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~ <br /> FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT . <br /> ' Project Title: 2009 Pothole Repair Project on Riverview St from E 16~' Ave <br /> to Floral Hill Dr and Floral Hill Dr from addresses 3087-2855 <br /> Cross Street from Garfield St to Cleveland St <br /> City of Eugene Project No. 4624 <br /> Bid Closing: Date: May 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~ ! Iti'Z ~C:w~ t__C;~~-~~.~~- E lost ~L~~~~~~ ~ ~~c~~~;~~~ <br /> i <br /> Contact Person: e ~Ce ~ Y" vc~ c~_, S ~ ~ ~ ~ ~ ~ . <br /> Bidder's Telephone Number: ~ ~ ~ ~ ~5 <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 fuLrnishing 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 /> 2) <br /> <br /> _3) <br /> <br />