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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Alton Baker Park Lot 8 Access Drive at <br /> .2720 Leo Harris Parkway <br /> City of Eugene Project No. 4612 <br /> Bid Closing: ,Date: August 6, 2009 Time: 2:00 p.m. - ~ . <br /> Submit to: 99 E. Broadway, Suite 400, Eugene Oregon 97401 <br /> Disclosure Deadline: 2:00 p.m. -This form must be submitted by bid closing date <br /> and time. <br /> Bidders are required to .submit a first tier subcontractor disclosure form, substantially as described in <br /> ORS 279C.370, prior to the Bid Closing Date and time. For this project the First-Tier <br /> Subcontractor Disclosure Statement must be submitted regardless of the bid amount. <br /> BIDDER INFORMATION <br /> Bidder's Name: Q.; ~'`~5~~ c_._ <br /> t <br /> Contact Person: ~ ~ ~ ~ Lt~:~ r, j~ <br /> Bidder's. Telephone Number: ~1 ~ ~ ~ ~ ~ <br /> Check here if the bid amount less deductive alternates, if any, is.$100,000 or less. If the bid <br /> amount less deductive alternates, if any, is equal to or less than $100,000, the remainder of the <br /> form does not need to be completed, but the form must still be submitted. <br /> List below the Name, Dollar Value, and Construction Contractors Board ("CCB") License Number, <br /> and Category of Work that will be performed by each subcontractor that will be furnishing labor, or <br /> <br /> -labor and materials. Enter "NONE" if there are no subcontractors that need to be disclosed (IF <br /> NEEDED, ATTACH ADIDITIONAL SHEETS). <br /> Name/Address Dollar Value/CCB# Category of Work <br /> 1) _ <br /> 2) . <br /> 3) <br /> <br />