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f- <br /> L <br /> FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: <br /> J Fox Hollow at Amazon Creek Enhancement <br /> Storm Water Project " <br /> City of Eugene Project No. 4524 <br /> Bid Closing: Date: June 11, 2009 Time: 2:00 p.m. <br /> Submit to: 99 E. Broadway, Suite 400, Eugene Oregon 97401 <br /> <br /> j' 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 INFORMATION <br /> ~'~BB CONS7"RUCTION CO" ~ pgA•~ pE~TA CO,NCRFOT~Q~ <br /> Bidder's Name: <br /> Contact Person: Avow Le_e_ `~b~ <br /> Bidder's Telephone Number:_ (~4 ~ ~ egg • ZZ ~ " <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 /> form does not need to be completed, but the form must still 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# Cate ory of Work " <br /> '~dZ c~'" .e~ <br /> chi c ~ n ~ v <br /> 1~ <br /> 3) " <br /> _ _ _ <br /> <br />