HomeMy WebLinkAboutReimbursable Work Request - GRIS{,
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State of Washington
NR
A19 -1A `' Invoice Voucher
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Health Care Authority
PO Box 42691
Olympia WA 98504
L.�, 4<000
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 disabled veterans status.
Grant County B
840 E Plum Street
Moses Lake, WA 98837 Tam Tay&, f" BOCC Chair (sign in ink) r
'� j 7 .
(title)
(date)
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1070
1763-94250
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 disabled veterans status.
Grant County B
840 E Plum Street
Moses Lake, WA 98837 Tam Tay&, f" BOCC Chair (sign in ink) r
'� j 7 .
(title)
(date)
PREPARED BY/ DATE
Reyna Gonzales July 24, 2019
CURR DOC NO
VCA
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
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.0
.....................................::
252.34
266.41
1,384.95
TELEPHONE
(509) 764-2660 AIS Effective 7/1117 through g/30/19 REVISEC> 12/31/1
DOC DATE VENDOR NO. AGENCY APPROVAL:
SWV0002426-19 Sarah Mariani 360-725-3774 sarah.marianiCa_hca.wa.aov
19 Biennium Contract
Page 1 Rev 311118
TAX IDENTIFICATION NUMBER
MONTH OF SERVICE I RECEIVED BY DATE RECEIVED
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Apr -19
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11.1
Admin
mrn
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5 0
1 .83
355.37
21
Community -Based it -Based Coord' at'o -
Px
22.5
Community Coalition Coordinator nator
Co mu ' t - Based Process
..................... ...................................::::::.:.:..:::...
22.5
Community Coalition
Community -Based Process
Universal -Direct
NO in
22.5.1
Community Coalition Coordinator- ML
Co -
mmunity Based Process
Universal -Direct
2,998.99 �>
22.5.1
Community Coalition - IVIL
Community -Based Process
Universal -Direct
WOMEN
22.2.1
Strengthening Families Program Supplies -ML
Education-
Universal Direct
469.99
22.2,1
Strengthening Families Program Coordinator -ML
Education
Universal -Direct
2, 684.30
22.5.1
Community Coalition Coordinator-Quincyo
u '
C mm nity-Based Process
Universal -Direct
3,574.78
22.5.1
Community Coalition - Quincy
Community -Based Process
y
-
Universal -Direct
t rsa/ Direct
22.1.1
Under the Influence of You event -Supplies Quincy
information Dissemination
Universal -Direct
371.28
22.3.1
Healthy Alternatives -Family Movie Seres-Quincy
Alternatives
Universal -Direct
496.00
22.1.1
RXTake-Back Event - Supplies- Quincy
Information Dissemination-
Universal Direct
......................._:,..:..
PREPARED BY/ DATE
Reyna Gonzales July 24, 2019
CURR DOC NO
VCA
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
:>::;>:.>:.:�:;:.:�:;.:;::<:::...........::.:....:.:;>^>::>::std:::>:'::<:>:�:<:>�<s>:�-,:•.:: <;«:<>�:
.0
.....................................::
252.34
266.41
1,384.95
TELEPHONE
(509) 764-2660 AIS Effective 7/1117 through g/30/19 REVISEC> 12/31/1
DOC DATE VENDOR NO. AGENCY APPROVAL:
SWV0002426-19 Sarah Mariani 360-725-3774 sarah.marianiCa_hca.wa.aov
19 Biennium Contract
Page 1 Rev 311118