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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />- - <br />FAX: (971) 673-0769 <br />s 1'orOfrc> 17scvuly,, <br />1'ro~ecf`D13 <br />PUBLIC WORKS FEE INFORMATION FORM <br />For use by public agencies that have contracted with a contractor on a public works project regulated by <br />ORS 279C.800 to 279C.870, in compliance with ORS 279C.825. Also for use by public agencies that are a <br />party to a public works project pursuant to ORS 279C.800(6)(a)(B) or (C). <br />PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public <br />works fee of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The <br />minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the <br />bureau may be unable to properly credit you for payment received. <br />PUBLIC AGENCY: Eugene School District 4J AGENCY 639 <br />AGENCY CONTACT PERSON: _Ben Brantley PHONE: (541) 687-3259 <br />PROJECT MANAGER NAME: Ben Brantley PHONE: f541),60-3259 <br />MAILING ADDRESS: 715 W. 41th Ave., Eugene, OR 97402 _ <br />PROJECT NAME: cc T1 leiA _ S <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Ste„ P r t AV A(, S . 6. ~ <br />PROJECT NUMBER: 4l6. 57Z .~fo o y c~+ <br />DATE AWARDED: ' ~ rc' c7g <br />CONTRACTOR BUSINESS NAME (DBA): 6t42.• Q y~~r may` <br />CONTRACTOR CCB#: <br />nn ov <br />CONTRACT AMOUNT: AMOUNT DUE:_ i • Q <br />Contract amount x.001 <br />(Please duplicate this form for future use) <br />14l0b,~ 4ia~Dolb 2(~q `fbo <br />WH-39 (Rev. 11/07) <br />