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INVOICE VOUCHER <br /> Agency Name Grant Award Start Date End Date <br /> EVERETT POLICE DEPARTMENT $55,636 7/1/09 6/30/10 <br /> Name of Authorized Representative Authorized Representative E-mail Address Title <br /> Greg Lineberry Deputy Chief <br /> Applicant Mailing Address Phone Number Ext. Fax number <br /> 3002 Wetmore Avenue <br /> Everett, WA 98201 <br /> Project Contact Person(if other than above) Project Contact Person E-mail Address Contact Title <br /> David Fudge dfudgeRci.everett.wa.us Lieutenant <br /> Contact Mailing Address (if other than above) Phone Number Ext. Fax number <br /> (425) 257-8404 • ( ) <br /> (1) EXPENDITURES REPORTED—Financial assistance grants <br /> July-Sept. Oct—Dec Jan—March April -June Cumulative <br /> On-the-water <br /> patrol <br /> Adventures in <br /> boating classes <br /> Total <br /> Balance: <br /> (2) EXPENDITURES REPORTED—Special Assistance Grant (if applicable) <br /> Attach a copy of Report of activities <br /> July-Sept. Oct—Dec Jan—March April -June Cumulative <br /> On-the-water <br /> patrol <br /> Balance: <br /> Vendor's Certificate: 1 hereby certify under penalty of perjury that the items and total listed herein are proper charges for services furnished to the State of <br /> Washington, and that services rendered have been provided without discrimination because of age,sex,marital status,race, creed,color, national origin, <br /> handicap,religion,or Vietnam era or disabled veterans status. By my signature below,I certify that the information in this report above is accurate and was <br /> performed in compliance with the agency contract under Chapter 352-65 WAC. <br /> Signature <br /> Name Title Date <br /> Agency Information Only: <br /> Prepared by Telephone No Date Agency approval Date <br /> Doc Date Pmt Due Date Current No Ref Doc Vendor No Vendor Message UBI No. <br /> Ref Doc Trans Mod Fund Master Sub Obj Sub Sub City/To Proj Sub Amount Invoice No <br /> Code Index Obj wn MOS Proj <br /> 155L0 NZ 0008 BA53 <br /> Accounting Approval For Payment Date Warrant Total Warrant No <br /> 182009-66 Page 7 cc 155L0 <br />