HomeMy WebLinkAboutReimbursable Work Request - GRIS (002)2009-11 Biennium Contract Page 1
Rev 7-1-09
Form
State of Washington
nccviiq -A .. ....(Dor Contract Number
1070
A19 -1A
Invoice Voucher
1763-94250
Health Care Au!horily_.
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, merchandise or services furnished to the
Washington, and that all furnished
State of
-Orypia,WA 98504-2691
goods and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin.
handicap, religion, or Vietnam era or disabled veterans status. I
Grant Gounty
840 E Plum St
f
Moses Lake WA 98837-1874
(sign in ink)
-------_
Tom Taylor, BOCC Chair
LdateL
.. . ..... .
TAX IDENTIFICATION NUMBER MONTH/YEAR OF SERVICE
RECEIVED BY DATE RECEIVED
91-6001319
May -19
4-:
r�li&61104 C lVi z
IBM A T Ty� NAM ip _pFS 20* M is.
_�
E P eniera
11.1 Admin
510.83 350 85
21 Community -Based Coordination-Px Community -Based Process
U n iversal-I n direct•
243.22
1,104.90
22.5 Community Coalition Coordinator Community -Based Process
Universal -Direct
0.00
22.5 Community Coalition Community -Based Process
Universal -Direct
0.00
J. -F A
0.00
22.5.1 Community Coalition Coordinator -ML Community -Based Process
Universal -Direct
4,759.43
0.00
22.5.1 Community Coalition - ML Community -Based Process
Universal -Direct
=4,759.43
22.1.1 Community Prevention Education- ML Information Dissemination
Universal -Direct
0.00
0.00
22.2.1 Positive Action- ML Education
Universal -Direct
0.00
0.00
22.2,1 Strenghening Families Program Supplies - ML Education
Universal Direct
608.79 387.42
0.00
22.2.1 Strenghening Families Program Coordinator - ML Education
Universaf-Direct
996.21
22.2.1 PAX Good Behavior Game- Coordination- ML Education
Universal -Direct
687.56
7-t 687.57
687.56
687,57
22.6.1 Environmental Policy- ML Environmental
Universal -'Direct
4.
0.00
0.00
22.7.1 Training -Summer Inst. Meals & Hotel- ML Other
Universal -Direct
0.00
22.7.1 Training -Student Support Conf. Reg. & Mileage -ML Other
Universal -Direct
312.40
0.00
312.40
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22.5.1 Community Coalition Coordinator - Quincy C
Community -Based Process
Universal -Direct
4,085.59
0.00
22.5.1 Community Coalition - Quincy Community -Based Process
Universal -Direct
2,640.24
300.00'
6,725.83
22.1.1 Youth Development- Quincy Information Dissemination
Universal -Direct
300.00
0.00
22.1.1 Public Awareness- Quincy0.00
Information Dissemination
Universal -Direct
0.00
22.2.1 Middle School LikfeSkills - Quincy Education
Universal -Direct
r.
0.00
0.00
22.2.1 Strengthening Families Program - Quincy Education
Universal -Direct
0.00
0.00
22,3.1 Healthy Alternatives -Graduating Senior Night supplies -Quincy0.00
Alternafives
Universal -Direct
22.3.1 Healthy Alternatives -Summer Movie in the Park- Bumblebee Series -Quincy Alternatives
Universal -Direct
0.00
22.6.1 Environmental Policy -Quincy Environmental
Universal -Direct
0.00
22.7.1 Training - Summer Inst Meals -Quincy Other
Universal -Direct
0.00
400.00
400.00
0.00
0.00
0.00
PREPARED BY/ DATE TELEPHONE
.
�608.7 -147.62 55 0
Reyna Gonzales 10/1012019
509764-2660
A19 Effective 7/1119 through 6/30/21 REVISED7118/19
CURR DOC NO DOC DATE
VENDOR NO.
AGENCY APPROVAL:
BH
SWV0002426-19 Sarah Marian! 360-725-3774 mariase@dshs.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
2009-11 Biennium Contract Page 1
Rev 7-1-09