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Supplemental Budget One-Time Dollar (1X$) REQUEST FORM <br />TO: Budget Office <br />DATE: 10/25/10 <br />Department: Public Works <br />Executive Manager Signature: <br />1. Description of 1X$ 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 />Reduce the capital appropriation for Delta Ponds Bridge to match ARRA award after favorable bids, <br />since there is no revenue to back the appropriation. <br />2. Fiscal Information <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, signed BJE. 72505 <br />