HomeMy WebLinkAboutGrant Related - BOCC (006)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: Kafl'12 Stockton
CONFIDENTIAL INFORMATION: ❑YES ® NO
DATE: 7/1 6/2025
PHONE:2937
111111liq 1111 i,iii 11 -
WX
1-
K MM
❑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
- ME!
Reimbursement request from Renew on the American Rescue Plan Act (ARPA)
for Designated Crisis Response (DCR) May 2025 in the amount of $24,165.45 and
Suicide Prevention June 2025 in the amount of $12,229.58, totaling $36,395-03.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO * N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A
DATE OF ACTION. P �� DEFERRED OR CONTINUED TO:
WITHDRAWN:
APPROVE: DENIED ABSTAIN
D 1:
D3-
4/23/24
0
r% Ank
1 IC7 n e w
Grant Behavioral Health 8 Wellness
PO Box 1057
Moses Lake, WA 98837
Phone (509) 764-2643 Fax (509) 764-4124
BILL TO:
Grant County -ARPA DCR
PO Box 37
Ephrata, WA 98823
DATE: July 9, 2025
INVOICE 5/31/2025
FOR: May-25
ARPA- PSY DCR
DESCRIPTION
Amount
Total Amount
ARPA- -DCR Abundiz, Lanny
$ 243165.45
$ 24,165.45
$
Total
24,165.45
Th a n k you!!!
Contract #—ARPA- DCR CO -RESPONDER
Submitted to GC by: Reyna Gonzales
Request for Reimbursement No. $24,165.45
Grant County's Subrecipient Checklist:
State Auditor's Office Audit Procedures for Testing Activities Allowed
And Not Allowed, As Published In 2007
Questions to ask before submitting a payment request
Was the expenditure or cost:
_X_ Made for an allowable activity under the grant guidelines?
_X_ Authorized (or not prohibited) under state or local laws or regulations?
_X_ Approved by the federal awarding agency, if required?
_X_ Allowable per Circular A-87 (June 2004 version), Attachment B, items 1-43?
For payroll transactions:
_X_ Does the employee's time and effort documentation meet the requirements of
Circular A-1 22?
_X Allocable to the program? (i.e., was the dollar amount charged to the program
relative to the benefits received by the program? Is the federal grantor being
charged its fair share of the cost?)
_X_ Based on actual costs, not budgeted or projected amounts?
X_ Applied uniformly to federal and non-federal activities (i.e., is the federal
government being charged the same amount as if non-federal funds were being
used to pay the cost)?
_X_ Given consistent accounting treatment within and between accounting periods?
(Consistency in accounting requires that costs incurred for the same purpose, in
like circumstances, be treated as either direct costs only or indirect costs only
with respect to final cost objectives).
_X_ Calculated in conformity with generally accepted accounting principles, or
another comprehensive basis of accounting, when required under the applicable
cost principles?
_X Not included as a cost (or used to meet cost sharing requirements) of other
federally -supported activities of the current or a prior period?
X Net of all applicable credits? (e.g., volume or cash discounts, insurance
recoveries, refunds, rebates, trade-ins, adjustments for checks not cashed, and
scrap sales).
X Not included as both a direct billing and as a component of indirect costs?
X Properly classified (e.g., some costs may be incorrectly claimed as a direct cost
instead of being incorporated as part of the indirect cost rate).
_X_ Supported by appropriate documentation? (e.g., approved purchase orders,
receiving reports, vendor invoices, canceled checks, and time and attendance
records.) Documentation may be in an electronic form.
_X_ Correctly charged to the proper account code and grant period?
Page 1
Open Year
Journal Entry TRX Date Account Number
ACCOUNT TRANSACTIONS - GL FOR MAY 2025
Account Description Credit Amount
Debit Amount Reference
2025
1018376
5/31/2025 108.150.00.9000.564411100
MENTAL HEALTH ... ARPA.REG SALARIES & WAGES
0.00000
11,398.09 ALLOCATE SALARIES MAY 2025
2025
1018378
5/31/2025 108.150.00.9000.564411202
MENTAL HEALTH ... ARPA.OVERTIME
0.00000
3,193.67 ALLOCATE OT MAY 2025
2025
1018377
5/31/2025 108.150.00.9000.564411300
MENTAL HEALTH ... ARPA.OTHER COMPENSATION
0.00000
2,558.03 ALLOCATE OTHER COMP MAY 2025
2025
1018379
5/31/2025 108.150.00.9000.564412100
MENTAL HEALTH... ARPA.RETIREMENT
0.00000
1,329.31 ALLOCATE RETIREMENT MAY 2025
2025
1018380
5/31/2025 108.150.00.9000.564412200
MENTAL HEALTH ... ARPA.SOCIAL SECURITY
0.00000
1,302.71 ALLOCATE SOC SEC MAY 2025
2025
1018381
5/31/2025 108.150.00.9000.564412300
MENTAL HEALTH ... ARPA.MED & LIFE INS
0.00000
1,035.83 ALLOCATE MED/LIFE INS MAY 2025
2025
1018382
5/31/2025 108.150.00.9000.564412301
MENTAL HEALTH...ARPA.FMLA STATEWIDE INS
0.00000
44.94 ALLOCATE FMLA MAY 2025
2025
1018383
5/31/2025 108.150.00.9000.564412400
MENTAL HEALTH... ARPA.INDUSTRIAL INSURANCE
0.00000
336.90 ALLOCATE IND INS MAY 2025
2025
1016147
5/27/2025 108.150.00.9000.564414100
MENTAL HEALTH... ARPA.PROFESSIONAL SERVICES
2025
1016147
5/27/2025 108.150.00.9000.564414200
MENTAL HEALTH... ARPA.COMMUNICATION
2025
1012958
5/6/2025 108.150.00.9000.564414202
MENTAL HEALTH ... ARPA.CELL PHONE
2025
1014408
5/13/2025 108.150.00.9000.564414301
MENTAL HEALTH...
ARPA..LODGING-TRAINING
2025
1012977
5/6/2025 108.150.00.9000.564414302
MENTAL HEALTH ... ARPA..MEALS - TRAINING
TOTAL
ADMIN
TOTAL FOR MAY 2025 ARPA CO -RESPONDERS
7/10/2025 7:29
0.00000
190.96 Renew
0.00000
22.08 Renew
0.00000
41.32 287333762696 00**
0.00000
413.50 6613 - GRIS APR 2025
0.00000
101.25 ALLOWANCE - MEALS
21,968.59
0.10000
2,196.86
24,165.45
21,199.48000
F L-121
0
0
* renew
Ci-ai* OtzhaAcs- o� Hcolth 6 W)cf4ncP.%
NON-EXEMPT
1-7*7L-eave
Printed Narne: Lanny Abundiz Slips (A/L,
Pay Period: April 27, 2025
Employee ID #: 3707
Staff SignatUre:
SupeNisor hitiais for Nori-Standard Workweek
'11A a A A
V,
Supervisor Signature: Pay Period: 4/27/2025 (mm/ddlyyyy)
Pay Date: 5/1612025
CLINICAL Apr 27
Sun
Apr 28
Apr 29
Apr 30
May 01
May 02
May 03
May 04
May 05
May 06
May 07
May 08
May 09
May 10
4
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
TOTAL
I
GC Sheriff ARPA (9000)
10.00
10.00
10.00
MOO
1 24.00
10.00
17.00
10.00
101.00
1311- CLINICAL
OTHER HOURS 'WORKED
JURY DUTY
CRISIS BENCH ONLY (please
enter hours)
Total Worked Hrs
10.00
10.00
10.00
10.00
24.00
10.00
17.00
10.00
101.00
1.00
ANNUAL
SICK
HOLIDAY
OTHER (Bereavement 1 Military)
FLEX/COMP TAKEN
LWOP
TOTAL HOURS
10.00
10.00
10.00
10.00
24.00
10.00
17.00
10.00
11011.00
Total Worked Hrs
I-Vtaken
GP ENTERED
LEAVE
PAYROLL SPREADSHEET
40,00 40.00
- longne annIne sickne snect holne milpay/ civil salyne
bervne
11 1 cto r -,
e '111-3
c
80.00 0.00 0.00 0.00 0.00 0.00 0.00 80.00
61.00 c 61.00
0,00
61,00
LVVOP
b* r
� � *fir ��.�� �- � � 7
lit
7�
�,.,c c,
ITS Q"c"POSES - DO NOT WRITE IN THIS SECTION
0*0
renewQwum, "Noviorcaf vohh 6 well., zp%
NON-t:Now
Printed Name: Lanny Abundiz 010",
Pay Period: April 27, 2026
Employee ID #: 3707
Staff Signature:
Supervisor Signature:
EGE:.ftt�
gar z i 2025
**'*Leave
Slips (AIL,
Supervisor Initials for Non -Standard Workweek
Pay Period: 4/27/2025 (mmidd/yyyy)
Pay Date: 5116/2025
CLINICAL Apr 27
Sun
Apr 28
Mon
Apr 29
Tue
Apr 30
Wed
May 01
Thu
10.00
May 02
Fri
May 03
Sat
May 04
Sun
May 05
Mon
May 06
Tue
May 07
Wed
May 08
Thu
May 09
Fri
May 10
Sat
TOTAL
GC Sheriff ARPA (9000)
10.00
10.00
10M
10.00
10.00
10.00
10.00
80.00
BH- CLINICAL
%00
7.00
21.00
OTHER HOURS WORKED
JURY DUTY
CRISIS BENCH ONLY (please
enter hours)
Total Worked Hm
10.00
10.00
10.00
10.00
24.00
10.00
17.00
10.00
101.00
1.00
ANNUAL
SICK
HOLIDAY
OTHER (Bereavement Military)
FLEXICOMP TAKEN
LWOP
TOTAL HOURS
10.00
10.00
10.001
10.001
... 24.001
10.001
17-00
10.00
101.00,
Total Worked Hrs 40.00
LV taken -
GP ENTERED
LEAVE
PAYROLL SPREADSHEET ilk
40.00
milpayl
Iongne annIne I sickne snect holne I bervne civil salyne
80.001 0.00 1 0.00 1 0.00 1 0.00 1 0.00 1 0.00 180.00
61.00
LWOP
61.00
0.00
61.00
YP�;�SF d, +I f
'�4-�ec�- (3�4 cl��cc�'
U� . ;�K.Pf� hr� ��at ��
'"PAYROLL PURPOSES - DO NOT WRITE IN THIS SECTION "'
0
0
re
,enw
NON-EXEMPT
Printed Name: Lanny ADundiz Z)I;ps �L,
. ........ ....... --
Pay Period: May 111 2025
Employee ID #: 3707
X�-
ard Workweek
Staff Signature: "Supervisor Initials for Non -Stand
Pay Period: 5111/2025 (mmldd/yyyy)
Supervisor Signature:
.. .. .. ....
a Pay Date, 5/3012025
May 11
May 12
May 13,
May 14
May IS
May 16
May 17
May 18
May 19
May 20
May 21
May 22
May 23
May 24
CLINICAL Sun
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
TOTAL
GC Sheriff ARPA (9000)
10,.00
1 OM
10,00
10M
12,00
10,00
--T
10M
- - ------------ -
9.00
1.00
10.00
12.00
79.00
39.00
0.33
BH- CLINICAL
-
i _.._..___
_.____._.....__..___...
..........
14,00
OTHER HOURS WORKED
. . ........
- - ----- - -- -
JURY DUTY
CRISIS BENCH ONLY (please
enter hours)
Total Worked Hrs
10.00 10,00 10.00
10,00
14.00
12.00
10.00
10.00
1 10.00
10.00
12.00
118.00
1 1,00
---1
ANNUAL
SICK
HOLIDAY
OTHER (Bereavement Military)
FLEX/COMP TAKEN
. .. . .......
-T-
LWOP
TOTAL.10.00
HOURS
10.00
10.00 10.00=14.
10.001
0 0
12.00
-iR--0L- 10.001
i 10.00 12.00
118.00
1
Total Worked Hrs
,61.00
LV taken
GP ENTERED
LEAVE
�PAYROI�.L SPREADSHEET`
longne
= annine
sickne
snect
holne milpay/civil
salyne
bervne
80.00
0.00
0.00
1 0.00
.... . . . ....
0.00 "ll 0.00
0.00
80.00
U-T Clio..
LWOP
52.00 52.00
0.00
5200
' 'PAYROLL PURPOSES - 00 NOT WRITE IN THIS SECTION "'
Renew -May 2025
TS
Network & Security Services
$
1,186,19
System Administration Services
$
822.45
Generat Het desk & Asset Management
$
14,548.80
System Administration Services
$
1�265.62
Accounting Apptication- GP
$
663.84
Software as a Service
$
6,146.77
VOIP-PHONE 4,260.55_
$ 24,633.67 $ 28,894-22
ACCOUNT 4152 $0.00
129 $ 190,96
108.150.00.0000-564.12,4152 564 109 20,766.75
108.150.00_0000.566.004152 566 11 2,100.55
MHBG-
8053
2
381-92
Recovery Coach -Crisis -
8079
2
381.92
CV-2 DCR- Rick G. -
7609.564.41
1
190-96
ARPA SUICIDE PR BETHANY-
9000
1
190.96
ARPA-Psychol- Lanny A.
9000,564.41
1
190.96-00,
Housing,- 50%- CSRA
8078
0.25
47.74
Prevention - ML SUPTRS
9097
1
190.96
Prevention -'pity of Quincy
9064
1
190.96
20.25 24,633.67
Ednerics V01P Services (Phones)
193,00 4,260,55
22.08
ACCOUNT
4200
MH8G
168.00 564
3,708.67
SUD
12 566
264.90
MHBG
2 8053
44.15
recovery coach
2 8079
44,15
CV-2 DCR- Rick G. -
1 7609-41
22.08
ARRA SU ICI DE PREY -Bethany
1 9000.566.51
22.08
ARPA-Psychot- Lanny A.
1 9000.564.41
2Z08
Moses Lake
1 9097
22.08
4,150.17
$ 4,150.17
DCL-
3 8003
66.23
1 8002
22,08
1 8001
22.08
110.38
25
$ 4,260.55
$ 4,260,55
Z0Zt[,?J%$4,ZZ
$0.00
Renew without DCL 05-2025
Opm-mom M-1- (2025-tsilmated Supporl Cmerage)
E3, W
1 129
72S
17.793I03%
Renew 6LHVERS:
7
125
5,6000000%
Renew NETWORK DEVICES:
58
771
7.5226978%
Renew UP Users:
51
181
6 4102564A
lRenew servers;
71
1251
5,6000000%1
Network & Secur.)(Servlces Hisiyear I Hourly Rat@ ' Total I Yearly Quanpriv Monthly
,john Martin 2080,001 911,97 189,217.60 $ 14,234.27
14.234.27 S 3,558.57 $ 1,186.19
-Wtem Administration Servim
Hrs/year
I Hourly Rate'
Total
Yearly
Quarterly --
Monthly
Keith Curiley
2080MI
$ 8433
$ 176,238,40
$ 9,869.35
$
2,46734
$ 822.45
$ 9,869.35
$
2,467.34
$ 822.45
Phone Services NUMbef of Urt"
Rate
Total
Yearty
Quarterly
Monthly
Ednefics VOW Services (Phones) 193,001
$ 22.,W539
1 $4,260-bb 1
$51.126.60
$12,781.65
$ 4,260.551
-]--,
Q -set Management M(Hq esK &
Hr*Iytm-
HoitlyRate
Total
Yearly
Quarterly
Varle5sa Brown
7,,B
2U80,00
$ 56.23
$ 116,958.40
$ 20,810.53
S 5,202.63
S 1,734,21
IC11(y Gu e
H cky Gutierrez
208(,),00
$ 76,81
$ 159.764.8101
$ 28,427,12
$ 7,1W78
$ 2,368,93
�.,
Jeremy Hall
2080,00
$ 67,79
$ 141,003,20
$ 25,088.85
$ 6,272.21.
$ 2,090,74
Evan Little
2080.OU
$ 77.94
$ 162.115,20
$ 28,845.33
$ 7,211.33
$ 2,403,78
Seth Sampson
2080100
$ 69,2,,.,)
$ 144,040,00
$ 25,629.19
$ 6.407,30
$ 2,13517
Atex Sukhoyetskiy
2080, 00 1
$ 73
$ 138,798,40
$ 24,696.54
, $ 6,174,14
$ 2.058.05
Luke Lartkhaar
2080. 00, 1
-66
$ 56.98 ,
$ 118,518.40 f
$ 21,088,10
1 S 5,272.03 1
$ 1,757,34
System: Administration Services
Total Cost
Years
Tot/Yr
Yearly
Quarterly
Monthly
foam,viewer (Yf,,-,Ir I of 3 Year Contract)
$ 34,77161
3,1"M
$ 11,591,20
$ 649,11
162,28
S 54,09
EdneticsISMARTnet Maintenance
$ 22,000,,00
1,00
$ 22,000,00
$ 1,232,00
S 308M
$ 10M7
Netapp Story Hawware Service
$ 33,15800
1.00
$ 33,158,00
$ 1,856,85
$ 464.21
$ 154.74
Ednetit.5 One
$ 24,978,319
1,00
$ 24,978,38
$ 1,39839
$ 349,70
$ 116,57
Rut)r;k (Replaced Veeand )
$ 538,428,91
3,00
$ 179,476.30
$ 10,050.67
$ 2.512.67
$ 837.56
Accounting Application Total Cost Years I TatfYi I Yearly Quarterly Monthly
Dynamics GP .124,270,0() 1,001 $ :124,270,00 $ 7,966,03 $ 1.991.51 $ 66184
7,966-03 S 16991.51 $ 663.84
mamre m a Sirrvice
User Cost
Yearly
-
Monthly
Lm,-hange Ontine Plan IG
6,017.19
b,00
$ 41.81
$ 203.05
$ S2.2 b
$ 17.42
Offics 365 G3
$ 169,819„4A
12100
$ 280.03
$ 34,44169
$ 8,610,92
$ 2,870,31
Azu,re Anve Directory Pren'Oum Ptan 1
$ 45,205.40
151. OO
$ 62.79
$ 9,481.29
$ 2,370,32
$ 790,11
Adobe Acrobat Pro
$ 18,328.21
28,00
$ 113.14
$ 3,167.92
$ 791.98
$ 263.99
Adobe ItIustrator
$ 1.786.39
1.00
$ 446.35
$ 446.35
$ 111,59
$ 37,210
Adot)e Creative Mud Alt Apps
$ 14.9X93
2,00
$ 933-18
$ 1,86636
$ 466,59
$ 155.53
Barracuda Er-tiailAtc.,tiaiverari(jAnti.�Spatr,:�
$ 38.333.33
IWOO
$ 159.72
$ 21958.00
5 5,98%50
$ 1096. 50
Btut, Beam
$ 3,11100
1'00
$ 18&62
$ 188,62
$ 47.16
$ 15.72
Losetf iche DMS Maintanance Cost
$ 3,703.45
35.00,
$ 10581
$ 3,703,45
, S 925-86
$ 308.621
M:*-17 73,751.28 1 S
28894.E
*11miufts 3% COLA and Annual Rai yes 'WII IW730. JO
RENEW MOSES LAKE FIB
FIRSTNET ATTV ACCOUNTING TECH
Suft with AT&T 840 E PLUk,ST
MOSES LAKE 'A'A 98837-1874
ALItoPay- Set tip automatic payments that you can, update whenever you want Go to
firstrietcentral-firstnet,com today.
Page-. I of 249
Issoe Date, Apr 19, 2025
Account Number, 287333762696
Foundation Account- 62317818
lnvoice: 287333762696XO42 72025
Account summary
Your last bill $5113-29
Payment, Apr 16 - Thank you' 45,213,2191
Remaining balance $0,00
Service summary
Wireless $5,214.27
Total services $5,214.27
Total due
Please pay by May 14, 2025
$5t214.27
Ways to pay and manage your account:
L71, firstnetcentral. firstnet.com Call 611 800.574.7000
mrr IWC TTY 65677 FirstNet dev- e W.241-
from any other pl-?rAv
rTotal due 1
$51214827
Please pay by-
L May 14, 2025
�� —r'r o
� I
Refum, ffig; pot wi!t y-out chec* 'n ft_ enr,/ ma take 7 a tia oo t
I osed gr"AVe, P , , y d ys S
FIRSTNET RENEW N1 O'S E S LA K Et F N
Please pay $5,214.27 by May 14, 2025
amm" BLOt with AT&T ATMNI AICICOUNT IVG TECH
840 E PLUM S T
00SES L4KE, WA 98237-1874
Account nurroer-1 28733376,2696
mckjo-o account rummer on your check
Make check Payable to
0 CHCK FOR AUTOPAY
AT&T MOBIL ITY
PO Box 6463
Carol Stream, IL 60197-6463
99900267333762696000000005214270
00 5214 7000
Report name
Monthly summary report with cost centers
Report type
Wireless number summary
View by
All accounts
Date range
April 2025
Group
Level 2 node description
Subgroup
Wireless number
Subgroup 2
User name
Subgroup 3
Wireless number and descriptions
Crisis 805.2...-..44
5092980717
............
$41-32
Crisis 8052 - 44
5094315054
JESUS GARCIA
5094315054
$41.32
Crisis 8052 - 44
.5094318315
ANGELINO SERRANO
5094318315
$41-32
Crises .80521.71,414
5 97 1i229
C1 151 SHADOW
50976-11229
............ ... .. ....
$41.32
Crisis 805.2.1-7 44
........... I-BRIA-N,N,E G R I F F,1TH-
5097611648
...... ..........
$41-32
Cri-si-s-8052 --4.4
9977 D2 4
HECTOR ZAVALA 3 R
5097700204
541.32
Crisi.s.8052 - 44
5097703146
..... ... .........
JARED DETROLIO
5097703146 (8052-44)
$41.32
Cris..!s 805.2-44
509717.1-5032-1-.1-1-
THOMASI-M ITCH E,LL
5097715032
$41.32
Crisis 8052- 41
5094312-319
EDWARDO GONZALES
5094312319 (8052-41)
- ---- -- - ---- --
41.32
Crisis 8052- 41
...... ............... ...... ........
5094318237
.......... .... ............. I --- . ......
SHANNON DARLINGTON
....... -...
5094318237
$41.32
Crisi's 8052- 41
.5097611256
TRACI HUNT
- ---- ---- ............
5097611256
41.32
Crisis 8052- 41
KAYLEEN SIMPSON
5097703094 (8052-41)
$41.32
Crisis 8052- 41
............... .... ............
5097703235
.......... . ............... ..........
JONATHAN MUCK
.5097703235 (8052-41)
$41.32
Crist-s-8,052- 41
50.9770400-9
RENEW CIS PHONE
5097704009 (8052-41)
$41.32
C.ri.s,ils 805.2-4.1
5 39793 1C 1
..-,K,I.LIAH K.1-NIG
5097930016
$41.32
Crisi's 8052- 41
�5098551236
CECILLIA DINE
........... .............. ...... ......... .
5098551236
............ .............. ............. ...... ..............
$51.51
8052-41.
$671-31
............ ............ ..... .
DCL -8001
. ......... .. ............. .......
5098550347
.......... . ........ - .......
TINA STEINMETZ
........ .......... .............
5098550347
$44.10x.
DCL -8002
............. ............ ..............
5097079873
....... ..........
DAWN DAVIS
. .....
5097079873(8002)
$41.32
DCL -8003
5097.. .50....4166
DCL STANDBY
5097504166(8003)
-------------
9.59
DCL -8003
5097504167
DCL LARSON
5097504167(8003)
$19.59
DCL.1-I..8003
5997 11 23
EI I iYLEE LONAS
5097611.023
541-32
DCL - 8003
5097611141
CHELSEA ROLLY
5097611141(8003)
541,32
DCL -8003 .... ..
5097704408
-
MISSY LOPEZ
.5097704409(8003)
........ --- --------
$41.32
8003
$163.14
DCR Gamed - 7609
5094318734
RICARDO GAMEZ
5094318734
$41.32
DCR 9000-41
5097079630
LANNYABUNDIZ
.........
5097079630
...... .......
$41.32
Employment- 8063
5097705458
ROBERT WEST
5097705458
$41.32
Employment -.8063
5097717633
JASON AVILA
5097717633
........... .......... ..... ... ..........
41.32
8063
$82.64
Housing
ALANTA FUTRELL
5097602187
$41-32
MH -12
50940.3.01807
QUINCY FRONT DESK
5094030807
$41.32
MH - 12
5094077309
ROYAL CITY FRONT OFFICE
..........
5094077309
...........
$41.32
MH - 12
5094318204
DELL ANDERSON
5094318204 (MH - 12)
$41.32
MH - 12
S097079796
LINZE GREENWALT
5097079796
Anna B. Serrano
From: Cedarbrook Lodge < noreply@canarytechno log ies.co m >
Sent: Monday, April 21, 2025 11.'07 AM
To-- Anna B. Serrano
0 Subject: Payment Receipt - Cedarbrook Lodge
CEDARBROOK
LODGE
Payment Receipt
V07 1 0001
Hetto Lanny Abundiz,
Thank you for submitting your payment. To view your payment detaits ctick the Link
below.
Invoice: C7XGR4AJYSSTQQOY3VL44
Date.* Apr, 21, 2025
Payment $413.50
Total $413-50
0
0
* ren w
Get Behavicrel Hoolth a Wellness
RENEW
Must attach training information including agenda, start and end times and meat information.
Forms missing any of the required information wilt be returned for completion,,
Attfletds must be filled incompletely.
A In -State Training 11 Out -of -State Training 1:1 Webinar
(Must be received 0-days in advance) (Must be received 90-days in advance)
Employee Name* Lanny Abond iz Today's Date- 02/10/2025
Washington State Annual Go -Response Confrence SeaTac, W
Training Name: Location:
Dates of training: 05/15/2025-05/16/2025
05/15/2025 6/2025
Departing Date: Returning Date, 05/1
Departing Time: ........ ReturningTime:
Registration Gust; .$225.00
Hotet: A Yes El No
? Lodge
Are there any room blocks for this training at a specific hotelsCedarbrook
Transportation: 0 Personal Car 9 Company Car
if requesting to take personat. car, direct supervisor signature is required below)
Airfare: 0 Yes It No
Flight / airport preferences' ?
How will this training add value to the organization?
This 'is a new program to our agency, connecting with other agencies who currently have the
---- -------------
program will allow to learn from others and what they are ding to provide support to law
enforcement agencies and the community.
TO BE COMPLETED BY DIRECT SUPERVISOR AND EXECUTIVE STAFF ONLY
Estimated Cost:
Training Approved.- RYe o
Direct Supervisor Signature:
Personal. Car Approval: 0 Yes ONo
Direct Supervisor Signature:.._........._..._. — -----
Executive Staff Approval: , f- Yes
Executive Staff Signature:
Funding Source-,
Date:
_____=Lt j�...7.s�
Date:
Date:-
RENEW
COUNTY AUDITOR
,aU M L GRANT COUNTY, WASHINGTON
Claimant: I Lanny Abundiz J Claimant's Dept: [crisis / ARPA
- - - - --------
Purpose of Travel: IWA State Annual Co -Response Conf Des finadon: SeaTaci WA
DATE
BF
---------------------
L
D
IE
TOTAL
5/15/2025
$17.25
$19 .50
$28.50
$3.75
$69.00
5/16/2 25
$28.50
$3.75
$32.25
- ---------
$0.00
$0.,00
$0.00
--------------------------
------
$0.00
I
L
1
$0.00
TOTAL
$101.25
CERTIFICATION
1, the undersigned, do hereby certify under penalty of perjury that the
claim is a just, due and unpaid obligation against the County, and that I
am authorized to certify to sat c ai
Claimant Signature:. ------- ----
Date.- 21-s—
rAMWW ^0WWAWWW J"W-AV 4MW A$e~ W AWW AW AUWW1MW 01 1
0 TRAVEL VERIFICATION 0
M.9E-..CQKP-LETEQ..UM ILET J(LR�A t. Q NLIB '0
I., the undersigned, do hereby certify under penalty of perjury that the
planned travel referenced on this form did, in fact, occur on and for the 0
Iduration of the dates provided on this form. Addition -ally, I attest that I
Othe allowance provided prior to travel was rightfully owed to me as a 0
Gsult of this travel. I
0
1Claimant Name:
$Claimant Signature:
0 0
$Date : I
0 0.
Departments shall maintain a copy of this form. The travel verification
0 section must be completed, on the Department's copy, upon the 0
1 employee's, return from travel. The department shall retain the fully I
Ocompleted copy for six years or in accordance with the I Washington Stateo I I
Records Retention Schedule (GS2011-184 Rev. 3).
01,MW.WMWAr~AW.AWWAVAMWAr.MWWAMWArANW.W,MWArAWWaMWArM ~AWJ
MILEAGE
DATE
FROM (ciTy, sen
TO (Ury, w)
MILES
RATE
TOTAL
$0.700
$0.00
$0.700
$0.00
$0,700
$0.00
$0.700
$0.00
L$V00
1 $0.00
TOTAL 1, $0.00 1
*TOTAL REIMBURSEMENT CLAIM
*Amount maybe different due to rounding*
Authorization required for Employees:
ELECTED OFFICIAL, DEPARTMENT HEAD1, OR DESIGNEE
Name (printed):
Signature:
Date: 4f
----------------
Authorization required for County Commissioners or Elected Officials-.
COUNTYAUDITOR
Name (printed) -
Signature:
Date:
lAuthonization. required for the County Auditor., Department Heads, meals expenses
tside of travel status, and out of state travel.,
COUNTY COMMISSIONERS
Commissioner
Commissioner:
Chairman BOCC:
Date*-
�y ANJIL
IIF :vz02!"")' per d*ie rates for Seattte,
Wash*ingtor,-,
Meals and incidental expenses (MME) rates and breakdown
First
MME
Incidentat
and
Prima 'l nation
County
total
Breakfast
Cinch
Diner
tastday
expenses
o
travel
Beaus
King
$
3
$
$38
$5
$69.00
Grenew
iss
PO Box 1057
Moses Lake, WA 98837
Phone (509) 764-2643
Fax (509) 764-4124
BILL TO:
Grant County
Attention: Karrie S. Stockton
PO Box 37
Ephrata, WA 98823
DATE: July 9, 2025
INVOICE # 6/30/2025
FOR: Jun-25
DESCRIPTION
Amount
units
Total Amount
ARPA FUNDS - SUICIDE PREVENTION
$ 12,229.58
1
$ 127229.58
Total
$ 127229.58
Thank you! !
Open Year
Journal Entry
TRX Date Account Number
ACCOUNT TRANSACTIONS - GL JUNE 2025
Account Description Credit Amount
Debit Amount Reference
2025
1022090
6/30/2025 108.150.00.9000.566511100
MH... ARPA.REG SALARIES & WAGES
0.00000
5,870.92 REALLOC SALARY 06/2025
2025
1022092
6/30/2025 108.150.00.9000.566512100
MH... ARPA.RETIREMENT
0.00000
534.84 REALLOC RETIREMENT 06/2025
2025
1022093
6/30/2025 108.150.00.9000.566512200
MH... ARPA.SOCIAL SECURITY
0.00000
411.94 REALLOC SOC SECURITY 06/2025
2025
1022094
6/30/2025 108.150.00.9000.566512300
MH... ARPA.MEDICAL & LIFE INSURANCE
0.00000
1,422.20 REALLOC MED & LIFE INS 06/2025
2025
1022096
6/30/2025 108.150.00.9000.566512301
MH... ARPA.STATEWIDE FMLA INSURANCE
0.00000
15.38 REALLOC FMLA 06/2025
2025
1022097
6/30/2025 108.150.00.9000.566512400
MH... ARPA.INDUSTRIAL INSURANCE
0.00000
22.62 REALLOC INDUST INS 06/2025
2025
1020044
6/4/2025 108.150.00.9000.566513100
MH... ARPA.SUPPLIES - OPERATING
0.00000
43.52 7348 PREVENTION - MAY 20250000*
2025
1020044
6/4/2025 108.150.00.9000.566513100
MH... ARPA.SUPPLIES - OPERATING
0.00000
184.89 7348 PREVENTION - MAY 20250'
2025
1020044
6/4/2025 108.150.00.9000.566513500
MH... ARPA.MINOR EQUIP <$550
0.00000
270.13 7348 PREVENTION - MAY 2025 ./
2025
1020483
6/24/2025 108.150.00.9000.566514100
MENTAL HEALTH... ARPA.PROFESSIONAL SERVICES
0.00000
190.96 Renew
2025
1020483
6/24/2025 108.150.00.9000.566514200
MH... ARPA.COMMUNICATIONS
0.00000
22.08 Renew
2025
1017506
6/3/2025 108.150.00.9000.566514202
MH... ARPA.COMMUNICATIONS-CELLULAR
0.00000
41.32 2873337626960000op
2025
1019579
6/17/2025 108.150.00.9000.566514400
MH... ARPA.ADVERTISING
0.00000
1,800.00 56008 oo"
2025
1020044
6/4/2025 108.150.00.9000.566514902
MENTAL HEALTH ... ARPA MISC DUES & SUBSCRIPTIONS
0.00000
287.00. 7348 PREVENTION - MAY 2025 -0000*
'OTAL 11,117.80
0MIN 0.10000 1,111.7E
'OTAL FOR JUNE 2025 ARPA SUICIDE PREVENTION 12,229.58
7/11/2025 8:58
Contract #_ARPA SUICIDE PREVENTION
Submitted to GC by: Reyna Gonzales
Request for Reimbursement No. $12,229.58
Grant County's Subrecipient Checklist:
State Auditor's Office Audit Procedures for Testing Activities Allowed
And Not Allowed, As Published In 2007
Questions to ask before submitting a payment request
Was the expenditure or cost:
_X_ Made for an allowable activity under the grant guidelines?
_X_ Authorized (or not prohibited) under state or local laws or regulations?
_X_ Approved by the federal awarding agency, if required?
_X_ Allowable per Circular A-87 (June 2004 version), Attachment B, items 1-43?
For payroll transactions:
_X_ Does the employee's time and effort documentation meet the requirements of
Circular A-122?
_X_ Allocable to the program? (i.e., was the dollar amount charged to the program
relative to the benefits received by the program? Is the federal grantor being
charged its fair share of the cost?)
_X_ Based on actual costs, not budgeted or projected amounts?
_X_ Applied uniformly to federal and non-federal activities (i.e., is the federal
government being charged the same amount as if non-federal funds were being
used to pay the cost)?
_X_ Given consistent accounting treatment within and between accounting periods?
(Consistency in accounting requires that costs incurred for the same purpose, in
like circumstances, be treated as either direct costs only or indirect costs only
with respect to final cost objectives).
_X_ Calculated in conformity with generally accepted accounting principles, or
another comprehensive basis of accounting, when required under the applicable
cost principles?
_X_ Not included as a cost (or used to meet cost sharing requirements) of other
federally -supported activities of the current or a prior period?
_X_ Net of all applicable credits? (e.g., volume or cash discounts, insurance
recoveries, refunds, rebates, trade-ins, adjustments for checks not cashed, and
scrap sales).
_X_ Not included as both a direct billing and as a component of indirect costs?
_X_ Properly classified (e.g., some costs may be incorrectly claimed as a direct cost
instead of being incorporated as part of the indirect cost rate).
_X_ Supported by appropriate documentation? (e.g., approved purchase orders,
receiving reports, vendor invoices, canceled checks, and time and attendance
records.) Documentation may be in an electronic form.
_X_ Correctly charged to the proper account code and grant period?
Page 1
o renew
Umnt 8"haviortA M001th 0 W-0finast.
NON-EXEMPT
***Leave
Printed Name: Bethany Ave y Slips (AIL,
Pay Period: June 8, 2025 ----------- -
Employee ID #: 5630 Staff Signature: ------
Supervisor initials for Non -Standard Workweek
Supervisor Signature: Pay'Porlod: 6/8/2025 (mmlddtyyyy)
Pay Date: 6127/2025
Jun08
CLINICAL
Sun
JunO9
Jun'10
Junll
Jun12
Jun 131
Jun 14
Jun15
Jun16
Jun17
Jun18
Jun19
Jun 20
Jun 21
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
TOTAL
ARPA 9000
iaoo
1
10.50
10.50
MOO
10.50
9.00
10.50
71-00
OTHER HOURS WORKED
0=1%
JURY DUTY
Total Worked Hrs
10.00
10.50
1 10.50
10.00
10.50
9.00
1 10.50
1
71.00
1.00
ANNUAL
SICK
HOLIDAY
8.00
8.00
OTHER (Bereavement/ Military)
FLEX/COMP TAKEN
1
200
2.00
LWOP
TOTAL HOURS
10.00
10.50
10.50
10-00
10.50
9.00
10.50
8.00
2.00
81.00
Total Worked Hrs 40, 00
GP ENTERED
LEAVE
PAYROLLSPREADS'HEET
80-0(
3.
41.00 02
LWOP
40.00 30.00
10.00
40.00
***PAYROLL PURPOSES - DO NOT WPJTE IN THIS SECTM ***
renewGmw* Aehaviomj "". Ith 6
Printed Name: Bethany Avey
Pay Period: May 25, 2025
Employee ID #: 5630
Staff Signature: n'l I
Ay
Supervisor Signature: a F(Jr,
"*Leave
Slips (AIL.
Supervisor Initials, for Noce -Standard Workweek
Pay Period: 5/25/2025 (mm/dd/yyyy)
Pay Date: 61812025
May 25
CLINICAL Sun
May 26
May 27
May 28
May 29
May 301
May 31
Jun 01
Jun 02
Jun 03
Jun 04
Jun 05
Jun 06
Jun 07
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
TOTAL
ARPA 9000
9.00
1050
11,00
9.00
10.50
10.50
1000
1
70.50
100,00%
OTHER HOURS WORKED
0,00%
JURY DUTY
Total Worked Hrs
9.00
10.50
11.o0
9.00
10.50
10,50
1 10.00
70.50
1.00
ANNUAL
SICK
HOLIDAY
&00
800
OTHER (Bereavement I Military)
FLEX/COMP TAKEN
1.50
1,50
LWOP
TOTAL HOURS
8.00
9.00
10.601
1.601
11.001
9.00 1
10.5011
10.50
10-00
80.00
Total Worked Hrs 16.00
LV taken 24.00
IGP ENTERED
LEAVE
PAYROLLSPREACftHEET
40.00
1 X
longne
annine
sickno
snect
holne milpay/
bervne
civil
Salyne
8 .00
0.00
0.00
1 "50
8.00 0.00
0.00
70.50
L4p.0
0 dg
A u
Vkk= �40 .0 U
LWOP
40 00 40.00
0.00
40.00
`PAYROLL PURPOSES - 00 NOT WRITE IN THIS SEC71ON *it*
American Rescue Plan
(Cares Act — ARPA)
0
Today's Date. 5/12/25
Vendor: Staples
0 Received Supervisor Approval
0 Scanned supporting documents
0 File into binder
0 Item(s) received
Rece*t Date: 5/2/25
1P
Detailed Description. "Ride to Save Lives" event items - receipt book & mints
`Charge to A-ig'Month:
17 MY 2024
0 January 2025
1-7 August 2024
0 February 2025
L7 September 2024
11 March 2025
F-1 October 2024
0 April 2025
01 November 2024
2 May 2025
01 December 2024
El June 2025
Defiverables:
* General Tasldorce supplies
* Goal 1: MH Literacy & BH Promotion
* Goal 2: Pastes ention
* Goal 3: Perception/ attitudes
* Staff Travel Professional Development
Requested
Supervisor Signature:
Form of Pa�rment
2 VISA **** 7348
E, Invoice (paid)
El Invoice (needs paid)
El Other:
El Food
Charge Account:
0 ARPA(g000)
0 Other:
43.52
Date: 5/12/25
Date: 5/12/2025
Prevention Requisition Form
Revised 07.2024
renewG.-rIet, 11thwim,01 400fth 11 taekwfl
i s•..
tri�) mortvi stmtford Road
Moievs Lake, WA 98837
509-,765-4600
a I ev
Starel, 1301 Regi sl:(-) rtr I
Date: 5/2/25 1"1 Me No 3 F 31 I'M
it a n-,s, ac, t i on ; 80853 Cashier: 199184t�
1
REWARDS NUMBER
y __Amount
LUEBKE PEP041H
I 02200(YM.O557 '16499 1&99 H
WRITE N STICK REGE
A 81-79 a 39
Subtot'd.1 4237
W01HOON 8A 0475
000*
0* `611 '43 r52
VISA. CREDIT US'0$43 52
Gard No. : XXXXXXXXXXXX7346 01
co'n'tactless
Ruth Ho : 002397
Modet; Isstiar
A'[Dj: AOOOOO00031010
[VRO: 0000000000
IAI) r! 0601120 3AOOOOO
TS1,,.
ARC.: 3030
E&L,v, Rewarda Point Summary
Points Redeemed Today 0
Points Remainino 195
Dollars Remaining $0,00
P011AS W1,11 post Within 5 bLisimifs,�a days.,
Te.rms and conditions apply.
the working and IE..,,avning �tora.
D,$Govef, qvejy tool to take on tomorrow ,I
inchad ing, products, services
and iiispiraflran that haflp You
A A
unlock w.hal# Is PosiSil")'18
THANK YOU FOR ISHOPPING AT
ST APLES11
nfl"133X311,6 1 1( K n
bistomar Ciony
OWOC), 5lYJ.(j;o1,3100
Grant Sehovioral Health 8 Well
�� Date,
Names
0 P-0 item):
Item(s) Requested (include a photo if you need a speciric
�20 L — - - ---------
Approximate Cast;
Funding Source, if n wn,
Reason for Requests,
7-1t,(4
1,P f
'pK- le-,
Date Needed By:
Supervisor's Signature
Date
Please have your supervisor sign the form and
then submit it to finance,
American Rescue Plan
(Cares Act - ARPA)
Today's Date: 5/6/25
Vendor: Amazon Business
ED Received Supervisor Approval
El Scanned supporting- documents
El File into binder
ED Item(s) received
Receipt Date: 55
Detailed Description: Ink for offics'.a., printer (5 pack)
0
'Charge to A-tg'Month:
E-1 Jule 2 0 24 0 Janual-V- 202-
El Au--TU.St 202February 202-
0
September2024 March2020
Oetober2024 April202,,5
-ember2024
ED No\ 2, M aV 202,;
0, December2024 E, June 202,S
Defiverables.,
* General Tasl<force supplies
* Goal 1: MH Literacy & BI-1 Promotion
* Goal 2'. Postvention
* Goal 3: Perception/ attitudes
0 Staff Travel 11 Professional Development
Requested by:
SuperNisor Signature:
Form of Payment
2V1SA **** 7348
, Invoice (paid)
ED Invoice (needs paid)
01 Cther-.
E, Food
Charge Account*
* ARPA (g000)
* Other -
Date: 5/6/25
Date: 05/06/2025
Prevention Requisition Form
Revised 07,2024
renewore* Ow"Wor" 0600% &IM"M
amazon.com
Details for Order #112-1197336-8162654
Print this age for your records.
Order Placed: May 5, 2025
Amazon.com order number: 112-1197336-8162654
Order Total: $184.89
r Approval
documents
Not Yet Shipped
Items Ordered
Price
1 of: HP Original 910XL Black, Cyan, Magenta, Yellow High -Yield Ink Cartridges (5-Pack)
I Works OfficeJet 80.10, 8020 Series
$170.41
OfficeJet Pro 8020, 8030 Series I Eligible for Instant Ink ( 6ZA58AN
Sold by: HiTnuch Business Services a BU of staples (setter profile)
Supplied by: Other
Government Price
Condition; New
Shipping Address:
ir
' ,# o
r
r
Shipping Speed:
"
FREE Prime Delivery
Payment information
Payment Method:
Item(s) Subtotal:
$170.41
Visa ending in 7348
Shipping & Handling:
$0.00
Billing address
Total before tax:
$170.41
GRIS PREVENTION GRANT COUNTY
Estimated tax to be collected:
$14.48 —
PO BOX 37
-----
EPHRATA, WA 98823-0037
Grand Total:
United States
Food
To view the status of your order, return to Order Summary.
Conditions of Use l Privacy Notice Q 1996-2025, Amazon.com, Inc. or its affiliates
Have an idea to help us improve? Send feedback >
Get to Know Us
Let Us Hetp You
Work with Amazon
Business Solutions
Buy For Your Business
Careers
Customer Service
Sett on Amazon Business
Amazon Business app
Buy wholesale
Blog
Shipping Rates &
Fulfillment By Amazon
Amazon Business
Today's Deals
About Amazon
Policies
Advertise on Amazon
Solutions
guy Again
Sustainability
Business FAQ
Amazon Global Selling
Manage Suppliers
PPE for Work
Press Center
Contact Us
Purchasing Systems
Bequest for quote
Investor Relations
Amazon Business Card
Amazon Devices
Pay by InvoicePurchasing
Line
Amazon Business Blog
E?UJ
'aM4W*F't"'4
renew
Grant Behavioral Hoolth 6 WeRmss
Names Bethany Ecamila Date@a 5/5125
Item(s) Requested (include a photo if you need a specific item):
Ink
Approximate Cost:
$170.41
Funding Source, if known,
Reason for Request: Taskforce supplies
Date Needed Bvs Upon approval
Supervisor's Signature
515125
Date
Please have your supervisor sign the form and
then submit it to finance.
American Rescue Plan
(Cares Act — ARPA)
Today's Date: 5/5/25
Vendor: Home Depot
El Received Supervisor Approval
El Scanned supporting documents
0 File into binder
Item(s) received
Receipt Date.- 5/2/25
Detailed Description: Battery& Charger for misters
1p
0
`Charge to A19'Month,
El JUIV, 2024 0 January 2025
0 August 2024 0 Februaty 2025
El September 2024 El March 2025
El October 2024
0 April 2025
0 November 2024
2 May 2025
0 December 2024
El June 2025
0
Deliverables,
0 General Tasldorce supplies
11 Goal 1: MH Literacy & BH Promotion
• Goal 2.' Postvention.
• Goal 3: Perception/ attitudes
11 Staff Travel / Professional Development
Requestedby:
ell, 61/1"
Supervisor Signature*
Form of Payment
42 VISA **** 7348
0 Invoice (paid)
El Invoice (needs paid)
El Other:
0 Food
Charge Account:
0 ARPA (9000)
0 Other:
Si 27 0.13
Date: 5/5/25
Date: 05/05/2025
Prevention Requisition Form
Revised 07.2024
renewWert ileboviarol 4*cft;** 6 W*Mom
Kl�
How doers
get more doner"
980 W CENTRAL DRIVE MOSES LAKE, WA 98837
509-765-9128
8966 00061 05738 05/02/25 03:09 PM
SALE SELF CHECKOUT
03$287195480 RYB18V4AHBTY <A> 199.00 V"
RYA ONE+ 4.0 AH HIGH PERK BATTERY 2-
033287205271 RYBONEWSCH <A> 49,97'
RYI3 ONES 18V Q FAST CHARGER
SUBTOTAL 248.97
SALES TAX 21.16
TOTAL $270,1$
X7(XXXXXXXXXX7348 VISA
U$D$ 270.13
AUTH CODE 002032/.9613842 TA
Contactless
AID AOOOOO00031010 VISA CREDIT
P.O./JOB NAME: 9000 ARPA
89656 05/02/25 03 : 09 PM
I I II 1I[11111 1III11111111 11 11I
RETURN POLICY DEFTNITIONS
POLICY ILL DAYS P01-TCY EXPIRE$ ON
A 1 90 07/�1/202b
renewOrdilh-Volla'Ohat'GI
Name. CSC 1 ,Gt, Date' S� 2 �
Item(s) Requested (include a photo if you need a specific item):
�e.crz�� I��oL I
(�lnu `c� to � bce-1��'''� 2�
Approxi mate Cost,
Funding Source, if known:
qO DO
V - !/,�.Le� f=
Reason for Request, ,�,
NMI
Date Needed By:
Supervisor's Signature Date
Please have your supervisor sign the form and
finance.then submitiot to
Renew- June 2025
TS
Network & Security Services
System Administration Services
General Helpdesk &Asset Management
System Administration Services
Accounting Application- GP
Software as a Service
VOIP-PHONE
ACCOUNT 4,152
108.150.00,0000-564.00.4152
108. 150.00,0000.566.004152
564
566
$ 1,186.19
$ 822.45
$ 14,548.80
$ 1,265.62
$ 66184
$ 6,146.77
MHBG
SUD
MHBG
recovep� coach
CV-2 DCR- Rick G. -
ARPA SUICIDE PREY -Bethany
ARPA-Psychol- Lanny A.
Moses Lake
4,260-55
24,63167 $ 28,894.22
129 $ 190.96 DCL-
120 22,867_po.pl
0
MH8G-
8053
2
381.92
Recovery Coach -Crisis -
8079
2
381,92
CV-2 DCR- Rick G. -
7609.564-41
1
190-96
ARPA SUICIDE PREY BETHANY-
9000
1
190.96.0,
AR PA- Psych ol- Lan ny A.
9000.564.41
1
190.96
Housing- 50,Yc- CBRA
8078
0-25
47.74
Prevention - ML SUPTRS
9097
1
190-96
Prevention- City of Quincy
9064
1
190.96
Edrietics V01P Services fPhoneS) ACCOUNT
i oq nn A - 1) A t) Ari.r; 22.08 4200
180.00 56.4 3,973-PI
0 566 -
2 8053 44.15
2 8079 44.15
1 7609-41 22.08
1 9000 SM51 22-08
1 9000.564,41 2Z08
1 9097 22-08
4,150-17 $ 4,150.17
3 8003 66-23
1 8002 22.08
1 8001, 22M 110.38
13
$ 4,260.55 $ 4,260.55
9.25 24,633.67 28,894,22
$28,894,22
$0,00
P7
_g
I-P
ki!
IMM"'i ME,
MA"
Wow
-16,500
2
'�.60%RenewSERW
wyu
'S.410 256494
13�
lohn 2060.001$ 90.97 1 - 189,21-7.60 $ 14,2-34.27 1 $ 3,558.57 1 $ 1
M_
rtin
i " 't
e 001S sort 84,73Y
.71t,y
76,38.40
9,869M 2,46.34
KeithCont822f45
Phone Services Numbotsal urns -I -Rate Tota( Yearly Quarterly Mo
1
Ednetics VOIP Sery.55 ices (Phones) 193.001 22-07539 $4,260$51,126.60 $12 78165 1 1 Wlh�f , *
-1-04 , Y y
. .... . .....
.3 u4p
Vanessa Brown
208 0M
$ 56.23
$ 116,958.40
$ 20,810.53
$
202163
Sr1
$
1,734.2
Ricky Gutierrez
2080M
$ 76.81
$ 159,764M
$ 28,427.12
$
7,1.06.78--1-
$
2,368.93
Jeremy Halt
2080.00
$ 6739
$ 141,003.20
$ 25,088.85
$
6,27121
$
2,090-74
Evan Littie
2080.00
$ 7T94
$ 162.115-20
$ 28,84533
$
7,211.33
$
2,403,78
Seth Sampson
2080-00
S 69-25
$ 144;040M
$ 25,629_19
$
6,407.30
$
2,135.77
Alex Sukhovetskiy
-"j "'
2080.001$
66.73
$ 138,79BAO
24,696.54
S
6.174A4
$
2,058.05
cL an �L u khaar
k, �A
20M00
1 $ 5&98
$ 118.51SA0
I
$ 21,086.10
$
5,272.03
$
1,757.34
MMIll I lllll�
Totat Cost
Years-
Tot/Yr
Yearly
Monthly
Teamviewer Year I of 3 Year Contract)
$ 34,773.61
3.00
11,591.20
$ 649.11
$ 162.26
$ 54,09.
Ednetics/SMARTnet Maintenance
$ 22,0M00
LOO
$ 22,000.00
$ 1,232.00
$ 308.00
$ 102,67
Netapp Storage Hardware Service
$ 33,156.0
1 1,00
$ 33J58.00
$ 1.856.85
$ 464.21
$ 154.74
Ednetics One
$ 24,976.38
1.00
$ 24,$78. 38
$ 1,398JS
$ 349.70
$ 116,57
Rubrik (Replaced Veeam) $ 538.428-91 3.00 $ 179.476M
$ 10,050.67
"A"
$ 2,512.67
$837.56, ;
#v
l�
Accounting..Applic-abon TOW Cost years TOVY( Yeafty QuarteMonth
rt� DvnamicsGP $ 124.270.00 1.00T l2_4t27M00 1 $ 7,966.03 $ 1,9915? 663184
W, Y.
4.
NO
Exchance Online Man IG
$ 5,017.19
5.00
S 41,81,
$ 209.05
$ 52-26
$ 17.42
Office 365 G3
S 169,819,44
123M
$ 280.03
$ 34,443.69
$ 8,610492
$ 2,870.31
Azure Active Directory Premium Plan I
$ 45,205,40
151.00
$ 62.79
$ 9,481.29
$ 2,370.32
$ 790.11
Adobe Acrobat Pro
$ 18,328.21
28.00
$ 113,14
$ 3,167.92
$ 791.98
$ 263.99
Adobe Illustrator
S: 1,785.39
Loo
S 446.35
$ 446,35
S 111.59:
$ .37.20
Adobe Creative C(oud AIL Apps
S 14,930.93
2.00
$ 933.18
$ ' 1,866.36
$ 46&59
155.53
Barracuda Email Arcnaiver and Anti -Spam
$ 38.333.33
150.00
$ 159.72
$ 23,958.00
$ 5,989.50
1,996.50
Blue Beam
S 3,113m
IGO
$ I88.62
$ 188-62
$ 47-16
S 15.72
Laserfiche DMS Maintanance Cost $ 3,703,45 35.001$ 105.81
$ 3,703.45
yg,
$ 925.86
V.
$ 308.62
28894.22
lt)dkudes 3% COLA and Annuat Raises MIMEM M lMi�� MIM,
American Rescue Plan 0 Received Supenisor Approval
(Cares Act — ARPA)
Scanned supporting documents
L-1 File into finder
0 Item(s) received
Today 's Da te 6 /6/2 5 Receipt Date: 6/2/25
Vendor: Columbia Basin Herald
Detailed Desc *tion.- Mental Health Awareness Month x1 0") for the local
rip
fl.ewsjo.age,r - ad ran ever y.,Wednesday.for , the mo. nth of Mav
`Charge to Aig'
Month:
JUIN,-r 2024
[1 January- 2025
E] August 2024
El FebruarV 202'
101 September 2024
March 202—
October 2024
-
April 2020
November 2024
171 MaV 2025
December 2024
June 202-
:3
Defiverables:
0 General Taskforce supplies
0 Goal i.: MH Literaev & BH Promotion
w
0 Goal 2: Postvention
0 Goal 3: Percept ion! attitudes
C1 Staff Travel / Professional Development
Requested by
Supenrisor Signature:
Form of Payment
VISA
Invoice (paid)
2 Invoice (needs paid)
7 Other:
0 Food
Charge Account.
0 ARPA (goon)
0 Other:
$ 00.00
Date: 616/25
Date: 6/6/2025
Prevention Requisition Form
Revl,wd 07.2024 renew
Columbia Basin Herald
PO BOX 910
MOSES LAKE, WA 98837
(509) 765-4561
ADVERMING STATEMENTANVOKE
v
ocuoirms to W31 IM 5
AMMAN RESCUE PLAN SUCM PREWNTM
At
S,
�777,
_77-M,
l•Va ,3 -C ! fi :. F u b„ ,
SOW
W + Vs
Cm
ftkll�
$0.00
AMERICAN RESCUE PLAN SUICIDE PEED
BET HANY AVEY
840 E PLUM ST
MOSES LAKE, WA 98837
6_1
Y
0&3112025
�241
t
Columbia RaOn H*mW
P0 Box 7000
COEUR 0 ALENE. ID $3416
FFK
-V, M� 'A
Balance Forward
0510712025
0510V2025
00002203'75-06072025
American Rescue Plan Suicide - Mental Health.
$460.00
051141025
05/14f2025
0000,220375-05:142025
Ame6can Rescue Plan SufcWe - MenW Health,
$4$U0
05121120,25
52112025
0OW220375-06212025
American Rescue Plan Suicide - Mental Heafth.
0512717025
83-366
138 15-13816
($1,000-00)
0612W025
OW812025
0000220375-05292025
Axmdcan Rescue Plan Suicide - Mental Hoalth
$460.00
ProvIous Amount Owed:
$1,000,00
Now Chwaos Thl* Podod.
Cash This Period:
(St000-Do)
Dabit Atijustments This Porlod.
$000
Credit Adjustments Thts Period:
S000
We AWsoate your business.
STATEMENT OF ACCOUNT
06/02/2025 11:48:42
RENEW MOSES LAKE FN
FIRSTNET ATTN ACCOUNTING TECH
Built with AT&T 840 E PLUM ST
MOSES LAKE, VVA 98837-1874
AutoPay. ' Set up automatic payments that you can update whenever you want. Go to
firstnetcentral.firstnet,com today,
Page:
I of 249
Issue Date,
May 19.2025
Account Number.
287333762696
Foundation Account; 62317818
Invoice.
287333762696XO5272025
Total due
12 1
Please pay by.
Jun 14, 2025
_ ------ ------------ -
Account summary
Your last bill $5,214.27
Payment, May 13 - Thank you 1 -$5,214.27
Remaining balance $0.00
Service summary
careless Page 2 $5,212.18
Total services $5,212.18
Total due
Please pay by Jun 14, 2025
$6,212.18
Ways to pay and manage your account:
firstneteentraffinstnet.com j Call,611 800.674.7000
from FiMtNet device, TTY 866-2414 6567
from any other phone
Re turn this pattion with your check in the enclos-od
envelope Payments may take 7 days to post.
FIRSTNET RENEW MOSES LAKE,
Please pay $5,212-18 by Jun 14, 2026
Built with AT&'r ATTN - ACCOUNTING TECH
840 E PLUM ST
MOSES LAKE. WA 98837-1874
Ar-count number'. 287333762696
Please include account number on your check
Make rheck payable to,
0 CHECK FOR AUTOPAY
AT&T MOBILITY
(SEE REVERSE'i
PO Box 6463
197-6463
D,)rol Stream, 1L. 60'
999002873337626960000000052121800000521218006
MH -44
15097709154
TANNER I ON
; 5E� 77C�'�1.54
.
MH - 44
................»«.....-. . .:. -...
' 509771r5043
I�1�1�ER1„'� �AII�E'�
i
� 5��7?�.��}�� �
R
w4
H 44
iir,.. _.,.._..._._.......__..._...__.....«.�....».«.«.w.................s..«.«.._..........ss.«........«.....f.....r................a.............._....._...
.
507715 7
..r«........«.............«.....1..............»........«..««........r.....♦t.. .........................................
.._,awn .:.:iwi.-.✓. ..:,..:_:__.:_. _. _., .:... ._.,....
3
TAI A N N E
Jr-_.�.i..v .a...vr.. _..SONIA_._ ss.sriis..s.. ♦
�_...:.._-,r- _......«.__......._._.........«_. -----. _.. .....,,. _.. .. ,
' n .._s.....................«............
7715207�
..
�{.��s.
"]
�3 6rµ1r
'ji.�ja �w
-----------
------ruuvaru«,.,
i FERNANDEZ
15097715530
,.... r r. .r. -v. ..... ................««._.r.._....t.a.........-_w. .
$41.32
:..r..:.n,----- ._..r.:✓i s............ :«.
I'� 1H - 44
.rs......«...»..««.......«......»
.50 771r7105
.......................,.._._.__♦.._......_s-..i.-...,.-nnwi:.,.:......__._.s.r...s.....♦......._........._............_.._:.__...........Y............s..s.s.._...............__..._....:...s..a...ss........s.._.._.i.._............_.,.,...,....................._....,...........,,..._......_....R......._.....«_............_....._..__...s........._...._......_.........._...........__......._........__._..........«.v....«.............»..............«.....
; INDELISA S�ALINAS
5� 77171�5
41.3
MH -44
......♦......«.«._.,.. :._..r_.. .a.,
15097717374
r.................«..._.s....._....s._..«...i««.....«........«...a....««..---- .«.........«..........«,....«.............s............'1-.....««s..
' LISA HAM ILTON
..... ui. '-............s........ ♦...a_............r.................... ._ . ...._.... ...................-....a........._,._............v_...
-----------
; 50 771.7374
}
«.....r..«...
$41-32
MH - 44
.v,._.ns✓iearo���.rii..r.«.......««....r.....»..
15097717661
-
SC TT DERTIN
w......._..._..e.....♦...«_<-......r...,.r......e«,................ ._........................ ...... .i..........»...«..«....«<
5097717661
».......«r..«w<.........♦.w.,r
41.32
MH -44
5097930640
:: .-
RYAN HARDY
.-w av r:nr ar ram ...-r..v.n. ..
15097930640�
4 1 . •Y Mh
♦.♦.r.._._ui vn._.u.--..n-.:_.:.:,:s:.._.....««
MH -44
..............«..«..«.....«...........«.«s..«...«....r.....s«+....«........w.r..s.s.s..s....«.r.........s.................s....«..�..✓✓
5097 3.5794
........ ...s.s..«..............«......................... ........ .......... .__._........ .......... ,.,.........................4..
JASMINE ARROYO
a.. .r.ra_..........r_.s....._.........rv.................................... .....__....-
, 5 979357 4
�..��.
H -44
....«...r r.•....♦.eaw-vur..m♦isr.........................«.«..............««......».....,.....»»......«....................r..w+.........«.............................«........«......_........................«.{......
r. «.....-r,e..w,.«.-....r-x-»,<m..v..e,.aern.vn.♦...<............... .................... _.-.,, u....v.._._.. .ni.:.<,�_.......uisrce..i iii_..ru.«:-_....ewin._..__._.._._............a✓_......_.__.._._ui:.�n;.:::...ii v.r...:.,,.::,2...wris_.uar.:.a...._......e....,._..,..,..
iZULEMA TIERREZM ONTRERAS
..♦.........i...«.....«'--...✓_........r...................
.._♦«........._.. ---.---..................<« �....-}. ...............«««..«♦ :-..r... <v_..xvr-ry
;5793 959 $51.51
...
I` H - 44
f 5 85503 3
_._............._....................a........_._..._---.........__......^
1 A+ HERY NYGREN
.._.._.......... . ..... _... .._.. ...... ....:
51.51
I IH -44
.... ..,,,.....n-,r-a.a.a--..,... r....-...------ .......r.......... a....._........_.........
... . .. . .......
.------_- __.:_...........,...-..:..,:.........r..,.._..:.:,,-..r,a.. ...,_... .. .,rr,,, . :...«.. r- ..----------- ...�.,,,...
. . ......t PATRIC RAPEA
<...... ....... «♦,<........r............. <........««............ .,........ ............ ....... ....-..........«.««.«......«...,.......
..
51i.51.
......... .......<,......_n,,: M ._rarM rn..
....:....,: a..,._._a..r_..
v... _.. ..._.. _ _ .. ._.. .. :,,.... .. , r .. . _............._....
......... ........................>__...
«r,.-«,.....«.. _............................._...____.,-......... «.. ,
:Total MH 4
�,n.. r,...,.n........ <...r..,.....,<.,........ .,...._.......... ...... .♦,.a«._........ .............. ... ««....«._.
« .
3 .4
«...
'
.:.wairrosswriii..ro...«....✓a.............................«............«......«....««...«.....«.«.«.............««i.....................s................«..................
MOT _ 8053
....... — --- ...
5 70792 4
--------- _.__....Y.:i s✓...------- .._. >.,. .__...... .a ....�._..... ... ..s.... �.�._.. ,.: :.. ...-__.....,.", ., .:-.._.,...... ..........
I" ARTS E N ALE
i......................
..w... ..,...._......... ..._........._............................_.........«..._.... _....... ...__....
5 707 4 ( 053)
41-32
................«.......«.««.«......««................................i...........«.....«.........r«««...«...w«..«.«......i............✓..............
MOT - 53
' 5 707926
.... ..'................r...................s_......s.......v...a_.a......... ...._........._. _-- _.... ...:...:,..:.v.:Y...vr�.irori.rx..._r..............x:_.,rr♦,....♦......«..r...........e.........................._...♦....«............r-........................«.«.....«........«...r......
FERNA�NDO AI AREA
. 5097079053
$41.32
MOT - 8053
5 1 4
FERNANDO GALAR A,
-...........
. 50 91.048
40.04
.....««.........«.«...«..«.........«.«
MOT - 8053
.......................... «....... .............................
................».«««..a.♦...............«.................«............................r................
5 37 4
...«.......--------- r....._
........... ........ ......... ...... riir.... . ...................✓...._. _....__..._s ........... i:,,_._:... ..........,
MARISOL GONZALES
...... ............................. ........................ .._...._.............. ......._............ ......... ......._.. .. -... ----._.....------
.. yn..,...-.v..............:...v.«............ ..............._...._........_._..........._._......._..............._.,._Y ........
5 37 4
.;.......... ........ ...... .uii ...._. u. ... .............. ..r.♦... ..................... «..«...........
......... 'r .. ...... ...................
$40.04
♦...« ......... .»«..««........
.«.....«........«............«...««.....«
-....:,...:-..._..<...,..>.:...........................................................................................:..,-,.r:.
.......................«.....«.........................«««.....«......«.«.............«....« ...
....<...;....a._...,r_....,.<....,..«_........... <♦ ................___.._....
........................ .«...._.._.._... _........_..__..._ :i _,.:i ,.... ..,,. ., ......:
.
........._......................,............. ...
.....ne. ............................................. ------ _._... ._.._._«................i
Total MOT
- _ .. --- ., .r ... .......... ........... ....................................................................................
..............._..--- --.«......
$1 .
?.
- 90
.......«...«.«....................................... «...........a.«...
:50977143 4
.............,........_«...._...._._a_r._.....a...._,_.__.....a..,a_..._,._«: .... .�_..... _... ,... .. .,._ .................
00
BETHAN ES AI LA
,. t....... ....................................
5 77143 4
.. .. ._
1r 2Prevention
...«.«.«..«
Pre'etl'ICr7
.............«.........««..... «.r«. .«....................... ......... ,a..,..,.... -0000.0
..
57717+534EAN
... .....................................I............, ................ ........... - ..... ..... ..
WATSON
......... ....a... ............ ... ........ .........
5771.734
.«........ .«........:.....
$41.32
.................«....,«a ..... ..............,....._........ ..... ......
Prevention - 4
..,........................................................................................................._.....................,.................................,...............,.....................a.......,
5097975242
.....,.,. ,.. - .. _._,. __ ..,.__ .,... __....
CRYSTAL R Z
.._....a,.»........«................_.♦...................._,.,..,.... ., _............... .. , .,.... ... ..:...
. 50 7 7.524
_..,....
�..
v.....r.........................,..>..«.....«,»«..........✓..«...»...............«.......................
Rec Coach - 79
-"..ra--: «. n._.y....._,<.._........_,.e.,........................ ........... .............. ............
5 771503
...._....w............. .......... ..................... .._..._._.._._......._......._...._.------------ ........... .------------
EEEISER PANIC
.._.......,...-..............r........r.........._.........._.................»..— -.----._........_....i....._...__._......_..r..r�....__.._.......u..._.s._..........
5 7715 3
w..ai_,
41..32
r...............».«»«....«.«............ ..«.«........._.....«......................._«._......................_..
Rec Coach a 8079
I
.wr..............✓«._...i.naive....m_.,....._.__«----- ._-._._.._.........._..........
:5097930005
.......✓......................_...._......._...................._............ ......... ..............._....,.... ... _....... _....... _...._..... ....:. _..
JAI' I E I U I, LEN I
rviiv...x..n.,...«..-.�ri....r,.................. _............................................
. .5097930005
.«............. .......... «....«...... .....
41..3
....................................................................«......«........«......................
........:�-w.�u.ri..............«.«........,...r...........................«...................................>................r........_............_._........_..........................
..
... ......_........._..., ._ ._...____ . ..., :,_ n : _i;
, v---- -----. ----...r....................ar-......_.... _...._...._.............._....._.._..._. _......_.i...?'_..........._..........»s.._....rii......n.....
otal$82.64
w._ . ..
.«.. .....
SU
.5094310572
PIN I ARI
5 431 57
......
41-3
........... ...1 ................................ ............
.......
........ .......... ......... ............. . ............................ ..........SUD 5 509707 5
......HEIDI
:EDDY DE........... ERRERA
5....... SU D Profession
41.3
..........
..........................................
. .....S 5 7 7 1
..........H .. . ... . ... .. .. ..... - -
....SUS
N EMI GAR IA
-------097079095
5 7 7 1 SHE
41-3
. .
.5097502545
..........
EEAINA SANTA RU
...................s...r...... ..................... ................ ........... .......... .......-... . .. .. ........ ...
5097502545
51-51
Sty
;5 7503 06
DALE WEAVER
:5097503006
51.51
«.., v......., ...w.................a..._.._..._...................♦.......«..«.«.....«....
SUD
«« .. ....... «.»««.........................«...........«................
.......... ... ............._.._... _.._ :....._.... _........ _. ,......
KATHY ERTREES
a
{ .......,.......- .------
5097509926
51�51
SU
5 77 33 7
DARCI AI�AMOS
5� 77�33 7 5 �
41.32
.wuinwi.:.'aw✓._.,:n_: _,.:.:. ...r .:...
■■■i (■may;� �ii .......:..
s U _
..._.,.......................«...««...«........r.........................«.«....«............................ ............ .i..__..«...._.......✓...............
`/ryj}(p.��i •1(�]•M(j��(/�■p [��\�
Y wL 6 J 4f 5 �i 6
5097705969
........__•__.-------- _._._..--..ii:_.n-_... _._...... .. .. .. ... ....-.......-...., .. ........ ... ...-........................
} (�/�� ��j�(( (�y+�j�y�ijt
! I 'fir/ i `{rI •
..t 1��.+�)(;/�/���,jji r(�rr�'S [�"��.{jr ..5..
.. ..:____.. _.......a....a..._........_...........................«....«...........«.«.».........._..-.............«...«............»..r.«.......«....«
two M1Y .rY Y :rF
("j^,�-,y .r{�y�c� Iy�j
rJ ""F' lf�a'
.«.........«...........«........«........««»»........»
SUD
.....».Y_.»«....
.509 553215
......................... ............ ..........
ARASEII VERD CO
... ................................__..._...- ......................_............».....»_.»...
15098553215
.».. .-.
51.51
MALEENA LOPEZ50985537SJ
51451
....,w...a................_a a. ...aa..nw.., -..,, a.... .,.__--•.
SLID
......«-.........-.w _:__,.-,,,.a,. _ ... .v_...a.. ._ ....... ...... ...............
.....-.....- ......... .... .....s..................................................................
509 553281.
..........................y............,........................................................... ........................
....................... ... - ... - ..... ,..,. ..., -..... .. .....,..... ,.. .-...._....
� I ABELLA VALE
...... . ,. ..... . ... ....-. ........ ... .... ........ _ .. _.._ .. ...,.... _ ._ ........
.....«._..................................................... . .. — ...--—...,...........,...,_..-. -- ....................,
15098553281
..-------- ............. ......_...........___.._._..__..__._......_._ . ._ .._. .. _.. _. . . ,... .. .. _. ---- ...., .. ,x..
__...-.......... «,r
$51.51.
_.. a... ,. _...
-
..�...v....«....r.....♦..._.".............................................«..........«..........._.......««...........«w..i.....................«.._..._.........««......«...............«........._.............__................------..._..., _.........._-- _-- ._..... ,...__. .... ..... ..... ......_. .... ....... ,. __._ . ... .-... ..
I
� Total U D$515-66
.-.- .. .t -... .. ..... .......... ......... ............ .......... . .. - ............. .,. ....... .......... .. . ..................................................................
«.».........«...... ........... ........................ .............................
ISe - 8059
......... .......... ......................................................................«.....................................-.............L...........,......_..................
i
j
1.5094.31.7 240
.... ..... ...... ., ...., ...- .....
DE EAN NA SAN DOVA�
... ........_.... ......._............._._.._......_.._,............................_.... _..., ..... _.._....,...._..._. ........
. s-. .. .. ...««.
i
Sty 4317 4� ��C15��
.« .«..«............«..«......«...«..»«.«.
$41.3
.
...... «............................ ...................................................................
WISe - 8059
.......... -...........
'........ ................. ............................................. ..................
15097073475
"..... ...;....................................-....... .... _ . .. ,_..... .... .. ... . .
} TATIANA H ERNANDE
_ _ .. _..,, . ...............,.-..... ..,................ .._.._. ....
F 50 7073475 �
$41.3
American Rescue Plan
(Cares Act - ARPA.)
Today's Date: 5/16/25
T-rendor% Washington State Department of Health
R isor Approval eceived Supen
0 Scanned s-upporting documents
El File into binder
Item(s) recei,, ed
Receipt Date.- -5-1.1,611-25
Dd ption. Counselor Agency Affiliated Registration renewal for Bethany
etaileDescri.
Late fee paid back to accounting department via cash payment by Bethany.
'Charge to A19'Month.
1 July 2024
0 JanuarV 2025
Lj Au,(,TU.St 2024
0 Februat"V 202-
E-] September 2024
7" March 202-
Octoter 2024
El zXpril 2025
November 2024
2, May 9.02 0
L ece-mber 2024
L_; June 202-
ID
Defi,verables:
• General Taskforce supplies
• Goal 1: MH Literacy & BH Promotion
• Goal 2>: Post-vention
• Goal 3. Perception/attitudes
,:Y Staff Travel / Professional Development
Requested by:
Ac,
SUpervisor Sirynature-
Form of Payrment
2, VISA **** 7348
Invoice (paid)
70 Invoice (needs paid)
101 Other:
Food
Charge Account:
0 ARPA(9000)
L-1 Other:
S 287 00
Date: 5/16/25
Date: 5/16/2025
Pre�ention Requisition Form
RC-v Ised OT 1_024
renew
I
Your payment was successful on 05/16/2025.
Please find the transaction details below:
Transaction ID-. 42ecfO I I ld9dc-*').'i.).3
%-,onnnnation Number: 250516"'.). 12-65045
*Note, Bethany paid accounting back for late fee via cash
payment of $95 on 5/16/25 (see receipt on last page)
Credential Number
T`ee Type
Anioun
Reneckval Fee
185 � 0 0
CAAR.CG.60708924
Lat-e Renewal Fee
S05.00
Subtotal
$280.00
------------
Convenience Fee (2.5%)
Total - $287.00
There is a 2,5% convenience fee required to use the online service when paying by credit/debit card, The
aunmill fe11 be charged in addition to your e(s). There is no convenience fee for ACH Payments.
mot
renewOfvf* S*hovtrol H#01h 6 ultarwss
I Date: 05/15/2025
Name,* Bethany Escamilla
Item(s) Requested (include a photo if you need a specific item):
A2ency affiliated counselor renewal fee NO ------
ltrtl
Funding Source, if known:
�UIIWI�
Reason for Request: Licensure
- ---------------------- -- ------
------------------- - -------- --- ---- Dt Needed, y: Upon approval --- ---- - - ----
05/15/2025
or
Supervisorfs Signature Date
Please have your supervisor sign the form and
then submit it to finance.
Secretary
By the authority of Chapter 18.19 RCW this person
Bethany Marie Avey
is granted a
Counselor Agency Affiliated Registration
Status Credential Number
Active CAAR.CG.60708924
Effective Date
05/16/2025
Do not let your credential expire'
You must make sure the Department of Health has
your renewal before it expires. It is a violation of
the law to practice without a current license and
may be subject to disciplinary action.
A timely postmark on your renewal will not prevent
an expired credential.
Renewals sent by mail take about two weeks to
process.
Credential Number - CAA R.CG.60708924
Expiration Date - 0511312026
Initial Issuance Expiration Date
0110412017 05/1312026
Personal Copy of Your Credential
Washington State Department of Health
By the authority of Chapter 18,19 RCW this person
Bethany Marie Avey
is granted a
Counselor Agency Affiliated Registration
Status
Active
Secretary
Crede�ntituber
CAAR.CG.60708924
Expiration Date
0511312026