HomeMy WebLinkAboutReimbursable Work Request - GRISl it
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State=V.-h.,
AMency No. Aereament ID or Contract N-,
1070 K3919
A19 -1A \t ,%
Invo
nc>Eucr
Health Care
Naw:
Authority
621 8th
Avenue SE
Vendors Cerff6cate. l hereby certify undarponal(y ofpsrjury that the items and totals listed herein are proper charges for materials, merchandtse er services
Olympia, WA 98504
furnished to the State of Washington, and that all goods furnished anNo-services rendered neve bean Provided Wthout disokninedon because of age, sex,
merltal status, race, meed, color, national origin, handicap, relg/on, or 'fair- era or disabled veterals at
YcrpoaoN<Twawvr
- -
BY
Grant
County
(sign In Ink)
840 E Plum St
Mosea Lake,
WA 98837
iqkA!i 10 -22 J")
title) (fie)
TAX IDENTIFICATION NUMBER
MONTHIYEAR
OF SERVICE
RECEIVED BY DATE RECEIVED
"'1319
Jul -20
BMS PROGRAM ACTIVITY NAME
cSAPETRATEGY
roM
SMG GFS PFS 1010 PFS DMA
EORMCE Son EOR Supp SOR 11 MHDP
Carryover EBP PP Genial
Total
11.1 A-,
0-00 581.58 575.C4 000 1C. 60
1,263.22
21 n:'y-Based Coordinanm-Px
Community -Baud Prccass
Univocal -Indirect
22 5 C -1-!y Coalition Co«dinalw
Communlly-Baud Process
unvoul-Direct
o co
22.5 C[xrmurnty Coalition
Community-Basetl Process
Universal -Direct
oo
0 00
22.5.1 Community Coalition Coordina«- ML
Communit aced Process
Univ sal-Drect
6,443.00
om
22.6.1 CmunitY Coalition - ML
Communi Basetl Proceu
UniversaFWecl
6 443 C0
22.1.2 PAX -Good Behevier Game -ML
Information Dssemirlatlon
Universal-Intlirect
0900
22.2.1 PtNative Action - ML
Education
Un -sal -Direct
0.00
22.2.1 Youth EmpoAerment - ML
Education
Universal -Direct
O.W
22.1.2 Outreach 8 Education -ML
Information Dissemination
Universal-Intlirect
0.00
22.1.2 Tek. They Her You -ML
Information Dissemination
Universal -Indirect
o.W
22.1.2 Urltlr The Influence Of You -ML
Information Dissaninatian
Universal -Indirect
0.00
22.1.2 Character Soong - ML
Information Diination
Universa'-Intlirect
0.000.00
22,1,2 You Ca, - ML
Information Dissemination
Universal -Indirect
22.6.2 Restorative Jusboe-ML
Environmenhl
Universal-IMirect
000
22.6.2 Trauma -Informed Schools - ML
Environmontal
Universal-IrMirect
0.00
22.7.1 Conlition/Communay Trltlning - ML
Omer
Universal -Direct
D.00
22.7.1 Coordinate Professional Development - ML
Other
Universal -Direct
0.00
0.00
0.00
22.5.1 Community Cceiruon Coordirlrar - Q
Community -Based Process
Universal -Direct
7,187.95 1.33250
8,520.45
22,5,1 Community CoalNon - Q
Carnmund Based Process
Uni-.*Drect
000
22.2.1 Stergthenirg Families Program - Q
Educaco,
Universal -D-1
0.00
22.2.1 SPORT PPW-Q
Education
Universal -Dred
0.00
22.3.1 Healthy Altemsoves- Q
Alternatives
Universal -Drat
o.W
22.1.1 Y-thDeveloponnt-Q
Information Dissemination
UniversaFDirect
o.o0
22.1 .2 Yor, Ca, - Q
Infomslion Dissemination
Universal -Indirect
0.00
22.1.2 Und.Tholnfluence Of You -Q
Information Disse recon
Universal -Indirect
0.00
22.1.2 Its Safe Disposal - Q
InformeUon Dssaminaton
Universal -Indirect
0.00
22.1.2 Starts With On> Q
Information Dissemination
Universal -Indust
o.00
Drug F140 Parks - Q
22.6.2 Dr
Environmental
Universal -Indirect
0.o0
2242 QHS Disciplinary - Q
Environmental
Universal -Indirect
0.00
22.7.1 Qoaleiar✓Communiry Tralnirg - Q
Other
Universal -Direct
0.00
22.7.1 Coordinator Prdessional Development - Q
pear
Universal-Dirxt
O.00
22.6.2 Plc Sustainability Polloy-Q
Environmental
Universal-11ntlireot
o.0o
2272 Community Education Workshops - Q
other
Uri-sakIndi-t
0.00
0900
0900
0.00
0.00
0.00
0.00
0.00
000
0 00
6,44300 581.58 7,762.99 0.00 0.00 0.00 0.00 0.00 1.439.10 0.00 0.00 0.00
16 226 67
PREPARED BY/ DATE
TELEPHONE
Reyru Goreaks 10/2812020
H. 784-2660
A19 Effective 7/1119 through 6/30121 REVISED 1012020
CURR DOC NO
DOC DATE
VENDOR NO. AGENCY APPROVAL:
SWV0002426-00 Sarah Mariani, 360-725-9401, Sarah.Mariani hca.Wa. ov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
RECEIVED
NOV - 5 2020
GRANT COUNTY COMMISSIONERS
P4,