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: K Stockton
CONTACT PERSON ATTENDING ROUNDTABLE: Kal'f I@ Stockton
CONFIDENTIAL INFORMATION: ❑YES 8 NO
DATE'. 9/1 $/Z026
PHONE:2937
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3
Reimbursement request from McKay on the Strategic Infrastructure Program (SIP)
No. 2025-03 Phase 1 Kitchen Expansion Project, in the amount of $1,200.
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: 9xC)2 zrn:-�
APPROVE: DENIED ABSTAIN
D1:
D2:
D3:
DEFERRED OR CONTINUED TO:
WITHDRAWN:
4/23/24
GRANT COUNTY
;-:ITRATEGIC 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: 2025-03
SIP Funding Recipient: McKay Healthcare and Rehabilitation Center
SIP Project Description: Phase I Kitchen Expansion
1, 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 ofIL.200.00 is just and
due and is an unpai*d obligation against Grant County.
Further, according to the SIP Project Funding Policies, I attest that at the next audit of any
entity, this project shall be called to the attention of the Washington State Auditor's
Office, and an emphasis audit will be requested to ensure that these funds were expended
toward the project and according to the intent of the proposal.
A
Signature
Audra Gutierrez-Ritari
Printed Name
Date Signed.
ra
A d in H U L IOU -
Title
Administrator
Printed Title
Completed, signed original certification and invoice can be mailed to:
Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823 or entailed to the
Grants Administrative Specialist, Kstockton@grantcountywa.,gov
Reimbursement # 17 in the amount of 1,.20-0.00
0"Nowm"
ATTACHMENT 4
rW it h 6 A IrEIr
TO: Public Hospital District No. 4 of Grant County, WA
PO Box 819
Soap Lake, WA 98851
Attn: Audra Gutierrez-Ritari
Professional Services through 8/28/2026
Total Budget:
Prior Amount Billed:
Current Invoice Amount:
Total Amount Billed:
Amount Remaining:
McKay Healthcare & Rehabilitation Center
Total Fee
INVOICE # 32576
Invoice Date: September 09, 2026
SIP 2025-03
TENW PROJECT ID: 2026-098
TENW PROJECT NAME: McKay Healthcare &
Rehabilitation Center
$3,000-00
$1,800.00
$1,200.00
$3,000.00
$0.00
$1,200.00
Total Professional Services: $1,200.00
)Utstandinq 1.nv
Invoice # Invoice Date Invoice Amount Balance Due
32576 9/9/2026 $11200.00 $1,200.00
Total Outstanding Balance Due $19200.0(
Remit to Address: 520 Kirkland Way - Suite 100 - Kirkland, WA 98033
INVOICE # 32576
Invoice Date: September 09, 2026
Page 2
TENW Project Name: McKay Healthcare &
Rehabilitation Center
TENW Project No.: 2026-098
Budget Summary Through: 8128/2026
- - ----------
Task Task k Fixed Fee T&M
Task Name Billing Budget
Prior Amt Billed Amt
This Invoice through this
No. % Complete % Spent
Type
Billed Remaining
invoice
100 .Trip Generation :Fixed Fee $3,000.0Q, 100.00 %
$1,800.00 $1,200.00 $3,000.Oa -
Memorandum
'' I
Total $3,000.00
1,800.00
$3,000.00 $0.00
Remit to Address: 520 Kirkland Way - Suite 100 - Kirkland, WA 98033