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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR 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 />I?or Office Use Oiily: <br />Project DL3 ~: <br />PUBLIC WORKS- FEE ADJUSTMENT FORM <br />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 />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 final 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 />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 />(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 />