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~~ ~ ~~ ~~-s~d~ <br />~?~ <br />CONTRACT FEE SECTION ~ C~~/'" \ <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 public agencies that have contracted with a contractor on a public works project regulated by <br />ORS 279C.800 to 279C.870, in compliance with ORS' 279C.825. Also for use by public agencies that are a <br />party to a public works project pursuant to ORS 279C.800(6)(a)(B) or (C). <br />PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public <br />works fee of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The <br />minimum fee is $250.00; the maximum fee is $7,500.00. Without the following .completed information, the <br />bureau may be unable to properly credit you for payment received. <br />PUBLIC AGENCY: Cit~f E~ene - En ing_, Bering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Braden PHONE: (541) 682-5238 <br />PROJECT MANAGER NAME: Matt Rodrigues PHONE: (541) 682-6036 <br />MAILING ADDRESS: 244E Broadway - <br />PROJECT NAME: 2008 Pothole ReQair Project <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: This project is r~air uotholes on the following streets• 1) 35`~ Place from 36`f' Avenue to 37`~ <br />Avenue 2) Berntzen Road from Royal Avenue to Elmira Road 3LBond Lane from Norkenzie Road to Fir. Acres Drive 4) <br />West Amazon Drive from drivewa at address 5215 to Fox Hollow Road. <br />PROJECT NUMBER: 4588 DATE AWARDED: 9/18/2008. <br />CONTRACTOR BUSINESS NAME (DBA): CPM Development Corporation dba Eggs Sand & Gravel <br />CONTRACTOR CCB#: 150240 <br />CONTRACT AMOUNT: $170 639.07 AMOUNT DUE: ~~~ <br />Contract amount x .001. <br />(Please duplicate this form for future use) <br />WH-39 (Rev. 11/07) <br />r 31 `~ 3 <br />~ ~~ ail <br />~I <br />