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• 0 <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 <br />t <br />rFl YY SC~ ~f 5 ~j ~l:t S" ~ ~ <br />For use by public agencies that have contracted with a contractor on a public works project regulated b <br />ORS 279C.800 to 279C.870, in compliance with ORS 279C.825. Also for use b y <br />party to a public works project pursuant to ORS 279C.800 Y Public agencies that are a <br />(6)(a)(B) or (C). <br />PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the u <br />works fee of, one-tenth of one percent of the contract price (contract amount x .001 <br />P blie <br />payable to BOLI. The <br />minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed informatio <br />bureau may be unable to properly credit you for payment received. n, the <br />PUBLIC AGENCY: _ Eu ene School District 4J AGENCY _ 639 <br />_ <br />AGENCY CONTACT PERSON: Ben. Brantley <br />~ - PHONE:' (541) 687-3259 <br />PROJECT MANAGER NAME: <br />_._Ben Brantley <br />PHONE: r` (541) 687-3259 <br />MAILING ADDRESS 715 W. 4th Ave., _Eygene. OR 9740? <br />PROJECT NAME: <br />CONTRACT NAME (if part of larger proj, <br />PROJECT LOCATION:) e~ OmA <br />PROJECT NUMBER: `h 7(~n <br />CONTRACTOR BUSINESS NAME (DBA): <br />CONTRACTOR CCB#: 140,6193 <br />CONTRACT AMOUNT: 6! 9I <br />410 6 t~ 1 aooi 3 <br />WH-39 (Rev. 11/07) <br />3Z79 <br />DATE AW. <br />Lkrfac" -mop. <br />AMOUNT DUE: 4%(. q(0 <br />Contract amount x .001 <br />(O 0 <br />(Please duplicate this form for future use) <br />k <br />