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Notice of Public Works - Page 2 • SECTION B: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(B) (a project for the construction, reconstruction, major renovation or painting of a privately owned road, highway, building, structure or improvement of any type that uses funds of a private entity and $750,000 or more of funds of a public agency) and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Name of Project Owner: Phone #: Fax #: Project Name: Project Number: Project Location (Street(s), City): Project County: Total Project Amount: $ Amount of Public Funds Provided for the project: $ Name(s) of Public Agency (ies) Providing Public Funds: Date the public agency or agencies commit to the provision of funds for the project: Will project use federal funds that require compliance with the Davis -Bacon Act? Date Work Expected to Begin: Date Work Expected to be Complete: YES [ ❑ SECTION C: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(C) (a project for the construction of a privately owned road, highway, building, structure or improvement of any type that uses funds of a private entity and in which 25 percent or more of the square footage of the completed project will be occupied or used by a public agency) and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Name of Project Owner: Phone #: Fax #: Project Name: Project Number: Project Location (Street(s), City): Project County: Total Project Amount: $ Amount of Public Funds Provided for the project: $ Name(s) of Public Agency(ies) Providing Public Funds: Total square footage of privately owned road, highway, building, structure or improvement: Percent of total square footage of the completed project that will be occupied or used by a public agency: Date the public agency or agencies entered into an agreement to occupy or use the completed project: Will project use federal funds that require compliance with the Davis -Bacon Act? YES []NO ❑ Date Work Expected to Begin: Date Work Expected to be Complete: THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. Signature of agency representative completing form: Printed Name: Phone #: Date: RETURN THIS COMPLETED FORM TO: Prevailing Wage Rate Unit • Bureau of Labor and Industries • 800 NE Oregon Street, #1045 • Portland, OR 97232 -2180 Telephone (971) 673 -0852 • FAX-(971) 673 -0769 WH -81 (Rev 03 -08)