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Supplemental Budget One-Time Dollar (1X$) REQUEST FORM <br />TO: Budget Office DATE: 6/28/2010 <br />Department: Public Works Administration - C_,pital Grants <br />Executive Manager Signature: <br />1. Description of 1X$ 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 />Public Works Department receives grants from outside sources for capital rehabilitation projects for <br />Airport runways, Wetland restoration, and trails. <br />2. Fiscal Information <br />Fund: Various Amount of M Request: $2?61.ti54 <br />F 1'[ impact: 0 Revenues Offset: 'S-2,261 X4 <br />Net'Request: $ 0.00 <br />Revenue Object Code(s) See attaehement Expenditure Object Cock(s) Sec Attachments <br />If Grant involved: Grant Number Fiscal Ycar Grant Reccived 2010 <br />Ori,,,inal 6 rant Amount: $ <br />Balance Remaining: (as of ) <br />3. Has a purchase order been issued on this request? Yes x No <br />If yes, Prior or Current Year purchase order? Current Year <br />If prior year, has purchase order been included in the Reserve for Encumbrances? If not, please <br />explain. Capital purchase order will automatically roll. <br />4. Attach a prepared, signed BJE. 69985 <br />