New Search
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 />'2v1v0t';w~ <br />__R = <br />l or Office Use Only: <br />1'1(jcct DB <br />PUBLIC WORKS FEE ADJUSTMENT FORM <br />THIS FORM TO BE USED FOR RECONCILIATION OF FEES UPON COMPLETION OF <br />PUBLIC WORKS PROJECTS <br />(As required by ORS 279C.825 and OAR 839-025-0210) <br />PUBLIC AGENCIES: Complete and mail this form to BOLI at the above address after completion of the public work project <br />and not less than 30 days after the final progress payment is made to the contractor. Public agencies are required to determine <br />the final contract price, including all change orders or other adjustments to the original contract price, and to calculate the <br />adjusted prevailing wage rate fee based on the revised contract price. Documentation must be included to support the fmal <br />contract price. Documentation of the final contract price may consist of change orders or other contract documents <br />substantiating the amount of the contract. The prevailing wage rate fee of one-tenth of one percent (.001) shall be applied to the <br />final contract price, with credit taken for fees already submitted. The public agency must submit any additional fee payable to <br />BOLI, or submit any request for refund, with this adjustment form. NO ADDITIONAL FEE IS REQUIRED TO BE PAID, <br />AND REFUNDS WILL NOT BE MADE, FOR RECONCILED AMOUNTS OF LESS THAN $100.00. <br />PUBLIC AGENCY: City of Eugene - En2ineerinz AGENCY 1336 <br />AGENCY CONTACT PERSON: Lynn Bro2den PHONE:(541) 682-5238 <br />MAILING ADDRESS: 99 E. Broadway <br />PROJECT NAME: PBM Amazon Path Rehabilitation from 19th Avenue to 31St Avenue <br />CONTRACT NAME (if part of larger project): <br />PROJECT NUMBER: 4602 PROJECT LOCATION: Amazon Path from 19th Ave to 31St Ave. <br />CONTRACTOR/BUSINESS NAME (DBA): KSH Construction Co. <br />CONTRACTOR CCB#: 166194 DATE AWARDED: 6/26/09 <br />FINAL CONTRACT/PROJECT AMOUNT: $485,800.84 FINAL FEE DUE: ` 95 go <br />(Include all change orders and adjustments to the contract price) (Final Contract amount X.001) <br />ORIGINAL CONTRACT AMOUNT:$366,366.00 INITIAL FEE PAID: $366.36 <br />(Original Contract amount X.001) <br />TOTAL ADJUSTMENT: BALANCE DUE*: I (q,'~'~ <br />or <br />REFUND DUE*: <br />q 332 - l *Final contract fee less initial fee paid <br />~ 1 <br />Sample Calculation: <br />Final Contract Amount: $ 400,000.00 Final Fee Due: $ 400.00 <br />Original Contract Amount: - 300,000.00 Initial Fee Paid: - 300.00 <br />Total Adjustment: $ 100,000.00 Additional Amount Due: $ 100.00 <br />(Please duplicate this form for future use) <br />WH-40 (Rev. 11/07) <br />