HomeMy WebLinkAboutGrant Related - New Hope DV/SAwVAC _ e4-.-
G RANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: New Hope/Kids Hope
REQUEST SUBMITTED BY: Kim Pope
CONTACT PERSON ATTENDING ROUNDTABLE. Tom Gaines
CONFIDENTIAL INFORMATION: DYES ®NO
DATE: 06/22/2026
PHONE: 509-764-8402
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®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
The attached grant agreement necessitates a signature by the Grant County Commissioner Chair.
This is not the final contract, it is the initial agreement which much be submitted with the application.
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: �` �J' DEFERRED OR CONTINUED TO:
APPROVE: DENIED
D1:
D2:
D3:
ORCTA1K1
WITHDRAWN:
4/23/24
Of
*X Children`s Advocacy Centers
of Washington
*+ X Children s Advocacy Center Capacity Building Grants
ACCREDITED CENTERS
July 1, 2026 through June 30, 2027
INSTRUCTIONS: Please complete this fillable form with the requested information, download and save to your computer.
You will then be able to email this form for digital signatures. Be sure to save and submit the signed copy to CACWA.
NOTE: If wet signatures are preferred, please print, get signatures, and submit the signed PDF to CACWA.
PROPOSAL FACE SHEET
Legal Name of Applicant Organization
CAC Name, if different
Grant County
Kids Hope
Mailing Address for Correspondence
Physical Street Address (if different)
311 W. Third Ave., Moss Lake, WA 98837
CACWA is only reimbursi, dges from now on via A H P ocessin¢. IF you didn't receive ACH
payments for last year's invoices, please contact CACWA's Contract & Finance Manager to set that up.
Name & Title of Person Authorized to Sign Contracts
Name of Current Board Chair
Kevin Burgess, Grant County Commissioner
Kim Pope
Telephone
Telephone
509 764 8402
509-764-8402
Email
Email
kpope@grantcountywa.gov
kpope@grantcountywa.gov
Name & Title of Primary Contact (if different than signer)
Name and Title of Fiscal Contact
Alyce Barrientoz, Financial Operations Specialist
Telephone
Telephone
509 764 8402
Email
Email
abarrientoz@grantcountywa.gov
Amount Applied For
Percent of total CAC budget requested $ represents
$ 60,300
75 %
Federal ID (EIN)
Is your SAM.GOV registration active? Yes
91 6001319
Expiration Date: 12/18/2026
Authorized Contract Signature
Date
Kim Po e Digitally signed by Kim Pope
p Date: 2026.06.23 09:16:20-07'00'
06/26/2026
Board Chair Signature
Date
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