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BUREAU OF LABOR AND INDUSTRIES <br />NOTICE OF AWARD OF PUBLIC WORKS CONTRACT <br />(For use by Public Agencies in Complying with ORS 279.363) <br />1.CONTRACTING AGENCY INFORMATION <br />Name <br />Address <br />City, State, Zip <br />Agency Representative <br />2. CONTRACT INFORMATION <br />Project Name <br />Project Manager Nam <br />ncy Number <br />hone <br />Project Number <br />Fax Number <br />Phone Nurnber <br />Project Location (Street(s), City, <br />Project County, <br />Contract Amount <br />Source of Funds (i.e. 100% Federal Funds, 50/50 Federal/State, 100°/a Local, etc.) <br />Note: If this project is Federally funded and subject to the Davis Bacon Act, do not submit this <br />form to the Oregon Bureau of Labor and Industries. If Federal funds are involved, but the projec <br />is subject to Oregon prevailing wage rate, please specify. <br />Date Contract Speci~cations First Advertised for Bid <br />Date Contract Awarded Date Work Expected to Begin <br />Date First Progress Payment Due Expected Date of Completion <br />3. PRIME CONTRACTOR INFORMATION <br />Name <br />Ad c4 <br />City, State, Zip <br />Construction Contractors Board Registration Number <br />Workers' Comp. Insurance Company, <br />Workers' Comp Policy/Binder Number <br />THIS FORM WILL BE RETURNED TO THE CONTRACTING AGENCY FOR <br />CORRECTION AND RESUBMITTAL IF INCOMPLETE. <br />RETURN THIS COMPLETED FORM TQ Bureau of Labor and Industries <br />Wage and Hour Division Rm 1160 <br />Prevailing Wage Section <br />8OO NE OREGON # 32 <br />PoRru-N~, OR 97232 <br />(503) 731-4074, ExT. 233 Fax: (503)731-4606 <br />Phone <br />g:\whd\pwr\bidaward.sam(Rev. 6/96) <br />WH-81 <br />