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CONTRACT FEE SECTION <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 <br />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, oy f Eugene - En ing Bering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: inn Brogden PHONE: (541) 682-5560 <br />PROJECT MANAGER NAME: David Starns PHONE: (541) 682-8306 <br />MAILING ADDRESS: 244E Broadway <br />PROJECT NAME: 2008 Communes Wastewater Extensions <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: At the following locations• 1ZAdams Street north of W. 12~' Avenue 2) Harris alley north <br />of E 21St Avenue 3) University alley south of E 19th Avenue 4) Grant Street north of W. 17~' Avenue <br />PROJECT NUMBER: 4506 DATE AWARDED: 7/3/2008 <br />CONTRACTOR BUSINESS NAME (DBA): 2G Inc. dba 2G Construction <br />CONTRACTOR CCB#: 40559 <br />CONTRACT AMOUNT: $115,470.25 AMOUNT DUE: ~~ <br />Contract amount x .001 <br />(Please duplicate this form for future use) <br />~; <br />a ~~ <br />r <._,~ <br />~ ~~ ~,'_ <br />WH-39 (Rev. 11/07) ~ ~ j~- ~!~-- <br />,,:... <br />~- ~~_..~ <br />~~t`-~ _ <br />,~ ... <br />`~ r <br />< < <br />