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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 /> <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: City of Eugene - En ing eerin~ AGENCY #: 1336 <br />AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541682-5238 <br />PROJECT MANAGER NAME: Doug Sinker PHONE: (541) 682-8460 <br />MAILING ADDRESS: 244E Broadway Eugene OR 97401 <br />PROJECT NAME: Pavement Preservation Program - 2008 Slurry Seal <br />CONTRACT NAME (if part of larger project): <br />PROJECT LOCATION: Various locations in the c~ <br />PROJECT NUMBER: 4510 DATE AWARDED: 6/6/2008 <br />CONTRACTOR BUSINESS NAME (DBA): Asphalt Maintenance Associates <br />CONTRACTOR CCB#: <br />e'~ <br />CONTRACT AMOUNT: $237 354.71 AMOUNT DUE: ~ ~~ ` ~ <br />Contract amount x .001 <br />®ATE• <br />BNITIALS' <br />WH-39 (Rev. 11/07) <br />(Please duplicate this form for future use) <br />zo~~$U 21 ~FUCo_., <br />7 ~1~3q/o$~~ <br />-cr ~Giz <br />