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F <br /> ~ ° <br /> . <br /> <br /> ~ ~ a Bureau of Labor and Indu ' <br /> stries <br /> N *z <br /> f - <br /> r+ .r;* <br /> Bead Avakian <br /> y 1$ 5 g Commissioner <br /> July 2, 2009 <br /> CITY GF EUGENE <br /> ENGINEERING DIVISION <br /> 99 E BRQADWAY STE 400 <br /> EUGENE, aR 97401 <br /> P <br /> AYMENT RECEIPT F <br /> ~R PUBLI~'~V~RK <br /> S FEE <br /> (SRS 839-025-0210 <br /> Name of Project: FIRE STATION 8 PARKING LQT RESURFACIN <br /> G~SOOBERNTZEN <br /> #61348 <br /> This certificate is proof the CITY QF EUGENE, ENGINEERING DIVISION made a fee <br /> payment of $250 for the public works project named above, based on the contract awar <br /> ded to <br /> SCGTT BROWN CQNTRUCTIQN INC ~CCB#: 64344 on 18wJun-09 leavin <br /> , } g a balance of $0 <br /> for this contract. <br /> As required by GRS ~79C.825 and QAR 839-0~5-0210, the agent shall u on tom letion of <br /> Y ~p p <br /> the contract, determine the final contract price, includin than e orders and ad'ustm <br /> g g ~ ents to the <br /> contract. If the final contract price varies by $140,000 or more, the a enc shall submit an <br /> g Y y <br /> add~tlonal payment or request far refund of fees, using form WH-40 to the bureau within 3 <br /> s o <br /> days of final payment to the contractor by the a enc . <br /> g Y <br /> 3 <br /> E <br /> i <br /> { <br /> i <br /> i <br /> 3 <br /> PORTLAND EUGENE BEND MEDF4RD <br /> 800 NE Oregon 5t. Suite 1x45 1400 Executive Parkway, Suite 200 Woxksource Bend 119 N nakdale Ave. <br /> Portland, QR 97232-2180 Eugene, 4R 97401-2158 1645 NE Forbes Rd, Ste 106 Medford, 4R 975012629 <br /> (971) 673-0761 (541) 686-7623 Bend, flR 97701-4990 (541} 776-b27Q <br /> Fax (971) 673-0762 FAX (541) .686-7980 (541} 322-2435 FAX (541} 776-6284 <br /> Oregon Relay TTY (800} 735-2900 FAX (541} 389-8265 ~ <br /> E <br /> SALEM PENDLETON <br /> 3865 Wolverine St. NE; E-1 1327 5E 3ra St <br /> Salem 4R 97305-1268 ~ <br /> ' Pendleton, 0R 97801-4101 <br /> (503} 378-3292 WWW.OregOn.gOV~bOIi (541) 276-78$4 <br /> E <br /> FAX (503} 373-7b3b AN EQUAL OPP~RTUNtTY EMPLOYER FAX (541} 276-5767 <br /> 1 <br /> <br />