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o F <br /> o <br /> R ~ <br /> <br /> ~ r . o Bureau of Labor and Yndustries <br /> . - R <br /> ` ' ~ Brad Avakian <br /> i <br /> ! A <br /> Commissioner <br /> 5g <br /> July 22, 2009 <br /> CITY GF EUGENE <br /> ENGINEERING DIVISIGN <br /> 99 E BRGAD~UAY STE 400 <br /> EUGENE, GR 97401 <br /> PAYMENT RE <br /> CEIPT FAR PUBLIC '~V~RKS FEE <br /> ~~RS 83~-X25-210 <br /> Name of Proj ect: 2009 PATHOLE REPAIR GN RIVERVIEW ST-E.1 NTH AVE #G 1521 <br /> This certificate is proof the CITY GF EUGENE, ENGINEERING DIVISIGN made a fee <br /> payment of $250 for the public works project named above, based on the contract awarded to <br /> DGGE SAND & GRAVEL ~DBA} ~CCB#:150240} on 26-Jun-09, leaving a balance of $0 for <br /> this contract. <br /> As required by GRS 279C.825 and GAR 839-D25-0210, the a enc shall u on com letion of <br /> g Y P p <br /> the contract, determine the final contract price, including change orders and ad~ustments to the <br /> J <br /> contract. If the f na1 contract price varies by $100,000 or more, the a enc shall submit an <br /> g Y y <br /> additional payment or request for refund of fees, using form WH-40, to the bureau within 30 <br /> days of f nal payment to the contractor by the agency. <br /> 1 <br /> i <br /> i <br /> E <br /> I <br /> PORTLAND ~ ~ EUGENE ~ ~ ~ ~ ~ BEND MEDFORD <br /> $00 NE Oregon St. Suite 1045 1400 Executive Parkway, Suite 200 Worksource Bend 119 N Oakdale Ave. <br /> Portland, 4R 9723 2180 Eugene, 4R 97401-2158 1645 NE Forbes Rd, Ste 106 Medford, OR 975012629 <br /> X971) 673-0761 (541) 686-7623 Bend, OR 97701-4990 (541} 776-6270 <br /> Fax (971} 673-0762 FAX X541) 686-7980 (541} 322-2435 FAX (541} 776-6284 <br /> ~regan Relay TTY X800} 735-2900 FAX X541} 389-8265 <br /> SALEM PENDLE <br /> 3865 Wolverine St. NE; E-1 1327 SE 3~ ~ ~ Z~~ <br /> Salem, OR 97305-1268 Pendleton, 0R 97801-4101 <br /> X503) 378-3292 www.Oregon.gov/bola X541} 276-7884 <br /> FAX X503} 373-7636 AN EQUAL GPPGRTUNZTY EMPLGYER FAx (541} 276-5767 <br /> <br />