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• • <br />'.S <br />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 ow, <br />r. <br />v <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: 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., Eugnene,.OR_97402 <br />PROJECT NAME: <br />CONTRACT NAME to part or urger project): <br />PROJECT LOCATION: Sap,,, CQ,-~t c?t~, 9;,~~.,,~ q?'kdS <br />PROJECT NUMBER: Al6 . ~j18 , (p O DATE AWARDED:' 1 ~o' yg <br />CONTRACTOR BUSINESS NAME (DBA): G iA~ 54.."6 <br />CONTRACTOR CCB#: 1,771 Q(d1 <br />CONTRACT AMOUNT: q 9Ct C-1)o~ <br />AMOUNT DUE: 9,2"'0. 9 q1 <br />Contract amount x.001 <br />(Please duplicate this form for future use) <br />L4 i o -1 `6 4 a,~Oi 3 9 `1G o <br />WH-39 (Rev. 11/07) <br />