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1~ <br /> ~ ~ ° <br /> ~w ~ <br /> <br /> ~ ~ o Bureau of Labor and industries <br /> rr~~ <br /> Brad Avakian <br /> • • • Cammissione~ <br /> 1859 <br /> July 22, 2009 <br /> CITY OF EUGENE <br /> ENGINEERING DIVISION <br /> 99 E BROADWAY STE 400 <br /> EUGENE, 0R 97401 <br /> PAY <br /> MENT RECEIPT FAR PUBLIC WU <br /> RKS FEE <br /> ~~RS 839-UZ5-OZl~ <br /> Name of Project: PMB .AMAZON PATH REHABILITATION PROJECT 19TH-31ST #6152 <br /> 2 E <br /> This certificate is proof the CITY OF EUGENE, ENGINEERING DNISION made a fee <br /> payment of $336.37 for the public works project named above based on the contract awarde <br /> d to <br /> KSH CONSTRUCTION CO CCB#:166194 on 26~Jun-09 leavin a <br /> ~ } balance of $30 for this <br /> contract. <br /> As required by ORS 279C.S25 and OAR 839-025-0210, the agency shall, upon completion of <br /> the contract, determine the final 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 /> 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 /> The contract amount was $366,366.00 X .OOI = $366.37 fee due <br /> $336.37 was paid ~eaving $30.00 due <br /> f <br /> E <br /> I <br /> f <br /> PORTLAND EUGENE BEND ~ ~ ~ MEDFORD <br /> 800 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Warksource Bend 119 N Oakdale Ave. <br /> Portland, OR 97232 2180 Eugene, OR 97401-2158 1b45 NE Forbes Rd, Ste 10b Medford, OR 975012b29 <br /> X971} b73-07b1 X541} b8b-7b23 Bend, OR 97701-4990 <br /> X541} 77b-b270 <br /> Fax X971} b73-07b2 FAX (541} b8b-7980 X541} 322-2435 FAX (541} 77b-b284 <br /> Oregon Relay TTY X500} 735-2900 FAX (541) 389-82b5 <br /> SALEM <br /> PENDLETON <br /> 38b5 Wolverine St. NE; E-1 1327 SE 3rd St. <br /> Salem, OR 97305-12b8 Pendleton, OR 97801-4101 <br /> (503} 378-3292 WWW.oregon.goV~bO~~ X541} 27b-7884 n ~ <br /> FAX X503} 373-7b3b FAX 541 27b-57b7~~~ ~ ~ 2009 <br /> AN EQUAL OPPORTUNITY EMPLOYER ~ } <br /> <br />