Laserfiche WebLink
'~..~ ,~.r+~ . <br />BUREAU OF LABOR AND INDUSTRIES <br />NOTICE OF AWARD OF PUBLIC WORKS CONTRACT <br />(For use by Public Agencies in Comptying wifh ORS 279.363) <br />1.CONTRA TING AGE CY INFORMATION <br />Name ~~ ~ ~~`~ <br />Address <br />City, State, Zip <br />Agency Representative <br />2.C <br />RMATION. • <br />Project Name ~ ~ L~ <br />Project Manager Name_ <br />Project Location <br />Project County, <br />Source of Funds (i.e. 100% Federal Funds, 50/50 FederallState, 100% Local, <br />ency Number ~~ ~ <br />i <br />ho <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. lf Federal funds are involved, but Ehe projec <br />is subject to Oregon prevailing wage rate, please specify. <br />Date Contract Speci£caEion Firs AdverEised for Bid "1~ 1-1 / <br />Date Contract Awarded '1 Date Work Expected Eo Begin . v I <br />Date First Progress Payment Due~ Vn o~i Expected Date of Completion~~ <br />3. PRIME CONTRACTOR INFORMATlO <br />Name 5 Y~k ~ el~~~ S <br />Adifirna~ ~~ O ~ ~ ~+ . O ~V . J~/~ <br />City~ State, <br />Constn~ction Contractors Board Registration <br />Workers' Comp. Insurance Company. <br />Workers' Comp Policy/Binder Numb <br />~ <br />Phone ~~ •~~O ~~~~ `~ <br />THIS FORM WILL BE RETURNED TO THE CONTRACTING AGENCY FOR <br />CORRECTION AND RESUBMITTAL IF INCOMPLETE. <br />RETURN THIS COMPLETED FORM ac Bureau of Labor and Industries <br />` Wage and Hour Division Rm 1160 <br />'I~ Prevailing Wage Section <br />~ ~ 8OO NE OREGON # 32 <br />, ~ PoRTUNO, OR 97232 <br />(503) 731-4074, Exr. 233 Fax: (503)731-4606 <br />e:~whd\pwr~bidaw~rd.anm(Rev 6/96) <br />WH-81 <br />~~~,~T~r~~1 ~ T~~G~•t.NJ~ ~~~5 Project Number ,~'~~ <br />-- _ _ ~ _ <br />