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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIES <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2188 <br />PHOIVE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />For Office Use O~ly; <br />Project DB #: <br />PUBLIC WORKS FEE INFORMATION FORM <br />For use by public agencies that have contracted with a contractor on a puhlic works project regulated by <br />ORS 2'79C.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• City of Eugene - Public Works (Eng) AGENCY #• 1336 <br />AGENCY CONTACT PERSON: L~ B=ogden PHONE: ~41 ~ 682-5238 <br />PROJECT MANAGER NAME: ~BHn Bonham PHONE• 5541 ) 682-5300 <br />MAILING ADDRESS: 244 E. Broadway, Eugene, Oregon 97401 <br />PROJECT NAME: Legacy Wastewa~er intercepttor - Phase II from Royal Avenue to <br />Terry Street <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION• xopal Avenue to Terry Street <br />PRO.TECT NUMBER: ~~ph '#4514 DATE AWARDED: 03/27/08 ~, <br />CONTRACTOR BUSINESS NAME (DBA): _ C~ M Construction Inc. <br />CONTRACTOR CCB#: 64507 <br />CONTRA.CT AMOUNT: $1,169 , 978. 20 AMOUNT DUE: ~ ~~, 1 ~p ~l °~~ <br />Contract amount x .OQl <br />(Ptease duplicate this form for future use) <br />WH-39 (Rev. I 1%07) <br />S ~.i /~1 ~ ~- ~^ D' ~~/I~- <br />DATE: LI~ V~- ~fi~ - <br />INITIALS: (/~L_- <br />