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MA's 2 6 ? � �
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Page 1 Rev 7-1-09
Date:
Form State of Washington
Agency No. Agreement ID or Contract Number
1070 K3919
A19 -1A Invoice Voucher
AGENCYNA113i
Health Care Authority
621 8th Avenue SE
Vendor's Ceific-=--Ihereby certify under penalty of perjury teat the items and totals listed herein are proper charges for materials, merchandise or services
furnished ts(th State ofWashin that
n�,, and d furnis and/or services rendered have been
Olympia, WA 98504
J�,o 'f�goods k' provided without discrimination because of age, sex,
marital s ane. creedb ational ong T, le ndicap, rel) lo
'o io Vietnam era or disabled veterans status.
t f
V
\,or
BY
Grant County
840 E Plum St
Lill in ink)
Cindy CarYer, BOCC Chair
Moses Lake, WA 98837
(p - (- 2-1
(date)
TAX IDENTIFICATION NUMBER MONTH/YEAR
1
OF SERVICE
RECEIVED BY DATE RECEIVED
**-***1319
Mar -21
BARS PROGRAM ACTMTY KAME CSAP STRATEGY
1011
. - I
SABO GF3 PFS 2019 S DMA SOR NCE $0111 PFSOR &8PP !OR 0 UHPP
Carryower EBP PP Gen" I
TOW
11.1 Admin
242.49 581-58 40.00 0.00 692.08
556. 15
21 Community -Based Coordination-Px Community -Based Process
UrAwsal-Indirect
0.00
22.5 Community Coalition Coordinator Community -Based Process
Universal -Direct
0.00
22.5 Community Cwhfion Community -Basted Process
Urdvarsal-Direct
0.00
22.5.1 Community Coalition Coordinator- ML Community -Based Process
Universa)-Dkwt
7,340.98,
7,340.98
22.5.1 Community Coalition - ML Community -Based Process
Universal-Dkwt
0.00
22.1.2 PAX -Good Behavior Game- ML- Program Startup 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
0.00
22.1.2 Outreach & Education- ML Information Dissemination
Universal -Indirect
0.00
221.2 Talk. They Hear You- ML Information Dissemination
Universal -Indirect
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
0.00
22.6.2 Trauma -Informed Schools - ML Environmental
Universal -Indirect
0.00
22.7.1 Coalition/Community Training - ML- Other
Universal -Direct
0.00
0.00
22.7.1 Coordinator Professional Development - ML Other
Universal -Direct
0.00
22.2.1 Strengthening Families Program - ML Education
Universal -Direct
0.00
22.5.1 Community Coalition Coordinator - Q Community -Based Process
Universal -Direct
76.92 494.24 8,371.02
8,942.18
22.5.1 Community Coalition - Q Community -Based Process
Universal -Direct
0.00
22.2.1 Strengthening Families Program - Q- Start-up Program Education
Universal -Direct
2,954.17
2,954.17
22.2.1 SPORT PPW- Q- Education
Universal -Direct
0.00
22.3.1 Healthy Alternatives - Q Alternatives
.Universal -Direct
0.00
22.1.1 Youth Development- Q- Information Dissemination
Universal -Direct
0.00
22.1.2 You Can - Q Information Dissemination
Universal ' -Indirect
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
5.82 280.00
285.82
22.6.2 Drug Free Parks - Q Environmental
Universal -Indirect
0.00
22.6.2 QHS Disciplinary - Q Environmental
Universal -Indirect
0.00
22.7.1 Coalition/Community Training - Q- Other
Universal -Direct
0.00
22.7.1 Coordinator Professional Development - Q Other
Universal -Direct
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
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,014.58 581.58 540.06 0.00 0.00 - - 0.00 0.001 0.00 0.00 0.00 9,343.10 0.00
21,079.30
PREPARED BYJ DATE
Reyna Gonzales 512412021
TELEPHONE
509 7642660
A19 Effective 711119 through 6130121 REVISED 10/2020
CURR DOC NO
DOC DATE
VENDOR NO. - -
AGENCY APPROVAL:
SWV0002426-00
I Sarah Mariani, 360-725-9401, Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
MA's 2 6 ? � �
C 119 A IN T (3
0 U!"J TY
;of
Page 1 Rev 7-1-09