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REQUEST FOR SIGNATURE FORM <br />Request for Signature County Manager 13 <br />1. Type of document Cooperative Agreement <br />2 . Aspen PO, contract or document number <br />3. Original contract number PW2023-18M <br />4. Contractor or grantor name 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) Admin Code: <br />Resolution Number: B2023-052 <br />8 . Program/project/service/grant name <br />Landscape Maintenance -Highway 96 and <br />9 . Brief description of goods, services or grant duties (will Highway 10 Interchange <br />be used for the County Board monthly contract report) <br />10. Original contract start date 06/01/23 <br />11. Original contract end date 12/31/43 <br />12. Amendment number and amendment start date <br />13 . Amendment end date <br />14. Contract type <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 John "Rich" Profaizer 651-266-7117 <br />22. Signatures <br />Department Preparer Tina Westling Date: 05/09/23 <br />Department Director [r [a.1:1. £5 t.raac,[o!:J. Date :05/09/2023 Brian E bucson /Ma/9.20231621 CDT) <br />Finance Analyst Date : <br />Attorney Date: <br />ll_ RAMSEY COUNTY <br />No Cost <br />July 24, 2023