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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />For Office Use Only: <br />Piujert Dl3 -k:' <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 BOLI. The <br />minimum fee is $250.00; the maximum fee is .$7,500.00. Without the following ,completed information, the <br />bureau maybe unable to properly credit you for payment received. <br />PUBLIC AGENCY: Public Works-En ing Bering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Broaden PHONE: (541) 682-5238 <br />PROJECT MANAGER NAME: MattRodrig~ues PHONE: (541) 682-6036 <br />MAILING ADDRESS: 244E Broadway Eugene OR 97401 <br />PROJECT NAME: 2008 Pavement Preservation Program 1) 27~' Avenue from Amazon Parkway to Jefferson Street <br />(Job #43422 2) Chambers Street from Railroad Boulevard to W 8~ Avenue (Job #4346L <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 1) 27~' Avenue from Amazon Parkway to Jefferson Street 2) Chambers Street from <br />RailroadBoulevard to W. 8th Avenue <br />PROJECT NUMBER: 4342 & 4346 DATE AWARDED: 4/25/2008 <br />CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br />CONTRACTOR CCB#: <br />CONTRACT AMOUNT: $830 561.65 AMOUNT DUE: ~ ~ J~ ~ 5~ <br />- Contract amount x .001 <br />PATE: •~~~~ (Please duplicate this form for future use) <br />IiV ITIALS:,,,,;~_ <br />~. <br />~` WH-39 (Rev. 11/07) <br /> <br />~~o~ <br />