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: E]YESE] NO
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DATE: 09/0712023
PHONE: x3501
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Request to the County Road Department for Reimbursable Work for the City of George, completed no later than 11/03/2023, maximum amount of $20,000, crackseal W Montmorency,
APPROVED
.
DENIED
ENIED
FITABLED/DEFERRED/NO ACTION TAKEN
OCONTINUED TO DATE:
DOTHER
DATE OF ACTION: I$>
-p— I
GRANT COUNTY
REQUEST TO THE COUNTY ROAD DEPA11TMENT
FOR REIMBURSABLE WORK
To The County engineer;
PurRiant to terms of an, agreement between the County and
(Name of Requesting Agency)
adopted and approved on q a �7 I c? 6-7 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
and hereby guarantees reimbui-sementto the County for all work done up to a maximum of :20iboo,
Work to be Completed: VV Mori+rn o *enci I Rt'�-kno;_4 Ava,i
04 rl.,11'\ It 14//
DATED:
SIGNATURE
X
3 ij-
(Agency Representative)
A
TITLE j
(V
To The Board of County, Commissioners: DATE Zo,7.3
I have eXamined the above request and made o 'ng recomi.
ade
Approved
-----------------
AT
C n1ty Road Engineer/D ctor of PublieWork-S
Denied,
Aeflon. of the Board of Countv Commissioner
s: DATE
The Engineers recommendation'is hereby approved.
The Engineer's recommendations 'is disapproved or 111odified as follows*.
Attest:
Clerk of the Board
Recommended flor use with Section 2
orForm: CRAB #10 1 and WAC 136-32-030
BOARD OF COUNTY COMMISSIONERS OF