HomeMy WebLinkAboutReimbursable Work Request - Public WorksK12-247
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GRANT COUNTY
REQUEST TO THE COUNTY ROAD DEP ARTMENT
FOR REIMBURSABLE WORK
To The Coimty Engineer:
Pursuant to ten -ns of an agreement between the County and
k'Name of Requesting Agency)
adopted and approved on 40010
- the undersigned herebyTequests the
County to perform the work listed below at a time and in a rna I nner convenient to the County. The.
undersigned further requests that the work be completed no later than -3 1 2-,3
and hereby guarantees reimbursement to the County for all work done u
p to a maximurn of $ L57�
Work to be Completed:
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DATED:
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SIGNATURE � —
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��A.geney ntAttVe
TITIle
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Al I/ , /' ft r
To The Board of County Commiss' 4,Zq
oners.: DATE , 'HOZ �,.
I have examined the above request and mad e - oil0 ing recur
Approved
Denied unty Road EngineeO
til-enOrrions :
r of Publieworks.
Action of the Board Of County Commissioners: DATE
The Engineer's reconunendation ishereby approved,
The Engineer's recommendations is disapproved or modified as follows:
Attest:
Clerk of thep
Recommended for use with Sectiol, 2
of Form: CRAB #10 1 and WAC 136-32-030
BOARD OF COUNTY COMMISSIONERS OF
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Gras:?4 COUNTY- WA.'qT41NrjTnNT