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~F <br /> <br /> <br />F~ O <br />~~ <br /> <br />~: "; G~ <br /> <br />F : o <br />i i <br />u <br />~r a s : z <br />e <br />regon <br />February 6, 2008 <br />CITY OF EUGENE <br />ENGINEERING DIVISION / BROGDEN <br />244 E BROADWAY <br />EUGENE, OR 97401 <br />Bureau of Labor and Industries <br />Brad Avalcian <br />Commissioner <br />C~~rU ~sz7 <br />PAYMENT RECEIPT FOR PUBLIC WORKS FEE <br />(ORS 839-025-0210) <br />Name of Project: CONCRETE PAVING,WASTEWATER & STORMWATER SYSTEMS <br />#59097 <br />This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION / BROGDEN <br />i' made a fee payment of $250 for the public works project named above, based on the contract <br />awarded to H & J CONSTRUCTION INC (CCB#: 88084) on 23-MAY-08, leaving a balance of <br />$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 varies by $100,000 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 BEND MEDFORD <br />800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Worksource Bend 119 N Oakdale Ave. <br />Portland, OR 97232-2180 Eugene, OR 97401-2158 1645 NE Porbes 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 />TTY (971) 673-0766 FAX (541) 389-8265 <br />SALEM PENDLETON <br />3865 Wolverine St. NE; E-i 1327 SE 3~ St. <br />Salem, OR 97305-1268 Pendleton, OR 97801-4101 ,~X <br />(503) 378-3292 WWW.OregOri.gOV~b011 (541) 276-7884 ~G' <br />FAX (503) 373-7636 AN EQUAL OPPORTUNITY EMPLOYER FAX (541) 276-5767 <br />JUN 1 `6 2nnR <br />