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OF <br /> E ; c Oj'1 Bureau of Labor and Industries <br /> _ _ ~ ~ j Brad Avakian <br /> •••9 • Commissioner <br /> <br /> j <br /> January 6, 2009 <br /> CITY OF EUGENE <br /> ENGINEERING DIVISION / BROGDEN <br /> 244 E BROADWAY <br /> EUGENE, OR 97401 <br /> PAYMENT RECEIPT FOR PUBLIC WORKS FEE <br /> (ORS 839-025-0210) . <br /> Name of Project: DELTA PONDS RIPARIAN PLANTING(2009-12) #59769 <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION/ BROGDEN <br /> made a fee payment. of $250 for the public works project named above, based on the contract <br /> awarded to ELMS LANDSCAPE SERVICES TNC (CCB#: 9999991) on 20-Oct-08, leaving a <br /> balance of $0 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 fmal contract price, including change orders and adjustments to the <br /> contract. If the final contract price. varies by $100,000 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 /> PORTLAND EUGENE BEND MEDFORD <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Worksource Bend 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) b73-0763 (541)686-7623 - Bend, OR 97701-4990 {541) 776-6270 <br /> Fax (971) 673-0762 FAX (541) 686-7980 (541) 322 <br /> 2435 PAX (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'a St. <br /> Salem, OR 97305-1268 Pendleton, OR 97801-4101 <br /> {503) 378-3292 www.oregon.gov/boli (541) 276-7s84 ~ <br /> FAX (503} 373-7636 A,N EQUAL OPPORTUNTTY EMPLOYER FAX (541) z76-5767 <br /> <br />