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CONTRACT FEE SECTION <br />PREVAILING WAGE RATE UNIT <br />BUREAU OF LABOR AND INDUSTRIE: <br />800 N.E. OREGON ST., #1045 <br />PORTLAND, OR 97232-2180 <br />PHONE: (971) 673-0852 <br />FAX: (971) 673-0769 <br />N E °PWA <br />®a-rE• <br />'r~er,A~.~- <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~of Eugene -Engineering AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br />PROJECT MANAGER NAME: Chuck Mueller PHONE: (541) 682-5295 <br />MAILING ADDRESS: 244 E. Broadway <br />PROJECT NAME: Tonawanda Pump Station <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Lorane Highway 680 feet west of Chambers Street <br />PROJECT NUMBER: 4544 DATE AWARDED: 9/12/2008 <br />CONTRACTOR BUSINESS NAME (DBA):. H & J Construction Inc. <br />CONTRACTOR CCB#: 88084 <br />CONTRACT AMOUNT: $90,050.00 AMOUNT DUE: ~ ~ ~®• <br />Contract amount x .001 <br />.(Please duplicate this form for future use) <br />53a- ~33a-C~~~`-I - ~ ~S~-~S <br />WH-39 (Rev. 11/07) <br />