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CONTRACT FEE SECTION <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 For Office Use'Onl}. . <br /><.Proiect DB # <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 S250.00; the maximum fee is 57,500 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 Broadwav Suite 400 <br />CITY, STATE, ZIP: Eugene. OR 97401 <br />AGENCY CONTACT PERSON: Lvnn Brogden PHONE: 541-682-5238 <br />PROJECT NIANAGER NAME: Doug Singer PHONE: 541-682-8460 <br />PROJECT NAME. Pavement Bond Measure on Harlow Road <br />CONTRACT NAME (if part of larger project) <br />PROJECT LOCATION: Harlow Road from 1-5 to Coburg Road <br />PROJECT NO: 4586 (Contract 2010-24) DATE CONTRACT FIRST ADVERTISED: 41612010 <br />DATE CONTRACT AWARDED: 05'2812010 CONTRACTOR CCB#: 2101 <br />CONTRACTOR BUSINESS NAME (DBA)• Knife River Corporation-Northwest <br />CONTRACTOR ADDRESS: 32260 Old Highw•av 34 <br />CITY, STATE, ZIP: Tangent. OR 97389 <br />CONTRACT AMOUNT: S775,077 50 FEE AMOUNT DUE/PAID: 77 5, a 7 <br />If less than S50K, is it part of a larger project' Dyes ❑no Contract amount x .001 = fee due <br />(Please duplicate this form for future use) DO ?_610 q" <br />313-9352-0Fi( 3041 W <br />WH-39 (Rev 03'09) <br />SCA _N -PWA <br />DATE <br />INITIALS: <br />