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o F CONTRACT FEE SECTION Z®(~ ~ ~ 1''~ '1 <br /> ~~ii ~'Q~ PREVAILING WAGE RATE UNIT <br /> F i G BURE <br /> 00 N E OREGON D IN#1045 RIES <br /> ~ - ~ - R Z PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852. <br /> 1859 FAX: (971) 673-0769 For Officc Usc Oul~~: <br /> 1'ri>jcci Df3 <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 Eu e'- <br /> n~e-En ineering AGENCY.#: 1336 <br /> <br /> ` AGENCY MAILING ADDRESS: 99 E. Broadway <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: L ny n Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Matt Rodriuges PHONE: (541) 682-6036 <br /> PROJECT NAME: 2009 Pothole Repair project on Riverview St from E. 16~` Ave. to Floral Hill Dr. and Floral Hill Dr. <br /> from addresses 3087-2855• Cross St. from Garfield St. to Cleveland St <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: Riverview-St-from E. 16~` Ave to Floral Hill Dr. and Floral Hill Drive from Addresses 3087- <br /> 2855• Cross St from Garfield St to Cleveland St <br /> PROJECT NO: 4624 DATE CONTRACT FIRST ADVERTISED: 5/14/2009 <br /> DATE CONTRACT AWARDED: June 26, 2009 CONTRACTOR CCB#: 150240 <br /> CONTRACTOR BUSINESS NAME (DBA): CPM Development dba E~~e Sand & Gravel <br /> CONTRACTOR ADDRESS: PO Box 1067 <br /> CITY, STATE, ZIP: Eugene, OR 97440 <br /> CONTRACT AMOUNT: $151,610.00 FEE AMOUNT DUE/PAID: Ob <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> WH-39 (Rev. 03/09) ~ ~ ~c31~ ' C.vo~~'~ 3i <br /> <br />