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HomeMy WebLinkAboutReimbursable Work Request - Renew (002)Form SUR=V.�hw A19-1A Inw . .. A�if.YNAIi Health Care Authority 821 8th Awnue BE Olympia, WA 98504 v0.ma.oAaA{uxr Gram Countya "0EPlum St Mose. Lake, WA 98837 Aterey N. AgreseewitDaCarweMNaber: - 1070 K3919 Vendo-'s cern6cit/ hereby cern under Pena o dry rha r items and Was listed herein are proper charges for mag as, mercha dise a services Renish the St Wmhingr and thet a/ tarnished �rendaedhavebeenp. idedmthoutdumi natiwbwc oofege,sex, sfaus, lac a algin, igion, a or disabled vetwwa sraus. I In Ink) t -.!Tidy Carter, B&C Chair (title) (dwi TAX IDENTIFICATION NUMBER MONTH/YEAR OF SERVICE = "1319 Nov-20 RECEIVED BY DATE RECEIVED Y(/q .:..JapaLINAC11111Y1N1.[ '`'47�.jwaranMTe.r ., '.1011 u{{ 'tw M-, {OR{ �.1y/Pe •. noteep,{e"fy -Yaiwrl 4' ;TaH ,::. 11.1 A6Wn ero'._W .. 0.00 581.58 58885 "'; l.,F, 24.00 184.60 1,358.83 21 Community-Based Coordna8a>-Px Car-,*y kised Process Univ lrMrect _ -, :y.^. ' ..'e... - .:' -., 0.00 22.5 C---* C- ion Coordinator Canmunity8ased Process Universa-Direct h' �.'..' : •• 0.00 22.5 Gahm Coa2on Corn-My-Besed Process Universal-Drect 7 '?'SS 0.00 225.1 Carrnunay Coalition Coordinator- MIL Cammu Process Universal-Direct 5,81106 5,814.08 225.1 Conmuney Coallti0n- ML Cammun' Process Uni srsel-Drecl 0.00 22.1.2 PAX-Good Behavior Gane - ML Information Disse niruNm Universal-Indirect 0.00 22.2.1 Positive Action -ML Educalon Universal-Direct 0.00 22.2.1 Y-M EmPcwsrmau-ML Education Universal-Dred - 0.00 22.1.2 Outreach S Education ML Inlamston Disseminatlan Universal Indirect 0.00 22.1.2 Talk. They Hea Vw- ML Infamullon Dissemination Universal-Indirect 0.00 22.1.2 Under The Influawe Of Vau- ML Infammian Dissemination Universa-In react 0.00 22.1.2 Character Strong -ML Information Dissemination U.-kindirecl 0.00 22.1.2 Vw Cori-ML Inlomutidr Dissemination Uaversakindrect 0.00 22.8.2 Restorative Justice-ML Envto -W Unvrsal-Indirect 0.00 22.6.2 Traeno•Informed Schools -ML Env rni UMversoHndiroet 0.00 22.7.1 m'^O^^"v Wier Ur -SWI-Doect 300.00 300.00 22.7.1 CoadinWa Professorial Devdagnent -ML Other UaversaFWecl 0.00 0.00 22.5.1 Community Cosilbon Cocrdinsta -O C-trBased Process Universa-Watt 7.108.12 982.47 8.090.59 22SA c-i, Comm-ft Process UniversW-Urea 0.00 22.2.1 StragU,enirg Families Program- Q Education Uni-sai-Direct 0.00 22.2.1 SPORT PPW-Q- Education Univers oi-t 750.00 750.00 22.3.1 Healthy ABematives • O Altema0ves Universa40irxt 0.00 22.1.1 Vo dti Develapmenl- Q- Inimru0on Dissemination Universal-Direct 0.00 22.1.2 Vw Can - Q Information Disse .A- Universal-Indirect 0.00 22.1.2 Under The Inata¢e Of Vw- O Information Disseminsew Univ kicrect 0.00 22.1.2 InlamelbnpssemeraUan Unive lydksct 0.00 22.1.2 Stats With Ons Q Intonation Dissemination Un-seWridrect 0.00 22.8.2 Drug Free Parks -O Environi Universal-indrect 0.00 22.8.2 OHS DeolPfimay -Q EnviraxrenW UniversaHridrect 0.00 22.7.1 Cwamrxanmonsv Tie -0- WA-s- moo OMr Universa-Direct 575.00 575.00 22.7.1 Coordinator Professional Development - Q Olhr Universal-Direct 0.00 22.8.2 Px Sustanebihy Poicy-O Enviori Univ--Wndrect 0.00 22.7.2 Communsy Education Workshops - O Other Unive lndi sct 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 .. 8,814.08 SWIM 7.870.77 1 ow 1 300.001 0.00 -'.24.00 X0.00 ..2A9207 - 0.00 0.00 0.601 1008.48 PREPARED BYI DATE TELEPHONE aayn. Go-W. 11&2020 500 76e-xeeo A19 EfketM 711119 through 8130121 REVISED 1012020 CURR DOC NO DOC DATE VENDOR NO. SWV0002426-00 AGENCY APPROVAL: Sarah Mariana 360-725.9401 Sarah.61ariani hca.wa. ov ACCOUwnNG APPROVAL FOR PAYMENT/ DATE neper