HomeMy WebLinkAboutReimbursable Work Request - Public WorksK19-055
4.L. REQUEST TO COUNTY ROAD DEPARTMENT FOR REIMBURSEMENT OF WORK
To The County Engineer:
Pursuant to terms of an agreement between the county and (Name of Requesting Agency)
Grant County Port District #9 adopted and approved on
April 2, 2019 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 Au ust 2019 and hereby guarantees reimbursement to the county
for all work done up to a maximum o 37,000
r Eel 6-.+tr PC 15L
All terms of said agreement shall apply with the following exceptions:
(list exceptions if any)
DATE April 2, 2019 SIGNATURE
(Agency Representative) TITLE Executive Director
To The Board of County Commissioners: DATE Z+ Amy Imn
I have examined the above request and make the following recommendations:
SIGNATURE P (County Engineer)
Action of the Board of County Commissioners: DATE �I �P I q
X The Engineer's recommendation is hereby approved.
❑ The Engineer's recommendation is not approved or modified as follows:
Board of County Commissioners
I
NOTE: This form is designed specifically to be used as a supplement to CRAB Form #101 where the
agreement is for a long term and contains Section 2. The upper part of the form should always be used;
the middle and lower parts may be used as is, or modified to suit local county policy adopted pursuant to
WAC 136-10-050(4). The form may also be used for Inter -Departmental work as required by WAC 136-
32-030 with slight modification as follows:
1. Delete first two and a half lines and start with, "The undersigned hereby requests..."
2. Delete "All terms of said agreements shall apply with the following exceptions ".
*Recommended for use with Section 2 of CRAB Form #101 and WAC 136-32-030
CRAB Form 102
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NOTE: This form is designed specifically to be used as a supplement to CRAB Form #101 where the
agreement is for a long term and contains Section 2. The upper part of the form should always be used;
the middle and lower parts may be used as is, or modified to suit local county policy adopted pursuant to
WAC 136-10-050(4). The form may also be used for Inter -Departmental work as required by WAC 136-
32-030 with slight modification as follows:
1. Delete first two and a half lines and start with, "The undersigned hereby requests..."
2. Delete "All terms of said agreements shall apply with the following exceptions ".
*Recommended for use with Section 2 of CRAB Form #101 and WAC 136-32-030
CRAB Form 102