HomeMy WebLinkAboutReimbursable Work Request - Public WorksGRANT COUNTY
Eot'EQUEST TO THE COUNTY ROAD DEPARTMENT
FOR REIMBURSABLE WOI�U
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To The County Engineer
Pursuant to terms of an agreement between the County and Of
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R.—el'1121 MGT
Amiga
(Name and Address of Req`uesting 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
undersigned further requests that the work be completed no later than
and hereby guarantees reimbursement to the County for all work done, including a 10% Administration Fee
for up to a maximum of $ coo
Work to be Completed:
SIGNATURE
{Agency Kepresentative)
---- ---------- 4 111
To The Board of County Commissioners: DATE 3boZZ�ez.*
I have examined the above request and made the following recornmendmions:
County Road Engineef/Director of Public- Wo&
Bill - --- - - -- -------- --------
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,-,
ttest,
C erk of the Bt
Recommended ror me with Section 2
of Form C RA13 #10 1 and WAC 136-32-030
GTON
Request to the Grant County PubUic Works Road Department For
Reimbursable Work..
Work requested is for the removal of the excess dirt and slit from the tall water ditches that
?re Identified on the map provided. Request is made for one County operator and one piece of
equipment (Grade All) provided by Grant County or The City of Quincy will provide
up to th,ree dump trucks, all flaggers needed and will call'in for locates..
Tim ilfioore
City of Quincy Building Department
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