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n <br />U <br />CONTRACT FEE.SI;CTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E: OREGON ST.,41045'. <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAR: (9,71) 673-0769 ' <br />n <br />U <br />17 7 <br /> <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 2790.870, in compliance with ORS 279C.825. Also for use by publit 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 BOLL The <br />minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the <br />burbau may be unable to properly credit you for payment received <br />PUBLIC AGENCY: Cit_y o naene - 9=neerin& AGENCY 1336 <br />AGENCY CONTACT PERSON: Lynn Bwg en PHONE: .j5411692-5238 <br />011682-6086. <br />" <br />PROJECT MANAGES NAME: Scott MOovich PHONE: <br />MAILING ADDRESS: 244 B Broadway."Eugene. OR 97401 <br />PROJECT NAME: Delta Ponds Rioarian Planting <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION; Delta Ponds off of Goodaast~*e lto~d <br />PROJECT NUMBER: fob 04572 DATE AWARDED: 1 l// 1n008 - <br />CONTRACTOR BUSINESS NAME (DBA): Second Growth. I <br />CONTRACTOR CCB#: 75643 - - <br />CONTRACT AMOUNT: -110-025.00 AMOUNT DUE: 0 r <br />Contract amount x .001 <br />(Please duplicate this form for future use) <br />WH-39 (ReV. 11/07) <br />,5 <br />t ~}p tt~~lo~ <br />