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Form #:A -102 COUNTY OF HAWAII <br /> Revised: 07/01 <br /> REQUEST TO TRANSFER FUNDS <br /> DEPARTMENT: PUBLIC WORKS DIVISION: HIGHWAY <br /> CONTACT: CY YOSHIOKA PHONE: 961 -8781 DATE: 06 / 13 / 10 <br /> FISCAL PERIOD: July 1, 20 10 to June 30, 20 11 <br /> FROM: ACCOUNT NUMBER ACCOUNT TITLE AMOUNT <br /> 020.911.5911.86.341 HIGHWAY MISC. WORKERS COMP $ 40,000.00 <br /> MISC. CHARGES <br /> TOTAL: $ 40,000.00 <br /> TO: ACCOUNT NUMBER ACCOUNT TITLE AMOUNT <br /> 020.901.5902.15.341 HIGHWAY EMPLOYEE BENFITS $ 40,000.00 <br /> HEALTH BENEFITS <br /> TOTAL: $ 40,000.00 <br /> EXPLANATION (Provide complete explanation): <br /> FUNDS AVAILABLE IN WORKERS COMP (LESS THAN ANTICIPATED CHARGES) TO COVER <br /> HEALTH BENEFIT CHARGES (UNDERESTIMATED CHARGES). <br /> SUBMITTED BY: DATE: li / v3 / t % <br /> artment Head <br /> ACTION: V Recommend Approval _ Recommend Deferral _ Recommend Denial <br /> Signed: La's. Lam; _ V.:Ai DATE: /: / <br /> Directo +f Finance �( <br /> / Approved Deferred Denied <br /> _ <br /> Signed: l� DATE: JUN 1 5 2011 <br /> ayor <br /> Transfer No. 34 <br /> 1 -02761 <br />