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~: <br />~~8 $9~ <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 Pt7BLIC WOP:KS FEE <br />(ORS $3'9-025-0210) <br />Name of Project: VIDERA PARK Ilvll'ROVEMENTS @ 2727 BLACKTAIL DRIVE #59845 <br />This certificate is proof the CITY OF EUGENE, ENGINEBRING DIVISION / BROGDEN <br />made a fee payment of $250 for the public works project named above, based on the contract <br />awarded to WILDISH CONSTRUCTION CO (CCB# 695) on 03-JUL-08, leaving a balance of <br />$0 for this contract. <br />`. <br />As required by ORS 2790.825 and OAR 839-025-6210,-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 BBND MEDFORD <br />800 NE Oregon St. Suite 1045 1400 Execuiive Parkwap, 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 97701-4940 (541)776-6270 <br />Fax (971) 673-0762 FAX (541) 686-798.0 (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-1 1327 SE 3"' St. <br />Salem, OR 97305-1268 Pendleton, OR 97801-4101 <br />(503) 378-3292 www.oregon.gov/bol (~1) ~~ <br />FAX (503) 373-7636 AN EQUAL OPPORTUNTI'Y EIvtl'LOYER FAX t541> 276-s767 <br />JUL 2 5 2008 <br />