HomeMy WebLinkAboutReimbursable Work Request - Public WorksGRANT COUNTY
REQUEST TO THE COUNTY ROAD DEPARTMENT
FOR REIMBURSABLE WORK
To The County Engineer/ Public Works Director:
Pursuant to terms of an agreement between the County and r1 Co -,o & Fire D+f4 16
(Name of Requesting Agency)
Adopted and approved on the undersigned hereby requests the County to perform the
work listed below at a time and in a manner convenient to the County. The undersigned further requests that the
work be completed no later than <Z/j/ /Zo?-�o and hereby guarantees reimbursement to the
County for all work done up to a maximum of $ !61(,o. 74 %o Gr -..,k. }11i ( pri., kl'" lo-"
All terms of said agreement shall apply with the following exceptions:
DATED: CQ I S Zvz a
SIGNATURE —�
(Agency Representative)
TITLE 1`1gr cLe- L
To the Board of County Commissioners:
DATE1/0 1.2 !j�Z6?�
I have examined the above request and made the following recommendations:
[A The request is approved ❑ The request is disapproved or modified as follows:
County Engineer/ Public Works Director
Action of the Board of County Commissioners: DATE
The Engineer's / Director's recommendation is hereby approved.
❑ The Engineer's / Director's recommendations is disapproved or modified as follows:
Recommended for use with Section 2 of Form:
CRAB #101 and WAC 136-32-030 Revised 10/19
ISSIONERS OF GRANT COUNTY, WASHINGTON