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Supplemental Budget One-Time Dollar (1X$) REQUEST FORM <br /> TO: Budget Office DATE: 10/26/09 <br /> Department: Public Works <br /> Executive Manager Signature: <br /> 1. Description of 1X$ Request/Justification: (attach additional pages as needed) <br /> Use insurance proceeds from fire to offset appropriation for acquisition. <br /> 2. Fiscal Information <br /> Fund: 532 Amount of 1N$ Request: $ $41;425.00 <br /> FTE Impact: none Revenues Offset: $ <br /> Net Request: $ 0 <br /> Revenue Object Codes}~32-9991-98000 Expenditure Object Code(s) 532-9332-61735-945011 <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 x <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 BJE # 68444 <br /> <br />