HomeMy WebLinkAbout2019-08-05 Letter to Scott Morishige re Payment Request for Ohana Zone, West Hawai'i Assessment Center & HousingHarry Kim
Alm -or
Will Okabe
Alanaging Director
Barbara I Kossow
Deputy Alanaging Director
(91runt of PH (uni"
Office of tor,gor
25 Aupuni Street, suite 2603 • Halo, Hawai'i 96720 • (808) 961-8211 + Fax (808) 961-6553
KONA 74-5044 Ane KeohokAlole Hwy., Bldg C . Kailua-Kona, Hawaii 96740
(808) 323 4444 • Fax (808) 323-4440
PAYMENT REQUEST FORM
OHANA ZONE — WEST HAWAII ASSESSMENT CENTERS & HOUSING (WHACH)
Form No. GCH OZ-WHACH-01, (0612019)
August 5, 2019
Mr. Scott Morishige
Governor's Coordinator on Homelessness
415 South Beretania Street, Room 415
Honolulu, Hawaii 96813
To Whom It May Concern:
RE: OHANA ZONE —WEST HAWAII ASSESSMENT CENTERS & HOUSING
CONTRACT NO.: DHS-19-GOV-0085
PAYMENT REQUEST NO.: 1
hereby request payment under the above stated contract for the Ohana Zone —
West Hawaii Assessment Centers & Housing in the amount of ONE HUNDRED
TWENTY-FIVE THOUSAND DOLLARS ($125,000.00). This amount represents an
advanced payment for mutually agreed upon advanced program services for the
WHACH for the contract period from June 15, 2019 to June 14, 2022.
I certify that the services for which the payment is being made will be and are
being satisfactorily rendered and that all contractual obligations under the contract
identified above are being duly fulfilled. Documentation specifying the amount
accounting for the initial start-up costs and expenses will be submitted subsequently in
accordance with the contract terms.
1121-4t;
/}
-
Wil Okabe
Managing Director
128sih
Cou iiy of llawai`i is an equal Oppaatuniry 1M'tovidcr and V;rnpbq,�vr
Subgrantees invoice And Expenditure Report
1.Recipient Organization:
2. Funding Source:
County of Hawaii, Office of Management
State of Hawaii, Department of Human Services
3. Address:
4. Contract Number:
5. Contract Amount:
25 Aupuni Street
DHS-I9-GOV-0085
$1 „500,000,00
6. Purpose
Hilo, HI 96720
A. X Initial Advance C. Reimbursement
0.,00%
B Periodic Advance D. Final Invoice
7. Contract Period:
8. Period Covered By This Report:
6115/19 - 6/14122
6115/19 - 9/14/19
9. Cash Transaction Data:
a. Total Cash Received To Date ...........................
1. Total Received
2. Total Invoiced
b. Total Disbursment..................
c. Cash On Hand/Deposit.....................................
d. Estimated Disbursement From:
e Amount of Cash Requested Herewith ..............
$0,00
$0.00 $0,00
$0,00
$125,000.00
10. Categories:
Contract
Budget
Expenditures:
Current
Period
Expenditures:
Year to Date
Percent of
Budget
Expended
Personnel Costs
$O-00
$0,00
$0.00
0.00%
Service Fees
$0,00
0.,00%
Contractual Services - Subcontracts
$1,500,000.00
$0.00
$0-00
0,00%
Program -support., development activities, volunteers
$0.00
0,00%
Advertising & Marketing
$0,00
0.00%
Board Meeting
$0.00
0.00%
Dues - Subscriptions
$0.00
0.00%
Equipment Purchases
$0,00
$0,00
$0.00
0.00%
Motor Vehicle Purchases
$000
$0,00
$0.00
0.00%
Equipment Purchase
$0.00
$O-00
$0.00
0.00%
Equipment Repair and Maintenance
$0.00
0.00%
Facility renovations and site work
$0..00
$0.00
$0.00
0.00%
Miscellaneous
$0.00
0.00%
Custodial Services
$0.00
0.00%
Lease Rent
$0,00
$0,00
$0.00
0.00%
Utilities
$0,00
$0,00
$0.00
0.00%
Postage
$0.00
0,00%
Printin 8 Publications
$0,00
$000
$0.00
0.00%
Professional Fees
$0.00
$0.00
0.0000
TOTAL$1,500,000„00
$0.00
$0.00
0.00%
11. Comments: Request for advanced payment.
2 -Certification' I Certify to the best of my knowledge and belief that this report is true in all respects and that all
disbursments have been made for the purpose and conditions of the grant agreement
rp�l -i100
Signature Date Reported
Reviewed By: (Signature Homelessness Assistant) Date
Reviewed By: (Signature -Community Dev Specialist) Date