HomeMy WebLinkAboutGrant Related - BOCC (002)GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
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To: Board of County Commissioners
this day of
Bourd of Cottnty Comm
issioners
Grant Coun, ty. washington
Amr.oxe Mmmroas A
Dist # I Dist # I Dist # I
Dist #2' Dist #-) Dist #2 ------------
Dist #3 .... . Dist #3
Dist #3
From: Janice Flynn, Administrative Services Coordinator
Data August 31, 2021
Re: Authorization for Release of BOCC Approved Funds #2, SIP #2021 -01 -
GC Hospital #4 — McKay Healthcare, Phase I Capital Improvement
Plan
McKay Healthcare has certified the requirements for release of funds in the above -
referenced SIP project, which was approved by the BOCC pursuant to Resolution
No. 21 -013 -CC dated February 16, 2021. The proof of requirements is in the form
of a signed Project Certification form from the Hospital and supporting invoicing of
the project that meets the requested amount.
To that end, I am requesting the release of funds on this SIP project as follows:
(1) 2nd installment of the grant award in the amount of Six Thousand
Three Hundred Fifty Nine and 72/100 Dollars ($6,359.72) to McKay
Healthcare.
Note: The full grant amount is $350,000. This leaves a balance of $336,240.28.
Thank you.
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAVY1.
PROJECT CERTIFICATION
This form must be signed and returned, with an invoice, for the approved fundm,g,
before reimbursement can be approved by Grant county.
SIP Project Proposal Number:
SIP Funding Recipient
-SIP Prof ect.Description
SIP202t-01
McK'ay Hospital & Rehab
Phase I Capital Improvement Plan
tie and ersligned, do hereby certify under penal of - . � that the ater 4
ty perjun , - m ials have
been fumished, the services rendered, and/or the labor Performed as desert 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 of $6.,359.72 is Just and
due and is an unpaid oblig tion a.gai inst Grant County.
Further, according to the SIPPr Ject Funding Policies, I attest that at the next audit of my
01
entity, this project shall be called to the attention of the Washington State Auditol*'s
Office and an emphasis audit will be requested to assure that the funds -were expended
toward the pro" of Y ordm*g to the intent of the proposal.
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Signature Title
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Printed Name
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0
Date Signed
Printed Title
Completed, signed original certification and invoice are tobe mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement #2 in the amount of $6,359.72
ATTACHMENT 4
MCKAY HEALTHCARE
501 PC[ 08/20/2021 91095
Invoice Number Invoice Date Description Gross Amount Discount Taken Net Amount Paid
6359.72 07/2812021 Admin - PS - SIP Grant $6;359.72 $0.00 $61359472
$6t359,72 $0,06T $6,359.72
AUTHORIZED SIGNATURE
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Fennell Cbnsulting Ing.
Electrical and Electronics
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SystemDesign
400 South Jefferson, Suite 301
Spokane, WA99204
Invoice
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Pennell Cansultina Inc.
Electdcal and ElectronIcs
System Design
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Revised Description of Work
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