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HomeMy WebLinkAboutInvoices - Renew (002)Forma . ""r� State of Washington A19 -1A �_i S4`' Invoice Voucher AGENCY'NAME Health Care Authority 621 8th Avenue SE Olympia, WA 98504 Agency No i4greemenf tDorConttact Number 1070 K5536 Vendor's Certificate. /hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goo s is ed and/or services rendered have been provided without discrimination because of age, sex, maxi 1 status, race, creed, color, nation itigin, ha n ap, religion, or Vietnam era or disabled veterans status. BY Community -Based Coordination-Px Community -Based Process Community Coalition Coordinator Community -Based Process Community Coalition Commun ity-Based Process ®Information Dissemination • , �� Information Dissemination Information Dissemination information Dissemination ®AlternativesAlternatives --_---- Alternatives ® --_---� Problem Identification & Referral Problem Identification & Referral Problem Identification &-Referral Problem Identification & Referral Comrnu-nit-y-Do—ali-tion- Start-up Costs Community -Based Process Community Coalition- Supplies/snacks for data team meeting Community -Based Process Community -Based Process Community -Based Process Environmental Environmental Environmental Environmental MEN gll� •FIR