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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 SUBM-ITTED BY:SHILO NELLIS CONTACT PERSON ATTENDING ROUNDTABLE SAVE BREN CONFIDENTIAL INFORMATION: DYES WNO DATE:08.27.24 PHONE, 509-754-6082 -------------- - DAgreement / Contract OAP Vouchers ElAppointment I Reappointment EIARPA Related 0 Bids / RFPs / Quotes Award E]Bid Opening Scheduled El Boards / Committees 0 Budget ElCornputer Related OCounty Code OEmergency Purchase D Employee Rel. ElFacilitles Related ElFinancial MFunds ElHearing ElInvoices I Purchase Orders []Grants — Fed/State/County E31-eases 17IMOA I MOU 0 Minutes nOrdinances 11 Out of State Travel El Petty Cash 11 Policies El Proclamations F Request for Purchase 0 Resolution 9 Recommendation OProfessional ServIConsultant D Support Letter E]Surplus Req, E]Tax Levies DThank You's ElTax Title Property nWSLCB IS ,,Jii::111 kill- all COUNTY ROAD DEPARTMENT REQUEST FOR REIMBURSABLE WORK TO THE PORT DISTRICT #9, POTHOLE AND BREAKAGE OF ASPHALT ON AIRPORT ST AND RAILROAD ST. 20X25FT If necessary, was this document reviewed by accounting? © YES El NO R N/A If necessary, was this document reviewed by legal? El YES 11 NO @9 N/A DATE OF ACTION: 901 3, K APPROVE: DENIED ABSIAIN D1: D2: D 3: DEFERRED OR CONTINUED TO, 4/23/24 GRANT CGUNTY REQUEST TO THE 'COUNTY ROAD DEPARTMENT FOR RE, IMHURSABLE WORK To The County Engineer: Pursuant to- terilis of an agreemeot betweet! the County and Z-4eo4z,46 .... . ......... (Name of Requesting Agency) adopted and approved on .__xVAzM �Ir the undersigned hereby re hosts the County to perform the work listed below at a time and in a manner conyetlient to theCounty. The undersigned ffirther requests that the work be -completed no'lator than and hereby guarantees reinibursement to th-e County for all work done Up to a niaxinium of $-&4 Work to be Coni�leted: eovme h"01 e". e POP/ IQ OPW DATED: N11 KONATURE TITLE To The Board of County CmTunissio-ners: I have examinod the above request and 9 Approved Denied DATE 0 .... . S.ZE.2..O Z4 - oad En0neer//X­*ft*` ector of Publiework-a Action the Board of County Commlssjo/ners,t DATE The Eng.ineer's recommendation is hereby approved. The Enineer's reconitnendations is disapproved or modiflod as follows. Attest: BOA OF C. STY COMMISSIONERS OF COUNTY, WASHUITON 0 "t, ' Ilerk of th 4 Ierk Ard 4 -V- R000mmendid for use with Section 2 OfForm., CRAB fi 101 and WAC 136-32-030 AUG '2 9 20f',L,`�N