New Search
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 <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: Adam Steffan PHONE: 541-682-5040 <br />PROJECT NAME: Bond Lane Park Play-¢round Renovation and State Street Park Plavground Renovation <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: 1295 Bond Lane (Job #4601) 2130 Dakota Street (State Street Park)(Job 04621) <br />PROJECT NO: 4601 & 4621 DATE CONTRACT FIRST ADVERTISED: 4/21/2010 <br />DATE CONTRACT AWARDED: 06/23/2010 CONTRACTOR CCB#: 40559 <br />CONTRACTOR BUSINESS NAME (DBA): 2G Inc. dba 2G Construction <br />CONTRACTOR ADDRESS: PO Box 11735 05, ?_0II 000500 <br />CITY, STATE, ZIP: <br />CONTRACT AMOUNT: $119.640.40 FEE AMOUNT DUE/PAID: n7,Z..c D <br />If less than $50K, is it part of a larger project? ❑yes ❑no Contract amount x .001 = fee due <br />(Please duplicate this form for future use) <br />INITIALS: - - - - - - 33~ - ° 335/- (D~~~-IS Y'Z iiL IO <br />WH-39 (Rev. 03/09 4335 1< ( 019555 a /,3?, 3( <br />334 ' <br />~ <br />