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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 /> PRONE: (971) 673-0852 ~ ~ '~~f ~~1'iy' is <br /> FAX: (971) 673-0769 ~Eo <br /> Of#ice,~ se'~nly~ i <br /> ' v <br /> k <br /> I~~~~~ p ~ ~1 Iit~ ~ i~~- <br /> f! hit ~3Y°sk~="~~`~ <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 /> <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 /> <br /> works fee of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The <br /> <br /> minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the <br /> <br /> bureau may be unable to properly credit you for payment received. <br /> PUBLIC AGENCY: City of Eugene - Engineering AGENCY 1336 <br /> AGENCY CONTACT PERSON: Lvnn Broaden PHONE: (5411 682-5238 <br /> PROJECT MANAGER NAME: Doug Singer PHONE: (5411 682-8460 <br /> MAILING ADDRESS: 99 E Broadwav Suite 400. Eugene. OR 97401 <br /> PROJECT NAME: Traffic Signal Hub Relocation from 858 Peazl Street to 125 E. 8i° Avenue <br /> CONTRACT NAME (if part of larger project): Same as above <br /> PROJECT LOCATION: 858 Peazl Street <br /> PROJECT NUMBER: Job #4578 DATE AWARDED: 3!23!2009 <br /> CONTRACTOR BUSINESS NAME (DBA): Lantz Electric. Inc. <br /> CONTRACTOR CCB#: 84679 <br /> U~ <br /> CONTRACT AMOUNT: $53.943 00 AMOUNT DUE: ~ ~ y <br /> Contract amount x .001 <br /> (Please duplicate this form for future use) <br /> 3~ ~ ~3~v ~i `z <br /> WH-39 (Rev. 11/07) f ~ <br /> <br />