HomeMy WebLinkAboutReimbursable Work Request - Public WorksREQUEST TO THE COUNTY ROAD DEPARTMENT
FOR REIMBURSABLE WORK K19-045
To The County Engineer:
Pursuant to terms of an agreement between the County and
(Name of Requesting Agency)
adopted and approved on 0613-51 l�& the undersigned hereby requests the County
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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 up
to a maximum of $ 701 - la /7A�� � U-+�k e'' '
C-1",.,4&11 9-
All terms of said agreement shall apply with the following exceptions:
DATE 0-13—�i9 SIGNATURE M&M
(Agency Representative)
TITLE 1�
To The Board of County Commissioners: DATE >
I have examined the above request and made the following recommendations: A
County Road Engineer
Action of the Board of County Commissioners: DATE
The Engineer's recommendation is hereby approved.
Attest:
❑ The Engineer's recommendations is disapproved or modified as follows:
NMI• 1 •
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Recommended for use with Section 2
of Form: CRAB #101 and WAC 136-32-030