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• <br />.�� *rte • <br />regon <br />Bureau of Labor and Industries <br />Brad Avakian <br />Commissioner <br />August 4, 2009 <br />CITY OF EUGENE <br />ENGINEERING DIVISION <br />99 E BROADWAY STE 400 <br />EUGENE, OR 97401 <br />PAYMENT RECEIPT FOR PUBLIC WORKS FEE <br />(ORS 839 -025 -0210) <br />Name of Project: CREST DRIVE NEIGHBORHOOD STREET IMPROVEMENTS #61626 <br />This certificate is proof the CITY OF EUGENE, ENGINEERING DIVISION made a fee <br />payment of $2120.41 for the public works project named above, based on the contract awarded <br />to DELTA CONCRETE (CCB #: 6297 1) on 2- Jul -09, leaving a balance of $0 for this contract. <br />As required by ORS 2790.825 and OAR 839 -025 -0210, the agency shall, upon completion of <br />the c P P <br />contract, determine the final contract price, including change orders and adjustments to the <br />contract. If the final contract price varies by $100,000 or more, the agency shall submit any <br />additional payment or request for refund of fees, using form WH -40, to the bureau within 30 <br />days of final payment to the contractor by the agency. <br />AUG 0 6 2009 <br />PORTLAND EUGENE BEND MEDFORD <br />800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Worksource Bend 119 N Oakdale Ave. <br />Portland, OR 97232 -2180 Eugene, OR 97401 -2158 1645 NE Forbes Rd, Ste 106 Medford, OR 97501 -2629 <br />(971) 673 -0763 (541) 686 -7623 Bend, OR 97701 -4990 (541) 776 -6270 <br />Fax (971) 673-0762 FAX (541) 686 -7980 (541) 322 -2435 FAX 541 <br />TTY (971) 673 -0766 FAX (541) 389 -8265 3 776 - 6284 <br />SALEM PENDLETON <br />3865 Wolverine St. NE; E -1 1327 SE 3rd St. <br />Salem, OR 97305 -1268 Pendleton, OR 97801 -4101 <br />(503) 378 -3292 www.oregon.gov /boh (541) 276 --7884 <br />FAX (503) 373 -7636 AN EQUAL OPPORTUNITY EMPLOYER FAX (541) 276 -5767 <br />If <br />L -•3 <br />