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~~o. <br /> FIRST-TIER SUBCONTRACTOR DISCLOSURE STATElYIENT. <br /> Project Title:. PBM Bailey Hill Road from W 18~' Avenue to Berkelsen Road <br /> .City of Eugene Project No. 4585 <br /> Bid Closing: Date: Apri17, 2009 Time: 2:00 p.m. <br /> Submit to: ~ 99 E. Broadway, Suite 4.00, 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 INFORMATIbN <br /> ' - Bidder's Name: ~b1/I D~ Jim-- <br /> Contact Person: ' . 1~I11~~- ,~.~~~,c,+~t7~~ <br /> Bidder's Telephone.Number: ,~~f -1jt5 <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 /> <br /> ' form does not need to be completed; but the form must sfill 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 /> ~c ~~~~~`~-5 ~~7 ~ ~7~ ~~'y C~~:~t~- GIB <br /> 3~i~t ~e~S ~7a ~ ~lQf~~4~ <br /> , ems. ~i <br /> l~ - , <br /> :J <br /> ~ ~~z~,~ Gt~y f~< <br /> <br />