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BUREAU OF LABOR AND INDUSTRL~S <br />NOTICE OF AWARD OF PUBLIC WORKS G~NTRACT <br />(For use by Public Agencies in Complying with ORS 279.363) <br />1. <br />Name _ <br />Address <br />Clty, State, 21p <br />Agency Representative <br />2.CONTRACT <br />Pro]ect Name -s <br />Projeck Manager <br />Project Location <br />Project <br />`SOUree of Funds (i.e. ~00% Fedaral <br />~ <br />Federal/State, ~00°/, Local, <br />~-5 <br />K-~~ <br />Note: If this proJect is Federally funded and subject to the Davis Bacon Ac4, do not su6mit <br />form to the Oregon Bureau of Labor and Industries. If Federal funds are involved, but the ~ <br />is subject to Oregon prevailing wage rate, please specify. <br />Date Contrack SpeclOcatlons,First Advertlsed for Bid VV ~GVV(/Vl `i <br />'•ate Contrect AwaMed _~_~~~ ~~ Date Work Expected to Bagin "~J ~~~ <br />Jate First Pragress Peyment Due ~~ Expected Date of Completion / <br />I w~ ~- <br />3. PRIME ~NTRACTOR INFORMATION ~ <br />Clty, State, Zip w~0 ~Q~l~tc~. ~ 1~~ vl ~ rn~~ Phone ~UN ~l/7i J'~~ Cj <br />Constructlon Contractors Board Registration Number ~ii~~' ~~~~ ~~~(p3 ~~jY,~S-fD"~ ~c (~ ~J~ <br />eHorkars' Camp. Insuranee Company ~ ~ ~ ~~ <br />Workers' Comp Policy/Blnder Number %'J~ ~~ ~~~ <br />THIS FORM WILL BE RETURNED TO THE CONTRACTING AGENCY FOR <br />CORRECTION AND RESUBMITTAL IF INCOMPLETE. <br />RETURN THIS COMPLETED FORM Ta Bureau of Labor and Industries <br />Wage and Hour Division Rm 7760 <br />Prevailing Wage 3ection <br />800 NE Oa~ooN # 32 <br />PoRruNO, OR 97232 <br />(503) 731-4074~ exr. 233 Fax: (503)731-4623 <br />g:1wh d\pwrlbidaward.sa m(Rcr. I N6) <br />WH-81 <br />AGENCY INFORMATION <br />Humber I ~~!/ ~ <br />