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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 CC <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 Eu eng eEn ineerine 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: Terry Colvin PHONE: 541-682-5398 <br />PROJECT NAME: Storm Water Project - Ayres Pond/Gilham Inlet Protection Structures <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Avres Pond/Gilham Inlet <br />PROJECT NO: 4683 (Contract #2011-00001) DATE CONTRACT FIRST ADVERTISED: 6/14/2010 <br />DATE CONTRACT AWARDED: 0713/2010 CONTRACTOR CCB#: 695 <br />CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br />CONTRACTOR ADDRESS: PO Box 7428 <br />CITY, STATE, ZIP: Eugene, OR 97401 f~2 C1//`/'5f'JJ 3 5 S <br />v <br />CONTRACT AMOUNT: $59.471.00 FEE AMOUNT DUE/PAID: <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 />53i-933 g050" <br />WH-39 (Rev. 03/09) <br />