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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 <br />For Office Use Only, <br />Project DB <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 BOLI 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: <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: West Bank Trail: Beaver Street-River Road Federal Aid Protect #X-STP-2385 (071) <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Beaver Street and River Road <br />PROJECT NO: 4279 DATE CONTRACT FIRST ADVERTISED: 11/5/2010 <br />DATE CONTRACT AWARDED: 01/14/2011 CONTRACTOR CCB#: 2101 <br />CONTRACTOR BUSINESS NAME (DBA): Knife River Corporation-Northwest <br />CONTRACTOR ADDRESS: 32260 Old Highway 34 <br />CITY, STATE, ZIP: Eugene. OR 97389 <br />CONTRACT AMOUNT: $1.575.618.90 FEE AMOUNT DUE/PAID: i 5`75L <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 />3y1 ~i3~4 Co127G~- t'9 75v~`I - 33(y ~%6 26(g ~ g <br />WH-39 (Rev 03/09) I- <br />