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~F 0 <br /> s <br /> ~ <br /> * * ~ Bureau of Labvr and Industries <br /> <br /> N~ .o <br /> * ~ ~ * ~ Brad Avakian <br /> t,***~ Commissioner <br /> r85g E <br /> I <br /> i <br /> October 14, 2005 <br /> CITY OF EUGENE <br /> ENGINEERING DNISION I BROGDEN <br /> 244 E BROADWAY <br /> EUGENE, OR 97441 <br /> i <br /> i <br /> 3 <br /> ARKS FEE <br /> ENT RECEIPT F(]R PUBLIC 'L~ <br /> PAYM <br /> (SRS 839-U~5-~21U} <br /> E <br /> Name of Project: 2008 PAVEMENT PRESERVATION BELTLINE-CHAMBERS #60428 ` <br /> ' EUGENE ENGINEERING DIVISION 1 BROGDEN <br /> This certificate 1s proof the CITY OF <br /> made a fee a ent of $1677.14 for the public works prof ect named above, based on the contract <br /> P ym <br /> awarded to EUGENE SAND CONSTRUCTION INC ~CCB#;177967} on 12-SEP-48, leaving a <br /> balance of $4 for this contract. <br /> - nc shall u on com letion of ! <br /> As required by ORS 2790,825 and OAR 839 025-0210, the age y p p <br /> . ~ the <br /> the contract, determine the final contract pnce,lncludxng change orders and adjustments to <br /> contract. If the final contract price varies by $1.40,040 or more, the agency shall submit any ' <br /> additional a ent or request for refund of fees, using form WH-40, to the bureau within 30 <br /> p Ym <br /> days of final payment to the contractor by the agency. <br /> 3 <br /> i <br /> I <br /> PORTLAND EUGENE BEND MEDFDRD <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Warksource Bend 119 N Oakdale Ave, <br /> Portland, OR 97232-2180 Eugene, OR 97401-215$ 1b~5 NE Forbes Rd, Ste 10b Medford, OR 97501-2b29 <br /> (971} b73-07b3 (541} b8b-7b23 Bend, OR 97701-4990 (541} 77b-b270 <br /> Fax (971}b73-07b2 FAX (541) b8b-79$0 (541) 322-2435 FAX (541) 77b-b284 <br /> TTY (971}b73-07bb FAX (541} 389-$2b5 <br /> 0 <br /> SALEM PENDLET~N <br /> 38b5 Wolverine St, NE; E-1 1327 SE 3~ St. <br /> Salem, OR 97305-12b8 Pendleton, OR 97801-4101 <br /> (503} 378-3292 www.oregon.gov/boll (541) 27b-7884 <br /> FAX (503} 373-7b3b ~ EQUAL OPPORTUNrIY EMPLOYER FAx (541} 27b-57b7 ~ <br /> <br />