HomeMy WebLinkAboutReimbursable Work Request - Renew (002)Form State of Washington
Al 9-1 A Invoice Voucher
Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
Grant CountyJ(sign
840 E Plum St
Moses Lake, WA 98837
40"N
1070 K3919
Vendor's Cen fAvcate. I hereby rtify under pe ny of perjury a a items and totals listed herein are proper charges for materials, merchandise or services
flumi, of CAI. Y
i State rasyhi, on, and that o ds furnish da or services rendered have been provided without discrimination because of age, sex,
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Pattal status r d' cc/ national ha, dicap, r n, Vietnam era or disabled veterans status.
(,BY T
in ink)
Cindy Cart, Chair 2-1
(title) (date)
TAX IDENTIFICATION NUMBER MONTHIYEAR OF SERVICE RECEIVED BY DATE RECEIVED
1319 Jan -21
5 NAMEW' 113P D 61V�0 --gosolk's000 ffit Q-
W-✓0-�5 J
11.1 Admin
0.00 581.58 190.78 622.35
1,394.71
21 Community -Based Coordination-Px Community -Based Process Universal-indirectA
NZ,
0.00
22.5 Community Coalition Coordinator Community -Based Process Universal- Direct
0.00
22.5 Community Coalition Community -Based Process Universal -Direct
_
AN 4
0.00
"ZiA Md;t 'PA %
22.5.1 Community Coalition Coordinator- ML Community -Based Process Universal- Direct
7,456.13
7,456.13
22.5.1 Community Coalition - ML Community -Based Process Universal- Direct
.:Alfjwffi
0.00
22.1.2 PAX -Good Behavior Game - ML Information Dissemination Universal- Indirect
823.37
823.37
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
22.1.2 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
4%r0.00
22.1.2 You Can - ML Information Dissemination Universal -Indirect
atom
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- DirectAIM%
0.00
22.7.1 Coordinator Professional Development - ML Other Universal -Direct
0.00
0.00
22.5,1 Community Coalition Coordinator - Q Community -Based Process Universal -Direct
2,334.79 7,779.33
10,114.121
22.5.1 Community Coalition - Q Community -Based Process Universal- Direct
50.00
50.00
22.2.1 Strengthening Families Program - Q Education Universal-Direot
0.00
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
is
0.00
22.1.2 Under The Influence Of You- Q Information Dissemination Universal- Indirect0.00
22.1.2 Rx Safe Disposal - 0 -Posters& Flyers for RX Take Back Event Information Dissemination Universal- Indirect
N
0.00
22.1.2 Starts With One- Q Information Dissemination Universal- Indirect
0.00
22.6.2 Drug Free Parks - Q Environmental Universald ndirect
0.00
22.6.2 QHS Disciplinary- Q Environmental Universal- Indirect
MEW
0.00
22 7.1 Coalition/Community Training - Q- WA Prev Summit 2020 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- Indirect0.00
0.00
0.00
0.00
0.00
A5
0.00
0.00
41W
0.00
0.00
0.00
A M Z [A
PREPARED BY/ DATE TELEPHONE
Reyna Gonzales 312/2021 509 764-2660
A19 Effective 7/11/19 through 6/30121 REVISED 1012020
CURR DOC NO DOC DATE
VENDOR NO. AGENCY APPROVAL:
SWV0002426-00 Sarah Mariani, 360-725-9401, Sarah. Marian i@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
V
R? E C E " E
MAR - 4 2021
Page 1 Rev7-1-09
"'RANT COUNT Y C OfoMl