HomeMy WebLinkAboutReimbursable Work Request - Public Works11GRANT 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 ROUNDTABLE: DAVE BREN
CONFIDENTIAL INFORMATION: ❑YES ®NO
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DATE: 05/30/24
PHONE 509-754-6082
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REQUEST TO THE ROAD DEPARTMENT FOR REIMBURSABLE WORK FOR ADAMS
COUNTY, APPROXIMATELY JUNE 17TH - JULY 3RD, 2024, FOR ASPHALT
PLANT INSPECTION FOR DANEKAS RD OVERLAY #2 UP TO A MAXIMUM OF $10,0000
If necessary, was this document reviewed by accounting? ❑ YES
---
LEGAL REVIEW,
If this 09pument
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If necessary, was this document reviewed by legal? ❑ YES ❑ NO
DATE OF ACTION: ` Lf- �q_
APPROVE: DENIED ABSTAIN
D1:
D2:
D3:
❑NO El N/A
DEFERRED OR CONTINUED TO:
❑ N/A
4/23/24 t
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GRANT 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 AdamsCounty
(Name of Requesting Agency)
Adopted and approved on July 30, 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 Approximately June 17th to July 3rd, 2024 with a total of 5 days of inspection
and hereby guarantees reimbursement to the
County for all work done up to a maximum of $10,000.00.
All terms of said agreement shall apply with the following exceptions:
DATED: 5Z29Z2024
Pe
Work Requested: SIGNATURE. --w.,
Asphalt Plant Inspection (Agencyr�sentative)
for Danekas Rd Overlay #2 Project
CRP -199 TITLE Adams Count V Engineer
To the Board of County Commissioners'.
DATE S.^S 0, ZOZK
I have examined the above request and made the following recommendations:
NA The request is approved El The request is disapproved or modified as follows. -
County Engineer/ Publi
Action of the Board of County Commissioners: DATE
A
I
orks Director
The Engineer's / Director's recommendation is hereby approved.
The Engineer's Director's recommendations is disapproved or modified as follows:
Attest: BOARD OF COUNTY COMMISSIO RS, OF GRANT COUNTY., WASHINGTON
Clerk of the Bard
Recommended for use with Section 2 of Form-,
CRAB #101 and WAC 136-32-030 Revised 10/19