HomeMy WebLinkAboutInvoices - Central ServicesFORM STATE OF WASHINGTON
A 19-1A44,
INVOICE VOUCHER
(Rev. 5/91)
AGENCY USE ONLY
AGENCY NO. LOCATION CODE P.R. OR AUTH. NO.
0550
Z3
AGENCY NAME
INSTRUCTIONS TO VENDOR OR CLAIMANT Submit this form to claim
payment for materials, merchandise or services. Show complete detail for
each item.
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 State of Washington, and that all goods furnished and/or
services rendered have been provided wi dis imination because of age,
sex, marital status ce, creed, color, Tonal rgin, handicap, religion, or
Vietnam era o Is led ve status.
BY b A N
(SIGN IN INK
)Z 2Z
Administrative Office of the Courts
VENDOR OR CLAIMANT Warrant is to be payable t0
Grant County, Board of County Commissioners
35 C street NW
Ephrata WA, 98823
S= # 0002426-03
UBI 132-001-884
FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For reporting Personal Services Contract Payments
(TITLE) (DATE)
to I.R.S.
RECEIVED BY
DATE RECEIVED
DATE
12/15/20
DESCRIPTION
QUANTITY
UNIT
PRICE
AMOUNT
FOR AGENCY
USE
WebEx room kits / Cisco Equipment packages for Superior
Courtro ms
5
Total
555,528.00
PREPARED BY
TELEPHONE NUMBER DATE
AGENCY APPROVAL DATE
DOC. DATE
PMT DUE DATE
CURRENT DOC. N0.
REF DOC,
VENDOR NUMBER
VENDOR MESSAGE
UBI NUMBER
REF TRANS
DOC CODE
M MASTERINDEX
0 FUND IND N PROGRAM
INDEX
SUB
OgJ
SUB
SUB
OR G
INDEX
WORKCLASS
ALLOC
COUNTY
BUDGET
UNIT
CITYITOWN
MOS
PROJECT
SUB
PROJ
PROD
PHAS AMOUNT
NVOICENUMBER
001 7ZO
48100
ACCOUNTING APPROVAL FOR PAYMENT
DATE WARRANT TOTAL
WARRANT NUMBER
DGr, 16 2027
^;ANT COUNTY COMMISSIONERS