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<br /> ' .1 <br /> FIRST-TIER SUBCONTRACTOR`DISCLOSURE STATEMENT <br /> Project Title: 2009 WASTEWATER PIPE REPLACEMENT BASINS <br /> DC3 1, DC32, DW 14, AND DW 15 AT VARIOUS <br /> LOCATIONS IN THE CITY <br /> City of Eugene Project No. 4638 <br /> Bid Closing: Date: June 30, 2009 Time: 2:00 p.m. <br /> Submit to: 99 E. Broadway, Suite.400, 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 tl~e bid amount. ' <br /> BIDDER INFORMATION ' <br /> Bidder's Name:; ~ ~ L.ca ~®~~;5 2~+v oU C.. c~ . <br /> Contact Person: ~o ~ e i .S <br /> Bidder's Telephone Number: ,~U 3 - ;3 6 ~ ` Z. G,.3 8 <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# Category of Work <br /> t <br /> 3) <br /> <br />