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REQUEST FOR SIGNATURE FORP Attachment A <br />Request for Signature <br />County Manager <br />1. Type of document <br />Cooperative Agreement <br />2. Aspen PO, contract or document number <br />3. Original contract number <br />PW2023-18M <br />4. Contractor or grantor name <br />City of Arden Hills <br />5. Contractor Aspen ID # and CERT SVN and/or DUN # <br />6. Requesting business unit <br />Additional business unit <br />7. Authority (required - DO NOT leave blank) <br />Admin Code: <br />Resolution Number: B2023-052 <br />8. Program/project/service/grant name <br />9. Brief description of goods, services or grant duties (will <br />be used for the County Board monthly contract report) <br />Landscape Maintenance - Highway 96 and <br />Highway 10 Interchange <br />10. Original contract start date <br />06/01/23 <br />11. Original contract end date <br />12/31/43 <br />12. Amendment number and amendment start date <br />13. Amendment end date <br />14. Contract type <br />No Cost <br />15. Original contract amount <br />16. Previous amendment(s) total <br />17. Amendment amount <br />18. New total contract value <br />19. Funding string <br />Funding source <br />20. Revenue agreement budgeted amount <br />21. County contact and phone number <br />John 'Rich" Profaizer 651-266-7117 <br />22. Signatures <br />Department Preparer <br />Tina Westling Date: 05/09/23 <br />Department Director <br />SFiaa E ltaxum <br />aE,,.,, ,,,,b;.. r Date: 05 09 2023 <br />Finance Analyst <br />�GG%K.GC� �GG Date: 7//7zJ <br />Attorne <br />d Date: July 24, 2023 <br />" / <br />= RAMSEY COUNTY <br />