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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: Doug Singer PHONE: 541-682-8460 <br />PROJECT NAME: Pavement Bond Measure - W. 18" Avenue Street Reconstruction <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: W. 18" Avenue <br />PROJECT NO: 4584 (Contract 42010-00032) DATE CONTRACT FIRST ADVERTISED: 5/28/2010 <br />DATE CONTRACT AWARDED: 0709/2010 CONTRACTOR CCB#: 2101 <br />CONTRACTOR BUSINESS NAME (DBA): Knife River Corporation - Northwest <br />CONTRACTOR ADDRESS: 32260 Old Highway 34 <br />CITY, STATE, ZIP: Tangent, OR 97389 <br />CONTRACT AMOUNT: $997.997.97 FEE AMOUNT DUE/PAID: 597, no <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 />3Y3-g332- - &184,1/ - "a 53b"/ <br />WH-39 (Rev. 03/09) <br />SCANNjD PWA <br />GATE: <br />INITIALS: <br />06 001106 !33 <br />