HomeMy WebLinkAboutReimbursable Work Request - Public WorksGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: Public Works
REQUEST SUBMITTED BY: Shilo Nellis
CONTACT PERSON ATTENDING MEETING: Sam Castro
CONFIDENTIAL INFORMATION: ❑YES F✓ NO
DATE: 08/22/2023
PHONE: x3501
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DATE OF ACTION: W2,4
AUG 2 2 2023
CONSENT,
GRANT COUNTY
REQUEST TO THE COUNTY ROAD DEPARTMENT K23-215
FOR REIMBURSABLE WORK
To The County Engineer/ Public Works Director:
Pursuant to terms of an agreement between the County and Adams Coin
Adopted nry
ad appoed n oJuly 3% (Name of Requesting Agency)
- 2012 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 Aovroximately 6ygust 28th to Seotemher11
.Igggc-tion not including._Sgptember 4 1h as_a holiday an _Wfth a, total
nof 5A s of
d hereby guarantees reimbursement to the
County for all work done up to a maximum of
All terms of said agreement shall apply with the following exceptions-,
DATED,
Work Requested: SIGNATURE .... .. . .. .
Asphalt Plant Inspection (Agency ire pre9rhtative)
for Deal Rd Project #2
CRP -197 TITLE AdamsC0100tv eer
_E
To the Board of County Commissioners:
DATE e4 t,5* �Z�
I have examined the above request and made the following recommendations,
The requestis approved 11 The requestis -disapproved or modified as follows.:
I -N --mov"W"W"b
Ir �Ae'
. . ....... ..... . ...
County Engineece?lUblic Works Dlrtor
Action of the or of County Commissioners: DATE__ .. ....... �.
El' The Engineer's Director's recommendation is hereby approved.
13 The Engineer's Director's recommendations I's disapproved or modified as follows:
Recommended for use with Section 2 of Form:
CRAB #101 and WAC 136-32-030 Revised 10/19