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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 />For Office Use Only: <br />Project DB <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: <br />AGENCY MAILING ADDRESS: <br />CITY, STATE, ZIP: <br />AGENCY CONTACT PERSON: <br />AGENCY <br />PHONE: ( ) <br />PROJECT MANAGER NAME: PHONE: ( ) <br />PROJECT NAME: <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: <br />PROJECT NO: DATE CONTRACT FIRST ADVERTISED: <br />DATE CONTRACT AWARDED: CONTRACTOR CCB#: <br />CONTRACTOR BUSINESS NAME (DBA): <br />CONTRACTOR ADDRESS: <br />CITY, STATE ZIP <br />CONTRACT AMOUNT: $ FEE AMOUNT DUEIPAID: $ <br />If less than $50K, is it part of a larger project? ❑yes C1no Contract amount x .001= fee due <br />(Please duplicate this form for future use.) <br />WH-39 (Rev. 03/09) <br />