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Supplemental Budget One-Time Dollar (1X$) REQUEST FORM <br /> TO: Budget Office DATE: 10/26/2009 <br /> Department: Public Works <br /> Executive Manager Signature: <br /> 1. Description of 1X$ Request/Justification: (attach additional pages as needed) <br /> Re-appropriation of 2009 Pothole program funding to finish work on Riverview, Cross Street, and <br /> other unimproved streets and pothole repair. <br /> Unimproved Street Overlay $233,320 <br /> Pothole Patrol Program $265,012 <br /> 2. Fiscal Information <br /> Fund: 131 Amount of 1X$ Request: $ 498;332 <br /> FTE Impact: none Revenues Offset: $ -498;332 <br /> Net Request: $ 0 <br /> 131-9311-61739-317017 $233,320 <br /> Revenue Object Code(s)131-9991-98000 Expenditure Object Code(s) iii-9a~2-629s6-31~01~ ~26s;oi2 <br /> If Grant involved: Grant Number Fiscal Year Grant Received <br /> Original Grant Amount: $ <br /> Balance Remaining: (as of ) <br /> <br /> 3. Has a purchase order been issued on this request? Yes X No _ <br /> If yes, Prior or Current Year purchase order? 2010-00005 <br /> If prior year, has purchase order been included in the Reserve for Encumbrances? If not, please <br /> explain. <br /> <br /> 4. Attach a prepared BJE # 64881 <br /> <br />