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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 /> With the implementation of HB2001 or Jobs and Transportation Act during the past legislative <br /> session, Public Works would request an increase in spending authority to maintain unimproved streets <br /> as part of the FY10 Pothole Program. <br /> 2. Fiscal Information <br /> Fund: 131 Amouunt of 1X$ Request: $ $350,000 <br /> FTE Impact: none Revenues Offset: $ <br /> Net Request: $ 0 <br /> Revenue Object Code(s) 131=8911-43523 ExpenditureObject Code(s) 131-9472-62956-317017•' <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 No _ <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 /> <br /> 4. Attach a prepared BJE # 68440 <br /> <br />