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CONTRACT FEE SECTION PREVAILING WAGE RATE UNIT BUREAU OF LABOR AND INDUSTRIES po 800 N.E. OREGON ST., #1045 PORTLAND, OR 97232-2180 = 0 0 PHONE: (971) 673-0852 FAX: (971) 673-0769 For Office use OnlN: Project M), 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.800 to 279C.870, in compliance with ORS 279C.825. 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 BOLI 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 BOLI. The minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the bureau may be unable to properly credit you for payment received. PUBLIC AGENCY: City of Eugene - Engineering AGENCY 1336 AGENCY MAILING ADDRESS: 99 E. Broadway CITY, STATE, ZIP: Eugene, OR 97401 AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 PROJECT MANAGER NAME: Adam Steffen PHONE: (541) 682-5040 PROJECT NAME: Alton Baker Park Irrigation and Utility Improvements located at 200 DU Island Road CONTRACT NAME (if part of larger project): PROJECT LOCATION: Alton Baker Park at 200 Dav Island Road PROJECT NO: 4613 Contract #2010-17 DATE CONTRACT FIRST ADVERTISED: 2/12/2010 DATE CONTRACT AWARDED: 3/29/2010 CONTRACTOR CCB#: LCB 912343 CONTRACTOR BUSINESS NAME (DBA): Elms Landscape Services, Inc. CONTRACTOR ADDRESS: 28780 Jager Lane CITY, STATE, ZIP: Junction City, OR 97448 CONTRACT AMOUNT: $152,302.24 FEE AMOUNT DUE/PAID: P,50, e-0- If less than $50K, is it part of a larger project? ❑yes ❑no Contract amount x .001 = fee due (Please duplicate this form for future use) `5 P ~ I 1 WH-39 (Rev. 03/09)