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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />For Office Use Only: <br />Project DB #: <br />PUBLIC WORKS FEE INFORMATION FORM <br />For use by public agencies that have contracted with a contractor on a public works project regulated by <br />ORS 279C.800 to 279C.870, in compliance with ORS 279C.825. Also for use by public agencies that are a <br />party to a public works project pursuant to ORS 279C.800(6)(a)(B) or (C). <br />PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public <br />works fee of one-tenth of one percent of the contract price (contract amount x.001), payable to BOLI. The <br />minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the <br />bureau may be unable to properly credit you for payment received. ~ <br />PUBLIC AGENCY: Public Works-Engineering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lvnn Brogden _ PHONE: (541~ 682-5238 <br />PROJECT MANAGER NAME: Matt Rodri~ues PHONE: (541) 682-6036 <br />MAILING ADDRESS: 244 E Broadway Eugene OR 97401 <br />PROJECT NAME: 2008 Pavement Preservation Pro r~ am 1) Chad Dr. from E. end to Coburg Rd• (Job #4423) <br />2) Bar~er Dr from Primrose St to Teny St (Job #4433L) Barger Dr. from Hi~hway 99 to Altimont St. (Job #4483) <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 1) Chad Dr. from E end to Cobur~ Rd• (Job #4423) 2 Barger Dr. from Primrose to Terrv St. <br />(Job #4433) 3, Barger Dr. from Hi~hwav 99 to Altimont St. (Job #4483) <br />PROJECT NUMBER: 4423, 443.3, 4483 DATE AWARDED: OS/02/08 <br />CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br />CONTRACTOR CCB#: 695 <br />~ ~ Q <br />CONTRACT AMOUNT: $926,017.00 AMOUNT DUE: 1~~~ ~~2 <br />Contract amount x .001 <br />J l--\~23 ~'~'!. 3~'z..- ~~ <br />, ~u,~3 ~12,' f. 38Q . 43 <br />~ u1,~~3 Z~ ~~. ~~1~' y~ <br />; <br />~ ~ <br />WH-39 (Rev. 11/07) <br />(Please duplicate this form for future use) <br />S CAN N/ OD-PWA <br />DATE: S! ~ D O <br />INITBALSC : <br />~ <br />--~ <br />~. <br />