HomeMy WebLinkAboutReimbursable Work Request - GRISForm '- . s State of Washington
A19 -1A
Invoice Voucher
Health Care Authority
PO Box 42691
Olympia WA 98504
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 without discrimination because of age, sex, marital status, race,
creed, color, national origin, handicap, religion, or Vietnam era or disab .dna tatus.
Grant County B,i
840 E Plum Street p � �� Chair
n � f �, (sign in ink)
Moses Laker WA 98837 D
ki
(title)
(date)
DATE RECEIVED
4,759.43 I
PREPARED BY DATE TELEPHONE
Reyna Gonzales July 25th, 2019 (509) 764-2660 A19 Effective 711117 through 6130/19 REVISED 12/31/18
CURR DOC NO DOC DATE VENDOR NO. AGENCY APPROVAL:
VGA SWV0002426-19 Sarah Mariani 360-725-3774 sarah.mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
19 Biennium Contract Page 1
Rev 3!1/18
TAX IDENTIFICATION NUMBER
MONTH OF SERVICE RECEIVED BY
May -19
BARS r pRocat=iii Ar` rm>7r ilult� or S csQp.si a�1�Y b �o�a �� t s 13
- cY-
11.1
Admin
r` r. 510.83
21
Community -Based Coordination-Px
Community -Based Process
Universal -Indirect
22.5
Community Coalition Coordinator
Community -Based Process
Universal -Direct
22.5
Community Coalition
Community -Based Process
Universal -Direct
'^, l'
T •'... -ti:. - YL, +.�
n{ Y
MOW d _
22.5.1
Community Coalition Coordinator - ML
Community -Based Process
Universal -Direct 4,759.43
22.5.1
Community Coalition - ML
Community -Based Process
Universal -Direct
22.2.1
Community Prevention Education -ML
Education
Universal -Direct
22.2.1
Positive Action - ML
Education
Universal -Direct
22.2.1
22.2.1
Strenghening Families Program Supplies - ML
Strenghening Families Program Coordinator- ML
Education
Education
Universal -Direct~ a
Universal -Direct " k
22.2,1
PAX Good Behavior Game- Supplies - ML
Education
Universal -Direct
22.2,1
PAX Good Behavior Game Coordination - ML
Education
Universal -Direct a= x
22.6.1
Environmental Policy- ML
Environmental
Universal -Direct_'
22.7.1
Training -.Summer Inst- Meals & Hotel- ML
Other
Universal -Direct
22.7.1
Training- Student Support Conf. Reg. & Mileage- ML
Other
Universal -Direct 312.40: _ LH
r
22.5.1
Community Coalition Coordinator - Quincy
Community -Based Process
Universal -Direct
22.5.1
Community Coalition - Quincy
Community -Based Process
Universal -Direct K
22.1.1
Youth Development - Quincy
Information Dissemination
Universal -Direct
22.1.1
Public Awareness - Quincy
Information Dissemination
Universal -Direct
22.2.1
Midle School Life Skills- Quincy
Education
Universal -Direct 4r
22.2.1
Strenghening Families Program - Quincy
Education
Universal -Direct
22.3.1
Healthy Alternatives- Grad night supplies- Quincy
Alternatives
Universal -Direct
22.3.1
Healthy Alternatives- Summer Movie Series- Quincy Alternatives
Fr _
Universal -Direct -
22.6.1
Enviornmental Policy - Quincy
Environmental
Universal -Direct c
22.7.1
22.7.1
Training- Summer Inst. Meals & Hotel- Quincy
Training- Summer Inst. Meals - Quincy
Other
Other
Universal -Direct
Universal -Direct
DATE RECEIVED
4,759.43 I
PREPARED BY DATE TELEPHONE
Reyna Gonzales July 25th, 2019 (509) 764-2660 A19 Effective 711117 through 6130/19 REVISED 12/31/18
CURR DOC NO DOC DATE VENDOR NO. AGENCY APPROVAL:
VGA SWV0002426-19 Sarah Mariani 360-725-3774 sarah.mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
19 Biennium Contract Page 1
Rev 3!1/18