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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 ~~up~~'~ (~i ~~ij:)jfi-~1~`=L~ ~~,,*"i~? <br /> FAX: (971) 673-0769 Por~OfficetUse~Only z,; <br /> i~~(3~ ~~x. Li lfl3 ,irr <br /> Pro3ect DB~~ii~-~ ~ ~ ~ N!. <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, is 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 BOLL. The <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: Citv of Eueene - Eneineerinp AGENCY 1336 <br /> <br /> AGENCY CONTACT PERSON: Lynn Broeden PHONE: 15411 682-5238 <br /> PROJECT MANAGER NAME: Kris Olson PHONE: (541) 682-5249 <br /> MAILING ADDRESS: 99 E Broadway Suite 400 Eueene OR 97401 <br /> PROJECT NAME: Storm improvements on Sorrel Wav from Walnut Lane to Roan Drive <br /> CONTRACT NAME (if part of larger project): Same as above <br /> PROJECT LOCATION: Sortel Wav from Walnut Lane to Roan Drive <br /> PROJECT NUMBER: Job #4540 DATE AWARDED: 3/17/2009 <br /> CONTRACTOR BUSINESS NAME (DBA): Camrock Excavation. [nc <br /> CONTRACTOR CCB#: 141879 <br /> CONTRACT AMOUNT: $249 360 00 AMOUNT DUE: } ~ ~V CX> <br /> Contract amount x .001 <br /> `3 ( Q' 8 ~ Z SCE <br /> (Please duplicate this form for future use) <br /> WH-39 (Rev. l1/07) <br /> <br />