Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 090378   Estimate Number: 0013 , Final     Spec Year: 1999
Primary JP: 22180(04)   Residency: TETRA TECH (01002)     Contract No: 411224
Date Created: 08/03/2010   Contractor FEI: 731603183     Account No: 432100

Project Number(s): BRO-STIM(192)CO
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD(EW-86): OVER UNNAMED CREEK, 4.2 MILES EAST AND 2.0 MILES NORTH OF US-75/SH-16 JUNCTION. PROJECT LENGTH = 0.138 MILES
Primary County: OKMULGEE              
Name of Road: COUNTY ROAD              
Prime Contractor: BELK BRIDGE, INC.           Time Charged: 309.00
    4 RIVER RIDGE ROAD           Time Allowed: 342.00
    BROKEN ARROW , OK   74014           Percent Time: 90.35 %

  Paid To Date: $356,975.28 Payable This Statement: $1,269.98

CONTRACTOR AFFIDAVIT
STATE OF ___________________ )  
  )      
COUNTY OF __________________ )  
The undersigned contractor or duly authorized agent, of lawful age, being first duly sworn, on oath say that this claim is true and correct.
Affiant further states that the work, services or materials as shown by this claim have been completed or supplied in accordance with the plans, specifications, orders, requests and all other terms of the contract. Affiant further states that (s)he is duly authorized agent of the contractor for the purpose of certifying the facts pertaining to the giving of things of value to government personnel in order to procure the contract or obtain payment; that (s)he is fully aware of the facts and circumstances surrounding the making of the contract and has been personally and directly involved in the proceedings leading to the procurement of the contract and the filing of this claim; and, neither the contractor nor anyone subject to the contractor's direction or control has been paid, given or donated or agreed to pay, give or donate to any officer or employee of the State of Oklahoma any money or other thing of value, either directly or
indirectly, in procuring the contract or obtaining payment. The affiant further certifies that all laborers, mechanics, apprentices and trainees employed by him/her or by any subcontractor performing work under the contract on the project have been paid wages at rates not less than those required by the contract provisions, and that the work performed by each such laborer, mechanic, apprentice or trainee conformed to the classifications set forth in the contract or training program provisions applicable to the wage rate paid.
Affiant hereby agrees that Contractor will accept this estimate as full compensation for all money due Contractor by the Department of Transportation, and hereby relinquish all claims, either in contract or in tort, which have arisen or which might arise out of the construction of said project. That to the best of my knowledge and belief, all indebtedness for labor, materials, fuel, equipment, equipment rental, parts, supplies, insurance premiums, and claims for items not specifically mentioned, which are attributable to performance of the work on this project or which were incorporated therein in any manner, have been paid in full, and that there are not now any presently outstanding, unpaid claims for such indebtedness; that my position with the company is such, that if there were any such outstanding claims of the nature specified herein, I would ordinarily be aware of them.
Further affiant sayeth not.                                
BELK BRIDGE, INC.                                
 
_________________________________________________
Affiant Signature
 
_________________________________________________
Affiant Printed Name
                          PE Seal
_________________________________________________
Affiant Company Position
Subscribed and sworn to before me this ______ day of ____________, 20____
My Commission Number: ____________ My Commission Expires: ______________
   
_________________________________________________              
_________________________________________________
                    Professional Engineer Signature
              Oklahoma Department of Transportation
Corporate Seal
Notary Seal                  

Oklahoma Department of Transportation
Final Estimate Summary
Created:    08/03/2010
Contract ID: 090378   Estimate Number: 0013     Contract No: 411224
Residency: TETRA TECH (01002)   Estimate Type: Final     Account No: 432100

Project Number(s): BRO-STIM(192)CO
Primary Job Piece No: 22180(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD(EW-86): OVER UNNAMED CREEK, 4.2 MILES EAST AND 2.0 MILES NORTH OF US-75/SH-16 JUNCTION. PROJECT LENGTH = 0.138 MILES
Primary County: OKMULGEE              
Name of Road: COUNTY ROAD              
Prime Contractor: BELK BRIDGE, INC.              
    4 RIVER RIDGE ROAD              
    BROKEN ARROW , OK   74014              
Surety Company: EMPLOYERS MUTUAL CASUALTY COMPANY              

Date Let: 04/23/2009 NTP Effective Date: 09/08/2009 Pay Period: 05/01/2010  TO  08/03/2010
Date Awarded: 04/27/2009 Date Work Began: 07/13/2009 Original Contract Time: 120
Date Contract Executed: 05/12/2009 Date Time Stopped: 05/17/2010 Current Time Charged: 309.00
Date NTP Issued: 05/15/2009 Completion Date: 05/17/2010 Current Time Allowed: 342.00
General Liability Expires: 08/27/2010 Workman's Comp Expires: 09/01/2010 Percent Time Used: 90.35 %
Specification Year: 1999        

Current Contract Amount: $356,975.26 Total to Date Prev to Date This Estimate
Bid Amount: $356,713.30 Participating: $355,502.28 $354,232.30 $1,269.98
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $-0.02 Non ARRA: $1,473.00 $1,473.00 $0.00
Unearned Balance: $-261.98 Total Earnings: $356,975.28 $355,705.30 $1,269.98
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $356,975.28 $355,705.30 $1,269.98
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $356,975.28 $355,705.30 $1,269.98

Estimate Adjustment Detail

Contract ID: 090378   Estimate Number: 0013     Primary JP: 22180(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Flowlines of Drainage Swales to Drain Approved 12/03/2009 0.0 $-8.00
002 FQCO Approved 08/02/2010 0.0 $269.96


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
No material stockpiles have been created for this contract.
Subtotals For Stockpile Payments $0.00


LIQUIDATED DAMAGES HISTORY
Adjustment Description Estimate Nbr Time Units Rate Adjustment Amount
No liquidated damages have been assessed on this contract.


CONTRACT ADJUSTMENTS HISTORY
Adjustment Description Estimate Nbr Adjustment Amount
No general contract adjustments have been created on this contract.
Subtotals For Contract Adjustments $0.00


LINE ITEM ADJUSTMENT HISTORY
Project Item Nbr Line Item Description Adjustment Type Estimate Nbr Adj Quantity Unit Price Adjusted Amount
No line item adjustments have been created on this contract.
Subtotals For Line Item Adjustments $0.00


MILESTONE ADJUSTMENTS
Milestone Number Milestone Description Time Allowed Time Used Rate Total
No milestones exist for this contract.

Line Item Detail

Contract ID: 090378   Estimate Number: 0013     Primary JP: 22180(04)



Line Item Number Item Description Item Number Units Bid Qty Current Quantity Quantity Paid This Est. Quantity Paid To Date Unit Price Amount Paid This Est. Amount Paid To Date
Fed/State Project Number:    BRO-STIM(192)CO Project:    22180(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201 0102 LSUM 1.000 1.000   1.000 $9,000.00 $0.00 $9,000.00
0002 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 143.000 1,227.000   1,227.000 $8.50 $0.00 $10,429.50
0003 UNCLASSIFIED BORROW 202(C) 0184 CY 4,824.000 4,824.000   4,824.000 $8.50 $0.00 $41,004.00
0004 TYPE A-SALVAGED TOPSOIL 205 4229 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
0005 TEMPORARY SILT FENCE 223 2801 LF 800.000 750.000   750.000 $1.50 $0.00 $1,125.00
0006 TEMPORARY SILT DIKE 227 0100 LF 200.000 28.000   28.000 $6.00 $0.00 $168.00
0007 SOLID SLAB SODDING 230(A) 2806 SY 2,275.000 2,951.700 103.837 2,951.700 $2.60 $269.98 $7,674.42
0008 VEGETATIVE MULCHING 233(A) 2817 AC 1.080 0.235   0.235 $450.00 $0.00 $105.75
0009 SEPARATOR FABRIC 325 5271 SY 1,878.000 0.000   0.000 $2.50 $0.00 $0.00
0010 TRAFFIC BOUND SURFACE COURSE TYPE E 403(E) 0225 TON 414.000 455.240   455.240 $19.50 $0.00 $8,877.18
0011 CLASS C CONCRETE 509(D) 0325 CY 20.000 0.000   0.000 $300.00 $0.00 $0.00
Subtotals For Category     0100/ROADWAY    $269.98 $82,383.85
Fed/State Project Number:    BRO-STIM(192)CO Project:    22180(04) Category:    0200/BRIDGE 'A'
0012 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 84.000 84.000   84.000 $10.00 $0.00 $840.00
0013 UNCLASSIFIED BACKFILL 501(D) 6353 CY 82.000 82.000   82.000 $15.00 $0.00 $1,230.00
0014 PRESTRESSED CONCRETE BEAMS (TYPE IV) 503(A) 1313 LF 316.670 316.670   316.670 $190.00 $0.00 $60,167.30
0015 CONCRETE RAIL (TR1) 504(E) 1380 LF 225.000 225.000   225.000 $80.00 $0.00 $18,000.00
0016 STRUCTURAL STEEL 506(A) 1322 LB 1,810.000 1,789.000   1,789.000 $4.00 $0.00 $7,156.00
0017 CLASS AA CONCRETE 509(A) 1326 CY 62.500 62.500   62.500 $550.00 $0.00 $34,375.00
0018 CLASS A CONCRETE 509(B) 1328 CY 53.800 53.800 0.000 53.800 $550.00 $0.00 $29,590.00
0019 REINFORCING STEEL 511(A) 1332 LB 21,500.000 21,500.000   21,500.000 $2.00 $0.00 $43,000.00
0020 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 380.000 380.000   380.000 $20.00 $0.00 $7,600.00
0021 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 380.000 357.860   357.860 $10.00 $0.00 $3,578.60
0022 TYPE I-A PLAIN RIPRAP 601(A-1)1353 TON 920.000 892.630   892.630 $27.50 $0.00 $24,547.33
0023 TYPE I-A FILTER BLANKET 601(A-2)1355 TON 195.000 205.710   205.710 $23.50 $0.00 $4,834.20
0024 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $2,000.00 $0.00 $2,000.00
0025 GUARD RAIL ANCHOR UNIT (TYPE II) 623(F) 6033 EA 4.000 4.000   4.000 $2,000.00 $0.00 $8,000.00
0026 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $3,200.00 $0.00 $3,200.00
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $248,118.43
Fed/State Project Number:    BRO-STIM(192)CO Project:    22180(04) Category:    0600/STAKING
0027 STAKING 642 0098 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
Subtotals For Category     0600/STAKING    $0.00 $4,000.00
Fed/State Project Number:    BRO-STIM(192)CO Project:    22180(04) Category:    0640/CONSTRUCTION
0028 (SP)SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $4,000.00 $1,000.00 $4,000.00
0029 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $17,000.00 $0.00 $17,000.00
Subtotals For Category     0640/CONSTRUCTION    $1,000.00 $21,000.00
Fed/State Project Number:    BRO-STIM(192)CO Project:    22180(04) Category:    0850/Non ARRA Funding
8001 24" CORR. GALV. STEEL PIPE 613(D) 0690 LF 0.000 32.000   32.000 $31.25 $0.00 $1,000.00
8002 24" GALV. STEEL CULVERT END SEC. RND. 613(G) 0761 EA 0.000 2.000   2.000 $236.50 $0.00 $473.00
Subtotals For Category     0850/Non ARRA Funding    $0.00 $1,473.00
Subtotals For Project BRO-STIM(192)CO /22180(04) $1,269.98 $356,975.28