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o F o CONTRACT FEE SECTION <br /> 'Q~ PREVAILING WAGE RATE UNIT <br /> 4 r _ ~ ~ BUREAU OF LABOR AND INDUSTRIES <br /> j a ' z 800 N.E.. OREGON ST., #1045 <br /> PORTLAND, OR 97232-2180" For Office Usc Only: <br /> ~8 5 9 PHONE: (971) 673-0852 <br /> FAX: (971) 673-0769 Project DB <br /> I <br /> PUBLIC WORKS FEE ADJUSTMENT FORM <br /> li THIS FORM TO BE USED FOR RECONCILIATION OF FEES UPON COMPLETION OF <br /> PUBLIC WORKS PROJECTS <br /> (As required by ORS 279C.825 and OAR 839-025-0210) <br /> PUBLIC AGENCIES: Complete and mail this form to BOLI at the above address after completion of the public work project <br /> and not less than 30 days after the final progress payment is made to the contractor. Public agencies are required to determine <br /> j the final contract price, including all change orders or other adjustments to the original contract price, and to calculate the <br /> adjusted prevailing wage rate fee based on the revised contract price. Documentation must be included to support the final <br /> contract price. Documentation of the final contract price may consist of change orders or other contract documents <br /> substantiating the amount of the contract. The prevailing wage rate fee of one-tenth of one percent (.001) shall be applied to <br /> .the fmal contract price, with credit taken for fees already submitted. The public agency must submit any additional fee payable <br /> to BOLI, or submit any request for refund, with this adjustment form. NO ADDITIONAL FEE IS REQUIRED TO BE <br /> PAID, AND REFUNDS WILL NOT BE MADE, FOR RECONCILED AMOUNTS OF LESS THAN $100.00. <br /> PUBLIC AGENCY: AGENCY <br /> AGENCY CONTACT PERSON: PHONE:( ) <br /> MAILING ADDRESS: <br /> PROJECT NAME: <br /> CONTRACT NAME.(if part of larger project): <br /> PROJECT NUMBER: PROJECT LOCATION: <br /> <br /> t~ CONTRACTOR/BUSINESS NAME (DBA): <br /> CONTRACTOR CCB#: DATE AWARDED: <br /> FINAL CONTRACT/PROJECT AMOUNT: FINAL FEE DUE: <br /> (Include all change orders and adjustments to the contract price) (Final Contract amount X <br /> .001) <br /> ORIGINAL CONTRACT AMOUNT: INITIAL FEE PAID: <br /> <br /> ,I' <br /> (Original Contract amount X .001) <br /> TOTAL ADJUSTMENT: BALANCE DUE*:' <br /> or <br /> REFUND DUE*: <br /> *Final contract fee less initial fee paid <br /> Sample Calculation: <br /> Final Contract Amount: $ 400,000.00 Final Fee Due: $ 400.00 <br /> Original Contract Amount: - 300.000.00 Initial Fee Paid: - 300.00 <br /> Total Adjustment: $100,000.00 Additional Amount Due: $100.00 <br /> (Please duplicate this form for future use) <br /> WH-40 (Rev. 11/07) <br /> <br />