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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 />City, State, Zip <br />Agency Representative Phone <br />2. CONTRACT INFORMATION <br />Project Name <br />Project Number <br />Project Manager Name Fax Number <br />Phone Number <br />Pr+oject Location (Street(s)~ City~ State) <br />Project County Contract Amount <br />Source of Funds (i.e.10096 Federal Funds, 50/50 Federal/State, 10096 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 OreBon prevailin9 wage rate, piease specify. <br />Oate Contract Specffications First Advertised for Bid <br />Date Contract Awarded Date Work Expected to Begin <br />Date First Progress Payment Due Expected Date of Completion <br />3. PRIME CONTRACTOR INFORMATION <br />Name <br />Address <br />City~ State, Zip Phone <br />Construction Contractors Board Registration Number <br />Workers' Comp. Insurance Company <br />Wor{cers' Comp PolicylBinder 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 />800 NE ORecoN # 32 <br />PoRruNO, OR 97252 <br />(503) 751-4074, ~. 250 Fnx: (503)731-4623 <br />L:~whd~pwNbidawardaam(Rev. 6/96) <br />WH-81 <br />