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~i <br /> I <br /> 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 For Office Use Only: <br /> Project DB <br /> PUBLIC WORKS FEE INFORMATION FORM <br /> For use by publ c agencies that have contracted with a contractor on a public works project regulated by <br /> ORS 279C.800 t 279C.870, in compliance with ORS 279C.825. Also for use by public agencies that are a <br /> party to a publi works project pursuant to ORS 279C.800(6)(a)(B) or (C). <br /> PUBLIC AGEN IES: Please complete and mail this form to BOLI at the above address, along with the public <br /> works fee of on -tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The <br /> minimum fee i $250.00; the maximum fee is $7,500.00. Without the following completed information, the <br /> bureau may be u able to properly credit you for payment received. <br /> _ AGENCY 1336 <br /> PUBLIC AGE CY: City of Eugene Engineering Division <br /> AGENCY CON ACT PERSON: inn Brogden PHONE: 541-682-5560 <br /> !PROJECT MA AGER NAME: Scott Milovich PHONE: 541-682-5560 <br /> MAILING AD RESS: 244 E Broadway~Eugene OR 97401 - <br /> PROJECT NAl~'IE: Rosetta Park Improvements at the intersection of Evergreen Drive and Beniamin Street <br /> CONTRACT AME (if part of larger project): <br /> PROJECT LO ATION: Evergreen Drive and Benj_am Street EugLene OR _ - <br /> PROJECT NU BER: 2009-02 DATE AWARDED: 7/14/2008 <br /> CONTRACT BUSINESS NAME (DBA): Scott Brown Construction Inc. <br /> i <br /> CONTRACT R CCB#: 64344 <br /> CONTRACT MOUNT: $186 999.00 AMOUNT DUE: ~ ` U" <br /> Contract amount x .001 <br /> I <br /> CANNE -pyyq <br /> <br /> j ATE; (Please duplicate this form for future use) <br /> ITIALB: <br /> WH-39 (Rev. X 1/07) ~ Zl) /gyp <br /> ~ l (JO <br /> ~~(9 3 ~ G'15 ~ UZ <br /> <br />