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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LA$OR AND INDUSTRIES <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />hor Office Use. Only: <br />Project DB ~k: <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: AGENCY #: <br />MAILING ADDRESS: <br />AGENCY CONTACT PERSON: <br />PHONE: ( ) <br />PROJECT MANAGER NAME: PHONE: ( ) <br />PROJECT NAME: <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: <br />PROJECT NUMBER: DATE AWARDED: <br />CONTRACTOR BUSINESS NAME (DBA): <br />CONTRACTOR CCB#: DATE CONTRACT 1ST ADVERTISED: <br />CONTRACT AMOUNT: AMOUNT DUE: <br />Contract amount x .001 <br />(Please duplicate this form for future use) <br />WH-39 (Rev. 07/08) <br />