GJN4625 Wildish 2010-00016 - Laserfiche WebLink

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BUREAU OF LABOR AND INDUSTRIES z' ' NOTICE OF PUBLIC WORKS (For use by public agencies in complying with ORS 279C.835 5g for public works awarded after January 1, 2008) ' NOTE: ORS 279C.835 requires that public contracting agencies include with this form a copy of the disclosure of first-tier subcontractors submitted pursuant to ORS 279C.370. PUBLIC AGENCY, INFORMATION Agency Name: Address: City, State, Zip: Agency Representative: Agency Number (if known): Agency Division: Phone: SECTION.A: To be completed when a public agency awards a contract to a contractor for a public works project, including CM/GC projects. (See reverse for public works projects in which no public agency awards a contract to a contractor.) CONTRACT INFORMATION: Project Name: Contract Name (if part of larger project): Project Manager Name: Phone Project Location (Street(s), City): Fax Project County: Contract Amount: $ If under $50,000, is this contract part of a larger project? YES NO If yes, total project amount: $ Will project use federal funds that require compliance with the Davis-Bacon Act? YES NO Date Contract Specifications First Advertised for Bid (if not advertised, date of RFP or first contact with contractor): If CM/GC Contract, Date Contract Became a Public Works Contract (see OAR 839-025-0020(6)): Date Contract Awarded: Date Work Expected to be Complete: Date Work Expected to Begin: PRIME CONTRACTOR INFORMATION: Name: Address: City, State Zip: Construction Contractors Board Registration Number: Name of Bonding Company: Address: Agent Name and Phone Number: Bond Number: Phone: ❑ Copy of first-tier subcontractors attached (see NOTE above). THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. Project Number:_ Contract Number: WH-81 (Rev 03-08)