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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Fire Station 8 Parking Lot Resurfacing located at 500 <br /> Berntzen Road <br /> City of Eugene Project No. 4595 <br /> Bid Closing: Date: April 28, 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: ~ c o`t t-'~ C~s~f c'T`~f ~ <br /> Contact Person: ~ ca~ ~ <br /> Bidder's Telephone Number:~~ ~'77ld 6 ~ -C~~6t~ <br /> Check here if the bid amount less deductive alternates if an is $100 000 or less. If the bid <br /> Y> > <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" if there are no subcontractors that need to be disclosed (IF <br /> <br /> NEEDED, ATTACH. ADDITIONAL SHEETS). <br /> Name/Address Dollar Value/CCB# Category of Work <br /> LL ~ s4'V't ~ ~ <br /> 2) <br /> 3) <br /> <br />