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OF ~ <br /> 'Q <br /> .c Bureau of Labor and Industries <br /> regOn <br /> Brad Avakian <br /> Convnissioner - <br /> •78594 <br /> September 26, 2008 <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: NORTH GAME FARM ROAD #59921 <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION / BROGDEN <br /> made a fee payment of $438.95 for the public works project named above, based on the contract <br /> awarded to DELTA CONSTRUCTION OR CONCRETE (CCB#: 62971) on OS-SEP-08, leaving <br /> a 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 final contract price; including change orders and adjustments to the <br /> contracf. 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, o the bureau within 30 <br /> days of final payment to the contractor by the agency. <br /> PORTLAND EUGENE BEND MEDFORD <br /> <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) 673-0763 (541) 686-7623 Bend, OR 97701-4990 (541) 776-6270 <br /> Fax (971) 673-0762 FAX (541) 686-7980 (541) 322-2435 FAX (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)276-7884 OCT 02 2~8 <br /> FAX (503) 373-7636 AN EQUAL OPPORTUNITY EMPLOYER FAx (541) 276-5767 <br /> <br />