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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 r <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: Scott Milovich PHONE: 541-682-6086 <br />PROJECT NAME: River Road Rectangular Rapid Flash Beacons <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Two existine oedestrain crossings on River Road <br />PROJECT NO: 4667 (Contract #2010-00028) DATE CONTRACT FIRST ADVERTISED: 5/4/2010 <br />DATE CONTRACT AWARDED: 06/22/2010 CONTRACTOR CCB#: 91668 <br />CONTRACTOR BUSINESS NAME.(DBA): Cherry City Electric <br />CONTRACTOR ADDRESS: 1596 22"d Street SE DO ~(/DaOSD~ <br />CITY, STATE, ZIP: Salem. OR 97302 <br />CONTRACT AMOUNT: $83.845.00 FEE AMOUNT DUE/PAID: o?W, 0~0 <br />If less than $50K, is it part of a larger project? ❑yes ❑no Contract amount x .001 = fee due <br />S CAN N D-PWA (Please duplicate this form for future use) <br />DATE: /Q <br />INITIALS: g X33 -g33z-~(8b~- 9os3~y <br />WH-39 (Rev. 03/09) <br />