HomeMy WebLinkAboutInvoices - FairgroundsGRANT COUNTY
Y
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: Fairgrounds
REQUEST SUBMITTED BY: Jim McKiernan
CONTACT PERSON ATTENDING ROUNDTABLE: Jim McKiernan
CONFIDENTIAL INFORMATION: EYES *NO
DATE: 11 /5/26
PHONE:509-237-2672
71w Agreement / Contract
DAP Vouchers
❑Appointment / Reappointment
______
DARPA Related
El Bids / RFPs / Quotes Award
❑Bid Opening Scheduled
El Boards 1 Committees
❑ Budget
L]Computer Related
ElCounty Code
❑Emergency Purchase
❑Employee Rel.
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❑ Financial
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❑WSLCB
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
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DATE OF ACTION: Ii(0 Z�
APPROVE: DENIED ABSTAIN
D2:
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D3:
DEFERRED OR CONTINUED TO:
WITHDRAWN:
4/23/24
FORM STATE OF WASHINGTON
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A19 -IA •= INVOICE VOUCHER
(Rev. 5/91) '
AGENCY USE ONLY
AGENCY NO. LOCATION CODE P.R. OR RUTH. NO.
AGENCY NAME
INSTRUCTIONS TO VENDOR OR CLAIMANTS Submit this form to claim
payment for materials, merchandise or services. Show complete detail for
Washington State Department of Agriculture
Fairs Program
each item.
PO Box 42560
Olympia, WA 98504-2560
Vendor's Certificate: I hereby certify under penalty of perjury that the items and
totals listed herein are proper charges for materials, merchandise or services
VENDOR OR CLAIMANT (Warrant is to be payable to)
furnished to the State of Washington, and that all goods furnished and/or
Grant County (Grant County Fair)
Attn: Central Services
services rendered have been provided without discrimination because of age,
sex, marital status, race, creed, color, national origin, handicap, religion, or
Vietnam era or disabled veterans status.
35 C St NW
Ephrata, WA 98823
gY
(SIGN )
(TITLE) DAT )
t2..
FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For reporting Personal Services Contract Payments to I.R.S.
RECEIVED BY
DATE RECEIVED
:DATE
_],,,,UNIT
DESCRIPTION
QUANTITY
PRICE
AMOUNT
FOR AGENCY
USE
INTERAGENCY
AGREEMENT NO. K6392
$
Capital
Improvement Grant -- Safety lighting; illuminating
1
225,000
The
Eastern side of the Rodeo grounds, pathways, ADA
Areas, Livestock areas. Promoting better access to Fair
Activities.
Total Due
$225,000
PREPARED BY 11ELEPHONE
Jim McKiernan
NUMBER
5O9-237-2672
DAT IAGENCY
nIGJ,,
APPROVAL
DATE
DOC. DATE
PMT DUE DATE
CURRENT DOC. NO.
J2426-59
REF DOC, VEND
R NUMBER
VENDOR MESSAGE
UBI NUMBER
REF
DOC
TRANS
CODE
M
0 . FUND
MASTER INDEX
SUB
OBJ
SUB
SUB
CRC
INDEX
WORKCLASS
ALLOC
COUNTY
BUDGET
IT
CITYITOWN
MOS
PROJECT
SUB
PROD
PROD
PHAS
AMOUNT
INVOICE NUMBER
APPN
INDEX
PROGRAM
I DE
057
E00
64470
NZ.
ACCOUNTING APPROVAL FOR PAYMENT
DATE
WARRANT TOTAL
WARRANT NUMBER