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BUREAU OF LABOR AND INDUSTRIES <br />NOTICE OF AWARD OF PUBLIC WORKS CONTRACT <br />(For use by Pubiic Agencies in Compiying 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 Project Number <br />Project Manager Name Fax Number _ <br />Phone Number _ <br />Project Location (Street(s), City, 8tate) <br />Project County. <br />Contract Amount <br />Source of Funds (i.e. 700% 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 />form to the Oregon Bureau of Labor and Indust~ies. 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 />Date Contract Awarded Date Work Expected to Besin <br />Date First Progress Payment Due Expected Date of Completion <br />3. PRIME CONTRACTOR INFORMATION <br />Name <br />City, State, <br />Phone <br />Construction Contractors Board Registration Number <br />Workers' Comp. Insurance Company <br />Workers' Comp Policy/Binder 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 />Prevalling Wage Section <br />800 NE ORecoH # 32 <br />PoeTU-NO, OR 97232 <br />(503) 731-4074, exr. 250 Fnx: (503)731-4623 <br />g:\whd\pwr\bidawA rd.sa m (Rev. 6/96) <br />WH-81 <br />