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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 />Project DB t~:_ <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-may be unable to properly credit you for payment received. <br />PUBLIC AGENCY: Public Works-Engineering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: X41) 682-5238 <br />PROJECT MANAGER NAME: Matt Rodrigues PHONE: (541) 682-6036 <br />MAILING ADDRESS: 244E Broadway Eugene OR 97401 <br />PROJECT NAME: 2008 Pavement Preservation Program 1) Chad Dr from E end to Coburg Rd. (Job #4423) <br />2 Barer Dr from Primrose St to Terry St (Job #4433~ZBarger Dr from Highway 99 to Altimont St. (Job #4483) <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 1) Chad Dr from E end to Coburg Rd (Job #4423) 2ZBar~er Dr from Primrose to Terrv St. <br />(Job #4433L) Barger Dr from Highway 99 to Altimont St (Job' #4483) <br />PROJECT NUMBER: 4423 4433, 4483 DATE AWARDED: 05/02/08 <br />CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br />CONTRACTOR CCB#: 695 <br />CONTRACT AMOUNT: $926.017.00 AMOUNT .DUE: ~ 1 ~V ~ ~Z <br />Contract amount x .001 <br />J L\y23 3n'1• ~~g 'c~3 <br />.~ ~~33 ~ Z' 1. 3~ <br />WH-39 (Rev. 11/07) <br />(Please duplicate this form for future use) <br />SCAN /hl D-PWA <br />C3ATE: S[ S D FS <br />INITIALS' :: <br />s `~ :~~ u4 -,. <br />o.,~ .. <br />~ ~~ ~ v ~~ti.feC. ~ ~ ~ ~ ~~ <br />__,.. <br />~~~=t ~.~~w~.R~~ ~- <br />~~9 i7 ~4 5 6l?~ ~ .. ~..:,...,. ......:....::.. <br />S <br />