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F <br /> <br /> F * ~ . , o Bureau of Labor and Yndustries <br /> ~M <br /> N x Brad Avakian <br /> i$ 5 9 Commissioner <br /> July 2009 <br /> CITY GF ~ EUGENE <br /> ENGINEERING DNISIGN <br /> 99 E BRGADwAY STE 400 <br /> EUGENE, GR 97401 <br /> PAYMENT RECEIPT F <br /> ~R PUBLIC ~~RKS F <br /> EE <br /> (SRS S39-U25-421 <br /> Name of Pro'ect: 2009 PAVEME <br /> J NT PERSERVATIGN PRGGRAM 1 BERTELSEN #61349 <br /> This certificate is proof the CITY GF EUGENE ENGINES <br /> RING DIVISIGN made a fee <br /> payment of $878.66 for the public works ra'ect named above based an th , <br /> P J e contract awarded to <br /> ~VILDISH CGNSTRUCTIGN CG ~CCB#: 695 on 15-Jun-09, leavin a balance of 0 far thi <br /> g $ s <br /> contract, <br /> As required by GRS 279C.825 and GAR 839-0250210 <br /> the agency shall, upon completion of <br /> the contract, determine the final contract price, includin chan e orders and ad'ustm <br /> g g J ents to the <br /> contract. If the final contract price varies by $100,000 or more, the a enc shall submit an <br /> g Y y <br /> additional payment or request for refund of fees, using farm WH-40, to the bureau within ~30 <br /> days of final payment to the contractor by the a enc , <br /> g Y <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 972322180 Eugene, OR 97401.2158 1645 NE Farber Rd, Ste 106 Medford, OR 97501-2629 <br /> (971} 673-0761 (541} 686-7623 Bend, OR 977'01-4990 X541} 776-6270 <br /> Fax (971} 673-0762 FAX X541} 686-7980 <br /> X541} 322 <br /> 2435 FAX X541} 776-6284 <br /> Oregon Relay TTY X800} 7352900 FAX X541} 389-8265 <br /> SALEM PENDLET4N <br /> 3865 Wolverine St. NE; E-1 1327 SE 3rd St. <br /> Salem, OR 97305-1265 Pendleton, OR 97801-4101 <br /> X503} 378-3292 www Oregon. ov/boli 541 276-7884 <br /> FAX X503} 373-7636 g ~ } <br /> AN EQUAL ~PPGP.TUNITY EMPLOYER FAX X541} 276-5767 <br /> ,f <br /> <br />