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0 <br />•78 59 <br />regon <br />February 6, 2008 <br />Bureau of Labor and Industries <br />Brad Avaldan <br />Commissioner <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 of Project: POLK STREET WATER QIJALTY VAULT #57851 <br />This certificate is proof the CITY OF EUGENE, ENGINEERING DNISION / BROGDEN <br />made a fee payment of $773.58 for the public works project named above, based on the contract <br />awarded to EMERY & SONS CONSTRUCTION INC (CCB#: 312) on 15-MAY-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 corltract`price, including change orders and adjustments to the <br />contract. If the final contract price varies by $lOq,000 or more, the agency shall 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 <br />800 NE Oregon St. Suite 1045 1400 Executive Pazkway, Suite 200 <br />Portland, OR 97232-2180.. Eugene, OR97401-2158 <br />(971) 673-0763' (541)686-7623 <br />Fax (971) 673-0762 FAX (541)686-7980 <br />TTY (971) 673-0766 <br />SALEM <br />3865 Wolverine $E. Nfi• E-1 <br />Salem, OR 97305-1268 <br />BEND <br />Worksource Bend <br />1645 NE Forbes Rd, Ste 106 <br />Bend, OR 97701-4990 <br />PAX (54)384-8265 <br />(503) 378-3292 www.oregon.gov~boli <br />FAx (503) s73-7636 AN EQUAL OPPORTUNITY EMPLOYER <br />MEDFORD <br />119N Oakdale Ave. <br />Medford, OR 97501=2629 <br />(541) 776-6270 <br />FAX (541) 776-6284 <br />PENDLETON <br />1327 SE 3"' St. <br />Pendleton, OR 97801-4101 <br />(541)276-7884 <br />FAX (541)-276-5767 JUN 0 6 2008 <br />