HomeMy WebLinkAboutGrant Related - BOCCGRANT 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: Kaft"I@ Stockton
CONFIDENTIAL INFORMATION: ❑YES ® NO
DATE: 2/1 2/206
PHONE:2937
❑Agreement / Contract
❑AP Vouchers
❑Appointment / Reappointment
❑ARPA Related
El Bids / RFPs / Quotes Award
❑ Bid Opening Scheduled
❑ Boards / Committees
❑ Budget
❑Computer Related
El County Code
❑Emergency Purchase
El 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
V � ,
W1 tio °..,
go
FINAL Reimbursement
request from Port of Royal Slope on the Strategic Infrastructure
Program (SIP), Project No. 2019-10 Waterline Extension, in the amount of $26,600.00.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A
If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A
DATE OF ACTION: ✓� ! � y�'� DEFERRED OR CONTINUED TO:
APPROVE: DENIED ABSTAIN
D1: LX 6
D2: C t
D3:
A
i�1 j�✓
4/23/24
WITHDRAWN:
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
INSTALLMENT 5 OF 5
PROJECT CERTIFICATION FORM
For the fifth and final release of $26,600.00
(from a $133,000.00 Grant)
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: 2019-10
SIP Funding Recipient: Port of Royal Slope
SIP Project Description: Waterline Extension East to Eldorado Stone
I, 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 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.
ture
Ct
Printed Name
Date Signed
Title
�X-PC IAT N � e. � j or C cf oY
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
I<SPORT*f
ROYAL SLOPE
Grant County
Stratigic Infrastructure Program
Administrative Services Coordinator
PO Box 37
Ephrata, WA 98823
Due Date
1/31/2026
PORT OF ROYAL SLOPE
P.O. Box 147
4572 Road 13.6 SW
Royal City, WA 99357
SIP Project Number: 2019-10
SIP Recipient: Port of Royal Slope
SIP Project Description: Water Line Extension East to Eldorado Stone
Grant 2019-10 Total Amount Remaining $ 26,600.00
Five of Five Installments in the amount of:
Remaining Amount 2019-10
$ 26,600.00
Phone: 509-346-2317 bvalentine@portofroyal.com Website: www.portofroyal.com