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pF CONTRACT FEE SECTION `ll~O ( / <br /> ~4i ~P~ PREVAILING WAGE RATF, UNIT <br /> ar_ - . c BUREAU OF LABOR AND INDUSTRIES <br /> ~ ~ 800 N.E. OREGON ST., #1045 <br /> m ~ ' Z PORTLAND, OR 97232-2180 <br /> • PHONE: (971) 673-0852 ~ ~ j <br /> 69 FAX: (971) 673-0769 ,For Office.'Use:Only <br /> . , <br /> <Prolect:DB#~ r ~r <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)(II) or (C). <br /> PUBLIC AGENCIES: Please complete and mail this form [o 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 maybe unable to properly credit you for payment received. <br /> PUBLIC AGENCY: Citv of Eueene - Eneineerina AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E. Broadway, Suite 400 <br /> CITY, STATE, ZIP: Eueene, Oreeon 97401 <br /> <br /> AGENCY CONTACT PERSON: Lvnn Broeden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: David Stams PHONE: (5411 682-8306 <br /> PROJECT NAME: 2009 Wastewater Rehabilitation Basins llW36. DA31, DA42, and DA43 <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: Prejec[ extends from W. 23rd Avenue south to Lazch Street and from Friendly Street east to <br /> <br /> dine Park Loon <br /> PROJECT NO: 4567 (Contract #2009-151 DATE CONTRACT FIRST ADVERTISED: 1/29/2009 <br /> <br /> DATE CONTRACT AWARDED: 4/10/2009 CONTRACTOR CCB#: 114278 <br /> <br /> CONTRACTOR BUSINESS NAME (DBA): Michels Corporation <br /> <br /> CONTRACTOR ADDRESS: 1715 16°i Street SE <br /> <br /> C1TY, STATE, ZIP: Salem, Oreeon 97302 ~~77~y <br /> <br /> CONTRACT AMOUNT: $$529,428.61 FEE AMOUNT DUE/PAID: ~ SG'I ~ <br /> <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> (Please duplicate this form for future use) <br /> WH-39 (Rev. 03/09) <br /> 532 °13~ 4~5Z\~ <br /> <br />