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0`1 ~lC~ fr? ~j <br />CONTRACT FEE SECTION 1 1= <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 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: City of Eugene - Engineering AGENCY 1336 <br />AGENCY MAILING ADDRESS: 99 E. Broadway, Suite 400 <br />CITY, STATE, ZIP: Eugene, Oregon 97401 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: 541-682-5238 <br />PROJECT MANAGER NAME: Matt Rodrigues PHONE: 541-682-6036 <br />PROJECT NAME: Paving on l Vh Ave. from Garfield St to Tying St (Job #4664) 13* Ave from Alder St to <br />Washington St. (Job 94657) <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: I I" Ave from Garfield St to Tying St. 13s' Ave from Alder St to Washin on St <br />PROJECT NO: 4664 & 4657 (Contract 2010-15) DATE CONTRACT FIRST ADVERTISED: 2/1/2010 <br />DATE CONTRACT AWARDED: 3/19/2010 CONTRACTOR CCB#: 695 <br />CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br />CONTRACTOR ADDRESS: PO Box 7428 <br />CITY, STATE, ZIP: Eugene, Oregon 97401 <br />CONTRACT AMOUNT: $792.819.50 FEE AMOUNT DUE/PAID: '7gol y.:2- <br />If less than $50K, is it part of a larger project? Dyes ❑no Contract amount x .001 = fee due <br />(Please duplicate this form for future use) -7 <br />- Cc l 7& 3d q- 07 3 <br />tII - 9,33Z <br />WH-39 (Rev. 03/09) R - g3 3 9 GAS' „7'71'U1_5 k/ 5 <br />z - ~ r ~b ~ <br />