929,365.00
$11,464.02
$749,695.18
$.00
$179,669.82
PROGRAM APPROVAL
Date
(The individual signing this voucher warrants they have the authority to sign this voucher.)
DOC DATE
CURRENT
REFERENCE DOC NO.
VENDOR NUMBER and SUFFIX
DOC. NO.
SWV0002426 03
ACCOUNT NO.
ASD NUMBER
VENDOR MESSAGE
39195
I KANS KEV MASTER SUB SUB MG MS GL ACCT SUB AMOUNT PROGRAM
CODE CODE INDEX OBJ SUB SID INDEX
OBJ
622CO320 NZ 6221 C
READY to BATCH PREPARER DATE WARRANT TOTAL
I CREATED BY I Karrie Stockton (Kstockton2) I DATE 14/23/2025 3:34:39 PM I
Form 19-1A
VOUCHER DISTRIBUTION
AGENCY
NUMBER
Short Code
Commerce Contract Number
CMS Invoice ID:
DEPARMENT OF
1030
20-6221C-111
421451
COMMERCE
E All Expenses under $1,000
Paid by Paid to Paid to Paid to Expense
Paid by UBI Contractor Paid to UBI Amount
Organization Name Type Organization Name Org Type Type
Subcontractor Total
Sub Subcontractor Total
Al VOUCHER FORM
Voucher #8
,TATaWASHINGTON STATE
C DEPARTMENT OF COMMERCE
AGENCY NUMBER
IDIS PROJECT NUMBER
COMMERCE CONTRACT NUMBER
A19 VOUCHER DISTRIBUTION
1030
107
20-6221 C-111
AGENCY NAME INSTRUCTION
DEPARTMENT OF COMMERCE
ATTN: CDBG-CV
PO BOX 42525 Vendor's
OLYMPIA, WA 98504-2525 proper
and
TO VENDOR OR CLAIMANT:
Submit this form to claim payment for materials, merchandise or services.
Certificate: I hereby certify under perjury that the items and totals listed herein are
charges for materials, merchandise or services furnished to the State of Washington,
that all goods furnished and/or services rendered have been provided without
because of age, sex, marital status, race, creed, color, national origin,
religion or Vietnam era or disabled veterans status.
VENDOR OR CLAIMANT (Warrant is to be payable to:) discrimination
handicap,
GRANT COUNTY
PO BOX 37
EPHRATA, WA 98823-0037
By: Karrie Stockton
(SIGN IN BLUE INK)
Grant Admin Specialist 4/23/2025
REPORTING PERIOD:
Mar-25
(TITLE) (DATE)
IDIS
Activity ID
DESCRIPTION
ORIGINAL
BUDGET
PRIOR AMOUNT
REQUESTED
AMOUNT THIS
INVOICE
REMAINING
BALANCE
Add or delete budget line items as needed. Includes CV1 and CV2 as applicable.
8310
21A General Admin (Grant County Expenses Only)
$ 225190.00
$ 1,917.94
$ 20,272.06
8311
05Q Public Services Admin. Budget (OIC)
$ 96,368.00
$ 94,600.20
'
$ 1,767.80
8311
05Q PS -Subsistence Payments (rent, mortage,utility) (OIC)
$ 237,073.42
$ 1469686.12
$ 90,387.30
8312
05X PS- Housing Counseling and Admin. Budget (OIC )
$ 110,715.59
$ 78,241.91
$ 32473.68
8313
18C - Microenterprise Assistance Admin. (OIC)
$ 1009263.97
$ 1009263.97
$ -
8313
18C - Microenterprise Financial Assistance. (OIC)
$ 25,697.02
$ 25,697.02
$ -
8313
18C - Microenterprise Training (OIC)
$ -
$ _
$ _
8706
050 - Urgent Need- Mental Health -General Public (Grant Co.
$ 304,900.00
$ 270,131.02
$ 11,464.02
$ 23,304.96
8706
050 - Urgent Need- Mental Health -Tele-Health (Grant Co.)
$ 32,157.00
$ 32,157.00
$ -
8706
050 - Urgent Need- Mental Health -County Jail (Grant Co.)
$ _
$ _
$ _
Balancesl
$ 929,365.00
$ 749,695.18
$ 11,464.02
$ 1168,205.80
BELOW THIS LINE IS FOR DEPTARTMENT OF COMMERCE
Moor
r
MASTER INDEX
SUB OBJ
SUB
SUB
OBJ
GL
ACCT
SUBSID
AMOUNT
INVOICE NUMBER
CI
622CO320
NZ
SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT
DATE
WARRANT TOTAL CMS Invoice ID:
ACCOUNTING APPROVAL FOR PAYMENT
DATE