HomeMy WebLinkAboutGrant Related - BOCC (002)Washington .ea.+ia - - Agreement 10 or Contract Number
form -' State of Washin
070 1763-94250
A1g.1A Invoice Voucher
ACENCY.14"fE
Health Care Authority
PO Box 42691
Olympia WA 98504
- . S'l\ DOH OR CtAMWN'T. .
Grant County
840 E Plum Street
Moses Lake, WA 98837
Vendor's Cenficate. I hereby certify under penalty of perjury that me items and totals listed herein are proper charges for materials, merchandise or services furnished
to me State of Washington, and that all goods furbished and/or services rendered have been provided without discninmaton because of age, sex, martial status, race,
reed, color, national origin, handicap, religion, or Vietnam era or disabled veterans status.
(sign nt ink/
Tom Taylor, BO& Chair X120 jq
(title) (date)
TAX IDENTIFICATION NUMBER
MONTH OF SERVICE
Jan -19
RECEIVED BY DATE RECEIVED
BARS. PROGRAM AOTmTY NAME -
CSAP aTRATEGr
IOM'
SHBG GFS PFS 2013 PFS 2018 DMA STIR
EBP PP -e-
ener111
SOR
�Tohl
ll 1Admm
510.83 225.19 907.12
152.23
1, 795.37
21 Community -Based Coordination-Px
Community -Based Process
Universal -Indirect
22.5 Community Coalition Coordinator
Community -Based Process
Universal -Direct
22.5 Community Coalition
Commumty-Based Process
Universal -Direct
225 1 Community Coalition Coordinator - ML
Community -Based Process
Universal -Direct
7,04283
7,042.83
22.5 1 Community Coalition - ML
Community -Based Process
Universal -Direct
11875
11875
227 1 CADCA Boot Camp- Meals. Hote1-ML
Other
Universal -Direct
767.40
767.40
227 1 Resiliency Conference- Speaker- ML
Other
Universal -Direct
531.05
537.05
22.7,1 PAX GBG Facilitator Training -ML
Other
Universal -Direct
11,339.00
11.33900
2251 Community Coalition Coordinator - Quincy
Community -Based Process
Universal -Direct
1 1,94003 1
1452.23
3,39226
22.51 Community Coalition - Quincy
Community -Based Process
Universal -Direct
107.50
107.50
22,71 CADCA Boot Camp- Meals, Hotel -Quincy
Other
Universal -Direct
- 767.40
767.40
227 1 New Coordinator Training - Meals and Hotel- Quincy
Other
Universal -Direct
45068
450.68
8,46003 51083 3,040.12 11,339.00 90712
' 2.05514
--.26,312241
PREPARED BV/DATE
Reyna Gonzales May 14, 2019
TELEPHONE
(509) 764-2660
A19 Effective 7/1/17 through 6/30/19 REVISED 12/31/18
CURR DOC NO
VCA
DOC DATE
VENDOR NO,
SWV0002426-19
AGENCY APPROVAL:
Sarah Mariani 360-725-3774 sarah.mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
19 Biennium Contract Page 1 Rei Yt i19