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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON ST., !11045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />For Office Use Ouly: ~ , <br />~`, <br />Project DB #.~1814'i <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 ORS <br />279C.800 to 279C.870, in compliance with ORS 279C.825. Also for use by public agencies that are a party to a <br />public works project pursuant to ORS 279C.800(6)(a)(B) or (C). <br />PUBLIC AGENCIES: Please complete and mail [his form to BOLL at the above address, along with the public works fee <br />--" ~-of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLL The minimum-fee is-$250.00; <br />[he maximum fee is $7,500.00. Without the following completed information, the bureau may be unable to properly credit <br />you for payment received. <br />G~ <br />PUBLIC AGENCY: CITY OF EUGENE PUBLIC WORKS ~TIPARKS <br />AGENCY#:2781 <br />AGENCY MAILING ADDRI <br />CITY. STATE 7_IP: 1~~A. <br />AGENCY CONTACT PERS( <br />PROJECT MANAGER NAM <br />PI-LONE: (SW/ )Lfi 2 ~f4 ~ S <br />PHONE: ( ) ~SCcINlt <br />PROJECT NAME: CITY CENTER SKATEPARK DESIGN BUILD <br />CONTRACT NAME (if pari of lazger project):CITY CENTER SKATEPARK DESIGN BUILD <br />PROJECT LOCATION: WASHINGTON JEFFERSON PK UNDER I-105 BRll)CEEUGENE <br />PROJECT NO: 2009200087/4555/2009.05340 CONTRACT NO. 4555/2009.05340 <br />DATE CONTRACT 1'" ADVERTISED: 27-APR-09 <br />DATE CONTRACT A WARDED: 18-AUG-09 <br />CONTRACTOR CCB#: 152121 _ <br />CONTRACTOR <br />CONTRACTOR <br />CITY, STATE, Z <br />CONTRACT AMOUNT: <br />FEE AMOUNT DUE/PAID: $250 Contract amount x .001 =fee due <br />If less than SOK is it part of a larger project ^yes ^no If yes, total project amount: 430000 ~ l ~ _ <br />WH-39.(Rev. 03/09) /+J"77~/ , <br />~Z~- q 338-Cv1 ~(o'Z- c~..'t..,• P <br />iZo c. ~. ~ $ ` (0 3 ~ <br /> <br />