HomeMy WebLinkAboutReimbursable Work Request - Public WorksGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: Public Works
DATE: 09/26/2023
REQUEST SUBMITTED BY: Shilo Nellis
PHONE: x3501
CONTACT PERSON ATTENDING MEETING: Sam Castro
CONFIDENTIAL INFORMATION: ❑YES[]✓ NO
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®Agreement / Contract MAP Vouchers
DAppointment / Reappointment
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0 Bids / RFPs / Quotes Award D Bid Opening Scheduled
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DComputer Related DCounty Code
D Emergency Purchase
0 Employee Rel.
F] Facilities Related F] Financial
F71 Funds
nHearing
n Invoices / Purchase Orders nGrants — Fed/State/County
nLeases
DIVIOA / MOU
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E]Out of State Travel
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0WSLC13
Reimbursable work, Agreement with Adams County adopted on 07/30/2012, request work Asphalt Plant Inspection to be completed no later than October 16th to November 3rd, 2023, with a
maximum amount of $8,000
MWA rem*
Signature:
Date:
(Prosecutor/Deputy Prosecutor)
,APPROVED
ODENIED
7TABLED/DEFERRED/NO ACTION TAKEN
❑CONTINUED TO DATE:
F-IOTHER
`�D 2 fi 2023
CONSENT
DATE OF ACTION: qIZ610�.?
%'03"'RANT COUNTY
REQUEST TO THE COUNTY ROAD DEPARTMENT
FOR REIMBURSABLE WORK
To The. cunt Engineer / Public Works Director:
Pursuant to terms of an agreement between the County and Adams gqqn.V
(Name of Requesting Agency)
Adopted and approved on July. 30,- 2,012 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 requeSt s that the
. f
work be completed no later than
ARRE%xiMatelv. October 16th to NoveMbgt
r 3rd��
h-0 a
insRection and hereby guarantees reimbursement to the
County for all work done up to a maximum of $8000.00%
All terms of said agreement shall apply with the following exceptions,
DATED, V1.1
W,ork Requested.,#
Asphalt Plant Inspection (Agency R%odep"n-tative)
for Hatton Rd Safety Project
CRP -196 TITLE Adams -go
.go.E.n
A est:
est"
Jerk of the Bojd
R"ended for use with Section 2 of Form,
CRAB #101 and WAC 136-32.030 Revised 10/19
BOARD OF COUNTY COMMISSIONERS OF GRANT COUNTYt WASHINGTON