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~,: , ~ - <br />_;~=- - • . <br />~. <br />+~~~~ .- <br />° ~ FIRST-TIER SUBCONTRACTOR-DISCLOSURE STATEMENT ~ : ~ ,_ <br />` Project Title: - ~ Tonawanda. Pump Station Capacity Upgrades ~ • <br />- City of Eugene Project No. 4544. ' , - <br />' - ~ Bid Closing: ~ ~ . ~ Dater August 12, 2008 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 />. -- <br />• - and time. <br />..~ Bidders.are required to submit a first tier subcontractor.disclosure form;~substantially as described in .~ <br />ORS 279C.370, prior Ito the Bid Closing Date' and time: For this project- file First-Tier ° <br />Subcontractor Disclosure Statement must be submitted regardless of the .bid amount. <br />. BIDDER INFORMATION <br />• , ' ~ ~ Bidder'ss Name: " ' ~ C~D %Z~ ~- ~~~ ~~= <br />" /'~ ' J <br />Contact Person: ` ~/~~~ ~ . /`~`~~' ' <br />Bidder's Telephone Number:. 6`Z//' ~ t7 ~ ~ '~ X6.3 • • <br />` - . ~Q . Check here if the bid amount less deductive alternates, if any,~is $100,000 or less. If the bid <br />m amount less deducti~e.alternates; if any, is~equal to or less than $.100,0.00, the remainder of the <br />_ ~ _' form does not need to be completed, but the form must still be submitted.. ' ' <br />.List below the Name, Dollar Value, and Construction Contractors Board ("CCB") License Number, <br />. ~ -. ~ " and Category of Work, that will be performed by. each subcontractor that will be fiunis~ing labor, or ~ - <br />labor and materials. Enter "NONE" if there are no: subcontractors that need to -be disclosed (IF <br />_ '~ `•` NEEDED,~~ATTACH ADDITIONAL SHEETS). ~ . <br />' ~ Name/Address- ~ -Dollar Value/CCB# .Category of.Work <br />- 1). ~ , <br />2) .. <br />.- <br />,, .~ <br />- . <br />