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OF O <br />R' !~ '; ~ <br />:o <br />e•8 59• <br />SAY 0 6 20D$ <br />regon <br />Bureau of Labor and Industries <br />Brad Avakian <br />Commissioner <br />February 6, 2008 <br />CITY OF EUGENE <br />ENGINEERING DIVISION / BROGDEN <br />244 E BROADWAY <br />EUGENE, OR 97401 <br />PAYMENT RECEIPT FOR PUBLIC WORKS FEE <br />(ORS 839-025-0210) <br />Name ofProject: 2008 PAVEMENT PRESERVATION CONCRETE PAN.REPLACE #59062 <br />This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION / BROGDEN <br />made a fee payment of $250 for the public works project named above, based on the contract <br />awarded to DBA:DELTA CONSTRUCTION CO (CCB#: 62971) on 24-MAR-08, leaving a <br />balance of $0 for this contract. <br />As required by ORS 279C.825 and OAR 839-025-0210, the agency shall, upon completion of <br />the contract, determine the final contract price, including change orders and adjustments to the <br />contract. If the final contract price vanes by $100,000 or more, the agency sha1I submit any <br />additional payment or request for refund of fees, using form WH-40, to the bureau within 30 <br />days of final payment to the contractor by the agency. <br />PORTLAND EUGENE BEND MEDPORD <br />800 NE Oregon St. Suite 1045 1400 Executive Pazkway, Suite 200 Worksource Bend 119 N Oakdale Ave. <br />Portland; OR 97232-2180 Eugene, OR 97401-2158 1645 NE Forbes Rd, Ste 106 Medford, OR 97501-2629 <br />(971} 673-0763 (541)686-7623 Bend, OR 97701-4990 (541) 776-6270 <br />~'' Fax (971) 673-0762 FAX (541) 686-7980 (541} 322 2435 FAX (541)776.6284 <br />i TTY (971) 673-0766 FAX (541) 389-8265 <br />SALEM PENDLETON <br />3865 Wolverine St. NE; E-1 1327 SE 3"' St. <br />Salem, OR 97305-1268 Pendleton, OR 97801-4101 <br />(503) 378-3292 www.Oregori.gov/bOli (s41) 276-7ss4 <br />FAX (503) 373-7636 Aj~I EQUAL OPPORTUNITY EMPLOYER FAX (541)276-5767 <br /> <br />