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.1 <br />CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR-AND INDUSTRIES <br />809 N.E. OREGON $T., #1045• <br />'PORTLANn, OR 97232-2180 <br />PHONE: (971)'673-0852' FAR: (971) 673-0769 -tce'tui; <br />PUBLIC WORKS FEE INFORMATION FORll2 <br />For nse •by public agencies that have contracted with' a contractor on a.public works project regulated by <br />ORS 279C.800 to 2790.870, in, compliance with QRS 279C.825. Also for use by public agencies that are a <br />party to i public works project. pursuant to OR9`279C.800(6)(a)(B) or (C). <br />PUBLIC AGENC'iBS: Please complete and mail this form to BOLI at the above address, along with the public <br />"works` feb of one-tenth of one percent of the contract.price (contract amount x .001), payable to SOLI. The <br />minimum. fee is •$250.00;• the maximum fee Is $7,500.06. Without the. following completed information, the <br />bureau may be unable to properly credit you for payment received. <br />PUBLIC AGENCY: Cater oL&Iene - Eneineering AGENCY.#: 1336 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br />PROJECT MANAGER NAME: Scott Milovich PHONE: (541) 682-6086 <br />MAILING ADDRESS: 244E BroadyAL Hug= O 97401 <br />PROJECT NAME: De11a Ponds Soil Amdendment and Seeedin g <br />2 <br />CONTRACT NAME (if part of larger project): Delta Ponds Marian Planting (20294 <br />go= Road <br />PROJECT-LOCATION: Delta Ponds offof QQod <br />PROJECT NUMBER: lob #4646- 5_ - • ~r:_ DATEAWARDED: 10/2012008 <br />CONTRACTOR BUSINESS NAME (DBA): Elms Landscape Services Inc <br />CONTRACTOR CCB#: 6855 (LM <br />CONTRACT AMOUNT:. $39.39520 AMOUNT DUE: ` <br />Contract amount x,.001 <br />.1 <br />(Please duplicate'this form for future use) <br />WH-39 (Rev. 1,1/07) V G 1 V O`T <br />a ~ tA <br />c <br />