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13urcau of Labor and Industrics <br />Prcvailin~; Wage Ratc Unit <br />80i1 N.1;. Orcgon ~t., !! 32 <br />!'c~rtland, OIZ 97232 <br />I'I~~~7ne (5O3) 7'~1-4074, I~~ax~ (503) 7"31-4(>? t <br />PUf31,1_C_WO1ZK_CON.7'IZAC'"I' 1~"l~;I~. INFORMA'1'1ON FORM <br />(I~or usc h~~ ct,ntractors in cotnplying with O{ZS 7_79.375) <br />THIS I~OKM "TO I3F USED FOR PROJECTS AWARDED AN"I'E:R 51?1''TEMI3ER 9, 1995 ONLY <br />CQnttact~r~: Please completc a~id rnail this form to [30L1 at the above address, along with thc appropriate t~ee <br />(1/lOth of I% of the contract price* ) payable to E~OLI. MINIMUM I~ f!;I? IS $100.00, MAXIMUM FI;I? Iti <br />$5,000.00. Without the followin~ cornpleted information, the bureau may bc unable to properly credit you for <br />payment receivcd. <br />C3USlNl?S~ NAMI; (UI3A) <br />MA11.,1NG AUDRESS: <br />YROJL;CT NAME?: <br />PROJI;CI' NUMBR,R: <br />('(' E3 tt <br />PiIONL: <br />(S"I~lil~:!?"1' OR PO 130X N~ <br />_ _ __ _ _ <br />._ __ . <br />_ _ ___ _ <br />(CI'I'Y, S'TA"Tk;, "l,ll") <br />P12OJl?C'I' LOCA"I'ION: ._______ _ <br />AGFNCY AWARDING CON'TRAC"C: <br />AGF:NCY CONT'ACT PERSON: <br />CONTRAC"C AMOUN'T: _ UATE AWARDED: <br />'(('onlrxct aiuount X .001) <br />_ P 11( ) N l:: ~ ---~- --- <br />1)A'('1~. WORK I3EGAN: <br />(Pleasc duplicate this form for tuture use) <br />1lM5197icc(~n s~m <br />