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HomeMy WebLinkAboutGrant Related - GRIS2009-11 Blennium Contract Page I Rev 7-1-09 For M State of Washington A19 1070 1763-94250 -1A Invoice Voucher Health Care Authority PO Box 42691 Vendor's Certificate, I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, Washington, and that all fumished merchandise or services fumished to the State of - 01 m pia, WA 98504-2691 goods and/or services rendered have been provided vAthout discdmination because of age, sex, marital handicap, religion, or Vietnam era or disabled veterans status. status, race, creed, color, national origin, Grant County --BY L 840 E Plum St (sign in ink) Moses Lake WA 98837-1874 Tom Tavlor., BOCC Ch ir a (date) TAX IDENTIFICATION NUMBER MONTHNEAR OF SERVICE RECEIVED BY DATE RECEIVED 91-6001319 Jun -19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ......... ....... ... .................. ..... ..... ....... . ..................... ...... ............ ----- --- ...... 510.87 181.49 . ............... ...... 487.48 21 Communit�-Based Coordination-Px Community -Based Process Universal -Indirect mom 1,179.84 22.5 Community Coalition Coordinator Community -Based Process Universal -Direct ... 0.00 22.5 Community Coalit.ion Community -Based Process Universal -Direct . ... .......... ......... . . .................. .. ..... ........... . . . . . . ...... . ..... .. 0.00 . . . . . ... .. . . .......... ......... . ....... ........ . ................ ............. ... ........ mom 0.00 22.5.1 Community Coalition Coordinator -ML Community -Based Process Universal -Direct . ......... N.M. 6,436.95 0.00 22.5.1 Community Coalition Supplies - MIL Community Prevention Education- ML Communit�-Based Process U n iversa t -Direct 1,159.27 .... . ................ 6,436.95 1,159.27 22.1.1 Information Dissemination Universal -Direct 0.00 22.2.1 Positive Action Program Curriculum- ML Education Universal -Direct 1,430.00 0.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... . . . . . . . . . . . . . . . . . . . . 1,430.00 22.2.1 Strenghening Families Program - ML Education Universal -Direct .... ..... 0.00 0.00 22.2.1 PAX Good Behavior Game- Supplies- ML Education Universal -Direct 7,250.83 0.00 22.2.1 PAX Good Behavior Game -Summit Plain Tickets- ML C Edu aton Universal -Direct 2,229.44 1,691.21 7,250.83 22.6.1 Environmental Policy- ML Environmental Universal -Direct 3,920.65 0.00 22.7.1 Training -Summer Inst, Meals & Hotel- ML Other UnIversal-Direct :-X 451.70 0.00 451.70 0.00 . .......... ... .. 0.00 . . . . . . . .... 0.00 . . . . . . . . . . . . 0.00 .. ....... .. . . . . . . . . . . . . . . . 0.00 0,00 0.00 0.00 .......... . . . . . . . . . . 0.00 22.5.1 Community Coalition Coordinator -Quincy Community -Based Process Universal -Direct 1,607.57 0.00 5,115.72 22.5.1 Community Coalition - Quincy Community -Based Process Universal -Direct 6,723.29 22.1.1 Youth Development -Quincy Information Dissemination Universal -Direct 0.00 0.00 22.1.1 Public Awareness- Quincy Information Dissemination Universal -Direct 0 ..... . . .... 0.00 0.00 22.2.1 Middle School LikfeSkills - Quincy Education U n iversa I -Direct 0.00 ..... 0.00 22.2.1 Strengthening Families Program - Quincy Education Universai-Direct 0.00 0.00 22.3.1 Healthy Altematives -Graduating Senior Night supplies -Quincy Alternatives Universal -Direct 0.00 22.3.1 Healthy Attematives -Summer Movie In the Park. Bumblebee Senes -Ouincy Altemadves Universal -Direct ....................................................................... 862.12 862.12 22.6.1 Environmental Policy -Quincy Environmental Universal -Direct 115.66 115.66 22.7.1 Training - Summer Inst. Meals & Hotel -Quincy Other Universal -Direct 661.05 0.00 ..... ...... 661.05 .. . ... .... .. 0.00 0.00 .. ... ..... 0.00 INX . . . . . . ... .. . PREPARED BY/ DATE TELEPHONE ............. 1. Reyna Gonzales 08/20/2019 509 764-2660 w,: 7 7 7::: active. :6130/211:'-.'��REVJSEDI/f CURR DOC NO DOC DATE VENDOR NO. 7 . 7- a w 7 w . . . . . . . AGENCY APPROVAL: BH SVW0002426-19 -ISarah Mariani 360-725-3774 marlase@dshs.wa.gov ACCOUNTING APPROVAL FOR PAYMENT/ DATE F 2009-11 Blennium Contract Page I Rev 7-1-09