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J.. <br /> c.._-- <br /> o F O CONTRACT FEE SECTION <br /> ~Fi PREVAILING WAGE RATE UNIT <br /> Q';' : ~ BUREAU OF LABOR AND INDUSTRIES • <br /> H : ~ ~ O 800 N.E. OREGON ST., #1045 <br /> a - ~ Z PORTLAND, OR 97232-2180 <br /> +~'•~.k,,,.•`~ PHONE: (971) 673-0852 <br /> X859 FAX: (971) 673=0769 For Office LTSe Onh~: <br /> Project DS#: <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: City of Eugene -Public Works Engineering AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E Broadway, Suite 400 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: 541-682-5238 <br /> PROJECT MANAGER NAME: Matt Rodrigues PHONE: 541-682-6036 <br /> PROJECT NAME: 2009 Pavement Preservation Program on Country Club Rd from Willa <br /> ig'llespie Rd to Southwood <br /> <br /> • Ln -Job #4425; Fox Hollow Rd from East Amazon Dr to Donald St -Job #4434• Crescent Ave from Shadow View to <br /> Coburn Rd -Job #4502 <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: Country Club Rd from Willa ig llespie Rd to Southwood Ln -Job #4425• Fox Hollow Rd from <br /> East Amazon Dr to Donald St -Job #4434; Crescent Ave from Shadow View to Coburg Rd -Job #4502 <br /> PROJECT NO: 4425,4434,4502 Cont. 2009-16 DATE CONTRACT FIRST ADVERTISED: 3/18/2009 <br /> DATE CONTRACT AWARDED: 4/23/2009 CONTRACTOR CCB#: 695 <br /> CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br /> CONTRACTOR ADDRESS: PO Box 7428 <br /> CITY, STATE, ZIP: Eu ene OR 97401. <br /> CONTRACT AMOUNT: $811-,846.00 FEE AMOUNT DUE/PAID ~J~ r <br /> If less than $50K,.is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> (Please duplicate this form for future. use) C~ ~ <br /> WH-39 (Rev. 03/09) ~-•j <br /> , <br /> ~ ~l-f ~ <br /> `~4 ~ ~ ~ <br /> <br />