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Grant Related - BOCC (011)
GRANT COUNTY BOARD OF COUNTY COMMISSIONERS 1l�JJ_.J T To: Board of County Commissioners Janice Flynn, Administrative Services Coordinator Data June 23, 2023 Re: Authorization for Release of Funds, Dept of Commerce, CDBG CV2 #20- 6221C-111., Reimbursement #33,, Renew Request #8 Renew has requested reimbursement regarding the above -referenced grant in the amount of $39,930.87 for May 2023 expenses. Their documentation is attached for review. I am requesting the release of funds for payment to Renew in the amount of $39,930.87. The attached A19 reflects both CV1 (01C) & CV2 (Renew) expenses for May 2023 as a combined A19 is required by Commerce. Thank you. JuN 2 / 2023 CONSENT 000 -2 7� CV -2 ARNP & DCR Gmnt Behavioral Ho6olth tj wellness 717 5/31/2023 iccto 'A TOTAL EXPENSES 108.150.00-0000.564.00.1100 I ko... $ 19,877-61 108-150-00-0000.564.00.2100 $ 21065627 108,150.00.0000-564.00.2200 $ 11519.26 108.150.00.0000-564-00.2300 11691.87 108-150.00.0000-564.00.2301 108,150-00-0000.564.00-2400 $ 157-08 108.150-00-.0000.564.00.2599 $ --------- - -- ------ -- ------ 108,150.00-0000-564.00,4151 108-150-00,0000-564,00.4152 al'S"qar� 108-150.00.0000.564.00.4202 4v6NJ 108.150.00-0000.564.00.4100 j�Ky*r tk4cok-' 108-1.50.00.0000.564.00.4902 Ago 6/16/2023 15:411 25,773.87 x -2 7� ` 5`4 717 419,46 6/16/2023 15:411 25,773.87 x ren Lu Otani; SeshavIOMI HoWth 6 Wo11nesa 513112023 CV1, ARNP.. DCR'' .,y ._. ..-,'..... ..... .,_ ... ARNExp. i M E +p! •Y1F T�"�`�t �F 9t P. /■ SALAR'- 11,315-20 ��jj �{[ �+]� r++� (q� �i t '• wi «ir j i.5 a 0 o4' 1 l 19 877.61 Retirement $ 11175.64 � 889.63 $ 2,065-27 55[ ' $64.23 655.03 $ 1519.26 Medical 1,049.24 642..63 F LA.c.7 .I 66 $ 43.32 21.88 135.20 157.08 Employment i 108.150-00-0000.564.00.4151 Jces-,;jd 08-150.00.0000.564-00.4152 IT Services� O' eti n ,, 150.00.0000.564.00.4202 .49 52.27 108.150.00-0000.564.00.4100 ri fncord 108.150.00.0000.564.00.490 V i 117 "): d 6/16/2023.15.41 $ 149.96 299.92 23 -May 5.27 194.54 23 -May $ 15.00 23 -Jun ----------- r-MP # NAME Pay source BEHAVIORAL HEALT JOURNAL ENTRIES Printed dame: Rici rdo Garner 6110x. '`AII GP ENTERED LEAVE 1-7 � Y ANNLV -SICK HOLDA'Y OTHERIBBEREAV DIVE. 0.00 10.0 Exn T 0.00 0.00 Printed Name: *tk�tdardo amez Leave Ups #{ (AIL. Pay Parte: May 14, 2023 Employee ID 5707 Staff Signature: Supervisor S gnature.- fi Supervisor Initials fair Non -Standard Workweek Pay Period: 5/14/2023 (mmlddly) Pay Date.. g ,x 61212023 DV -2 DDR CLINICAL May 14 May 9s May 16 may 11 May 18 May May 20 May 2�1 May 22 May 23 Ma. 2� Ma 25 Sun Y y May 26 t May 27 Mon Tue Wed` Thu Fri Sat Sun tttlort Tde i Wed Thi Fri Sat �l ar .. �:. t.. ,. ,'e.n -, •i C 2 D _ �LRi1 R .f. I a .. ...::.. _, '.. .. .:. .,. ., 'A X _ v x' a.' t ;:....• Ai.. .,�.� �,. ., ,.. `\ ... :. �+:: %', `3 .K fit. .m� x. ..,?.. E . o'F�: , r. ..: a b.. .. .. �''�, ... r.,. w. ,. ,. ..-, :.`P`^ ,� `:� '� $' ,R. hid fie. .. ,. .... v. i { ,j c. •.�h.. .., k ri, �. �.kk �,. a r '3 :'t• 1'. Y, :.......t ., :... :. aro, ..- ,*. ... ....... ,. •. .: { .. .�.. . A ,,t� a .. ..:.. ......... .... .. ., , Q -. , ..:: r w. n \. , t ♦ .i, '(+,i ., { � ....- F%t .. ....t . ,: Mk .. it ,. .� . • .. ... ..-. ��++ ... fQ, 3 a ..(�(�X: r . , 7. r`,R. M .. ,. .b.r .,`.k. .. t ..yy ,. F".. S .. [may) ., •� �t3+. a �, ,. t.,t. 4n: .ft, ,t ".y b .. .6r, i': =V- a . . � � dt. �y{h i}ht(/�iv .. -.. -!S :.[ ... ... --. ._. �i W- .. r a' t.�{'' .fit?: �. �e • .t `�,�: A�j}�� �jj� €: Ri TT tt M�YTV �3fJ: '''.�t'M, �r TOTAL . i � •., <,.,. , . .. :. :. .;. ..: CLINICAL:also 2 P^ S ;T.. .\. _!. +xC-•# �t�{. 4 x,C, �' /�� t. P".. �� 'rt>pt�'. `2•e`'. .'$•.� Cl. -i" d :., F � � mM� j.a �'C.? Xi r.'< a .aF:.+•f ��`\ .yp Y. p , .,, : �,, ., .i., ..,:.: -. .. .: . .. •,.. .. .�r:.. L.aVM .-E-.�•�,� `, .2''. a�r :.arc4� r H.. Y". '��'�``C.i5 i . •ak .%�'\ 22 �r. x ... ..,. '.:.. .'. ... ,� .. , ,:.;.. �.... h. c S` :. c ., -,.•,, �r art ,•,, �+ 9.00 .,... ,,...,.,. .. .: :.,>:, .r. i to } HOTEL LEASING 1,00 OTHER HOURS WOR ED F 1.t]fl o.at JURY DUTY 4 y M,Ga,, .l�w�, 'j t �j' �h 'i.�+;. !S S .A+vri 1. pl so 3 enter hours F i HUi:.a#DAV AL.L -� please eater a 1A please enter a "1*# _ Total Hrs M '- 10.00 10.00 10.00 10.00 ANNUAL _ 70.00 1.00 SICK r HOLIDAY 10.00 10.00 OTHER EBEREAVMENT! LEAVE.wKK.■ i FLEXICOM P TAKEN e r LWOP TOTAL HOURS • - 10-0t)A 10-091_10.00 10.00 10400 10.00 'IO.QD X0.00 TotalWorked Hs: 40400 04 0 _ e 4 80.00 .. LV taken 40.00 u 40.00 3b.Qt; total urorki _. FOR R0L1 L r,7q K y***** GP ENTERED LEAVE 1-7 � Y ANNLV -SICK HOLDA'Y OTHERIBBEREAV DIVE. 0.00 10.0 0.00 0.00 0.00 1 0.00 Lv taken from 40.00 Imp FLEX. SALRYE A Rt�LL SFREADSFIEE7 LONG • f i EXEMPT I I Printed Name: KA 6* h Sanchez Pay Period: 61120, 2023 Employee ID 0: 5629 Stiff SlgrtaWrw . . . . ......... Supervisprajonature: ------------ VIM��_�nx z- pr.W.". Maymt, CUMICAL Q2j 3f, �.04:% A MA ML -0.0 , fir.,71 Sun Mon Tue d Fri sat Sun "' 'n Mon OTHER HOURS W6RKED JURY DUTY - --- -- ------ - tl •.t. ANNUAL-' j J-1 OTHER (BEREAVM�T LEAVE.) FLMCOMP TAKM F MOP T,OTAL' 80 n .0 W, TOW Woftd HM '24LOO Waken I&OD a L-E—ki0kiD ------ IMF: 4., LLAPARAD �S 14T Slips MR, Pay Period: 413=023 Pay Date: JIM", Wed ThuFtIl sat TOTAL 4)- *-ni" :14 TA N I MNI MOW f9p. P-1 I 115`4;.� . : .;.• DDJ IW A v 8.0D i, .I� }i• :i t .t•� atm •�•Vr�.-t q::•, .f 1 _ t'h - . n .ti -00 IY-z VY'JD 4o.bo. -A0,00 4040 FORPAYROLL PURPOSE ONLY**** ANKLV Ltd K HOLDAY civa 0,00 8.00 0.00 1 FLr=x6 L s n nn I LONG' mq;, Printed Name:Weigh Sanchez ***Leave r! HOLDAY Slips (JVLV Pay Period: May, 142 20.23 Employee. ID 5629 Signature: VStaff Supervisor initials for Non -Standard workweek Supervisor Signature: C;77 X Pay Period: 5/14/2023 (mmIdd/YM) Pay Dato: CLINICAL Mai"15" !Y1,1 0! M a Y SuS. C ,n Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat e FP , Lj�, TOTAL 'g, Nis mu, MA U " � g RKv. "A", 00 OTHER HOURS WORKED NO 62.00. 904 JURY DUTY --- ---- ----- ta Woikod-k!��"' t7 L Z, . jl AN UL�� N �"j Mop _01i bd sl?�� 6 00. -x, 0 SICK Y HOLIbAY - - ---- ----8 06, 77 OTHER (BEREAMENT LEAVE."....) 4.bo 8-00 FLEXICOMP TAKEN 20.00 LWOP OTAL HOURS. WDO i. Total Worked Hrs 40.00 40.00 LV taken www*** FOR PAYROLL PURPn.Rr- C)MI Y* 'GP ENTERED: 24, LEAVEtFi [PAY OLLSPREADSHEET- i A NNLV 'SICK HOLDAY OTHEM V BEASA CIVE 0.00 1 8.00 0ft A 0 40.00 %vop FLEX: LONG HR SERVICES 05/01/2023 ...... . ..... ---- --- - o MHBG 8053136.60 * PFS- QUINCY 9062 68.30 * SOR- ML 9044 68,30 * SABG SL 9042 68.30 • ARNP 0000:6830•1, � -DcR6&130 0 CBRA- HOUSING 0000 68.30 • SUICIDE PREV. ARPA .. ......... .... ... - .. ......... . ........... . ... . ....... . . ... . . ... . . .. . ........ . ......... ..... . . . ......... ............. . ............ 0000 68.30 -16 s� Z� s 1b� b,tZ ��0� �� Six 1.s = 1��1. orb [HUMAN QE:SOURCFS RECEIVED JUN 05 Vj CTrant County Human Resources Invoice for Human Resources Services f n advance Of summer grant deadlines, Human Resources is asked to use headcount reports to set a cost-sh in-g-a-m-ount-for each non -general fund budgets utilizing HR services, Department Renew Contact Reyna Gonzales Invoice Date Invoice Amount: Renew Renew (DCL) 05/01/23 $8,263.67 $1,361.08 This invoice will be used for departments to generate vouchers for revenue payment to Human Resources. Processing questions should be directed to the Auditor's Office - Accounting Department. Kirk Eslinger HR Director . . . . . . . . . . . . . . . . . 75�UOA Np-,.-v Head C Cts 63 e�Wdp-us 9 03291 139%1 3. - Ln' �z, 'tJ& Se Jfe� 4r*— etwoTk & ar, [John Martin 2080.00 81.06 :$ 168,604.80 19,780.45 4.945.111.4' , I. rdg q-7 Vanessa Brown Gutierre4 . 2080.00 46.67� $ 0 Moly 97,073.60, -21,078 5,269.7i ij 756.57Ricky Jeremy Hall 080.00 -2 65.74 $ �,136,739 A .2. 29)691,94 �.-;-,7,422 99 -$-24 74.33 Evan Little -2080.00 .57,40 119,392,00 :"25,925.12 Seth Sarripson 2080.00._.$ 61.34 127,587.20 27o704.o $-8,9260.1 .368.72 - ------ I$ 100 ��:18,063: 2080,0 01$ 51. .108,056.00 5,86590'1:'$ 14,9s5.30 `*mPUrJY gatt$ jrktWe 8-31% COLA, fftrleaseS, & Meftal Adjustments Al - BH- 05/2023 NetWbrk & s'ecualkServices `:: ahn'.affiftf-1, 1#64837 bSystemsAdm"in�ist'rafig 500,76 4,412. 1 E; arlaizemd 10,655.34 ,4 7 550,48 r. �Sysfems *��-ibdministratton 603-27 A C16': Ull ilh,- k 'A661foh 0,10 443.09 42 TOTAL INVOICE 22,793.47 ;-TOTAL PER, EMPLOY5E MHBG 299,91 Prevention- SABG ML 9057 149,96 SABG-QUINCY 9050 149.96 SOAP LAKE-SABG-9042 149.96 Suicide Prevention -Grant County -ABPA 149.96 CV -2 DM 14196 :CV-2.ARNP 149,96 CBRA- 149.96 TOTAL GRANTS - - -------- - - 1,849.62 ':16,753 6W ;p s j6UP Nett Pridge .60 5,21 E4riejjCj/SM TM t,M, 1. t,irk AR e a n 9 $�',--,2%0.63. 6 100 ��:18,063: 9 9 4, .030: T A j' M87 8 -,52 2 92,49, app orage art sham ervice , r "'00 $ r' 'r -"-r .80: 26. . .... , 5 06 4 t. 13 L5 3.84 a ane - Edne*6 V'rA — --- -- Ware';. $ --31;.593 83 1.00 .31, 249.47.1 :::10412, ,Veeam Batku W6re p Sbft -10;761-57 3�32,595.16---- -57' `662.80 65, --'7.2 1'()o �: 1289.071 127, 0 P -D- years ftcountlim,A' Dynamics GP I T. -Y Y, Y 11 4,37-9,90 - 1.001 -S 114,379.90 7,239.2-3. S 1,809_81 I Anq `*mPUrJY gatt$ jrktWe 8-31% COLA, fftrleaseS, & Meftal Adjustments Al - BH- 05/2023 NetWbrk & s'ecualkServices `:: ahn'.affiftf-1, 1#64837 bSystemsAdm"in�ist'rafig 500,76 4,412. 1 E; arlaizemd 10,655.34 ,4 7 550,48 r. �Sysfems *��-ibdministratton 603-27 A C16': Ull ilh,- k 'A661foh 0,10 443.09 42 TOTAL INVOICE 22,793.47 ;-TOTAL PER, EMPLOY5E MHBG 299,91 Prevention- SABG ML 9057 149,96 SABG-QUINCY 9050 149.96 SOAP LAKE-SABG-9042 149.96 Suicide Prevention -Grant County -ABPA 149.96 CV -2 DM 14196 :CV-2.ARNP 149,96 CBRA- 149.96 TOTAL GRANTS - - -------- - - 1,849.62 venzo!n; E s 51.67 66.371 MB ---- -- -_ i4it3jil�3xritt +t•tr`aY: ``.ii tt:iiw"Y"F Y:" "eS`Y': S TY Y �Y.Y:2Yt2XY`7�Y<xK`Yw�xxY::2YfQs.:",o3a3Yii>•,tx2Zlk;•ss?t;:tit.�< .= i •.Y .tx 2 � � � �.�'�?S.�t fir. ��z.. t t,��,s�:ti:��•;!, rr•St�<.%�rc�t. ;t :2YTiiZ1:S�, :F :i�SS.Kttti ri.;i >ii:t iii S21lECi'f flt �1 2Sa:I:t><:. ,v•Fv %t•••a•• Y.Y. ut � .t qq .> s2.�!.� �s:l2tjttxts>;ggYaiti <.� aa..f2 q<2x.E�;>i:•,.,€'j t<7:, t L•vii "ifs;:., iw E"fS r~�l,>;.. f•.#{:..r t � ,. • .:fi.,FFFE.E.S'33..Y of°:#x«;u;t ts•s�et esn•}. 3:; >., # .zytlaf��.:.� :t�tft� t;Z,2 t=t;"�,�;; It.:•'#:� �t'•S•A*Fff_>i ;e J10*.t( �� tt•i 11�i S tdi3till 1, i iia>i• t1 •u..z2 ,:•i� a. +1 i.i 2 r23t„ i `' i(` i:ia.lt; i:i:i�f .�ti:i'tt.t Ii ei`"II �y 4 iS`(e`•t . aE i. i .>": ! <.� iait� •;r xit s iS• s� t 1t 2t..` r < I t'..> .•£'<•�y'.'�t:i.2#e4.. t [{i. • t i t{1 '. viitiSi rii :{ t of [ F v. • .s • w 2• �.tl <�f `Ivi !i� 2 v#x € d ,.v �"at38888: f. <f�fI>.�vitt S�ii"f 3 � I x>t"l. e>..f'•t3<.It:.>«7 ,41 ♦(Y♦tt f .t �!2 •v.>i ra u %l tt. .i 4 s �.I!.:. : Yi•`i=3i•<<ivc C t XI;i3A0l1a.Y {I.�13 �1ikl .V CCR..E wA < Y WM✓ H:�YI>%1.YnYa T i%l <RNY� LY4<\ flAt.fxfAYA NJ' t Overview of Oines, continued �.- $.67 t e t $.61 Usage j $1.67 and $1.67 Page Monthly Pure E Charges by C Cennkr i i Number Charges Charges 509431-8315 Ahpl Serrano 35 $49.99 -_ 509-707-94501 I -SIS Lapp 37 X9.99 --<. 509-717-9630 ny Abut 33 $49.99 W -•- 5M--761-1259 Traci Hunt' 41 $49.99 --- 50-770-0204 Hector Zavla 43 $49.99 -- 60-770-3094 ftleen Simpson 46 $49.99 -- `509-770-M3148 gored Detrollo 46 $49.99 -- 649-770-4009 Ai wlmo Q,uemda 49 $49.99 -- 509-770-4235 A Imo Quezada 51 $39.99 -- 509 470.4559 dosis Laputop 52 $39.99 -- 5M-770-5442 Pete Gormles 53 $49.99 -_ 609--771-5032 done M chell 55 $49.99 -- 509-771-55 Cdsls Left 59 $39.99 - j Subtdal $709.5 $.,oto CPJSIS SOLUTIONS � DCR 500-431-2319 EdEfis Gamles i 60 $49.99 - j 509-431-8237 Shannon Ful 97- 41C3rcia Garr�e cru+ 73 . 9 - 0-3235 Jran Mum 75 $49.99 --- 5044934016 101ah King 81 $49.99 �-- SubtDbl $24935 $.00 DCL ; t 509-707-9873 NikPi Danis 38 $49.99 - ! 509-750-4166 Dci WidV 90 $25.00 -- ! 509-750-4167 Clef Larsanf 97 $25.44 509-761-1023 Jenna Lancs 119 $49.99 -- 509-7611141 Chelsea R61q 721---- 509-770-4406 Nosey Lope 123 $49.99 -- ' , ! Sub l $=M Invoice Number Account Number date Due Page Surcharges Taxes, and Ofim Governmental Third -Party Charges and Surcharges Charges Toa] Credits and Fps (includes Tax} Charges -- $.61 51.67 66.371 MB ---- -- -_ 49 -.._ $.61 $1.67 -_ $.61 $1.67 �.- $.67 $1.67 $.61 $1.67 -- $.61 $1.67 -- $.61 $1.67 -- $.02 $.00 $.02 x%00 $.61 $1.67 -- $.61 $1.67��, -- U2 U0 $M $6.79 $18357 --- $.61 $1.67 -�-- $.61 $1.67 $1.67 $1.67 $ $3 1% - $.61 $1.67 --- $.36 $1.52 -- $.36 $1.52 - $.61 $1.67 --• $.61 $1.67 -- $.61 ,$1.67 $.D0 $3.18 $9.72 $52.27 --- $40.01 -- $52.2J7 - $52.27 - $52.27 $52.27 -- $62.27 $52.27 - $40.01 -- $40.01 -- $52.27 -- $52.27 -'-• $40.01 $M $735.01 ---- $52.27 52.27 52.27 v� --- $52.27 -- $52.27 $M $261.35 --- $52.27 - $26.88 $26.88 $52.27 -- $5t-2j�.27 - S52.2lT '"FM Voice Plan ming Data Voice Niessgfng Dais 32 1 66.371 MB ---- -- -_ 49 1 20,062.2111119MB ._.... ._..... �..r. 2 " .838MB _.... ...�... - 11 1 165.468MB - - -- 111 1 175.817MB .-._. _..._ ._.. 22 13 835.821MB -. ....�.. 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Number charges Charges (Charges Credos and Fees OndudesTax) Charges Usage Usage Usage GeamNng Raaming Aoamrng 1 ' MED T 1 509-767--1743 l�,yiI lelgh Ssnchea 725 X49. - $.61 $1.67 3 - 157.615MB --- -- c 1.277 $49.99 - -- $.8 $1.67 ' $52.27 603 -- 564.397MB 509-_.770-0808 Tr Mora: 135 $39.99 --- - $.62 $.DD -- $40.01 -- - - Subtotal $13997 $A $1.241 $334 $14455 M ■ EP ■ i 509-781-1229 lhren Hemandez 136 $49.99 - --- $.61 $1.67 - $52.27 Subtotal $49.99 $.61 $1.67 $M $5227 i MH GC i 509-431-0321tehe�le Laska 137 X1'9.99 - -- $.61 $1.67 -- $52.27 83 1 180.103MB --- -- __ 509-707-9109 I ! ru: Garr. 139 $49.99 --- - $.61 $1.67 -- $52.27 S - 6$.887MB -- -- __ 509-707-9521belle L&*a 141 $39.99 -- -�- $.02 $.00 $40.01 --' 5.606GB 509"-760-0954' Coulee Front Off 742 $49.99 -_ -- $.61 $1.67 $52.27 - --� -- - -- -- 509-761-0593 llh GG -$49.99 __ -- -5.51 --,3`l -- _$50.81 509-770-0581 - 509--770-0581 Judy Miller 144 $39.99 - $.02 $.0€� - $40.01 -- .413GB - --- -- 509--'770-3250 Lisa Hamilton 145 $"39.99 -- -- $.02 $.00 --- $40.01 -- - 3.301GB -- -- 509-770-3890 Mh Go 146 -$.39.99 --- -- $.00 $.00 -$39.99509-770-4047 Jody Miller, 147 $49.99 -- -- $.61 $1.67 - $52.27 - 2 106.540MB - - -- 509-771-7374 Lisa Hamilton 148 $49.99 $.61 $1.67 -- $52.27 - - 255.081MB - - -- l SubtaWl $M.94 $M $8.04 $.0D 0. f MH LAPTOP 509--770-4528 Bkbara.lldnson 150 $39.99 ---. - $.02 $.DO $40.011 509-771--5074 lam Bailey, '- 151 $39.99 - --- $.02 .001G8 - -- -- 1 Subtt bi $79. $M M $.04 $ $8042 MH MATTAWA, 509-407-7:308 MatIm Front Office 152 $49.99 01 $1.67 -- $52.27 - -- -- - 509431-0572 Sonia M*na 153 $49.99 - U71 $1.67 -- $52.27 9 - 92.473MB - - 509"-771-7057 1 a'ltm WM 155 $39.99 -- -`-- $.0 X011 -- $40.01 --- 4~70768 - - - i Subtotal $13997 $M $a $124 $3.34 $ W $144th € ! i • I • I f i 1 1 veruon%/ PO BOX 489 Manage Your Account Account Number Date Due NEWARK, NJ 07101-0489 b2b.verlzonvvi i'e less corn 87157683540001 OS/29/23 1 Munge your address at Invoice Number 9934262658 hWJ/=-vef1zononterpr19e.com Quick Bill Summary Apr 07 - May 06 KEYLiNE IGI III liffil III I I 1 91 ill. Kill COUNTY OF GRANT Previous Balance (see back for details) $6,641.76 840 E PLUM ST Payment - Thank You -$6j641.76 MOSES LAKE, WA 98837-1874 Balance Forward $x0 Monthly Charges $5,959.09 Usage and Purchase Charges Voice $.00 Messaging $.00 Data $.00 Surcharges and Other Charges & Credits $57.46 Taxes, Governmental Surcharges & Fees $160.53 Total Current Charges $6,177.08 Total Charges Due by May 29, 2023 $6,177,08 Pay from phone Pay on the Web Questions: VPMT (#763) At b2b.verizmvirelesszom 1;800,922.0204 or *611 fmm your phone ------------------------------------------------------------------ ver'i'zonv Bill Date May 06, 2023 Account Number 871576835-00001 Invoice Number 9934262658 COUNTY OF GRANT 840 E PLUM ST Total Amount Due by May- 29 2023 MOSES LIVE, WA 98837-1874 , Make check payable to Verizon Wireless, Please return this remit slip with payment. $6,177mO8 $ PO BOX 660108 DALLAS, TX 75266-0108 99342626580108715768350000100000617708003006177082 �,A �� � S(,�,y�-�6`eZ- CILWASHINGTON STATE DEPARTMENT OF LICENSING Web PaymentInvoice invoice transaction that au have paid for. Payment confirmation #: 0-072-391-798 Payment date: 31 -May -2023 Process date: 31 -May -2023 Payment type.- CHECK Account number: *****9639 Routing number: 125100089 Confirmation # Description Amount 0-072-372-684 Pay for your order of driving records -- $15.00 Total $16.00 Tendered $15.04 r n Or -ant; Behavioral Health 87, Wellness C :V2 - T:e :16 :he a I Ith 5/31/2023 .......... ........... ..... . ........... .... .... . TOTAL EXPENSES all A 108.150.00.0000.564-00.4108 M!FSavo -- C�oo.A-- � 6/8/2023.11':10 $ 141 .157-00 CV-,T&Jehe t , c�rc�nt Btthavia�i #�ias�ith s �U+nElneses CV2— Tee h e a 5/31/2023 TOTALEXPENSES GP LEDGER r F - l S I .. :.. �, 7.:`. �... .r,.. � ?.jv ) ;.r: �'� _..: ., , .:..~ .: t C ,. jt @�'hS "sa.;. ,(C'• 3 .M �� - � � 108.150.00.0000.564.00.4108Teleheafth: Ma ,: ���3� 4za � :.4 = : ,: a t � :; s 3:.: ;�,. Y ,._ 14,15.Q0, 'j $ 14,1.57.0! Giee.1tM"'Im mgmm�g. .,�w.;,......:.:.rc.::,....w.(.,_..,:.....,.. ....... .. :.. ._:R: .�.��SS 6/8/202311:10 BILLING MONTH AmlkL iris teleheaith Accounts Payable Renew 840 E. Plum Street Moses Lake, WA 98823 Iris Telehealth Medical Group PA 114 West 7th Street, Suite 900 Austin, TX 78701 https://iristelehealth.com/ acr,ounting@lrlstelehealth.com For Services Provided Month Ending 05/31/2023 Invoice 'No. INV -15894 , Date 05/3V2023 Due Date 06/15/2023 Reference outpatient Emily Epstein NP 110 Hours ISO Less: Payments/Credits Applied Balance P46.1 $160500,00 $0.00 S00.00 Payment Details Please make checks payable to Iris "Telehealth Medical Group, Our remittance address Is (PLEASE NOTE NEW ADDRESS),- ACH Details Lockbox Details Bank Name: Bank of America.. NA IRIS TELEHEALTH MEDICAL CROUP PA Account Name: Iris Telehealth Medical Group, PA P 0 Box 843382 Account Number: 5860 3803 5590 Dallas, TX 75284-3382 ACH Routing NUmber: 111000025 L) Ai4�lAlKtl�war�A�ICMPMNiAVpt611�11aNwllollr�}6yy�/�y/iW'�j�IYMNWIMAYA4ri�w�irf(YI{RVM�hM1�11l:lriM aysf+s+AY , •� • a AYA1ktN .fr�R=�b71 r -Rd��•ll• ��. r a i[�i jy.•�f � : � � �1.l.�'�1.r.�� ���f � gig �y airs: e.1.OrhYrbila�blaay�u.raur6w�Mi:i.viabr�n +kM�metlf#+6 a�aila�ttNW411�'f7��kMktN�Y.1Y.MMlk'M1�1Y�dcft�liaNefukt��l�gq'�''�+1f.:tclar Emily Epstein NA - NiNuwKNYMIrw xwsRNstw7�or�nHwelWYrtaeNllralrar�7e`eeu�Wr7tY.YNnu�i�u�katfYmRiwMNu[MM�k+lM61N 5/1/2023 M�.MV.IIW�lrb+P4ae9m'lSK7lW,0 10 5/2/2023 10 5/11/2023 10 5/15/2023 10 5/16/2023 10 5/18/2023 10 5/22/2023 10 5/23/2023 10 5/2V2023 10 5,26/2023 10 5/30/2023 �.���.�.r.;'MNKM�'1'.x—'4blpY:t11E14A�4'�YA1WlW�W.�4fdlMlraf.Npllwu`IIMl.NeNIr�;I��ro{• 10 t�rr� f M`A i• A19 VOUCHER FORM Voucher #8 �`" a.� �/,/.�,'S]-jlj`]G,TON STATE - " , ; ., 21 A General Adm n Grant Co ; un Ex eases :. _ _ Y) tY . p . Onl AGENCY NUMBER IDIS PROJECT NUMBER COMMERCE CONTRACT NUMBER ' DEPARTMENT OF COMMERCE 3 = t IeB9 23,090.00 25 425:05 ; - . ,,:. 8311 OS Public S%er isrJ, : '- Q ,, _ _ _es Admin. Bud et OIC _ :. '- ,.: _; ;8311 A19 VOUCHER DISTRIBUTION $ _=. $ $ $ 1030 J t 3,P $ 101,690.99{.�,lll} r,r $ , -�MM;, �sy f�� - �2a �� $ 27,914.32 $ f ya r,� , ,i : $ r : .,:. r -, d x�,. x , .. .,� 1. - E t dj. $ 110,879.44 :$ :71520 $ .. �} �., ,. - i?n; k ,... ty of aA,S;s ,-:.. a1YA c5 n,:, 4 .� �t x.. 11 .., �� 1 �n,�� ; n� 04,11r.7.01 „ 25 77M7 , . _ ,� y ..�.,�.ls. �; ,,. ,, ,, z $ . .� :: $ ; 18 000.00 : ,.f , Y�4u, >� I I- � I - � - I - , 7" -1 107 20-6221 C-1 11 _AG. 1115-ENCY NAME . ,: . . = -, 1 - 8C . Micr : 8313 oente, rise Assistance Adrni rp_:. , , n (OIC) . _ _ INS TRUCTION TO VENDOR OR"CLAIMANT DEPARTMENT OF COMMERCE ;� O50 -: r� 1 ,r U gent Need- Mental,Health -Tele-Health Gra . : ,. r -r r.$ .__11 _,. _ _., t __ __. _::. _..__ __:: _ _ Submit this form to claim payment for materials, merchandise or services. ATTN: CDBG-CV _$ - 106,000.00. PO BOX 42525 OLYMPIA, WA 98504-2525 .� �. .: .... s.M .. ., , $ Vendor's Certificate: I hereby certify under perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, 9 , 336,157.00 929 365.00 , $ 33137.04rr 4 and that all goods furnished and/or services rendered have been provided without VENDOR OR CLAIMANT (Warrant is to be payable to:) `' _ _ , . B a lan .,;, ,. ces .. , , _..,.. ,y , .,. ;.., ,, . _ �.. , .. , .__ ,� __ :,. . , , . ._, ,. .. , a _ _� .. discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion or Vietnam era or disabled veterans status. GRANT COUNTYI ._ I 11. I I � � I -1 �,; -, -- � ------�- - -- - -� � � .�-, , - - :- �-� - � - -'-� - - "� � I I.,- I 11 - .,- - I I - - I .1� I 1. 11. I � , ; , -1I I .,-,,���.,,—�--,-,��-.��--�,�,-- ,�,. ,', - � , -1- -�;, I I ,�, --�,� - �- - - - - -�- , I PO BOX 37 � I — — - -, - ". :. � � :', Byf:.-, -1� 11 -'',--, I �,-.-,, ... �, - : ---�:-,,�,:����--�,!-,---,,--����-�--,--,:-�_--��-��,- —,-,-,� ''" — ,. .;, �, 1� , � ,.., - � -�, - — - —,:— , , � -, � ,;; - , ;.-:: . ..... ��,, I", —, -, —, � — I I -,� — -� - � ",:: ,,, �, - - I -:, ,�,�,--, - , , I I 1- � - §'-, �,- - — " ;5 � �! �.,,: , — , EPHRA,TA, WA 98823-0037 _ , l- f ,. (SIGN IN BLUE INK) / ,. Rob Jones, Chalr, 06/27/2023 REPORTING PERIOD• ,/ Ma -23 (TITLE) (DATE) 1. I I -;ID IS Activity ID := : DESCRLP , .. , „ :. :; _ TION _, - ORIGLN�►L -, = PRIOR AMOUNT___ , -' --AMOUNT THIS - , _ RE MAINING I I-. _, ,- _ %: ;: , , - ;, B UDGET REQUESTED fNV OI C E BALANCE- , .- 11 .,. ; , Add a r delet e, bud et line: �tems.as needed , ,,. .. , Inc(udes_CV1 and CV2 as a _- _ PPlacable.. 8 310 - " , ; ., 21 A General Adm n Grant Co ; un Ex eases :. _ _ Y) tY . p . Onl $ - $ $ 23 ,0.90.00 23,090.00 ._ :' r.re_.: ; - , e 367:84 I - $J4x�#�: �. ' , . :. 70 535.28 -' - 1 _ l t .x ;, , 3 f �Y - ,F< f . $ r,.rx »^rpu'-'4S'. _.a}4f�'' d n•'S ;6r' .. "i:h :" ...::- 1. r - , d , . • . , , ,, ,s ' $ �Yr , " �..i".f S F9're�.k '/�: .51.; $ �A 23,090.00 25 425:05 ; - . ,,:. 8311 OS Public S%er isrJ, : '- Q ,, _ _ _es Admin. Bud et OIC _ :. '- ,.: _; ;8311 • • OS PS> Subsistence Pa eats rent ,�mo I -1$ r. e $ _=. $ $ $ Ile75,000.00 ' 271,367.84 � e _ ._110 715.5= 9 110,715.59 188,034.57 188,034.57 -:.:.".::- ;:. -� 198 000.00 32,157.00 J t 3,P $ 101,690.99{.�,lll} r,r $ , -�MM;, �sy f�� - �2a �� $ 27,914.32 $ f ya r,� , ,i : $ r : .,:. r -, d x�,. x , .. .,� 1. - E t dj. $ 110,879.44 :$ :71520 $ .. �} �., ,. - i?n; k ,... ty of aA,S;s ,-:.. a1YA c5 n,:, 4 .� �t x.. 11 .., �� 1 �n,�� ; n� 04,11r.7.01 „ 25 77M7 , . _ ,� y ..�.,�.ls. �; ,,. ,, ,, z $ . .� :: $ ; 18 000.00 : ,.f , Y�4u, >� _ i 73,309.01 82,762.31 . _ ; 76,439:93 �� X68,109 e.- :. , _ ; - e, ;- 8312 - 0 - 5X PS ;Housin Counselln OIC ,. g g ;: ). - 1 - 8C . Micr : 8313 oente, rise Assistance Adrni rp_:. , , n (OIC) . _ _ - - __.... :., ,. �:., _ .::. _ 050 ;- LTrene.t Need -:Ment ,.;. g al Health -General Pubilc Gr . ._ ( ant Co, , :' ;� O50 -: r� 1 ,r U gent Need- Mental,Health -Tele-Health Gra . : ,. r -r r.$ = _ -_ .' ;. , . . 050 - Ur eat- ee - = _ �, N d 1VlentalHealth -Co g _ . _: unt Jail Grant Cor __ :.. : _ _ Y _$ - 106,000.00. $r. - .� �. .: .... s.M .. ., , $ 106,001.0:00 $ . 336,157.00 929 365.00 , $ 33137.04rr 4 ,.�� .� 1,U 2.5 5.4 _ _ , . B a lan .,;, ,. ces .. , , _..,.. ,y , .,. ;.., ,, . _ �.. , .. , .__ ,� __ :,. . , , . ._, ,. .. , a _ _� .. -.�--- I ,_- - `,� , - 1 17� , , ,-'-,:? , -- - -- ` - '�� ��--�-�,,,-�s, ,� - - - , -- -, --"- - I M SUB .RA NS O =SUB G L.=----- CODE D MASTER INDEX SUB OBJ OBJ' ACCT11 SUBSID -- AMOUNT INVOICE NUMBER CI 622CO320 NZ SIGNATURE OF ACCOUNTING_ PREPARER FOR PAYMENT - - DATE WARRANT TOTAL CMS Invoice ID: Jennifer Lewis, Program Manager ACCOUNTING APPROVAL ORPAY.MENT DATE