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~~ - , <br />,N'riALS: <br />CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON 5T., #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 BOLL. 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: City of Eugene - Engineerins~ AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: (54.11..682-5238 <br />PROJECT MANAGER NAME: John Bonham PHONE: (541682-5300 <br />MAILING ADDRESS: 244E Broadway - <br />PROJECT NAME: Concrete alley paving and constructing_wastewater and stormwater systems on 6`~' Alley between <br />T ler Street to Polk Street <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 6`i' Alley between Tamer Street and Polk Street <br />PROJECT NUMBER: Job #4527 DATE AWARDED: 5/23/2008 <br />CONTRACTOR BUSINESS NAME (DBA): H & J Construction Inc. <br />CONTRACTOR CCB#: 88084 <br />CONTRACT AMOUNT: $100,116.90 AMOUNT DUE: ~'~w~~~ <br />Contract amount x .001 <br />(Please duplicate this form for future use) <br />~.~,. __. <br />--~ ~ ~ ,~, <br />~_ 2~~ <br />l ~ <br />WH-39 (Rev. 11/07) <br />~C~~~~~ <br />