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Print Page 1 of 5 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: 816-806-4168 Fax: 855-856-5240 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 about:blank 9/18/2018 Print Page 2 of 5 about:blank 9/18/2018 Print Page 3 of 5 about:blank 9/18/2018 Print Page 4 of 5 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: ________________________________________________________________________________ __________________________________________________________________________________________________________________ about:blank 9/18/2018 Print Page 5 of 5 RICK'S AUTOMOTIVE 2121 S. CAMPBELL SPRINGFIELD, MO. 65807 Phone: 417-887-2225 Fax: 417-882-7268 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 about:blank 9/18/2018