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o F o CONTRACT FEE SECTION <br /> PREVAILING WAGE RATE UNIT ~ p Q o <br /> ~ : C BUREAU OF LABOR AND INDUSTRIES 0 <br /> a ,t 800 N.E. OREGON ST., #1045 <br /> = Z PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> 1869 FAX: (971) 673-0769 For Office Use Only: <br /> <br /> . ~ Pruj~ct DE; - <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 East Broadway, Suite 400 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: David Starns PHONE: (541) 682-8306 <br /> .PROJECT NAME: 2009 Wastewater Rehabilitation Point Repairs at various locations <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION:. Various locations in the City of Eugene <br /> PROJECT NO: 4594 DATE CONTRACT FIRST ADVERTISED: 5/7/2009 <br /> DATE CONTRACT AWARDED: 6/19/2009 CONTRACTOR CCB#: 88084 <br /> CONTRACTOR BUSINESS NAME (DBA): H & J Construction Inc. <br /> CONTRACTOR ADDRESS: PO Box 2432 <br /> CITY, STATE, ZIP: Eugene, OR 97402 <br /> CONTRACT AMOUNT: $296,677.00 FEE AMOUNT DUE/PAID: o2~T(o ~ <br /> If less than $50K, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> (Please duplicate this form for future use) <br /> ~s~~/ <br /> WH-39 (Rev. 03/09) 53 2-' 3 3 2 - lp 1 ~ b '7 ~ e°j~1 so? ~J~ <br /> _ _ _ _ <br /> <br />