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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: 2009 Pavement Preservation Program on West 1 l~' Avenue <br /> from Garfield Street to Tyinn Street -Job #4340, 6~' and 7~' <br /> Avenues from High Street to Washington Street Job #4529 <br /> City of Eugene Project No. 4340 & 4529 <br /> . Bid Closing: Dater May 27, 2009 Time: 2:00 p.m. <br /> Submit to: 99 E. Broadway, Suite 400, Eugene Oregon 97401 <br /> Disclosure Deadline: 2:00 p.m. -This form must be submitted by bid closing date <br /> and time. ' <br /> Bidders are required to submit a first tier subcontractor disclosure form, substantially as described in <br /> ORS 279C.370, prior to the Bid Closing Date and time. For this project the First-Tier <br /> Subcontractor Disclosure Statement must be submitted regardless of the bid amount. <br /> BIDDER INFORMATION ' <br /> Bidder's Name: WILDISH CONSTRUCTION CO. <br /> Contact Person: JOE WORTH <br /> Bidder's Telephone Number: 5 41- 4~ 5-17 0 9 <br /> ? Check here if the bid amount less deductive alternates, if any, is $100,000 or less. If the bid <br /> amount less deductive alternates, if any, is equal to or less than $100,000, the remainder of the <br /> form does not need to be completed, but the form must still be submitted. <br /> List below the Name, Dollar Value, and Construction Contractors Board ("CCB") License Number, <br /> and Category of Work that will be performed by each subcontractor that will be furnishing labor, or <br /> labor and materials. Enter "NONE" xf there are no subcontractors that need to be disclosed (IF <br /> NEEDED, ATTACH ADDITIONAL SHEETS). <br /> Name/Address Dollar Value/CCB# Category of Work <br /> <br /> . <br /> r~oQ~ ~w 0 ©©9' 138~g, <br /> . ~ . <br /> 2) <br /> 3) <br /> <br />