GJN 004681 Fund 343 PWR BOLI - Laserfiche WebLink

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CONTRACT FEE SECTION PREVAILING WAGE RATE UNIT BUREAU OF LABOR AND INDUSTRIES 800 N.E. OREGON ST., #1045 PORTLAND, OR 97232 -2180 PHONE: (971) 673 -0852 FAX: (971) 673 -0769 For Office Use Only: Project DB #: PUBLIC WORKS FEE INFORMATION FORM For use by public agencies that have contracted with a contractor on a public works project regulated by ORS 279C.800 to 279C.870, in compliance with ORS 279C.825. Also for use by public agencies that are a party to a public works project pursuant to ORS 279C.800(6)(a)(B) or (C). PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public works fee of one -tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the bureau may be unable to properly credit you for payment received. PUBLIC AGENCY: City of Eugene - Engineering AGENCY #: 1336 AGENCY MAILING ADDRESS: 99 E. Broadway CITY, STATE, ZIP: Eugene, OR 97401 AGENCY CONTACT PERSON: Lynn Brogden PHONE: 541- 682 -5238 PROJECT MANAGER NAME: Doug Singer PHONE: 541- 682 -8460 PROJECT NAME: Pavement Bond Measure 18 Avenue from Washington Street to Patterson Street and Jefferson CONTRACT NAME (if part of larger project): PROJECT LOCATION: 18` Avenue from Washington Street to Patterson Street and Jefferson intersection PROJECT NO: 4681 DATE CONTRACT FIRST ADVERTISED: 6/16/2011 DATE CONTRACT AWARDED: 07/20/2011 CONTRACTOR CCB #: 2101 CONTRACTOR BUSINESS NAME (DBA): Knife River Corporation - Northwest CONTRACTOR ADDRESS: 32260 Old Highway 34 CITY, STATE, ZIP: Tangent, OR 97389 CONTRACT AMOUNT: $ 1,049,104.90 FEE AMOUNT DUE /PAID If less than $50K, is it part of a larger project? ❑yes ❑no Contract amount x .00� 1 fee due (Please duplicate this form for future use) Sy �� vC L/3- 9332 -4 , 9 4 4 1 - 90 a/ WH -39 (Rev. 03/09)