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o f o CONTRACT FEE SECTION ~®v" l 1 i <br /> ~4i 'P~ PREVAILING WAGE RATE UNIT <br /> : ~ BUREAU OF LABOR AND INDUSTRIES <br /> N = `s D 800 N.E. OREGON ST.; #1045 ~ <br /> ' m = - Re Z PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> 185`J FAX: (971) 673-0769 For Ofi'ice l;'sc Only: <br /> I'rojcct I~F3 <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-Engineering AGENCY 1336 <br /> ..AGENCY MAILING ADDRESS:, 99 E: Broadway <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynri Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Doug_Singer PHONE: (541) 682:-8460 <br /> PROJECT NAME: PMB Amazon Path Rehabilitation project from 19`f' Avenue to 31S` Avenue <br /> CONTRACT NAME (if part of larger project): . <br /> PROJECT LOCATION: Amazon Path from 19~' Avenue to 31S` Avenue <br /> PROJECT NO: 4602 DATE CONTRACT FIRST ADVERTISED: 5/19/2009 <br /> DATE CONTRACT AWARDED: June 26 2009 CONTRACTOR CCB#: 166194 <br /> CONTRACTOR BUSINESS NAME (DBA): KSH Construction Co. <br /> CONTRACTOR ADDRESS: PO Box 21431 <br /> CITY, STATE, ZIP: Keizer. OR 97307 <br /> CONTRACT AMOUNT: $366 366.00 FEE AMOUNT DUE/PAID: 33 Za .3'7 <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> (Please duplicate this form for future use) <br /> 3 ~{3 - q 3 3z - ~ r 95' s ~1 <br /> WH-39 (Rev. 03/09) <br /> <br /> - _ _ _ _ <br /> <br />