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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 />FAX: (971) 673-0769 <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 BOLL 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: _ (541) 687-3259 <br />MAILING ADDRESS: 715 W. 4th Ave., Eupene,_OR 97402 <br />PROJECT NAME: <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 4-75 <br />;d • CDF .'7~ DATE AWARDED: <br />PROJECT NUMBER: <br />CONTRACTOR BUSINESS NAME (DBA): l C C r ice, <br />CONTRACTOR CCB#: %4. 0-191 <br />tPot,2~0'~o <br />CONTRACT AMOUNT: <br />AMOUNT DUEIZL~2 25C5 W, <br />Co ract amount x .00I <br />/ . , Nv, <br />(Please duplicate this form for future use) <br />WH-39 (Rev. 11/07) 410Cr U ~ a~0 l3 3~5 C1 _(0 O <br />