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FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT <br />Project Title: 2010 Pavement Preservation Program <br />PPP Valley River Drive and Goodpasture Island Road from <br />Willagillespie Road to Delta Ponds - Job #4637 <br />PBM Goodpasture Island Road from Delta Highway to <br />Kingsley Road - Job #4435 <br />City of Eugene Project No. 4637 and 4435 <br />Bid Closing: Date: April 20, 2010 Time: 2:00 p.m. <br />Submit to: 99 E. Broadway, Suite 400, Eugene Oregon 97401 <br />Disclosure Deadline: 2:00 p.m. - This form must be submitted by bid closing date <br />and time. <br />Bidders are required to submit a first tier subcontractor disclosure form, substantially as described in <br />ORS 279C.370, prior to the Bid Closing Date and time. For this project the First-Tier <br />Subcontractor Disclosure Statement must be submitted regardless of the bid amount. <br />BIDDER INFORMATION <br />Bidder's Name: Knife FNw Corporation • NoAhwest <br />Contact Person: <br />Bidder's Telephone Number: <br />CM 6M - LGD0 <br />❑ Check here if the bid amount less deductive alternates, if any, is $100,000 or less. If the bid <br />amount less deductive alternates, if any, is equal to or less than $100,000, the remainder of the <br />form does not need to be completed, but the form must still be submitted. <br />r <br />List below the Name, Dollar Value, and Construction Contractors Board ("CCB") License Number, <br />and Category of Work that will be performed by each subcontractor that will be furnishing labor, or <br />labor and materials. Enter "NONE" if there are no subcontractors that need to be disclosed (IF <br />NEEDED, ATTACH ADDITIONAL SHEETS). <br />Name/Address Dollar Value/CCB# Category of Work <br />ZX2 <br />6 In q,-' CC-b /66 135 <br />I Ibi b s~ .co: 3 3 1 <br />St3E <br />3/ _ ~Aey- r' 4 et", g l,{~~1U Ji VLIS x`~ ~~G7~~ 1.G'r. <br />i6-74, ~ t ~F 5X c I ~6 <br />6A- q-7657- <br />