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Home My WebLink AboutGrant 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 suBnniTrED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kat"fl@ Stockton CONFIDENTIAL INFORMATION: ❑YES ® NO DATE: 5/23/2025 PHONE:2937 M, ❑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 Community Services of Moses Lake(Moses Lake Food Bank) on the United States Department of Agriculture (USDA) Grant No. K5556 in the amount of $23,023.07. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 7 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: Co ` .3`o2S DEFERRED OR CONTINUED TO: APPROVE: DENIED ABSTAIN L D1: D2: D3: 4/23/24 WITHDRAWN: a4a.=r WASHINGTON STATE AGENCY USE ONLY - _ w s I ' DEPARTMENT OF AGRICULTURE r AGENCY NUMBER AGREEMENT NUMBER 4950 K5556 FORM A19-IA CSFRF COUNTY INVOICE VOUCHER Instruction to Vendor or Claimant: Submit this form to claim payment for materials, AGENCY NAME: DEPARTMENT OF AGRICULTURE 1111 WASHINGTON ST SE, 2nd FLOOR merchandise or services. Show complete detail for each item. P.O. BOX 42560 OLYMPIA, 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: Grant County 35 C Street NW/PO Box 37 By: Karrie Stockton Ephrata Wa 98823 (SIGN IN INK - ANY COLOR EXCEPT BLACK) 0 Grant Administrative Specialist 5/22/2025 Statewide Vendor Number: SWV0002426-59 (Title) (Date) SUBRECIPIENT INVOICE VOUCHER REIMBURSEMENT REQUEST EXPENDITURE DETAIL Total Budget Expenditure Period: 00/00/00 to 00/00/00 $ 759054.29 Remaining Funds for May Expended this Billing Net Amount $ 409872.29 Period Salaries & Benefits Adjustment Requested $ - Pass -through Awards $ 23,023.07 $ 23,023.07 Food Purchases $ - Distribution & Transportation $ - Indirect Costs $ - Other $ - Total This Period $ 23,023.07 $ - $ 23,023.07 IIELOV,v - FOR AGRICULTURE USE ONL FED TAX ID # PROGRAM APPROVAL DATE DOC INPUT DATE CURRENT DOC. NO. REFERENCE DOC NO. VENDOR NUMBER SUFFIX ACCOUNT NO. ECMS CONTRACT # VENDOR MESSAGE TRANS FUND FUND APPN PROGRAM SUB SUB INVOICE CODE SOURCE (ACCT) INDEX INDEX OBJ SUB OBJ AMOUNT NUMBER ACCT APPROVAL FOR PAYMENT DATE $ AGR-XXXX (N/10/21) CSML Invoice #2 Farm to Food Contract # K5556 Attn: Karrie Stockton Fr: Nan Gardener, CSIVIL Please see attached invoices and check stubs for request for reimbursement, Casa Caro Farms Invoice #4 $ 4,88560 Palouse Pastured Poultry #1 $1 033M9 #2 $ 7 3 9 7 , 7 8 Total Submitted $23023,07 Balance of Contract Re it ing 98 47 IIq . I a ifterence u.1 11w IINIVS Of those un necd- 11(Y Box 6X.A * 1075 W Nflianna Drivt.,, * Moses I -akc, \VA')8837 * 509WAS I () I oft cc #509-765-7 ^77 (ax on klk-Ckxlk! P.O. 13ox 68319299 Beacon Road NE I Moses Lak'e. WA 98837 Community Services of Moses Lake, Inc. Casa Can Farms, LLC Date Type Reference 5119/2025 Bill WA Trust - CHUG Invoice #4 5/19/2025 Original Amt. Balance Due Discount 4,885M 4,885.60 Check Amount Payment 4,885.60 41885.60 4M5.60,10"'A 13272 www.che�ksforWss.,com M8245-5'776 Or # 3SM650-1 CAnAA Tn Cnflrl rr%t#n#v r-AntrArt K '"W 'W'%W W a'%,# 'W -W Cornmunity Services of Farm/Vendor Checklist* YES NO Farm/Vendor Name Casa Cano Farms, LLC Agency Name Moses Lake (Vendor must fill out) 12210 South Madison F?d Agency 9299 Beacon Road NE I certify that I am not de -barred or x Farm/Vendor Address Valley Ford, WA 99036 Address Moses L,,ake, VVA 98837 ineligible from receiving public funds. , Agency I identify as a mm ebe, r of a socially Farm[Vendor UEI# JSMCGZTZKXZ7 Contact Nan Gardener disadvantaged grOLJP, as defined by x (SAM ID) Person USDA AUMC7 Items on this invoice are all grown Farm/Vendor UBI# 603-360-811 Contact Jia-i Gantenbeirl raised and produced in Washington x (Business License) Person State am a new vendor ( I ,e,, I did not sell Farm/Vendor '.,0asacanofarms0-)qr Agency t.oSML(Qrn1t 9 orq 0--." to this agency during 12 months x Email/Phone I 0M Contact Info. before July 1, 2022) Delivery Date 5/16/2025 Delivery Addre4 9299 Beacon Road NE M(-,)ses Lake, VVA 98837 Amount Due $4a885.60 Invoice Number 4 Payment Due Date 30-days frown Delivery, Item Description Unit Unit Price Quantity Total lte'rn Cost Notes Sausage - Casa Caro lbs $985 4960 jOrder Total: $49885 potinds tinless otherwise noted Community Servilces of Moses Lake, Inc. Palouse Pastured Poultry Date Type Reference 5/1/2025 Bill WA Trust - CHKG 5/13/2025 Original Amt. Balance Due Discount 10,,739-69 10t739_69 Invoice #1 Farm to Food: Country Contract K55 Check Amount Payment 10,739.69 10,739-69 10,739.69 -" 13272 mvwxhacksforless.com 800-245-6775 Order # 3S34650-1 JI j 2 Date: 5/ 1 .")5 Sold To: Community Services of Moses Lake 19299 Beacon Rd NE Moses Lake, WA 98K37 509-431-3473 Palouse Pastured Poultry I nVoice: 900 1 4 W. Babb Rd. Rosalia, WA 99170 509-5 23-4833 enimylo.se pasturedpoulte,,,coiii Corn -Free, Soy -Free, GMO-Free, Pasture -Raised Chicken, Turkeys and Eggs ---------- Size Price/size Quantity Total classit'ication Free -Range Pastured Clilcken 330 chickens total S w at Weiolit of 195167 lb S 10,73969 (61 cases) Pastured Extra Lar5%. Ecgs Z� - S6.751'dozen (Minimum .2.7 ozildoz) Pastured Larne Egos (Minimum 24 oz-'doz) ----------------- `6.'O.'dozen Pastured Medium Eggs - S5.50/dozeii (Minimum 21 oz./doz) ----------- - --- --- Pastured Small Eggs ..._. (minimum 15 ozidoz) Free -Range Pastured $7.00/lb Turkeys, Total Thanks so much'. S 10, 7 _39.69 ------------------------------------- t-AKM I U t-UV_LJ - k-o-UU1 'It Y %--ovi It' cls-ok __T__ r I I Farm/Vendor Checklist: YES NO Farm/Vendor Name Palouse Pastured Poultry ' Agency Name Corrrnunay Serv�ces of Moses Lake i (Vendor must fill out Far 4 W Babb Road, Ros.alla, WA 99170 Agency Address 9299 Beac-on Road NEL Moses Lake WA I certify that I am not de -barred or 9,883 1 7 ineligible from receiving public funds x Address I identity as a member of a socially UE fit UV93D4138FR67 Contact Name Nan Gafdener disadvantaged group, as defined by x I'SAM USDA - 'Farm/Vendor UBI# Agency Contact J,�nn Gantenbeun Items I on viis invoice are all grown raised, and produced in Washington x i 602-546-876 Person 3473 I(Business License) (Delivery State Farm Email/Phone # 4 3!e M--MV- Agency Contact Info. QW—L Ibmifood.0fg Delivery Date Invoice Number Item Description Broiler Chicken hank giving `14,jrkey. Small Eggs MedlUrn Eggs Large Eggs XL Eggs Red Field Hers - / I I f Delivery Address Amount Due $0.00 Payment Due Date 30-days from Delivery Type of Unit Total Item Notes (lbs, Unit Price Quantity Total Item Cost Weight* —package)-- per lb $550 3200 10739,69 -",,952 67' per lb $7,00 000 per dozen $3.50 0,00 per dozen S5.50 0"00 per dozen, $6,50 0,00 per dozen $615 0,00 per lb $350 000 0.00 n, 00 000 [39 Order Total: 9 $10,7.69 1,952-671 4 Ott IFS F-v (3 ry gg, "0 -- Al- 1 Community Services of Moses Lake, Inc. Palouse Pastured Poultry Date Twe Reference 5/8/2025 Bill WA Trust - CHKG 518/2025 Original Amt.. Balance Due Discount 7,397.78 7,397.78 Invoice 8002 Farm 410 Food: Country Contract K Check Amount 16651 Payment 7,397.78 7,397.78 7,$97.78-o-** 13272 www.checksfor1ess.,c*m 800-245-57-75 Order # 3534650-1 I Date: 5,18/25 Sold To: Community Services of Moses Lake 9299 Beacon Rd NE Moses Lake, WA 988-37 *N09-4"* 1 -347" Palouse Pastured Poultry Invoice: 8002) 4 W. Babb Rd. Rosalia, WA 99170 '509-523-4833 emniv(� palousepasturedpoultry.com Corn -:Free, Sov-14're e, GMO-Free, Pasture -Raised Chicken, Turkeys and Egigs size Price/size Quantity Total class *1 fication Free --Range Pastured 227.5 chickens Chicken $5.';O'lb total weialit of 19778 3. 1345.05 lb (44 cases) Pastured Extra Lai -,le Egi,ys — S./dozen (Minimurn 27 ozi/doz) Pastured Lame e Eggs (MInMium 24 oz/doz) S6.50/dozen Pastured Medium Eggs — $5.50"dozen (Minimum .1.1 oz/doz) Pastured Small Eggs ozen (minimum 15 o7-,f'doz) Free -Range Pastured S7.001b Turkeys Total Thanks so much! 7,31 9 7. -1 FARM TO FOOD - Count ry Contract K5556 I Farm/Vendor Name Palouse Pastured Poultry Agency Name Commumty Services of Moses Lake Farm/Vendor Checklist: (Vendor must fill out YES NO Farm/Vendor 4 W Babb Road, I osalia, 9299 Beacon Road NE MoSeS Lake, VVA I certify that I am not de -barred or x 'Address WA 99170 Agency Address 198 8 3 ineligible from receiving public funds. I identify as a member of a socially SAM UEl# UV93D4D8FR67 Contact Name Nar,, Gardener disadvantaged group, as defined by x USDA Agency Contact Items on this invoice are all grown , Farm/Vendor UBI# 602-546-876 person Jun Gantenbe:in (509)431- raised, and produced In Washington x (Business License) (Delivery) 3473 State -------------------- Farm Email/Phone # 141MgyCPdIOUSqpaStLft L Agency Contact Info. CSML E:mIfood orgjt Delive Date 05/08/20250 Delivery Address Amount Due $0.00 Invoice Number 2 Payment Due Date 30-days from Defive, --of Unit Total Item Item Descdption (lbs, Unit Price Quantity Total Item Cost Weight* Notes J_package) , I I I - I .. I --- I Broiler Chicken per lb $550 2 2",'," 5" 7397,78 1,345,05 Ttianksgiving TUrkey per lb $7,00 0,00 Small Eggs per. dozen S3,50 0.00 Medium Eggs per dozen $5,50 OM Large Eggs per dozef`� S6,50 0.00 XL Eggs per dozen $6,75 0,00 Red Field Hens tier lb $350 0,00 0,00 0 ,AZO 0,00 Order Total. $7,397"7871