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=~c~~~~7 <br /> o F o CONTRACT FEE SECTION <br /> ~w 'Q~ PREVAILING WAGE RATE UNIT <br /> ~ * C BUREAU OF LABOR AND INDUSTRIES <br /> a 800 N.E. OREGON ST., #1045 <br /> - ~ 2 PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> [g 59 ~ 'FAX: (971) 673-0769 For Office Usc Oi~l~: <br /> Project D[3 r: <br /> PUBLIC WORKS FEE INFORMATION FORM <br /> For use by public agencies that have confracted with a contractor on a public works project regulated by <br /> OR5.279C.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 BOI;I. 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~ Eu ene-Engineering AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E. Broadway, Suite 40'0 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Jenifer Willer PHONE: (541) 682-5364. <br /> PROJECT NAME: Chad Drive extension from the East end of Chad Drive to North Game Farm Road <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: Chad Drive and North Game Farm Road <br /> PROJECT NO: 3923 (Contract #2009-000271 DATE CONTRACT FIRST ADVERTISED: 4/27/2009 <br /> DATE CONTRACT AWARDED: June 15, 2009 CONTRACTOR CCB#: 62971 <br /> CONTRACTOR BUSINESS NAME (DBA): Babb Construction Co. dba Delta Const. Co. dba Delta Concrete <br /> CONTRACTOR ADDRESS: 999 Division Avenue <br /> CITY, STATE, ZIP: Eugene, OR 97404 ' / <br /> CONTRACT AMOUNT: $ ~y i FEE AMOUNT DUE/PAID: ~lI ~ 9 y <br /> If less than $SOK, is. it part of a larger project? ?yes ?no Contract amount x .001 =fee due ~ 61 <br /> Please du licate this form for future use ~ <br /> ( P ) <br /> <br /> WH-39 (Rev. 03/09) <br /> <br />