RFO 2 23 2017 Redacted

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Message: RFO -
RFO -
From Carrie Hoelscher Date Thursday, February 23, 2017 8:31 AM
To Kraft, Emily
Cc
Journal [email protected]
Recipients
image001.jpg (4 Kb HTML) image002.png (7 Kb HTML) RFO - 2-23-17.docx (56 Kb HTML) RFO - 2-23-17 Estimate.pdf (96 Kb HTML)
Good Morning Emily,
Attached is an RFO for for your review.
Thanks!
Carrie
Carrie Hoelscher
A2A Program Manager
Email 1
106 5th Ave. S, PO Box 65
Greenwood, MO 64034
Phone: [phone]
Fax: [phone]
www.allianceforlifemissouri.com
Our Vision: To unify and champion LIFE ministries.
Ourmission: To save and change lives through Equipping people, Empowering ministries, and Engaging communities toward a culture of LIFE.
Find Us on FB
-https://www.facebook.com/AFLmissouri
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Attachment 12
 [Reimbursement Request for Other Services]
Office of Administration
Commissioner’s Office
Reimbursement Request for Other Services
Program: Alternatives to Abortion
Contractor: __Alliance for Life_______________________________________
Subcontractor: __Pregnancy Care Center____________________________
Please enter below the information for each item/service to be purchased. List the date of purchase, item to be purchased, cost for the item, and the
justification. Items must be approved before purchased/provided to be reimbursed.
Client Name _Candace Moran______________________ Date Enrolled _______1-26-16__________________________
Total Cost
(include
formal Justification, include other sources of
Proposed Purchase DateItem
estimate funding that have been attempted
from
provider of
services)
Candace has been enrolled in the A2A
Parts: program for over one year and has
$663.17 followed through on requirements of
the program. She needs these car
Headlight
Labor: repairs so she can safely get to her full
2-22-17 Assembly Four
$145.60 time job. She also needs these repairs to
Uniroyal Tires
pass a car inspection and drive
Discount: legally. There are no other resources to
$131.25 assist with these costs. She is a single
mother.
Total:
Amt to be reimbursed
$677.52
The following items and services are not eligible for reimbursement: taxes, travel expenses, shipping charges, insurance, interest, penalties, termination payments,
attorney fees, and liquidated damages. Please subtract these charges from your total reimbursement request prior to submission.
Authorized person requesting purchase: _Janet Doss_____________________________________________________
Alliance for Life Program Manager: ___Carrie Hoelscher_____________________________________
Purchase is Approved ___ Denied ___ A2A Signature __________________________________ Date __________
Reason for denying purchase: ________________________________________________________________________________
__________________________________________________________________________________________________________________
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RICK'S AUTOMOTIVE 2121 S. CAMPBELL SPRINGFIELD, MO. 65807 Phone: [phone] Fax: [phone]
WWW.RICKSAUTOMOTIVE.COM
INVOICE
209317 Org. Est. # 438400
Date: 02/22/2017 Tax Resale # : 16839579
PREGNANCY CARE CENTER #37752
: Odometer In 123149 Lic # :AF5A0X - MO 1342 E PRIMROSE SUITE C Springfield, MO 65804 : 417-877-0800 314 Home : 417-877-0800
2010 Dodge - Avenger Express - 2.4L, In-Line4 (144CI) VIN(B)
VIN # :1B3CC1FB0 AN212163
Qty Sale Ext Labor Description Ext Part Description / Number
0.00 . Symptoms: TC, WAIT, 2/22, INSPECT HEADLIGHT OUT, INSPECT TIRES CANDACE
81.60 HEADLAMP ASSEMBLY (COMPLETE) - Remove & Replace -IN STOCK KEYSTONE
58.00 MOUNT & BALANCE 4 TIRES Remove wheels from vehicle. Computer road force simulated balance. Reinstall wheels to vehicle and torque lug nuts to manufacturer's specifications. Wheel
4.00 FEDERAL DOT REGISTRATION DOT# 2.00 State Tire Fee ***Discount*** PER TIM
237.85 237.85 1.00 RIGHT HEADLIGHT ASSEMBLY CH2503182N
4.50 18.00 4.00 DISPOSAL FEE TD
4.50 18.00 4.00 TPMS SERVICE VALVE 17-20018
97.33 389.32 4.00 UNIROYAL Tiger Paw Touring 215/60R17 95T U26289
Org. Estimate Current Estimate Revisions 0.00 0.00 0.00 Labor: 145.60
Bal Due: $677.52
Total: 677.52
Tax: 0.00
SubTotal: 677.52
Parts: 663.17
Discount:
131.25 -
[ Payments - ]
NATIONWIDE LIMITED WARRANTY 1-800-457-0019
Vehicle Received: 2/22/2017
Three years or 36,000 miles limited labor warranty, whichever comes first, (some exclusions may apply). Manufactures warranty on parts. Warranty work must be performed at, or authorized
Date_____________________ Time________________ Signature ___________________________________________________________________________________________
Page 1 of 1 Written By: CUMMINGS, TIM - Technicians : HOYT, AUSTIN 115 Copyright (c) 2017 Mitchell Repair Information Company, LLC invhrs 11.10.16dj
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