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~zo~~ 0 4 ~ <br /> ~Q~/7~ (/y/A(~~~ <br /> F CONTRACT FEE SECTION ~ ~V <br /> ~4i ~ PREVAILING WAGE RATE UNIT <br /> BUREAU OF LABOR AND INDUSTRIES <br /> (N ' c ~ 800 N.E. OREGON ST., #1045 <br /> _ ' ~ PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 ~ , <br /> 89 FAX: (971) 673-0769~~ For OffrceaUse Outy <br /> ~ <br /> i , <br /> ~ I ~ I y,i fY <br /> PlojecUD13 #'l ~ i ~ w <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 [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 may be unable [o properly credit you for payment received. <br /> PUBLIC AGENCY: City of Eueene - Eneineerine AGENCY 1336 <br /> AGENCY MAILING ADDRESS: 99 E. Broadtvav. Suite 400 <br /> CITY, STATE, ZIP: Eueene, Oreeon 97401 <br /> AGENCY CONTACT PERSON: Lvnn Broeden PHONE: (5411 682-5238 <br /> PROJF,CT MANAGER NAME: Patrick Cox PHONE: (5411 682-6854 <br /> PROJECT NAME: Eueene Airport -Terminal Ramn Reconstruction, Section 2 AIP 3-41-0018-42 & 43 <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: Eueene Airoort <br /> PROJECT NO: 4590 (Contract 2009-17) DATE CONTRACT FIRST ADVERTISED: 1/21/2009 <br /> DATE CONTRACT AWARDED: 4/10/2009 CONTRACTOR CCB#: 695 <br /> CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br /> CONTRACTOR ADDRESS: PO Box7428 <br /> CITY, STATE, ZIP: Eueene. Oreeon 97401 n /1 <br /> CONTRACT AMOUNT: $970.348.00 FEE AMOUNT DUE/PAID: ~ I V' `~S <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =tee due <br /> (Please duplicate this form for future use) <br /> WH-39 (Rev. 03/09) <br /> <br /> s) z 43a~( QaS~kca~-- <br /> <br />