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5105.43 xB NEW YORK STATE DEPARTMENT OF TRANSPORTATION BETTERMENT REQUEST (Betterment Worksheet, Design Deposit Estimate) Betterment Resolution dated , Resolution # The betterment work and payment information provided bythe New York State Department of Transportation in this document has been verified by the Village of Gowanda. The Village of Gowanda requests the New York State Department of Transportation include this betterment in their capital project. The Villagé of Gowanda understands the following: .. Expenses for the requested betterment work included in the State’s contract and performed by the State’s contractor are the sole responsibility of stakeholder who requested the betterment. Full payment for the Design Betterment Share Estimate must be received by the Office of the State Comptroller no iater than ten(10) business days before letting. If the payment is not received by this date, the betterment work may be removed from the project. The payment can be sent to he Regional Utility Unit any time aifter the Betterment Request is approved. All received monies will be deposited into an escrow account and accrue interest. If the contract bid price for the cost of the betterment work exceeds the initial payment, the difference must be paid to the comptroller, Written notice of the need for additional payment will be given. If the contract bid price for the cost of the betterment work is less than the deposit, the difference will remain in escrow. Any remaining monies will be returned to the stakeholder, with interest, upon close out of the project. if the betterment share runs out of money during constriction, work will stop until additional payment is made by the stakeholder to coverthe additional costs of the work. (Print/Type Name) Owner or Agent Title Sign Here (Signature) Date ae eau Page 5 of 6