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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 Name <br />Project Location (Street(s), City, <br />Project County, <br />~gency Number <br />Phone_ <br />Project Number <br />Fax Number _ <br />Phone Number <br />Contract Amour <br />Source of Funds (i.e. 100°k Federal Funds, 50/50 Federal/State, 100% 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 Specifications First Advertised for Bid <br />Date Contract Awarded Date Worlc Expected to Begin <br />Date First Progress Payment Due Expected Date of Completion <br />3. PRIME CONTRACTOR INFORMATION <br />Name <br />Add <br />City, State, <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 />SOO NE OREGON # 32 <br />PoRruNU, OR 97232 <br />(503) 731-4074, exr. 250 Fax: (503)737-4623 <br />Phone <br />g:\whd\pwr\bidaward.sam(Rev. 6/96) <br />WH-81 <br />