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: BOCC
REQUEST SUBMITTED BY: Karrl@ Stockton
CONTACT PERSON ATTENDING ROUNDTABLE: Kafl'I@ Stockton
CONFIDENTIAL INFORMATION: ❑YES ® NO
DATE:11 /6/2025
PHONE:2g37
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Reimbursement request from McKay Healthcare &Rehab Center on the
Strategic Infrastructure Program (SIP) No. 2023-01 Phase 1 Architecture & Engineering
Site Plan, in the amount of $5,690.50. This is the final reimbursement on this project.
If necessary, was this document reviewed by accounting? ❑ YES
•
❑NO ON/A
If necessary, was this document reviewed by legal? El YES ❑ NO
DATE OF ACTION: DEFERRED OR CONTINUED TO:
WITHDRAWN:
APPROVE: DENIED ABSTAIN
D2:
D3:
4/23/24
W N/A
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: SIP2023-01
SIP Funding Recipient McKay Hospital & Rehab
SIP Project Description Phase 1 Architecture and Engineering Site Plan
L the undersigned, do hereby certify under penalty of perjury, that the materials have
been furnished, the services rendered, and/or the labor performed as described in the
project proposal for the above -referenced SIP Project and that I am authorized to
authenticate and certify to this claim. I also certify that this claim of $5,690�es 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
Audra Gutierrez
Printed Name
10 b— I Q's
Date Signed
a- 0
Admnustrator/Superintendent
Title
Adm inistrator/Supen' ntendent
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement # 32 in the amount of $5,690.50
ATTACHMENT 4
MACC Estimating Group, LLC
PO Box 935
E�°°CEIVED
Liberty Lake, WA 99019 US
MACC
(509) 981--9393
iim @m acc estimating cam
ESTIMATING GROUP
Vendor #: VS7(c
INVOICE
Bars Code Name -Arnount
1300
09/02/2025
McKay Healthcare
Tot8l 1:2 A 'C0 V
Due on receipt
127 2nd Ave SW
Dopt. Head Approval:
09/0212025
Soap Lake, Washington 98851
us
DATE ACTIVITY DESCRIPTION QTY RATE AN40UNT
04/25/2025 Cost Estimating Design Development 1 22,000-00 22,000.00
08/29/2025 Cost Estimating Construction Documents 0 22,000-00 0.00
22,000.00
0,00
22,000,00
$223000.00
ENTERED
OCT 0 9 ZGZ5 Estimate Summary 58,00000
Estimate BS2025-11
Y Xinvoice 1242 14,000.00
BY:
This invoice 1300 $22.000,,00
Total, 'invoiced 36,000,00
Pay invoice
L-
C
McKAY HEALTHCARE
656 MACC ESTIMATING GROUP LLC .......... .... 10/23/2025 95519
Invoice Number Invoice Date ----- �Zescnption.,._ Gross Amount Discount Taken Net -Amount Paid
1300 09/02121025Admin - PS - SIP $22,000-00 $0.00 $22jQ00.11*00
------------ - - - ---- --------
$22,00g.0__L $0.001 - - -------- $22,000.
00
US BANK
McKAY HEALTHCARE
12-7 SECOND AVE SW - PO BOX 819 96-651/1232
SOAP LAKE, WA 98851
(509) 2.46-1111
PAY TO THE
ORDER OF
MEMO
Twenty Two Thousand Dollars and 00 Cents
MACC ESTIMATING GROUP LLC
PO Box 935
Liberty Lake, WA 99019
XM
060L, 109 S S I Tia 1: 1 23 201�S 11�I: L S 3 2 LOO 20 L 3 till'
656 MACC ESTIMATING GROUP LLC 10/23/2025 95519
------- - -- - ----
Invoice Number Invoice Date De Gross Amount Discount Taken Net Amount'Pa"Id
1300 02025.
Adin- PS - SIP $22,000.00 $0.00 $221000.00
9/02/
$229000.00 $0.00 - ------ $22 -.0-01