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CONSENT AGENDA REQUEST FORM

*PLEASE NOTE: THE COMMISSIONERS OFFICE WILL KEEP ALL ORIGINALS UNLESS OTHERWISE REQUESTED
DEPARTMENT/OFFICE:*
Which department/office is requesting this?
DATE OF REQUEST:*
DATE OF REQUEST:
What day are your requesting this?
REQUESTED MEETING DATE:*
REQUESTED MEETING DATE:
What date do you want this item place on the consent agenda?
NAME & TITLE OF REQUESTOR:*
Email Address*
Phone Number*
NARRATIVE OF REQUEST:*
What, exactly, are you requesting?
NAME OF CONTRACTOR:
Who is involved?
NAME OF CONTRACT/AGREEMENT/GRANT & NUMBER
What is the name of the contract, agreement, or grant, and the number?
Expenditure Request:
Is this is an expenditure request
--------------------------------------FOR COMMISSIONERS STAFF USE ONLY--------------------------------------
ACTION TAKEN:
1. APPROVED/CONFIRMED
2. DENIED
What action was taken by the County Commissioners?
SUBJECT TO BUDGET APPROPRIATIONS/PUBLIC HEARING
1. YES
Does this need to have a budget appropriation action or a public hearing set?

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CONSENT AGENDA REQUEST FORM

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