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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 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />For Office Use Only: <br />Project DB #; <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 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: Cit~f Eugene - En ing_eering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Broaden ~ PHONE: -(541) 682-5238 <br />PROJECT MANAGER NAME: Joe Ramirez PHONE: (541) 682-5228 <br />MAILING ADDRESS: 244E Broadwa~Eugene OR 974701 <br />PROJECT NAME: Robin Hood Avenue Storm Modifications <br />CONTRACT NAME (if part of larger project): <br />PROJECT` LOCATION: Robin Hood Avenue <br />PROJECT NUMBER: 4571 DATE AWARDED: 9/2/2008 <br />CONTRACTOR BUSINESS NAME (DBA): Kipco Inc <br />CONTRACTOR CCB#: <br />CONTRACT AMOUNT: $53 460.00 AMOUNT DUE: ~c~-~b~~ <br />Contract amount x .001 <br />5 ~ 1 - ~1 `33z -- ~e (~~ ~ - l~S Z~ <br />(Please duplicate this form for future use) <br />C~ <br />WH-39 (Rev. 11/07) <br />lv <br />