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.. <br />FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br />Project Title: 2008 Pothole Repair Project, <br />City of Eugene Project No. 4588 <br />Bid Closing: Date: August 28, 2008 Time: 2:00 p.m. <br />Submit to: ~ 244 E. Broadway, Eugene, Oregon 97401 <br />Disclosure Deadline: 2:00 p.m. -This form mustbe submitted by bid closing date <br />and time. <br />Bidders aze required to submit a first tier subcontractor disclosureform, substantially as described in <br />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: <br />Contact Person: ~C~,~n0. <br />r C~ ru~t3't,-Q <br />v , <br />Bidder's Telephone Number: ~ ~ ~ _ ~. s `S <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 Boazd ("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) <br />2) <br />3) <br /> <br />