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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Awbrey Pazk Renovation at 4291 River Road <br /> City of Eugene Project No. 3907 <br /> Bid Closing: Date: July 29, 2004 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 quote closing date <br /> and time. <br /> <br /> fFor this proj ect, the First-tier Subcontractor Disclosure Statement must be submitted regardless <br /> of the bid amount. <br /> BIDDER INFORMATION <br /> Bidder's Name: Aspen Springs co <br /> Contact Person: Tom Burg <br /> Bidder's Telephone Number: 541-953-1692 <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 $100,000, the remainder of the <br /> form does not need to be completed, but the form must still be submitted. <br /> List below the Name, Dollaz Value, and Construction Contractors Board ("CCB'~ License Number, <br /> and Category of Work that will be performed by each subcontractor that will be furnishing labor, or <br /> labor and materials. Enter "NONE" if there aze no subcontractors that need to be disclosed (IF <br /> NEEDED, ATTACH ADDITIONAL SHEETS). <br /> Name/Address Dollaz Value/CCB# Category of Work <br /> 1) tfkriyt uh6an 6n?r~e~c ~ 2,7 L0O.OU 2'F`Hi ~f~eu <br /> 2421 Riverview S'~re~' oc.BL#G2GZ L-Qn~l fjC4~Aih4 <br /> 2) SK ~r ~lecfrico~ Car~7~ ~ <br /> 2~1'.~4? ~lec~ri cd~ <br /> Z~s7 Don? Sf • G$ 45129 <br /> e1 p12 91477 <br /> 3) <br /> <br />