HomeMy WebLinkAboutGrant Related - BOCC (004)GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
FNSTALLMENT 2 OF 5
PROJECT CERTIFICATION F'-fi., M
For the second release of $26,601,:1',
(from a $133,000.00 x
This form must be signed and returned, with an invoice, for the approved funding,
before reimbursement can be approved by Grant County,
SIP Project Proposal Number: 2019-10
SIP Funding Recipient: Port of Royal Slope
SIP Project Description: Waterline Extension East to Eldorado Stone
I, the undersigned, do hereby certify under penalty of perjury, that the materials have been
furnished, the. services rendered, and/or the labor performed as described 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 is just and due, and is. an unpaid obligation
against Grant County.
Further, according to the SIP Project Funding Policies, I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's Office
and an emphasis audit will be requested to assure that these funds were expended toward
the project and according to the intent of the proposal.
\\rigr
iganature
�l h 0
rented Name
,�e4
Date Signed
;5.
Title
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
II.LPS7:'i£RAl�i1�4'�1fCt6'YS�S.fUt9J!iG1F5A1V•.rt1 .1R./ef•J1L�X791•MP.+AHF:1'HSY SYCt'E'St�LS�SJI��.:�c Y8V'��
RECEIVED
y
�1
JAN
� 2021
7
y_ y Ai.T tell epi t''� ;cs t I ��� ,Ny yj5t S. y�`+,�.y ry
.i ,• ? ��G�t1�...e LL.a�'.:. °_�'zL• �i?,,,tQ„.�1 10, NN
_::�<.�:-+tt>_:..-isusa:.Sc::.�>-::-ro •w•,:�:,ve.a ^= n2tett!1 � a: -•••::::e• u<..ar�x'..;••:_r.^.u�w•�:5*�•�:Z�er�U.'wtr_:ar:cs.4
aux t,.
,3
P0 r of
no.
. L SLOPE
Grant County
Stratigic Infrastructure Program
Administrative Services Coordinator
PO Box 37
Ephrata, WA 98823
Due Date
1/31/2023
PORT OF ROYAL SLOPE
P.O. Box 147
4572 Road 13.6 SW
Royal City, WA 99357
SIP Project Number: 2019-10
SIP Recipient: Port of Royal Slope
SIP Project Description: Water Line Extension East to Eldorado Stone
Grant 2019-10 Total Amount Remaining $ 106,400.00
Second of Five Installments in the amount of:
Remaining Amount 2019-10
$ 26,600.00
$ 79,800.00
Phone: 509-346-2317 bvalentine@portofroyal.com Website: www.portofroyal.com