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FIIZST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Chad Drive Extension from the East End of Chad Drive to <br /> . North Game Farm Road <br /> City of Eugene Project No. 3923 <br /> -Bid Closing: Date: May 19, 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 /> ~O~STRUCTION CO.>D A: DELTA CONGF~~T® <br /> Bidder's Name: <br /> Contact Person: pct, ~c~sp r1 <br /> Bidder's Telephone Number: ~~g-?Z, <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" if 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 /> 1) ~N ~ ~ ~ iV~R 1 ~jC~ <br /> ,~Ob ~#Z t O ~ ~-SPHC~.-nC ~oNc¢x~. <br /> Jaoe t~yis~oN Avg. <br /> . 2) LQrI-r~ j-i~Fcruc ~ 19~~}48 /-~i~ SrrE. ~~~c,~~ <br /> 39 53 ~I ~ <br /> . ORS <br /> <br /> . 3) <br /> <br />