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Date Submitted: 8/2312023
COMMISSIONERS CONSENT AGENDA REQUEST FORM
Must be submitted by 12-00 pm on Thursday
OFFICE / DEPARTMENT: J-
BOCC
Please select your Office or Department from the
dropdown list.
REQUESTOR-6* DA"rE OF
Janice Flynn 8/29/2023 1
Date this request is
Name of person making submitted
this request
PHONE #: * INDIVIDUALATTEND11TG-:11
509 754 2011 ext 2937 11Janice Flynn
Phone number to reach requestor Name of individual that will be
with any questions attending either the roundtable
and/or consent agenda meeting to
answer any questions
TYPE(S) OF DOCUMENTSBEING SLI: MITTEW
AGREEMENT / CONTRACT
AP VOUCHERS
APPOINTMENT
REAPPOINTMENT
ARPA RELATED
BIDS / RFPs /QUOTES
AWARD
El BID OPENING
SCHEDULED
Ej BOARDS /COMMITTEES
[E]BUDGET
COMPUTER RELATED
COUNTY CODE
EMERGENCY PURCHASE
EMPLOYEE RELATIONS
FACILITIES RELATED
FINANCIAL
FUNDS
HEARING
INVOICES / PURCHASE
ORDERS
Ej GRANTS - FED / STATE
FED
[]LEASES
MOA / MOU
MINUTES
ORDINANCES
CONFIDENTIAL,:
NO
Does this document contain
1,1confidential information
E] OUT OF STATE TRAVEL Check
PETTY CASH
all
boxes
POLICIES
that
PROCLAMATIONS
apply
REQUEST FOR
and
PURCHASE
supply
RESOLUTION
TAX LEVIES
THANK YOU'S
TAX TITLE PROPERTY
WSLCB
supporting documentation
D
W., ORDING FOR A.G ENDA: *
Reimbursement request for Strategic Infrastructure
Program (SIP) Project No. 2021 -01 for Grant County
Hospital #4 - McKay Healthcare, Phase 1 Capital
Improvement Plan, in the amount of $20,749.24 grant
monies.
FILE UPLOAD:*
Request.pdf
oad documents that are requested to be on the
sent agenda
Please provide the suggested wording that will placed
as the title for this document on the consent agenda
LEGAL REVIEW:* LEGAL SIGNATURE DATE OF LEGAL
NOFirst M. Last REVIEW
Is legal review required for this I mm/dd/yyyy
action?
To Be Completed by BOCC Staff
BOCC ACTION
0"
PIOPPROVED
M DENIED
[]TABLED/
DEFERRED / NO
ACTION TAKEN
CONTINUED TO
DATE:
[E] OTHER
DATE OF ACTION
a
o,'mm/dd/y _3
M
GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
Memo AUG 2 9 2023
cor�s�NT
To: Board of County Commissioners
From: Janice Flynn, Administrative Services Coordinato
Dater August 23, 2023
Re: Authorization for Release of BOCC Approved Funds, Request #13,, SIP
#2021-01- GC Hospital #4 — McKay Healthcare, Phase I Capital
Improvement Plan
McKay Healthcare has certified the requirements for release of funds in the above -
referenced SIP project, which was approved by the BOCC pursuant to Resolution
No. 21 -013 -CC dated February 16, 2021. The proof of requirements is in the form
of a signed Project Certification form from the Hospital and supporting invoicing of
the project that meets the requested amount.
To that end, I am requesting the release of funds on this SIP project as follows:
(1) 13th installment of the grant award in the amount of Twenty
Thousand, Seven Hundred - Forty Nine and 24/100 Dollars
($20,749.24) to McKay Healthcare.
Note: The full grant/loan amount is $350,000. This leaves a balance of
$149,867.63.
Thank you.
AUG 2 3 2023
(3,RANT 5rD'OJUNTY
GRANT COUNTY
STRATEGIC INFRASTRUCTURE PROGRAM
PROJECT CERTIFICATION
This form must be signed and returned, with an *Invoice, for the approved funding,
before reimbursement can be approved by Grant County,
SIP Project Proposal Nurnben.
SIP Funding Recipient
SIP Project Description
SIP2021-01
McKay Hospital & Rehab
Phase I Capital Improvement Plan
1, the undersigned, do hereby certify under penalty of perjul)r, that the materials have
been furnished, the services rendered, and/or the labor performed as described in the
project proposal for the above -referenced SIP Project and that I am authorized to
authenticate and certify to this claim. I also certify that this claim of $20,749.24 is just
and due and is an unpaid obligation against Grant County,,
Further, according to the SIP Project Funding Policies, I attest that at the next audit of my
entity, this project shall be called to the attention of the Washington State Auditor's
Office and an emphasis audit will be requested to assure that these funds were expended
toward the project and according to the intent of the proposal.
Signa. ilre
Victor Odiakosa
Printed Name
Date Signed
Administrator/Superintendent
Title
0.
Administrator/Superintendent
Printed Title
Completed, signed original certification and invoice are to be mailed to:
Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823
Reimbursement #.,-1.3 1 In the amount of �20,749.24
ATTACHMENT 4
MCKAY HEALTHCARE
501 PC1 07/13/2023 93065
Invoice Number Invoice Date -'Description Gross Amount Discount Taken Net Amount Paid'
06/19/2023 Admin - PS - Other $11000.0() $0.00 $1,000.00
$1,000.00 $0.00 $1,000.001
TOTE PC[
ORDER OF 400 S Jefferson, Ste 301
Spokane, WA 99204
r=01� L09306SI10 1109 123 2067 10108 I5360?389S30,19
'!rxq Wk eennell CO a lac.
rElect nalitin
r1cal and Electronics
System Design
400 South Jefferson, Suite 301
Spokane, WA 99204
Public Hospital District #4
of Grant County WA
PO Box 819
Soap Lake, WA 98851
Aftno, Erica Gaertner
6/19/2023•
RECEIVED JUN 1 9 2023
Grant County
H09
Job Name:
McKay Healthcare Generator Replacement
Electrical ond Electronics
system DesIgn
Billing Cutoff:
15th
Rob
Job Number.
2021.13
Revised Description of Work
milli
Accum Prior Mos
Current month
Total Billed
Previous
Total %
Balance to
item Description of Work
Budget
%
Previous Billed
Current %
Current to Bill
Billed
Total Billed
Complete
I Design Development
5A03-89
100%
5,503.89
100%
$
100%
$5,503.89
$
2.65% Construction Documents
$
81255.83
1001
8,,255.83
100%
$
100%
$8,255.83
$
3 100% Construction Documents
$
9,478.93
1001
91478.93
1001
$
100yo
$9,478.93
$
4 Bid Phase
$
611.54
100%
611.54
100%
100%
$611.54
$
5 Construction Administration
$
6,115.43
41%
2,500.00
5171
11000.00
57%
---- $3,500.00
$ 2.,615-43
6 Project Close Out
$
611-64
0.00
0%
$0.00
611-54
TOTAL
30j577.16-
$ 26,350.19
x.,000.00
27,350.19
3..226.97
ReImbursables
Design Trip #1 (4/28/21)
$
653-62
100%
653-62
100%
100%$653-62
Design Trip #2 (6/14/21)
$
653,62
100%
653,62
100%
$
100%
$653.62
'Design Trip #3 (10/12121)
653.62
100%
653.62
100%
$
100%
$653.62
Design Trip #4 (1119122)
$
653.62:
100%
653-62
100%
100%
$653-62
$
Pre-Bld Walk Through #1
$
893.62
100%
893.62
100%
$
100%
$893.62
$
Trip #1
$
893.62
0.00
0%
$0.00 S
893-62
Utility Coordination
$
1,101.12
0.00
$
0%
WOO
$ 1,101.12
L&I Permit Fees
920.00
100%
920-00
100%
$
100%
$920.00
$
Total Reimbursables
$
61422.84
$ 41428.10
$
$ 4,428.10
$ 11994.74
CONTRACT TOTAL
$
37,000.00
30,778.29
---- --- -- ------ -----
$ 11000.00
1 $ 31 t778.29
$ 5t221.71
Change Orders.
DC0#I - Dept. of Health Fees
$
61176.50
100%
6,176.50
100%
100%
$6,176-50
DC0#2 Second Pre-Bid Wallithru
11135.72
100%
1,135.72
100%
$
100%
$1,135,72
Project Totals
$
44,312.22
$ 38,090.51
$ L1,000.00
$ 39,090.51
$ 5,221.71
AR Use
Only:
invoice #
3267
Date.,
6/19/2023
WE:
E
MCKAY HEALTHCARE
563 Colvied Inc 08/02/2023 93102
Invoice Number
Invoice Date
Description
Gross Amount:
Discount Taken l
Net Amount Paid
164005
06/08/2023
SIP No. 2021001 - Generator
$19,749.24
$0.00
$19,749.24
$191749.241
$0,00
$19j749.241
0 f-$
TO THE Colvico Inc
ORDEn OF PO Box 2682
L Spokane, WA 99220
111604L093102,11 ls*L23206?L0ll"m 1536073139530111
Please remit paymont to:
WACO, Inc.
PO Box 2682
Spokane, WA 09220
0
SJLCL TOO
Publf,o Ho-spital 0161.1 4 Of Grant Co.
PO BOX W 0
Soap Lake., WPB� 98851
AIA INVOICE M, 164005
INVOICE DATE: 6/a/2o23
PERIOD TO; f3/31/2o23
APP LICATION #; 2
DUE DATE: 7/712023
JOB: 10 -
IUV f Elk a �YH 0 -al I h I ��a r
awwkW44 ent
Clontract 2022-12
Totals $769,34OA0 $0,00 .'$32'0A61.06 1440,898.63 $0.00
PREVIOUS RETAINAGE ORIGINAL CONTRACT SUM $ 76777-34.0 0
CURRENT BILLING $10,218.06 014ANOE13Y CR R Nor: oRbw s 1,614A9
NEW RETAINAGE CONTRACT SUM TO DATE $
TOTAL COMPLETED AND STORED $
TOTAL RETAINAGE $0.00
TOTAL EARNED LESS RETAINAGE $ 320,40,80
LESS PREV CERTIFIOATES FOR PAY 302,233.00
0.40% SALES TAX;
CURRENT PAYMENT OUE $
- ---------
PRIEVIOUS;
CURRENT
STORED
TOTAL
- -------------
%
ITEM
mftw*040000101
0,11 D.ESCRIPTION
VALUE
APPLICATION
COMPLVED
MAX11RIALS
C O MPLF -TED
COMPLETE
BALANCE
RETAINAGIE
S+ r ileal04000.00
$20000.*
$0,00
$0,00,
$2o000.00
100%
$0.00
2
Bon -6
$00300.00
$6A00,00
$0,00
$0.00
$04300.00
1006/0
3
Perailts 4 Fees
$54000,00
$5,600400
$OOD
$0,00
100%
$0.00
40*00
-4
IV obIlizatlon
$180300.00
$180300,00
$0.00
$0 00
$1613300.00
100%
$0.00
$0.00
6
CWtaq 0-$ Rentalg;. Shkk
$11 k200,00
$111200.00
$0100
$9.00
11, q,00,00
100%
$0.00
$0.00
6
SuporvIslon
$70000.00
$2A50.00
$1,400-00
$01,00
$%850.0
650/0
$3*160100
$%00
7
Elooffical Warranty
$700.00
$0.00
10.0
$0.00
$0.00
a
Demolition
$36t000,00
$6 90100
$0.00
119%
$20J00,00
$0.00
9.
CondOlt
300
$730,
$4%630.00
$0.00
$0,00
$43-630.00
60%
29,470,00
$0.00
10
Manholes Ductbanks
$260000.00
.
$26,000
-
$26,000.00
100%
$0.00
$0,00
1i
81do, w(ro Cablo
$0.00
$0.00
5 %904.60
40/5
$1321095.60
$01%
Q
$0,460000
$111.100.00
$44.60
$0.00
.$1,72240
20%
$0,727.60
$0.00
13
MIN D01008
$3P200.00
$0.00
$0.00
$0.00
$0.0
00/0
$30200,00
$0.00
`14
Coblnets a 12nblo$'urds
$0,000.00
$0.00
$0060D.00
$0.00
$60'600,OD
81%
$1,600.00
$0.00
iS.
Gedunding A Bobding,
$5.0430,00
$.1,020,00
$10086.00
$0.00
$2)716,00
$0.00
16
Supporting Devices
$14j180,00
$8,164,00
40,00
$0.00
$8,1154-00
.68%
$60026.00
$0.00
17
006tricol Idonlilloatlo"
,OD
0.00 $0.00
:$OOD
0 %
$0.00
118
a.
$0.00
%
$Otscuo
19
1n101boards
$86,700.00
$80,00,00
$0.00
$00005,010.0
930/0
som
20
Ciroltil(Brokers
$11J00.00.
$0.00
4040
$6.0
$0,00
0*10
$110100.00
$0.00
21
f ries
Fuse! Poso Ac Mao
$04900,00
$570.00
$0,00
$6,770,00
$54M.00
$0.00
22
$0,00
$0,00
$10,006.00
730A
$4oO95.00
$0,00
EMOrgericy Pow -or OcAeratfon
$40,010.00
$470166,00
$0.00
40.00
W*165100
06%,
$10806.00
$0.00
24
16(drior Lightfro'
$1,660A0
sitauo
$0,00
$10,560.00
100%
$0.00
$0.00
2$
Power SYstems,%ody
$0,000-00
$54000.0D
$0.00
$0.00
$5,000.00
100%
$0.00
$0.,00
ALt 1.1
:Supervision
1X0 00
$$
0.00
20%
$4,A00.00
$0.00
ALT *1-2
Efe.cIrIcAl Warm*
$134000
$0.00
$0.00
$734000
$0.00
'ALT 1-3
1rolIllon
$21o400,00
$2t140,00
$0.00
$2o*140,00
10%
$19,260.00
ALT 1-4
Condull
$24
$A610.00
.00
$0 .00
$15j260.0
$00
ALT 1-6
81do. Wire Calble
$04,300,00
$0.00
$0,00
$0.00
$9.06
.0.00
ALTI-6
Ch-Ult, Otbahor'S
$12,000.00
$0.00
$0,00
$0,00
$0,00
011/0
$12000.00
$0.00
ALT 1.7
Power Systems- Study
$110000
$1,000.00
$0.00
$0.00
$1000,0.00
100%0.00
$0.00
Col
Disconnect for Water Heater
$I1814.49
$0.00
$696900
$0.0'
$696,64
37%
$11,010.63
$0.00
Totals $769,34OA0 $0,00 .'$32'0A61.06 1440,898.63 $0.00
PREVIOUS RETAINAGE ORIGINAL CONTRACT SUM $ 76777-34.0 0
CURRENT BILLING $10,218.06 014ANOE13Y CR R Nor: oRbw s 1,614A9
NEW RETAINAGE CONTRACT SUM TO DATE $
TOTAL COMPLETED AND STORED $
TOTAL RETAINAGE $0.00
TOTAL EARNED LESS RETAINAGE $ 320,40,80
LESS PREV CERTIFIOATES FOR PAY 302,233.00
0.40% SALES TAX;
CURRENT PAYMENT OUE $
EXHIBIT "01' PREVAILING WAGE, AFFIDAVIT FORM
PREVAILING WAGE. AFFID"IT FORM
$TAT Ef OF WAS14INGTON
ss.
COUNTY OFSPOKANE:
1, the undersigned, having been duty sworn, depose, say and ce thatin comma ioll Ivith the
perfomiance of the r1c, payment for wb this vowher is submitted, I have paid pr fling wage rates in
accor(huice With flio Statement of In gat to PcotyProvalffingt Wages previously filed Wi0i the Distrioti and no
lab-oroll Nvorl'anon or me6liffil es n th pro
to so pt ed upon such work has boon p, id I a t1ja *
OY o vatung rate of
Wage or less than tho 1111*111*11111m rfatc0f- wages as speified. in the POO n IP
0 at 0011tbatl h(mve read the -above
tv
and fm%yoingr statement and certificate, kRow the conte thercof an 'Orth thordi I is true
tits dflic substalice (is sot f I
to iny knowledge Md bolief
Signature of Contractor's Atithoeized Representative:
Namex. Lase Kure. Tide-..Pro*eqtM4,A1-1qSqr,
SUBSCRIBED AND SW IR to before mo flit "s h Afli day of it
— 11, v.,20234
wo
T
0
0
Title,*,
Re, siding at: (A
My Appoi utment Expi res
10,
S Am
.0.