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Home My WebLink AboutGrant Related - BOCCS, 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: Karrle Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kafl'1@ Stockton CONFIDENTIAL INFORMATION: ❑YES ® NO DATE: 7/3/2025 PHONE:2937 i an ! / / .i FAVjNONE ❑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 Port District 4, Coulee City on the Strategic Infrastructure Program (SIP) No. 2023-05, new Coulee City Medical Center project in the amount of$5,509.85. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO W N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: 72-21 - Z6 DEFERRED OR CONTINUED TO - APPROVE: DENIED ABSTAIN D 1: D2: D3: WITHDRAWN: 4/23/24 GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved by Grant County, SIP Project Proposal Number: 2023-05 SIP Funding Recipient: Grant County Fort District #4, Coulee City SIP Project Description: New Coulee City Medical Clinic I, the undersigned, do hereby certify under penalty of perjury, that the materials have been furnished, the services rendered, and/or the labor perforned as described in the project proposal for the above -referenced SIP Project and that I am authorized to authenticate and certify to this claim. I also certify that this claim of $ 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. Signature Printed Name :;A� Date Signed Title Printed Title Completed,. signed original certification and invoice are to be mailed to: Grant .administrative specialist, rO Dox 37, Ephratz, WA 9660 ATTACHMENT 4 Hut LIST ovmc _.�._ �. _..r•....�_ �...�........a. w.�.:.. ,......... ........ ....... .._........., ................._..�..�w.....OU u�,`RC *"A woo GENERAL FUND p. 0. BOX 537 WAR NTS: COULEE CITY, WA 99115 ND RtAL.S HAVE BEEN FURNISHED, �,� DES-�-�44 A R PENALTY OF �PEpiURY) THAT THE MATE NST GRANT COUNTY IPO I, THE UNDERSIGNED, DO HEREBY CERTIFY 131�lDE D UNPAID ��►LIGATION AGA1 p HEREIN AND 714AT THE CLAIM IS A ,BUST, DUE AN CLAIM LABOR �'Et��ORIVii�D AS DESCRIBED � � •A.:UTI�E�iT#CA't'E AND +CAR 1IF1� SAID THAT 1 AM AUTHORIZED TO A WARRANT NO.Alm AUDITOR SIGNED BY.' � �,••� yew �r Arv� .ate �X+j •✓ t .0 A (;rant Countr Port District *4 4:45 PM Check Detail 0411717-5 April I - 21.2025 lb Item Account Paid Amount Num Date 'rype— ----------- -Travis Liening Cash Account Check 4207 04/2112026 -161.00 513.10 - CorrlmissiO— .161-00 TOTAL Check 4208 0412112025 joy Beardsley TOTAL Check 4209 04121/2026 McDonald, Howard TOTAL Check 42110 0412112026 Chris Erickson TOTAL Cineck 4211 0412112026 ShirleyRae Maes TOTAL Check 4212 04i2i12025 Axe Fire & Security TOTAL Check 42113 04/2112026 u S Bank Cash Account 513,10 - COMMissio— .161.00 -.161.00 Cash Account 513.10 - commissio. -161.00 -161.00 Cash Account 514.10 - Port Secret.. -400-00 400.00 Cash Account Property Management -250-00 -250.00 Cash Account 773. New construction-64 -773.64 Cash Account 13 514.30 - Office SuPP-- -304. 30 C) -T-1p 514.30 - Office SuPP. -• -1,169.64 Capital Projects -239-01 Miscellaneous Expe--- — Page I Grant .M A t Coun' Port District 94 4:4.5 PIN Check Detail 0411V26 April I - 21,2025 no Date Name Item Account paid Amount Type gum .1,730-08 TOTAL Check 42114 04121/2 25 Grant County PUD Cash Account -196-18 538.40 - Utilities -196.18 TOTAL Cash Account Check 42116 04/21112025 Gray & Osbome, Inc. 514.40 - professiona. -815.92 -815,92 TOTAL Columbia Glass Cash Account Check 4216 0412112025 169.654 New Construction -1 -1,169.64 TOTAL Check 4217 04121/2025 -fown of Coulee CRY Cash Account -141.89 538.40 - Utilities -141,89 TOTAL Check 4218 0412112026 Consolidated disp... Cash Account -94.30 538-40 - Utilities -94.30 7CTAL Check 4219 0412112026 Boss Public Affairs... Cash Account -1,159.83 514.40 - Professiona -M59-83 TOTAL Check 4220 0412112025 Centurylink Cash Account -85.60 538.40 - Utilities -85.60 TOTAL page 2 IPA,^ve Fire & Securitiy (509) 423-5764 630 Valley Mail Pkwy #364 East Wenatchee, WA 98802 A -.XE FIRE & SECURITY To--, D�tem of lssLie nvokc-2 M--wnber Amnoutnt Due (U-SM Shirley Rae Maas 03124/2025 0000529 Coui.ee City ZIP .. Du 04/2312025 . .. � vrq : yeq . ��.. �y yy�y �p+P.p� Tn-oayUieTlil ainfess Push/Pull Plate $22.00 8 $176.00 +Coulee City t Screws $1.00 $16-00 +Coulee City I ravel Charge $125.00 1 $125-00 +Coulee Cibj Labor $100.00 4 $400.00 +Coulee City Subtotal 717.00 Coulee City {7.9%) 56.64 Total 773.64 Amount Paid 0.00 Amouni. Duee... $773.64 Includes trip and labor from 3124/2025 and labor and hardware for stainless plates Net 20 Grant County Port District No. 4 P.O. Box 537 Coulee City, WA 99115 CXIMLY 8z7- CONSULTING ENGNEERS March 7, 2025 Project Na. 20840.00 Invoice No- 28 Project 20840.00 Coulee City Medical Clinic Professional Services from January.,26 2025 to February 22, 2025 Professional Personnel Hours Rate Am.ount P. Manager Meskimen, Michael 4.00 203.98 815.92 Totals 4.00 815.92 Total Labor Billing Limits Current Prior To -Date Total Billings 815.92 273,279.02 2742094.94 Limit 294,000.00 Remaining 19,905.06 Total this Invoice g15.92 1130 Rainier Avenue S., Suite 300 Seattle, Washington 98144 (206) 284-0860 Fax (206) 283-3206 COLUMBIA GLASS, LLC 1607 W BROADWAY AVE #A DOSES LAKE, WA 98837 Bill To COULEE MEDICAL CENTER 218 W MAIN ST COULEE CITY, WA 99115 Ship To 218 W MAIN COULEE CITY Invoice Date Invoice # 3/21/2025 27376 P.O. Number Terms Due Date Rep Ship 3/3 I /2025 JMT 3/21/2025 Quantity Item Code Description Price Each Amount 1 DOORS D-51994 0.00 O.00T 2@ SPEAK THRU 1 SPECIAL ORDE... HY-535208 2,162.00 2,162.00T 3/8" CZAR TEMPERED TO DRAW WHOLES BRUSHED NICKEL. HARDWARE 1 @ 48 1 /4" X 51 3/8" I @ 50 114" 42 7/8" DONE 4/8/25 BILLY JAY Finance charges of 1-1 /2% per month of unpaid balance (18% per annum) will be charged on accounts not paid by the due date. S u btota! $2,162.00 Saps Tax (8.2%) $177.28 Total $21,339,28 PaymentalC red its _$11169.64 Balance Due $15169.64 Phone # Fax # 509-765-3576 509-765-2127 Web Site v^w.columbia-glass.com Cans an Name: GRANT CPD 4 Coreorate Account Number: 4484 7345 5003 5621 1-010 Statement Date: 03-25-2025 f-11 ki i t eAk, i 11/ V Oq Aw f k ti .7, ra. .7% 71: 777 V . ., . . ....... . .. ..... . ... ?:. . ... ....... . . . ... . . . . . . . . . . ... . . . . ... . .... ..... . EW-ACTIVIT-Y 'RICE TOTAL Post Tran Date Date Refereiice Nuinber Transaction Description Arnount 03-04 03-03 2464565062500012335862 COLUMBIA GLASS LLC WWW.COLUMBIA- WA 1,169,64 03-17t O3-14 24011345073500113370750 ZOOM.COM 888-799-9666 ZOOM.US CA 17.30 Department, 00000 Total: Division: 00000 Total: $1,186.94 $1,186.94 V10 Off ist Order of lusiness Checks, Deposit Slips, lusiness ,orms. & Check velopes IVA �ra Off ist /7 Drder of lusiness A' Checksti iL Deposit Slips, ;usiness 'orms, & Check rotak, S460.18 rotal: $460.18 fline: $41.79 Tax S41.17 Page 2 of 2 112 M Invoice 27376 from Columbia Glass, LLC i message %caroline@columbia-glass.com> � � Tue, Apr 22, 2025 at 9:17 AN ro: PORTDIST4@hotmail.com Invoice -0iue:03I31/2025 27376 Dear KRAIG FULLER: Amount Due: $ 1 ,169.64 Your invoice-27376 for 2,339.28 is attached. Please remit payment at your earliest convenience. Thank you for your business W we appreciate it very much. Sincerely, COLUMBIA GLASS, LLc 509-765-3576 www.columbia-glass.com �cz ��r�ti RU GENERAL FUND GRANT COUNTY PORT DISTRICT #4 VCHER LIST P. 0. BOX 537 DATE.* COULEE CITY, WA 99115 WARRANTS �� -� ..`� t warrant To: 0--LA Description UQtz - Arnount 14 �ajl "ir .lw k- oil Rill 11 11 Ip THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THATTHE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORM ED AS DESCRIBED HEREINo AND THAT THE CLAIM IS A JUST., DUE AND UN PAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. SIGNED B 4. WARRANT NO. AUDITOR PORT DISTRICT COMMISSIONERS it Grant County Port District #4 1:32 Prill Check Detail 02/1326 February I - 13,2025 Type Nurn Date Name Item Account Paid Amount Check 4186 02112/2025 Grant County PUD Cash Account 538.40 - Utilities -225.48 TOTAL -225.48 Check 4186 02112/2025 Town of Coulee City Cash Account 538.40 - Utilities -166.89 TOTAL -166.89 Check 4187 02112/2025 Grant County Elect... Cash Account 514.40 - Election Co.. -484.51 TOTAL 484.51 Check 4188 02112/2025 Consolidated disp ... Cash Account 538.40 - Utilities -62.22 TOTAL -62.22 Check 4189 0211212025 Axe Fire & Security Cash Account Miscellaneous Expe... -322,6 TOTAL -322,62 Check 4190 02112J2025 Coulee City Chamb... Cash Account 514.40 -Advertising/... -2,000-00 TOTAL -2,000.00 Check 4191 02/1312026 ShirleyRae Maes Cash Account Property Management -250.00 Axe Fire & Securiby (509) 423-5764 630 Valley Mail Pkwy #364 East Wenatchee, WA 98802 AXE FIRE & SECURITY TO Dcu' Of Issue In v o i c pe, N urin b e r Amo Lint Due (U t'), D) ::Shirley Rae Maes 02106/2025 0000488 Couleety $322=62 0310812025 New Lever Description Rty ninte a U n e T 0 t Grade 1 Commercial Entry Lever 626 Finish $199.00 1 $199.00 +Coulee City Labor $100.00 1 $100000 +Coulee City Subtotal 299.00 Coulee City (7.9%) 23.62 Total 322.62 Amount Paid 0.00 Amount- Due, (U.QjD) $322.62 Net 29 GRANT COUNT"' STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved by Grant County. SIP Project Proposal Number: 2023-05 SIP Funding Recipient: Grant County Port District #4, Coulee City SIP Project Description: New Coulee City Medical Clinic 1, the undersigned, do hereby certify under penalty of perjury, that the materials have eri . been finished, the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I am uthorize to authenticate and certify to this claim. I also certify that this claim of 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. Signature V� (en t CIS -r7Q N Printed \Tame 77 Date Signed Y, Printed Title 0 Completed, signed original certification and invoice are to be mailed to: Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823 FA Of 7, ATTACHMENT 4 GENERAL FUND GRANT COUNTY PORT DISTRICT #4 *--� - Vo..uc4ER LIST P.O. BOX 537 DATE: - I WARRANTS: CO U LEE CITY, WA 99115 I, THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERvTCES RENDERE0011 THE' LABOR PERFORMED AS DESCRIBED HE, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. WARRANT NO. �' � `��'� APPROVED: AUDITOR �`��100 D < SIGN B PORT DISTRICT COMMISSIONERS Please tear payment coupon at perforation. '. r-4 R: Y-, -r7% Purchases Gash Late New GRANT CPD 4 Previous And Other Cash Advance Payment Balance 4484 7345 5003 5621 Balance + Charges Advances + Fees + Charges Credits Payments -1 7-77-7 - - - - - - - - - -- -- - - - - - - - - ........... TOTAL CORPORATE ACTIVITY GRANT CPD 4 $1,730,08 CR 4484-7345-5003-5621 Post Iran NUMber Transaction Description Amount Date Date Reference -- 04-28 04-26 74798265i180oo000000892 PAYMENT - THANK YOU 00000 C 1,730.08 PY ....... .. -E ITY WAC: CHRISTINE A ERICKSON CREDITS PURCHASES CASH ADV TOTAL ACTIVITY $23256-14 $0.00 $2,256.14 4484-7301-6265-6580 $0.00 Post Tian Date Date _Reference Number Transaction Amount 05-05 05-02 24692165123100128879792 SAFEGUARD BUS SS INC800-523-6660N AMAZON.COM*NS9SX0 AMZN,COM/BILLWA W9.08-0-4 672-80126103652862181 05-07 05-06 05-08 05-07 24692165 6 24492`165128J0000938W6 SP BARZEL LOCK USLOCKSUPPLY.'NY C07.65 ZOO M,COM 888-799-9BL926 ZOOM -US CA 05-iS 05-14 05---15-- 2401 j usl s4i ow 01425075 246921651951012549891-ONCOM'AMZN.COWBILL *NZ4RQ- AMZN *COM/81LL WA05-J6 AMAZON.COM*NZ3362JJi WA 359.54 05-22 05-21 24692165141107171010777 CUSTOMER SERVICE CALL 800-344-5696 SEND BILLING INQUIRIES TO: U.S. BANK P.O. Box 6335 Fargo, ND 58125-6335 ACCOUNT NUMBER 4484-7 345-50 03 -5621 STATEMENT DATE DISPUTED AMOUNT 05126125 .00 AMOUNT DUE 1,730.30 ACCOUNT SUMMARY PREVIOUS BALANCE 1.204.24 -QTHFR CHARGES 2.256.14 CASH ADVANCES .00 r-ASH ADVANCE FEES .00 .00 CREDITS .00 P I ACCOUNT BALANCE 1,730.30 Page i of 2 i t Details for Order #111 -2520048-1453034 Print "chis page for your na'cords. order Placed: April 25,2025 Amazon.com order number: 111-2520048-1453034 Order Total: $719.08 Not Yet Shipped Items Ordered 4 of: Kwikset 99120-037 SmartCode 912 Z-wave Plus Leverset, Satin Nickel Sold by: Arnazon.com Services, Inc Supplied by: Other Condition: New Shipping Address: ShirleyRae Maes 211 E FIRST COULEE CITY. WA 99115-5257 United States Shipping Speed: FREE Prime Delivery Payment information Payment Method- 0 Visa ending in 6580 Itern(s) Subtotal: Shipping & Handling: Billing address Total before tax: Charles Erickson Estimated tax to be collected: 16799 ROAD 48 NE HARTLINE, WA 99135-5105 Grand Total: United States To view the status of your order, return to Order Summary. Conditions of Use I Privacy Notice @ 1996-2025, Amazon.corn. Inc. or its affiliates A6 TOR C.)F PAGE_ A o n c o rn Y 0 U r 0i" d ea r S Your 1 Islus Arvna7on ive g Gifft R e 1.5.. T & G I "t Price $166.15 $664.60 $0.00 $664.60 $54.48 $719.08 .taft for Order #111- 670776 -`i _, rint t, visae,., for your records. order Placed: May 14, 2025 Amazon.com order number:111-6707768-1993017 Girder Total: $359.54 Shipped on May 21, 2025 Price items Ordered $166.15 2 a : Kwikset 99120-037 SmartCode 972 Z-Wave Plus Leverset, Satin Nickel Said by: Amazon.com services, Inc Supplied by: tither Condition: New Shipping Address: ShirleyRae Maes 211 EFiRST COULEE CITY, WA 99115-5257 United States Shipping Speed: FREE Prime Delivery Payment information ltem(s) Subtotal: $332.3a Payment Method: Sipping &Handling: S0.00 Visa ending in 6580 Total before tax: $332.30 Billing address Estimated tax to be collected: $27.24 Charles Erickson 16799 ROAD 4.8 NE Grand Total: $359.54 #�ARTLINE, WA 99135-51 QS United States Visa ending in 6580: May 21, 2025: $359.54 Credit Card transactions To view the status of your order, return to Order Summary. Conditions of Use l Privacy Notice ®1996-2025, Amazon.com, inc. or its affiliates _ _Health • 3— ♦ ;S `s.r^ 4J Disc, C ,r;� x# zft - ;.l C j t't Rc 1 c g Data i y l! t ..i.P Pi•X:ati.� } tir S *. e`J F}F 2�`s{r:£fi IL?. G i f ! F.t 1i�?wL st3i fi� ++ i ] Of s r a r c�tl Lz ilt ri •_ ; �6- 201�t f zr�n, omp inn. Of �i-s ff... ��- ama.lzon.com' Final Detaiii I s for Order A, .2 Print. this pag2 for your records. Order Placed: May 14,2025 Amazon.com order number. 111-7883549-2365862 oraerTotal: W9,77 Shipped on May 14.12025 Items Ordered 1 of: Kwiksat 99120-037 SmartCode 912 Z-Wave Plus Leverset, Satin Nickel Sold by: Amay-on.com services, Inc Supplied by: Other Condition: New Shipping Address: ShirleyRae Maes 211 E FIRST COULEE CITY, WA 99115-5257 United States Shipping Speed: FREE Prime Delivery Price $1 66.15 Paymentinformation items) Subtotal: �1 66-1 S Payment Method: Visa ending in 6580 Shipping & Handling: $0.00 Billing address Total before tax: $166.15 Charles Erickson Estimated tax to be collected: $1 3-62 16799 ROAD 48 NE Grand Total: HARTLINE, WA 99135-5105 United States Credit Card transactions Visa ending in 6580: May 14,2025: To view the status of your order, return to Order Summary. Conditions of Use I Privacy Notice 0 1996-2025. Amazon.corn, Inc. or its affiliates Enriiish umited statas ti--I) "Vf=", k0nV ah'04wre Y0114, 5pikVa 'j - Coldijis of U-si;- 11aCY �itCf.1Ia1ta F0 1996"1-2025, Arn-zon.cona. Inc, or Its affl-11,61 $179.77 $179.77 %0.%VVv %,p I " a a lb %w %w VO4 x a lb J a qftw a W M0 _w W. . — — — - 06113125 Check Detail June I - 16, 2025 Name Account Paid Amount Type Num Date 538.40 - Utilities -85.63 -85.63 TOTAL TOTAL TOTAL Check 4308 06/16/2025 TOWN OF COULEE CITY Cash Account 538.40 - Utilities Check 4309 0611612026 GRANT COUNTY PUD Cash Account 538.40 - Utilities Check 4310 06/16/2025 BOSS PUBLIC AFFAIRS CONSULTING Cash Account 514.40 - Professional Fees TOTAL Check 4311 TOTAL 06/16/2026 US BANK Cash Account 546.40 - Boat Slip Repairs 514.30 - Office Supplies Capital Projects -166.69 -166.69 -27.87 -27.87 -11251-28 -1,251.28 —�ES�f<<eG -17.30 -1,730.30 1J 'CP � CP Page 2 of 2