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Supplemental Budget One-Time Dollar (1X$) REQUEST FORM <br /> TO: Budget Office DATE: 05/07/2009 <br /> Department: Public Works <br /> Executive Manager Signature: <br /> 1. Description of 1X$ Request/Justification: (attach additional pages as needed) <br /> Please include the source of funds supporting the request and the specific project which requires <br /> completion. (ex: Request 1X$ from unspent resources to implement new technology that will incur <br /> longer term savings of $x per year.) <br /> This request recognizes the grant from Oregon Department of Transportation Bike and Pedestrian <br /> Program in conjunction with the transportation bond funding for the Bailey Hill project that will be <br /> starting this construction season. <br /> 2. Fiscal Information <br /> Fund: 312 Amount of 1X$ Request: $ 39,100 <br /> FTEImpact: 0 RevenuesOffset: $359,100 <br /> Net Request: $ 0.00 <br /> Revenue Object Code(s). 312-9332-43344. Expenditure Code(s) 312-9332-61735-995374-344 <br /> If Grant involved: Grant Number ~ 344 Fiscal Year Grant Received FY09 <br /> Original Grant Amount: $ 359,100 <br /> Balance Remaining:. (as of ) <br /> <br /> 3. Has a purchase order been issued on this request? Yes No X Purchase order in <br /> <br /> process of being issued <br /> If yes, Prior or Current Year purchase order? <br /> If prior year, has purchase order been included in the Reserve for Encumbrances? If not, please <br /> explain. <br /> 4. Attach a prepared, signed BJE. 66310 <br /> <br />