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) 673-0769ti~~a {I?orOe D;,i1~ <br />PUBLIC WORKS FEE INFORMATION FO <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: Eugene School District 4J AGENCY 639. <br />AGENCY CONTACT PERSON: Ben Brantley PHONE: (541) 687-3259 <br />PROJECT MANAGER NAME: Ben Brantley PHONE: __(541) 687-3259 <br />MAILING ADDRESS: 715 W. 4th Ave., Eugene, Q 97402 <br />PROJECT NAME: <br />CONTRACT NAME (if part of larger project): <br />•:ef'~e~sv.. ~;T~ ::toS~ w • tea. _ E~j~-~- -1~5 <br />PROJECT LOCATION: S~enGE~3ui}e Soo 4_1 `-I ~ ¢ c. 41t1,aS <br />PROJECT NUMBER: ~id• (o%o .76 b DATE AWARDED: <br />CONTRACTOR BUSINESS NAME (DBA):^^~ e=r lc, c~ <br />CONTRACTOR CCB#: <br />CONTRACT AMOUNT: <br />o~c~0 <br />-r- <br />AMOUNT DUE: 2 <br />(Please duplicate this form for future use) <br />Gt},•.~ o PO 103110 <br />~ 25(51 <br />amount x.001 <br />t <br />1 <br />4io~ u~ac~oi~ 3E~cl -].(Co <br />WH-39 (Rev. 11/07) <br />