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o F o CONTRACT FEE SECTION <br /> ~Fi 'P~ PREVAILING WAGE RATE UNIT <br /> ~ : G BUREAU OF LABOR AND INDUSTRIES <br /> ` ` 800. N.E. OREGON ST., #1045 <br /> N ~ z t'j PORTLAND, OR 97232-2180 <br /> PHONE: (971) 673-0852 <br /> ~*~59 \ FAX: (971) 673-0769 <br /> For Office lase Onl~~: <br /> 1'rq pct DE3 <br /> b _ <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: City of Eugene-Ensineering AGENCY 1336 <br /> AGENCY MAILING ADDRESS:' 99 E. Broadway, Suite 400 <br /> CITY, STATE, ZIP: Eugene, OR 97401 <br /> AGENCY CONTACT PERSON: Lynn Brogden PHONE: (541) 682-5238 <br /> PROJECT MANAGER NAME: Matt Rodrigues PHONE: (541) 682-6036 <br /> PROJECT NAME: 2009 Pavement Preservation Program 1) Bertelsen Rd from W. 11`x' Ave. to W. 18~` Ave (Job <br /> #4501) 2) Seneca Rd from Roosevelt Blvd to W. 7`'` Ave (Job #4561) 3) McKinley St from W 5~' Ave to W 11~' <br /> Avenue (Job #45611 <br /> CONTRACT NAME (if part of larger project): <br /> PROJECT LOCATION: 1) Bertelsen Rd from W. 11`~ Ave to W. 18~` Ave. 2) Seneca Rd from Roosevelt Blvd to W <br /> 7`'' Ave. 3) McKinley St. from W. 5~' Ave. to W. 11~` Ave. <br /> PROJECT NO: 4501, 4528 &4561 (Contract #2009-00026) <br /> DATE CONTRACT FIRST ADVERTISED: April 22, 2009 <br /> DATE CONTRACT AWARDED: June 15, 2009 CONTRACTOR CCB#: 695 <br /> CONTRACTOR BUSINESS NAME (DBA): Wildish Construction Co. <br /> CONTRACTOR ADDRESS: PO Box 7428 <br /> CITY, STATE, ZIP: Eu ene OR 97401 <br /> u~~ <br /> CONTRACT AMOUNT: $878,656.55 FEE AMOUNT DUE/PAID: ~ X73, ~ Lo <br /> If less than $SOK, is it part of a larger project? ?yes ?no Contract amount x .001 =fee due <br /> <br /> WH-39 (Rev. 03/09) CSb~ 4 S°b I 133-~ ~~z- lotZ'~~/, °rZS"~j~ ~t~~ ~ j <br /> (Please duplicate this form for future use) ~ ~3 ~ e5~ <br /> C~-~ 5i~1 t 33-4332-~~86~ _9~~~'f <br /> <br />