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~~b~ a~~ a~ ~/3 . <br /> o F o CONTRACT FEE SECTION <br /> ~Fi 'P~ PREVAILING WAGE RATE UNIT <br /> C BUREAU OF LABOR AND INDUSTRIES <br /> 800 N.E. OREGON ST., #1045 <br /> N f' - ~ _ PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> lf~59 ~ FAX: (971) 673-0769 For Office Use Only: <br /> Project DF3 <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 - En ine Bering AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E. Broadway Suite 400 <br /> CITY, STATE, ZIP: Eugene, OR 97401 - <br /> AGENCY CONTACT PERSON: Lynn Brog;den PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Doug Sineer PHONE: (541) 682-8460 <br /> PROJECT NAME: Pavement Preservation Program - 2009 Slurry Seal Proiect <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: 6 various locations in Eugene <br /> PROJECT NO: 4592 (Contract #2009-00023) DATE CONTRACT FIRST ADVERTISED: April 14, 2009 <br /> DATE CONTRACT AWARDED: June 17, 2009 CONTRACTOR CCB#: 65821 <br /> CONTRACTOR BUSINESS NAME (DBA): Valle Sy lorry Seal Co. <br /> CONTRACTOR ADDRESS: 3785 Channel Drive <br /> <br /> ' CITY, STATE, ZIP: West Sacramento, CA 95691 <br /> CONTRACT AMOUNT: $331,642.50 FEE AMOUNT DUE/PAID: ~ 3 ~ ~ ~ 5? <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due ~ 6~ <br /> 11,~(~~ <br /> (Please duplicate this form for future use) <br /> WH-39 (Rev. 03/09) <br /> <br />