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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 __ Agency Number <br />Address <br />_ _ _ __ _. <br />_ - _ ._ <br />City, State, Zip _ . _ _ _ <br />__ _ <br />_ ._ _ _ __ _ <br />___ . ___ _ _ <br />__ . ____ <br />___ ___ - <br />Agency Representative Phone <br />_ _ <br />2. CONTRACT INFORMATION <br />Project Name Project Number <br />Project Manager Name Fax Number <br />__ <br />__ <br />Phone Number <br />Project Location (Street(s), City, State) <br />Project County __ ___ ___ _ Contract Amount <br />__ _ _ _ _ <br />Source of Funds (i.e. 100% 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 />farm 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 />. _ __ . _ _ ___ <br />Date Contract Awarded ____ Date Work Expected to Begin __ <br />_ ---_ _ . _ <br />Date First Progress Payment Due __ ___ _ Expected Date of Completion <br />___ _ <br />3. PRIME CONTRACTOR INFORMATION <br />Name <br />Address <br />City, State, Zip . . _ Phnne <br />_ _. _ _ <br />Construction Contractors Board Registration Number ._ <br />__ ___ __ <br />. _ _ <br />Workers' Comp. Insurance Campany <br />Workers' Comp Policy/Binder Number <br />_. _. __ _ <br />__ _ _ <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 />PORTLAND~ OR 97232 <br />(503) 731-4074, exr. 250 Fax: (503)731-4623 <br />{;.Aµ~hd\pwr~bidaH~xrdsam(lic~~. b/7G) <br />WH-81 <br />