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old 3 <br /> ~0 <br /> o F o CONTRACT FEE .SECTION <br /> ~4i PREVAILING WAGE RATE UNIT <br /> ~ : C BUREAU OF LABOR AND INDUSTRIES <br /> 800 N.E. OREGON ST., #1045 <br /> m - ~ Z PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> 1~~59 FAX: (971) 673-0769 For Ofi'ice Usc Only: <br /> Project D[3'--`: <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 ineering AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E. Broadwav Suite 400 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Adam Steffen PHONE: (541) 682-5040 <br /> PROJECT NAME: Fire Station 8 parking lot resurfacing located at 500 Berntzen Road <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: 500 Berntzen Road <br /> PROJECT NO: 4595 (Contract #2009-000231 DATE CONTRACT FIRST ADVERTISED: April 14, 2009 <br /> DATE CONTRACT AWARDED: June 18, 2009 CONTRACTOR CCB#: 64344 <br /> CONTRACTOR BUSINESS NAME (DBA): Scott Brown Construction Inc. <br /> CONTRACTOR ADDRESS: PO Box 7882 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> CONTRACT AMOUNT: $81,681.05 FEE AMOUNT DUE/PAID:~~ .,)C?a <br /> If less than $50K, is it part of a larger project? ?yes ?no - Contract amount x .001 =fee due , <br /> ~h <br /> (Please duplicate this form for future use) ~~~1 <br /> r ; 31 i - 9 3 3l~ - ~d~ `~7~~3 Z <br /> <br /> WH-39 (Rev. 03/09) <br /> <br />