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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 I~,or Office. t;se. Only: <br /> Project D13 <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: Cit o~gene -Engineering AGENCY 1336 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Kris Olson PHONE: (541) 682-5249 <br /> MAILING ADDRESS: 99 E. Broadwav Suite 400. Eugene. OR 97401 <br /> PROJECT NAME: Acorn Park Street sidewalks from 630' south of W. 11'x' Avenue to 360' north of W. 13~' Place <br /> CONTRACT NAME (if.part of larger project): Same as above <br /> PROJECT LOCATION: Acorn Park Street <br /> <br /> .PROJECT NUMBER: Job #4552 DATE AWARDED: 2/11/2009 <br /> CONTRACTOR BUSINESS NAME (DBA): Professional Underground Services <br /> CONTRACTOR C 156231 <br /> CONTRACT OUNT: 45 507.10 AMOUNT DUE: <br /> Contract amount x .001 <br /> (Please duplicate this form for future use) <br /> ~ ~ <br /> <br /> WH-39 Rev. 11/07 ~ ~ ~ <br /> ( ~ C... 5 <br /> .nfi , , <br /> ~ <br /> <br />