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D~ <br /> 0 <br /> ~w ~ <br /> R ' <br /> <br /> ~ * ~ o Bureau of Labor and Industries <br /> kA <br /> ~ + ~ Brad Avakian <br /> Commissioner <br /> 85~ <br /> July 2, 2009 <br /> CITY OF EUGENE <br /> ENGINEERING DIVISION <br /> 99 E BROADWAY STE 40D <br /> EUGENE, OR 974D 1 <br /> PAY <br /> MENT RECEIPT FAR P <br /> UBLIC Wt~RKS FEE <br /> ~~RS $39-OZ5-0210 <br /> Name of Project: PAVEMENT PRESERVATION PROGRAM-200 <br /> 9 SLURRY SEAL PRG <br /> #61347 <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION made a fee <br /> payment of $331.65 for the public Works ro'ect named above based on the c <br /> p J ontract awarded to <br /> VALLEY SLURRY SEAL COMPANY ~CCB#: 65$21 } on 17-Jun-D9, leavin a balance of $ 0 <br /> F g <br /> for this contract. <br /> As required by ORS 2790.525 and OAR 539-025-D21 D the a enc shall u ' <br /> g y pon completion of <br /> the contract, determine the final contract rice, includin than e orders and ad' <br /> p g g Justments to the <br /> contract. If the final contract price varies by $1 OD,DOD or more the a enc shall submit an <br /> ~ g Y y <br /> addlt~onal payment or request far refund of fees, using form WH-4D, to the bureau within 30 <br /> days of f nal payment to the contractor by the agency. <br /> 1 <br /> I <br /> i <br /> I <br /> E <br /> PORTLAND EUGENE BEND MEDFOI~D <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Warksource Bend 119 N Oakdale Ave. <br /> Portland, OR 97232 <br /> 2180 Eugene, OR 97401-2158 1645 NE Forbes Rd, Ste 1.06 Medford, OR 975012629 <br /> (971} 673-0761. <br /> (541} 686-7623 Bend, OR 97701-4990 X541) 776-6270 <br /> Fax X971) 673-0762 FAX X541) 686-7980 X541} 322 <br /> 2435 FAX X541) 776-6284 <br /> Ore an Rela TTY 800 735-2900 <br /> g Y ~ ) FAX X541) 389-8265 <br /> f <br /> ~4 <br /> SALEM PENDLET4N <br /> 3865 Wolverine St. NE; E-1 1327 SE 3ra St. <br /> Salem, OR 97305-1268 Pendleton, OR 97801-41,01 <br /> (503) 378-3292 WWW.oregon.gOV~bO~.i X541) 276-7$84 <br /> FAX (503} 373-7636 <br /> AN EQUAL OPPORTUNITY EMPLOYEE. FAx (~4~) 276-5767 <br /> <br />