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~ F <br /> ~ ~ ~ <br /> ~ <br /> ~ ~ ~ Bureau of Labor and Industries <br /> v <br /> <br /> ~ * z Brad Avakian <br /> Commissioner <br /> rs~~ <br /> f <br /> Goober 14, 2008 <br /> CITY GF EUGENE <br /> ENGINEERING DIVISIGN 1 BRGGDEN <br /> 244 E BRGAD~wAY <br /> EUGENE, GR 97401 <br /> i <br /> { <br /> { <br /> E <br /> I~ <br /> i <br /> PAYMENT RECEIPT FAR PUBLIC ~~RKS FEE <br /> ~~Rs s39-o~~~oZia~ <br /> Name of Project: 2008 wASTEVLIATER MANHOLE REHABILITATION #59908 <br /> 3 <br /> i <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISIGN I BRGGDEN ~ <br /> made a fee payment of $250 for the public works project named above, based on the contract <br /> awarded to 2G CGNSTRUCTIGN ~DBA} ~CCB#: 40559 on 12-SEP-08, leaving a balance of $0 <br /> for this contract. <br /> As required by ORS 2790.825 and GAR 839-025-0210, the agency shall, upon completion of <br /> ' e orders and ad'ustments to the <br /> the contract, determine the final contract pace, including chang ~ <br /> rice varies b 100 000 or more the a enc shall submit an <br /> contract. If the final contract p y$ g y y <br /> ' ' the bureau within 3 0 <br /> add~t~anal payment or request for refund of fees, using form wH 40, to <br /> days of final payment to the contractor by the agency. <br /> PORTLAND EUGENE BEND MEDFORD ~ <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Vl~orksource Bend 119 N Oakdale Ave. ~ <br /> Portland, OR 97232-2180 Eugene, OR 97401-2158 1645 NE Forbes Rd, Ste 10b Medford, GR 97501-2629 i <br /> (971} 673-0763 X541} 686-7b23 Bend, 0R 97701-4990 (541} 77b-6270 ~ <br /> Fax X971} 673-0762 FAX (541} b8b-7980 X541} 322-2435 FAX X541} 776-6284 I <br /> TTY X971} 673-0766 FAX X541} 389-8265 ~ <br /> SALEM PENDLETON <br /> 3865 Wolverine St. NE; E-1 1327 SE 3~ St. <br /> Salem, OR 97305-12b8 Pendleton, OR 97801-4101 <br /> X503} 378-3292 www.oPegon.gov/ball (541} 276-7884 <br /> FAX (503} 373-763b AN E UAL GPPGRTiJNITY EMPLGYER FAX X541} 27b-5767 <br /> Q <br /> <br />