BOLI Fee 2010-05410 - Laserfiche WebLink

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CONTRACT FEE SECTION PREVAILING WAGE RATE UNIT BUREAU OF LABOR AND INDUSTRIES 800 N.E. OREGON ST., #1045 PORTLAND, OR 97232-2180 PHONE: (971} 673-0852 FAQ: (971} 673-0769 ~Jo~. ao~ooo 76g 3 For Office Use Only: Project DB #: PUBLIC WORKS FEE INFORMATION FORM For use by public agencies that have contracted with a contractor on a public works project regulated by ORS 279C.S00 to 279C.S70, in compliance with ORS 279C.S25. Also for use by public agencies that are a party to a public works project pursuant to ORS 279C.800(6}(a)(B} or (C}. PUBLIC AGENCIES: Please complete and mail this form to BALI at the above address, along with the public works fee of one-tenth of one percent of the contract price contract amount x .001 }, payable to B4LI. The minimum fee is $250.00; the maximum fee is $7,500.00. Without the fallowing completed information, the bureau may be unable to properly credit you for payment received. PUBLIC AGENCY: Ci of Eu ene-PW Parks & Maintenance AGENCY #:2781 AGENCY MAILING ADDRESS:1820 Roosevelt Blvd. CITY, STATE, ZIP Eu ene OR 97402 AGENCY CONTACT PERSON: Heather Nelson Contract Admin PHONE: 541 652-496b PROJECT MANAGER NAME:Lauri Holts PHONE: X541} 652-4925 r _--- rn l.uunu.ul~l~ PROJECT NAME: Delta Ponds Ve etation Mana ement CONTRACT NAINIE (if part of larger project}: PROJECT LOCATION: Delta Ponds Eu ene PROJECT NO: 905462 DATE CONTRACT FIRST ADVERTISED: S12 DATE CONTRACT AWARDED: 09/14/09 CONTRACTOR BUSINESS NAME (DBA): Walama Restoration Project • 1 IIIII 11911rt1 CONTRACTOR ADDRESS: PO Box 894 CITY, STATE ZIP Eu ene OR 97440 CONTRACT AMOUNT: $75 000.00 FEE AMOUNT DUEIPAID: $254.40 If less than $50K is it part of a larger project? ^yes ^no (Please duplicate this form for future use.) CONTRACTOR CCB#:166803 Contract amount x .001=fee due WH-39 Rev. 03109)