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CONTRACT FEE SECTION d 01 3?71_3 <br />PREVAILING WAGE RATE UNIT < <br />BUREAU OF LABOR AND INDUSTRIES ^a~31 <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 For Office lase Only: <br />Project DH <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 BOLL 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, OR 97401 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: 541-682-5238 <br />PROJECT MANAGER NAME: Matt Rodrigues PHONE: 541-682-6036 <br />PROJECT NAME: 2010 Pavement Preservation Program - 3 locations <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: On Hawkins Lane from W. 18"' Avenue to 100' south of Videra Drive (Job 94583 <br />33`d Avenue from Hilyard Street to Willamette Street (Job #4617) Oakway Road from Cal Young Road to <br />Fairwav Loon (Job #4644) <br />PROJECT NO: 4583, 4617 & 4655 DATE CONTRACT FIRST ADVERTISED: 4/6/2010 <br />DATE CONTRACT AWARDED: 05/12/2010 CONTRACTOR CCB#: 177967 <br />CONTRACTOR BUSINESS NAME (DBA): Eugene Sand Construction Inc. <br />CONTRACTOR ADDRESS: PO Box 1067 <br />CITY, STATE, ZIP: Eugene, OR 97440 <br />CONTRACT AMOUNT: $935,160.00 FEE AMOUNT DUE/PAID: <br />If less than $50K, is it part of a larger project? ❑yes ❑no Contract amount x .001 = fee due <br />0,-4 <br />j c15a3 y2 , 133 z - b t ilo Ll 9 -9°1 <br />41a1? 3`t2-~i33z- totBL~'9gs~'s~ o7.(v~' <br />WH-39 (Rev. 03/09) 5 qujs~ 34a --q33z -W3b4 oio55VY ~S~,SZ <br />