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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Bethel Drive Pedestrian Path <br /> City of Eugene Project No. 4101 <br /> Bid Closing: Date: December 20, 2005 Time: 2:00 p.m. <br /> Submit to: 244 E. Broadway, Eugene, Oregon 97401 <br /> Disclosure Deadline: 2:00 p.m. -This form must be submitted by bid closing date <br /> and time. <br /> Bidders aze required to submit a first tier subcontractor disclosure form, substantially as described <br /> in ORS 279C.370, prior to the Bid Closing Date and time. For this project the First-Tier <br /> Subcontractor Disclosure Statement must be submitted regardless of the bid amount. <br /> BIDDER INFORMATION <br /> Bidder's Name: C~~~' ~~~'I'R'c~G~t) <br /> Contact Person: (~i~t~t.Y S • ~c~Gc~c. <br /> G~i' <br /> Bidder's Telephone Number: _ ~ ~tC~ t L-t~ <br /> Check here if the bid amount less deductive alternates, if any, is $100,000 or less. If the bid <br /> amount less deductive alternates, if any, is equal to or less than $100,000, the remainder of the <br /> form does not need to be completed, but the form must still be submitted. <br /> List below the Name, Dollaz Value, and Construction Contractors Board ("CCB") License Number, <br /> and Category of Work that will be performed by each subcontractor that will be fiunishing labor, or <br /> labor and materials. Enter "NONE" if there aze no subcontractors that need to be disclosed (IF <br /> <br /> NEEDED, ATTACH ADDITIONAL SHEETS). <br /> NameJAddress Dollaz Value/CCB# Category of Work _ <br /> 1) <br /> <br /> 2) . <br /> <br /> 3) <br /> <br />