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HomeMy WebLinkAboutReimbursable Work Request - Public WorksRANT COUNTY COMMISSION E19AGENDA 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: JOHN BRISSEY CONFIDENTIAL INFORMATION: DYES ©NO DATE: 05/08/25 PHONE: 509-754-6082 1412 kM !i�lj ,► . ®Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related ❑County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders ❑ Grants — Fed/State/County ❑ Leases ❑ MOA / MOU El Minutes ❑Ordinances El Out of State Travel ❑Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution El Recommendation ❑Professional Serv/Consultant ❑Support Letter ❑Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB -- ----------------- REQUEST FOR REIMBURSABLE WORK FOR THE GRANT COUNTSPORT DISTRICT #9 FOR POTHOLES ON CORPORATE ST, AIRPORT ST/CAP ACCESS HOT MIX FOR A MAXIMUM OF $42,597-89 If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION:3V APPROVE: DENIED D1: 4aA ti D2: D3: ABSTAIN DEFERRED OR CONTINUED TO: 4/23/24 G"RANT COUNTY REQUEST TO T1-1E COUN,rY ROAD DEPARTINIEN'l- FOR REITNIBURSABLE WORK To The County Engineer: Pursuant to terms of an agreement between the County and t � -iee; &,rad (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 V & undersigned further requests that the work be completed no later than 1149 and hereby guarantees reimbursement to the County for all work done up to a maximum of S �7t Work to be Completed: I D A T EM: SIGNATURE (A gZik Re esentative) TITLE To The Board of County Comniissioners: DATE ( I have examined the above request and made the following recommendations: Approved A44K, Denied County Road Engineer/Director of PublieWorks Action of the Board of County Commissioners: DATE The Engineer's recommendation is hereby approved. The Engineer's recommendations is disapproved or modified as follows: BOARD OF COUNTY COMMISSIONERS OF Recommended for use with Section 2 ofform: CRAB H101 and WA C 136-32-030 IGTON