HomeMy WebLinkAboutReimbursable Work Request - Public WorksGRANT COUNTY
COMMISSIONERS a AGENDA MEETING REQUEST FORM
(must be submitted to the Clerk of the Board by 11,00prn on Thursday)
REQUESTING DEPARTMENT: Public Works
REQUEST SUBMITTED BY Shllo Nellis .
CONTACT PERSON ATTENDING MEETING: Sam Castro
CONFIDENTIAL INFORMATION: OYESM No
DATE, 08102/2023
PHONE: x 3501
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LEGAL REVI1EW,.APPROVALs�Q��'n Iete for Contracts, reeinent , Leases, C�r%nance,
Signature: Cate:
(Prosecutor/Deputy Prosecutor).
171TABLED/DEFERRED/N0 AGMON TAKEN
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Tovm of Hartil ne, Roqueat for Rahburambla Work) Complated no later than OaMer vnl 2024. Mw mum 4139,68447
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LEGAL REVI1EW,.APPROVALs�Q��'n Iete for Contracts, reeinent , Leases, C�r%nance,
Signature: Cate:
(Prosecutor/Deputy Prosecutor).
171TABLED/DEFERRED/N0 AGMON TAKEN
DCONTINUED TO CRATE;
DOTTIER
I
GRANT COUNTY
REQUEST TO THE COUNTY ROAD DEPARTMENT
FOR REIMBURSABLE WORK
To The County Engineer:
Pursuant to terms of an agreement between the County and Town of Hartline
(Name of Requesting Agency)
adopted and approved on L k L4,r ZG * 1 q 7 G —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 thanOctober, 30til, 2024
and hereby guarantees reimbursement to the County for all work done up to a maximum of $139,584.57
Work to be Completed: C t-\
SeCL 9 , OW LIF s+reeA./-s cx�
October 30th, 2024 lac kops WlCkkt^--s �1'v^ 165T +0 26 FT w'Cjep
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DATED: 7/27/2023
SIGNATURE 4n:d"-.ttr 461)"2&AX
(Agency Representative)
TITLE Mayor
To The Board of County Commissioners: DATE e3> I , Z D Z�'S
I have examined the above request and ma lowing recommendations:
and ma, low
zApproved
o7unZtyR�oad Engin
1-1 Denied pef7birector of PublicWorks
Action of the Board of County Commissioners: DATE
FYThe Engineer's recommendation is hereby approved.
The Engineer's recommendations is disapproved or modified as follows:
Recommended for use with Section 2
of orm: CRAB # 101 and WAC 136-32-030
BOARD OF COUNTY COMMISSIONERS OF
C.1 12A� COUNTY, WASHINGTON