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of o <br /> h~ <br /> <br /> ~ o Bureau of Labor and Industries <br /> N ' ~ - ~ Brad Avakian <br /> •*~~R <br /> .R Commissioner <br /> x859 <br /> July 2, 2009 <br /> CITY GF EUGENE <br /> ENGINEERING DIVISIGN <br /> 99 E BROADWAY STE 400 <br /> EUGENE, GR 97401 <br /> PAYNIE <br /> l~T RECEIPT FAR PUBLI <br /> C '~V(~RKS FEE <br /> ~oRS s~~-oZS-o~lo <br /> E <br /> Name of Praj ect: 2009 PAVEMENT PRESERVATION PRGGRAM 1 <br /> GARFIELD ST #61350 <br /> This certificate is proof the CITY aF EUGENE ~ ENGINEERING DIVISIG <br /> N made a fee <br /> payment of $789.59 for the ublic works ro'ect named above based on t <br /> p p ~ he contract awarded to <br /> '~VILDISH OGNSTRUCTIGN C4 ~CCB#: 695 on 15-Jun-09 leavin a balance of 0 for <br /> g $ this <br /> contract. <br /> As required. by GRS 2790.825 and QAR 839-025-0210, the agency shall, upon com letian of <br /> p <br /> the contract, determine the f nal contract price, including change orders and ad'ustments to the <br /> J <br /> contract. If the final contract price varies by $100,000 or more, the a enc shall submit an <br /> g Y Y <br /> add~t~onal payment or request for refund of fees, using form WH•40, to the bureau within 30 <br /> days of final payment to the contractor b the a enc . <br /> Y g Y <br /> 3 <br /> i <br /> i <br /> i <br /> i <br /> 3~ <br /> 3 <br /> PORTLAND EUGENE BEND MEDFORD ~ <br /> SOa NE Oregon St. Suite 1045 14aa Executive Parkway, Suite 200 Worksaurce Bend 119 N Oakdale Ave. <br /> Portland, OR 97232-218a Eugene, OR 974x1-2158 1645 NE Forbes Rd, Ste 1x6 Medford, OR 97501-2629 j <br /> X971} 673-0761 X541} 686-7623 Bend, OR 97701-4990 (541} 776-6270 <br /> Fax X971} 673-x762 FAX X541} 686-798a (541} 322-2435 FAX (541) 776-6284 ~ <br /> Oregon Relay TTY ~SOa} 735-29aa FAX X541} 389-8265 <br /> SALEM PENDLETON ~ <br /> 3865 Wolverine St. NE; E-1 1327 SE 3rd St. <br /> Salem, OR 97305-1268 Pendleton, OR 978x1-4101 <br /> (503) 378-3292 wwW,oregOn.gov/boll X541} 276-7884 <br /> FAX ~5a3} 373-7636 AN EQUAL ~PP~RTUN~TY EMPLQYER FAX (541} 276-5767 f <br /> 1 <br /> 3 <br /> I <br /> <br />