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C~NTIiACT FEE SECTION <br /> PREI~AILINC 1~VAGE BATE UNIT <br /> BUREAU DF LAROR AND INDUSTRIES <br /> w 80tI N.E. UR1fGQ~f T., #11I45 <br /> , _ , <br /> ' PURTLAND, 9732-~1$~ <br /> + rr <br /> r*r'. PRUNE, {97I~ ~7~-a$~2 ~ t.° . ~ <br /> t :1 ° <br /> FAX. {971) 6?3-U7b9 , ;'fur I~fllce '~~~~3uly. fy <br /> ~s~ <br /> Pro~ec~ DB <br /> P~1BLI' V4~ORI~ FEE INF~RI~AT~~N ~~R11~ <br /> For use by public agencies that have contracted with a contractor on a public works project regulated by <br /> ORS Z79C.80~ to 279C.8"TII, in eompGance with QR 279C.825. Also far use lay public agencies that are a <br /> gar#y to a public works project pursuant to ORS 27C.840(b~{a){B~ or {C). <br /> PUBLIU AGENCIES; Please complete and mail this form to SOLI at the above address, al~~g with the public <br /> works fc~ of one-tenth of one percent ~f the contract price {contract amount x .001}, payable to BDLI. The <br /> minimum fie is ~50.D~; the maximum fee is ~7,500.~0. Without the follawirtg completed t~f~rmation, the <br /> bureau maybe unable to properly credit you For payment received. <br /> PU$LIC AGENCY: City o~~ene - En~ine~rlflQ AGENCY 133 <br /> AGENCY MAILING ADDRESS: 99 E~ Broadway <br /> CITY, STATE, Z1P: E~~ene, OR 97401 - _ _ <br /> AGENCY CONTACT PER5UIt1; I~ynn Brn~den _ PRUNE; (54l] ~~-5235. <br /> PROJECT MANAGER l1lAlIr1E: Adam t den I~HUN~:: ~541~ 6~2-5440 <br /> PROJECT NAIVE; Alton Baker Park Lot S access driv~2720 Lea Harris Parkway _ <br /> CONTRACT NAME {if part of larger project}: - <br /> PROJECT LOCATIUN: Alton Baker Park <br /> PROTECT [Y0: 4~I2 ~C~~tract #2014-000 IIATE CONTRACT FIRST ADVERTISED: 7123#2009 <br /> DATE C~I~TRACT A1~VARDED; 811912D09 C~NTRACT~R CCB#: 17797 <br /> <br /> CONTRACTOR BUSINESS NAME {DBA}: Eugene Sand Construction, Inc. <br /> CONTRACTOR ADDRESS; PC Box 107 <br /> <br /> CITY, STAVE, SIP: Eu~er~e, Ore~an 97440 <br /> o~ <br /> <br /> CONTt~ACT AMOUNT: ~5~ 20$,50 FEE AMOUNT DEEIPAID: <br /> If ies~ than SDK, is it part afa larger project? ?yes ?no Contract amount x .DO1 =fee due <br /> (Please duplicate this farm for future use} <br /> ~ <br /> <br /> V~H-39 (Itev. 03109} <br /> <br />