HomeMy WebLinkAbout*Other - GRISForm State of Washington®r
Al 9-1 A Invoice Voucher
Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
Grant County
840 E Plum St
Moses Lake, WA 98837
1070 K3919
Vendor's C 'mta-_�areby certify under penal perjury tPat the items and totals listed herein are proper charges for materials, merchandise or services
u s'.hed t,;p
ft 'Imis fhe Stat �of W%�shington, and that all oo fftw d and/or services rendered have been provided without discrimination because of age, sex,
marital sta race, Jeed, c b r, na nal origin, an 'c p, re , J . . n, or Vietnam era or disabled veterans status.
BY
-"indy Carter, Chair iign in ink)
C
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(title) (date)
TAX IDENTIFICATION NUMBER MONTH/YEAR OF SERVICE
**-***1319 6/1/2021- Supplemental #1
RECEIVED BYE RECEIVED
:r
APOW 4010 V-0:11NO10- _N
1 18 AAR
St I
MID= -
o' �-MKAOR�NCE;23;�& RM 'q
C$5A Cam
W--?
11.1 Admin
(6.06)
(6.06)
21 Community -Based Coordination-Px Community -Based Process
Universal -Indirect
MOO -lklif a -
0.00
22.5 Community Coalition Coordinator Community -Based Process
Universal- Direct
0.00
22.5 Community Coalition Community -Based Process
Universal -Direct
10
0.00
4-elff 7- -7-
22.5.1 Community Coalition Coordinator- ML Community -Based Process
Universal -Direct
0.00
22.5.1 Community Coalition - MIL Community -Based Process
Universal -Direct
0.00
22.1.2 PAX -Good Behavior Game - ML- Information Dissemination
Universal- Indirect
0.00
22.2.1 Positive Action - ML Education
Universal -Direct
0.00
22.2.1 Youth Empowerment - ML Education
Universal- Direct
SU
0.00
22.1.2 Outreach & Education- ML Information Dissemination
Universal -Indirect
@
0.00'
22.1.2 Talk. They Hear You- ML Information Dissemination
Universal- Indirect
_014
0.00
22.1.2 Under The Influence Of You- ML Information Dissemination
Universal -Indirect
0.00
22.1.2 Character Strong - ML Information Dissemination
Universal -Indirect
0.00-
22.1.2 You Can - ML Information Dissemination
Universal- Indirect
0.00
22.6.2 Restorative Justice -ML Environmental
Universal- Indirect
Miami
0.00
22.6.2 Trauma -Informed Schools - ML Environmental
Universal- Indirect
'0_
0.00
22.7.1 Coalition/Community Training - ML- Other
Universal- Direct
0.00
22.7.1 Coordinator Professional Development - ML Other
Universal -Direct
0.00
22.2.1 Strengthening Families Program Education
Universal- Direct
0.00
22.5.1 Community Coalition Coordinator - Q Community -Based Process
Universal- Direct
No-
0.00
22.5.1 Community Coalition - Q Community -Based Process
Universal- Direct
0.00
22.2.1 Strengthening Families Program - Q Education
Universal -Direct
0.00
22.2.1 SPORT PPW- Q- Program Start-up Costs Education
Universal- Direct
0.00
22.3.1 Healthy Alternatives - Q- Program Start-up Cost Alternatives
Universal- Direct
(75.72)
(75.72)
22.1.1 Youth Development- Q- Information Dissemination
Universal- Direct
_230
0.00,
22.1.2 You Can - Q Information Dissemination
Universal- Indirect
%%y=0.00
22.1.2 Under The Influence Of You- Q Information Dissemination
Universal- Indirect
0.00
22.1.2 Rx Safe Disposal - Q - Information Dissemination
Universal- Indirect
0.00
22.1.2 Starts With One- Q Information Dissemination
Universal- Indirect
_41-
0.00
22.6.2 Drug Free Parks - Q Environmental
Universal- Indirect
N1
0.00'
22.6.2 QHS Disciplinary - Q. Environmental
Universal- Indirect
0.00
22.7.1 Coalition/Comm unity Training - Q- Other
Universal- Direct
0.00
22.7.1 Coordinator Professional Development - Q Other
Universal- Direct
AN,
0.00
22.6.2 Px Sustainability Policy - Q Environmental
Universal- Indirect
0.00
22.7.2 Community Education Workshops - Q- Other
Universal -Indirect
-
0.00
22.7.2 Community Education Workshops - Q- Supplies Other
Universal -Indirect:;
0.00
M
X
0,00'
R�
0.00
R
0.00
0.00
0.00
ANN
0.00
0.00
0.00
_4 [0 Q' W; 0: M
PREPARED BY/ DATE TELEPHONE
Reyna Gonzales 810412021 509 764-2660
A19 Effective 7/1/19 through 6/30/21 REVISED 10/2020
CURR DOC NO DOC DATE
VENDOR NO. AGENCY APPROVAL:
SWV0002426-00 Sarah Mariani, 360-725-9401, Sarah. Marian iahcama.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
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Page 1 Rev 7-1-09