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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, dnl},. <br />:Project 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. alone 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 $250.00; the maximum fee is $7,50000. Without the followm.g completed information. the <br />bureau may be unable to properly credit you for payment received <br />PUBLIC AGENCY- City of Eugene - En meerina AGENCY 1336 <br />AGENCY MAILING ADDRESS 99 E Broadwav Suite 400 <br />CITY, STATE, ZIP: Eueene. OR 97401 <br />AGENCY CONTACT PERSON: Lvnn Brogden PHONE: 541-682-5238 <br />PROJECT MANAGER NAME: Jenifer Willer PHONE: 541-682-5364 <br />PROJECT NAME: Pavement Bond Measure - Patterson Street Rehabilitation <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION- Patterson Street from 13" Avenue to 24 h Avenue. E 18" Avenue from Patterson Street to <br />Hard Street. E 23rd Avenue from Patterson Street to Hilvard Street <br />PROJECT NO: Job =4622 (Contract *2010-26) DATE CONTRACT FIRST ADVERTISED: 5.72010 <br />DATE CONTRACT AWARDED. 06%082010 CONTRACTOR CCB#: 695 <br />CONTRACTOR BUSINESS NAME (DBA): Wtldish Construction Co <br />CONTRACTOR ADDRESS. PO Box 7428 t2n 2,0 /00/y ff q <br />CITY, STATE, ZIP: Eugene. OR 97401 <br />CONTRACT AMOUNT: 51.089.526 20 FEE AMOUNT DUE/PAID: l i 039, $3 <br />If less than S50K, is it part of a larger project? Oyes Ono Contract amount x .001 = fee due <br />(Please duplicate this form for future use) <br />3'{3- g332-10lVo`~- q'5s741 <br />W14-39 (Rev 0309) SCAN N E -P A <br />DATE II <br />INITIALS <br />