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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 />3'rnject DI3 ~~: <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 maybe 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) 682-5238 <br />PROJECT MANAGER NAME: Chuck Mueller PHONE: 682-5295 <br />MAILING ADDRESS: 244E Broadway <br />PROJECT NAME: 2008 Pavement Preservation Program Villard Street Concrete Panel Replacement from E. 15~' <br />Avenue to 300 feet north <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Villard Street from E. 15's Avenue to 300 feet north <br />PROJECT NUMBER: =Job #4557 DATE AWARDED: <br />CONTRACTOR BUSINESS NAME (DBA): Babb Construction dba Delta Construction Co. <br />CONTRACTOR CCB#: 62971 <br />CONTRACT AMOUNT: $52,819.00 AMOUNT DUE: ~ ~ 5~ ' ~~ <br />Contract amount x .001 <br />(Please duplicate this form for future use) <br />WH-39 (Rev. 11/07) -,..~. ~us.lU.. ~m.z, <br />SCANNED-PWA ~~~Q`O~S <br />DATE: ~~ ~ ~'~ ,., - ~~,., <br />I'NITIALS' <br />