HomeMy WebLinkAboutAgreements/Contracts - New Hope DV/SA.............. ...... _..__ _
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`1-3,11INGTON STATE
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AGENCY NUMBER I0I9 PROJECT NUMBER
A19 VOUCHER DISTRIBUTION
1030 0021
18-62210-005
AGENCY NAN]E
INSTRUCTION TO VENDOR OR CLAIMANT: _
DEPARTMENT OF COMMERCE
Submit this forrn to claim payment for materials, merchandise or services,
ATTN: CDBG
Show complete detail for each item.
PO BOX 4252
...............................
OLYMPIA, WA 94504-2525
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, and:
VENDOR OR CLAIMANT (Warrant is to be payable to:)
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 COUNT'
Bye LO
_.
PO BOA. 371
SIGVJ IN MK)
)
EPH RA'T'A, WA 98823-0037
I -Or -n Taylor, ®lfp OCC Chair
RPO
EPOR`l I G PERIOD: JUNE 2019 FINAL
(TITLE)
(DATE)
Description p
QUANTITY AMOUNT
PREVIOUSLY AMOUNT
REMAINING
BUDGET REQUESTED THIS INVOICE
BALANCE
7714
05 Public Services
117,597.00
83,814.93
33,782,07
_ ..
$0.00
$0.00
$0.00
7717
21 A General Admin
_
3,500.00
.. .............__ _
.__ _
_
$3,500.00
._. _
_
$0.00
$0.00
$0.04:
............................... .... __ ..........
_.................... .................. ................ .......
_
$0.00
$0.00
TOTAL PA MEW RE UES T
......
$121,097.00
$83,814.93:
33 782.07
$31500.00
Everything below this line is for Dept of Commerce
FED TAX Iii #
PROGRAM APPROVAL
DATE
1C: DATE CURRENT DOC, Pio.
REFERENCE DOC No:
VENDOR NUMBER
r�
SWV0002426-03
CCCUNT NO,
ASI? NUMBER
VENDOR MESSAGE
---------------------------
34112
CDB Pmt
M SUB
TRANS
CGDE
O MASTER SUB SUS
D INDEX OBJ 081AMOUNT
GL ACCT
.......... .........._._ ......................
SUBSID
_.._..._....................._._......._. .
INVOICE
NUMBER
+62280320 NZ
, 8 -622,10 -Cos
..........
. - _ _ _
.. ... .......
......... _ _ _ _
__ . ....... __
_ ...... _
SIGNATURE OF ACCOUNTING PREPARER FORPAYMENT
T RAN -To
i > f t £;f APPROVAL I'PAY i�#�#T
�I�
_ _ _
i
STATE OF NN-'ASHINGTON
DEPT OF CONINIERCE
ATTN: CDBG PROGRAM
PO BOX 425255
OLYINIPIA. NVA 98504-2525
C01VINMUNITY ACTION AGENCY
OIC OF WASHINGTON
815 FRUITVALE BLVD
YAKIMA WA 98902
TOTAL AINIOUNT REQUESTED THIS.
CONTRACT NO:
.
1 8-622 1 0-005
REPORT PERIOD:
Jun -19
REPORT NUMBER:
12
$33,782.07
2018 COMMUNITY DEVELOPMENT BLOCK GRANT - PUBLIC SERVICES GRANTS
CERTIFICATION: I certify that the information on this form is a
true and accurate report of the cash status and that all reported
expenditures are properly chargeable to the referenced Prant.
Signature:
Printed Name: -RITA DEBORD
Title: CFO
Date: 7/16/2019
1. Name of Service Activity: Asset Development 38
CDBG amount requested for these program activities this period: $16,627.30
Description of service program how low- and moderate -income (LMI) persons were served this period: Housing counseling, credit coaching., foreclosure
services. business start -Lip, financial education workshops and high school classes. Free tax -prep.
2. Name of Service Activity: Energy Assistance 89 �ICDBG
amount requested for these program activities this period: $1,441.82
Description of service program how low- and moderate -income (LMI) persons were served this period: Energy assistance and conservation education.
-vice Activitv: Asset Develop/Energy Assist Admin -Indirect Admin
Name of Service
program activities this period:
CDBG amount requested for these pt $15,712.95
Description of service program how low- and moderate -income (LMI) persons were served this period: General administration expenses associated with
managing energy assistance and asset development activities oversight and assessments. indirect admin.
Contract 18-62210-005
Submitted to GC by: OIC OF WASHINGTON
Request for Reimbursement No. 12
JUNE FINAL 2019
Grant County's Subrecipient Checklist:
State Auditor's Office Audit Procedures for Testing Activities Allowed
And Not Allowed, As Published In 2007
Questions to ask before submitting a payment request
Was the expenditure or cost:
X Made for an allowable activity under the grant guidelines?
X Authorized (or not prohibited) under state or local laws or regulations?
X Approved by the federal awarding agency, if required?
N/A Allowable per Circular A-87 (June 2004 version), Attachment B, items 1 -43?
For payroll transactions:
X Does the employee's time and effort documentation meet the- requirements of
CircularA-122?
X Allocable to the program? (i.e., was the dollar amount charged to the program
relative to the benefits received by the program? Is the federal grantor being
charged its fair share of the. cost?)
X Based on actual costs, not budgeted or projected amounts?
X Applied uniformly to federal and non-federal activities (i.e., is the federal
government being charged the same amount as if non-federal funds were being
used to pay the cost)?
X Given consistent accounting treatment within and between accounting periods?
(Consistency in accounting requires that costs incurred for the same purpose, in
like circumstances, be treated as either direct costs only or indirect costs only
with respect to final cost objectives).
X Calculated in conformity with generally accepte*d accounting principles, or
another comprehensive basis of accounting, when required under the applicable
.cost principles?
X Not included as a cost (or used to meet cost sharing requirements) of other
federally -supported activities of the current or a prior period?
X Net of all applicable credits? (e.g., volume or cash discounts, insurance
recoveries, refunds, rebates, trade-ins, adjustments for checks not cashed, and
scrap sales).
N/A Not included as both a direct billing and as a component of indirect costs?
N/A Properly classified (e.g., some costs may be incorrectly claimed as a direct cost
instead of being incorporated as part of the indirect cost rate).
X Supported by appropriate documentation? (e.g., approved purchase orders,
receiving reports, vendor invoices, canceled checks, and time and attendance
records.) Documentation may be in an electronic form.
X Correctly charged to the proper account code and grant period?
1:1DATANONSHARED\ACCOUNTING\inarrid's stuffiCDBG\CDBG ML 264 2018-191Subrecipient Checklist 2018-19.docPage
OIC OF WASHINGTON
For User: INGRID FRANK
RW Expenditure report for: 264 - 264 CDBG
Report year: 7/1/2018 thru 6/30/2019
Account Budget
Admn Admin - Asset Dev/Energy Asst $1)990.41
Asst Asset Development $6,519.43
Ener Energy Assistance $11440.00
Report Totals $91949.84
r,
,� VVI 6 rN
General Ledger System
Period ending-
June 2019
Date:
7/16/2019
----Monthly--------------
-----------------To
Date ---------------
Expenditures Pct
Budget
Expenditures
Pct
$9)936.80 499.23%
$23,519.00
$23,531.86
100.05%
$16,555.76 253.94%
$777457.31
$77,457.31
100-00%
$11460.17 101.40%
$161620.69
$16,639.04
100.11%
$27,952.73 280.94%
$117,597.00
$1177628.21
100.03%
gy
44
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Gt�.�,.-t- Cra-� o�lA.oc, '11. S �1
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Page:
Page 1 of 1
Date:
7/16/2019
Time:
11:44-.40 AM
Annual budget
Unexpended
$231519.00
($12.86)
$777457.31
$0.00
$167620.69
($18.35)
$117,597.00
($31.21)
General Ledoer Systern
OIC OF WASHINGTON
For User: INGRID FRANK
Page: Page 2 of 2
Fund Expenditure report for: 264 - CDBG PS 7/1/18-6/30/19 (Fund status: Active) Date: 7/16/2019
Report year: 7/1/2018 thru 6/30/2019 Period ending: June 2019 Time: 10:43:23 AM
---------------
Moll th ly -------------- ----------------- To Date ---------------
Account Budget Expenditures Pct Budget Expenditures Pct Annual budget Unexpended
5355 PAID FAMILY MEDICAL LEAVE ° ° $195.43
$35.43 $40.40 114.03 /° $195.43 $195.43 100.00 /° $0.00
5360 DISABILITY OIC EXPENSE $82.00 $186.36 227.27% $863.16 $863.16 100.00% $863.16 $0.00
5361 MEDICAL INSURANCE,OiC EXP $1,078.00 $3,216.00 298.33% $127881.72 $121881.72 100.00% $127881.72 $0.00
5362 LIFE INSURANCE,OIC EXP $31.00 $54.36 175.35% $251.85 $251.85 100.00% $251.85 $0.00
5363 PENSION,01C EXP $285.00 $707.00 248.07% $37420.06 $31420.06 100.00% $31420.06 $0.00
5399 FRINGE $502.00 $1,222.26 243.48% $67002.06 $61002.06 100.00% $61002.06 $0.00
Total for sub program --- - $6,519.43 $167555.76 253.94% $777457.31 $77,457.31 100.00% $771457.31 $0.00
Sub program: 4 ENERGY ASSISTANCE
5311 SALARI SWAGES EXPENSE $996.00 $11023.42 102.75% $11,897.69 $11,503.74 96.69% $117897.69 $393.95
5351 FICA,OIC E $76.00 $76.29 100.38% $846.00 $860.43 101.71% $846.00 ($14.43)
5352 LAND I,OIC SHARE $19.00 $6.80 35.79% $107.00 $113.32 105.91% $107.00 ($6.32)
5353 STATE UCI(ES),OIC EXP $24.00 $21.29 88.71% $233.00 $239.27 102.69% $233.00
($6.27)
5355 PAID FAMILY MEDICAL LEAVE $0.00 $3.85 0.00% $0.00 $45.32 0.00% $0.00 ($45.32)
5360 DISABILITY OIC EXPENSE $20.00 $12.42 62.10% $119.00 $189.23 159.02% $119.00 ($70.23)
5361 MEDICAL INSURANCE,OIC EXP $136.00 $140.56 103.35% $17577.00 $1,565.31 99.26% $17577.00 $11.69
5362 LIFE INSURANCE,OIC EXP $13.00 $3.63 27.92% $35.00 $55.60 158.86% $35.00 ($20.60)
5363 PENSION,OIC EXP $58.00 $67.47 116.33% $652.00 $801.06 122.86%
$652.00 ($149.06)
5399 FRINGE $98.00 $104.44 106.57% $13154.00 $17265.76 109.68% $11154.00
($111.76)
Total for sub program 54 -----> $1,440.00 $1,460.17 101.40% $161620.69 $161639.04 100-11% $16,620.69
($18.35)
Total for program 25 -----> $77959.43 $18,015.93 226.35%
Total for department 010 -----> $7,959.43 $18,015.93 226.35%
Fund Totals $9,949.84 $301023.29 301.75%
e�
S�Y�a
Y
r
$941078.00 $941096.35 100.02% $94,078.00 ($18.35)
$947078.00 $94,096.35 100.02% $94,078.00 ($18.35)
$1177597.00 $1251125.88 106.40% $117,597.00 ($7,528.88)
ot--1 .. ( , 'z , 1 w,! 9 ''m - :0
. . . ........
Q7AA-�,,,,�_
tiia adi c�L�t- -r ��•s'-i � � 33��5',0�
General Ledger System,
OIC OF WASHINGTON
For User: INGRID FRANK Page- Page 1 of 2
g g
Fund Expenditure report for: 264 - CDBG PS 7/1/18-6/30/19 (Fund status: Active) Date: 7/16/2019
Report year.- 7/1/2018 thru 6/30/2019 Period ending: June 2019 Time: 10:43:22 AM
--------------- Moli tli ly------------------------------- To Date ---------------
Accou nt
cite ---------------
Account Budget Expenditures Pct Budget Expenditures Pct Annual budget Unexpended
Department: 008 DIRECT ADMIN �j �` d d "' ,r
Program: 83 COO/ I.T.
5500 TRAVEL $22.41 $0.00 0.00% $122.41 $122.41 100.00%
$122.41 $0.00
Total for sub program -----> $22.41 $0.00 0.00% $122.41 $122.41 100.00%
$122.41 $0.00
Total for program 83 -----> $22.41 $0.00 0.00% $122.41 $122.41 100.00% $122.41
$0.00
Total for department 008 -----> $22.41 $0.00 0.00% $122.41 $122.41 100.00% $122.41 $0.00
Department: 009 INDIRECT ADMIN o /]f
Program. 02 ADMIN. POOL -BASE
5312 SALARY ADM. ALLOCATION $1,243.00 $5,051.66 406.41% $14,817.00 $13,439.31 90.70% $14,817.00 $11377.69
5354 P/R TAX & BEN. ADM ALLOC. $516.00 $27519.08 488.19% $67115.00 $61548.33 107.09% $6,115.00 ($433.33)
5999 NON PERSONNEL ADM. ALLOC. $209.00 $2,366.06 1132.09% $21464.59 $37421.81 138.84% $21464.59 ($957.22)
Total for sub program -----> $1,968.00 $9,936,804.92% $23,396.59 $231409.45 100.05% $23,396.59 ($12.86)
Total for program 02 -----> $1,968.00 $97936.80 504.92/ $237396.59 $23,409.45 100.05/
$237396.59 ($12.86)
Program: 03 ADMIN POOL -OTHERk'kfi�'�c,--/ 0 qq" � I ,,-(�c
5312 SALARY ADM. ALLOCATION $0.00 $17058.23 0.00/ $0.00 $47420.41 0.00/
$0.00 ($4,420.41)
5354 P/R TAX & BEN. ADM ALLOC. $0.00 $527.71 0.00% $0.00 $27144.55 0.00% $0.00 ($2,144.55)
5999 NON PERSONNEL ADM. ALLOC. $0.00 $484.62 0.00% $0.00 $932.71 0.00% $0.00 ($932.71)
Total for sub program -----> $0.00 $2,070.56 0.00% $0.00 $77497.67 0.00%
$0.00 ($7,497.67)
Total for program 03 -----> $0.00 $27070.56 0.00% $0.00 $7,497.67 0.00%
$0.00 ($7,497.67)
Total for department 009 -----> $1,968.00 $121007.36 610.13% $237396.59 $301907.12 132.10%
$231396.59 ($7,510.53)
Department: 010 PROGRAM
Program: 25 PROGRAM SUPPORT 5Q0 /7)
5311 SALARIES,WAGES EXPENSE $4,076.00 $107100.00 247.79% $48,857.98 $48,857.98 100.00% $487857.98 $0.00
5351 FICA,01C EXP $299.00 $726.42 242.95% $37555.37 $37555.37 100.00% $37555.37 $0.00
5352 LAND I,OIC SHARE $39.00 $92.88 238.15% $413.44 $413.44 100.00% $413.44 $0.00
5353 STATE UCI(ES),OIC EXP $92.00 $210.08 228.35% $11016.24 $1,016.24 100.00% $1,016.24 $0.00