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OF <br /> ~ O F <br /> <br /> F ~ ' o Ye On Bureau of Labor and Industries <br /> " ' - - ' _ ~ j j Brad Avakian <br /> l a 5 9'~ Commissioner <br /> t <br /> r. <br /> I <br /> December 16, 2008 <br /> CITY OF EUGENE j <br /> ENGINEERING DIVISION / BROGDEN <br /> 244 E BROADWAY <br /> EUGENE, OR 97401 <br /> _ ~ <br /> PAYMENT RECEIPT FOR PUBLIC WORKS FEE <br /> (ORS 839-025-0210) <br /> Name of Project: GOLDEN GARDENS PONDS IMPROVEMENTS #59303 <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION / BROGDEN <br /> made a fee payment of $926.93 for the public works project named above,. based. on the contract <br /> awarded to KSH CONSTRUCTION CO (CCB#: 166194) on 20-Jun-08, leaving a balance of $0 <br /> 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 $ l 00,000 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 /> :F,ORTLAND , ; , _ ..EUGENE . BEND MEDFORD <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200. VJorksource Berid 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=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-1 1327 SE 3~d St. <br /> Salem, OR 97305-1268 Pendleton, OR 97801-4101 <br /> (503) 378-3292 WWW.OTegOri.gOV~b011 (541) 276-7884 <br /> FAX (503) 373-7636 A1~1 EQUAL OPPORTUNITY EMPLOYER FAX. (541) 276-5767 <br /> <br />