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r~ ~~qg f- <br /> FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br /> Project Title: Echo Hollow Tennis Court Overlay at 1655 Echo Hollow Road <br /> City of Eugene Project No. ~ 4608 <br /> Bid Closing: Date: September 15, 2009 Time: 2:00 p.m. <br /> Submit to: 99 E. Broadway, Suite 400, Eugene Oregon 97401 <br /> Disclosure Deadline: Z:00 p.m. -This form must be submitted by bid closing date and <br /> 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: ~ ~ Ct,t~ ~~lS}`, ~~1C <br /> Contact Person: ~ ! ~~G~.S~~"c~ <br /> Bidder's Telephone Number: f ~ `,.5 ~ ~ J <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 /> labor and materials. Enter "NONE" if there are no subcontractors that need to be disclosed (IF <br /> <br /> NEEDED, ATTACH ADDITIONAL SHEETS). <br /> Name/Address Dollar Value/CCB# Category of Work. <br /> 3) . <br /> <br />