Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 100126   Estimate Number: 0003 , Final     Spec Year: 1999
Primary JP: 26727(04)   Residency: PURCELL (03200)     Contract No: 511007
Date Created: 09/27/2010   Contractor FEI: 730731258     Account No: 400300

Project Number(s): STP-STIM(298)AG
Contract Description: RESURFACE (ASPHALT) CITY STREET (NW 10TH ST): FROM MAIN STREET EXTEND WEST, IN THE TOWN OF BLANCHARD. PROJECT LENGTH = 0.674 MILES.
Primary County: MCCLAIN              
Name of Road: CITY STREET              
Prime Contractor: HASKELL LEMON CONSTRUCTION CO.           Time Charged: 31.00
    P. O. BOX 75608           Time Allowed: 45.00
    OKLAHOMA CITY , OK   73147-0608           Percent Time: 68.89 %

  Paid To Date: $194,573.58 Payable This Statement: $-270.83

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.                                
HASKELL LEMON CONSTRUCTION CO.                               
 
_________________________________________________
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:    09/27/2010
Contract ID: 100126   Estimate Number: 0003     Contract No: 511007
Residency: PURCELL (03200)   Estimate Type: Final     Account No: 400300

Project Number(s): STP-STIM(298)AG
Primary Job Piece No: 26727(04)
Contract Description: RESURFACE (ASPHALT) CITY STREET (NW 10TH ST): FROM MAIN STREET EXTEND WEST, IN THE TOWN OF BLANCHARD. PROJECT LENGTH = 0.674 MILES.
Primary County: MCCLAIN              
Name of Road: CITY STREET              
Prime Contractor: HASKELL LEMON CONSTRUCTION CO.              
    P. O. BOX 75608              
    OKLAHOMA CITY , OK   73147-0608              
Surety Company: WESTERN SURETY COMPANY              

Date Let: 02/18/2010 NTP Effective Date: 04/26/2010 Pay Period: 05/16/2010  TO  09/15/2010
Date Awarded: 03/01/2010 Date Work Began: 04/27/2010 Original Contract Time: 30
Date Contract Executed: 03/09/2010 Date Time Stopped: 05/25/2010 Current Time Charged: 31.00
Date NTP Issued: 03/16/2010 Completion Date: 05/25/2010 Current Time Allowed: 45.00
General Liability Expires: 07/01/2011 Workman's Comp Expires: 07/01/2011 Percent Time Used: 68.89 %
Specification Year: 1999        

Current Contract Amount: $197,611.47 Total to Date Prev to Date This Estimate
Bid Amount: $213,850.00 Participating: $176,762.47 $197,611.47 $-20,849.00
Percent Complete: 98.46 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $3,037.89 Non ARRA: $20,849.00 $0.00 $20,849.00
Unearned Balance: $19,276.42 Total Earnings: $197,611.47 $197,611.47 $0.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $197,611.47 $197,611.47 $0.00
Other Adjustments: $-3,037.89 $-2,767.06 $-270.83
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $194,573.58 $194,844.41 $-270.83

Estimate Adjustment Detail

Contract ID: 100126   Estimate Number: 0003     Primary JP: 26727(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Change Pay Item from Fly Ash to CKD. Approved 07/06/2010 0.0 $-6,651.00
002 CO FINALIZING CONTRACT ITEMS QUANTITIES Approved 09/07/2010 0.0 $-9,587.53


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
26727(04) 0007 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0001 0.00 $0.00 $3,316.15
26727(04) 0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0002 0.00 $0.00 $3,346.63
26727(04) 0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) * QAQC 0002 0.00 $0.00 $-9,429.84
26727(04) 0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) * QAQC 0003 0.00 $0.00 $-270.83
Subtotals For Line Item Adjustments $-3,037.89
* = User applied Line Item Adjustments


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

Line Item Detail

Contract ID: 100126   Estimate Number: 0003     Primary JP: 26727(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:    STP-STIM(298)AG Project:    26727(04) Category:    0100/ROADWAY
0001 TEMPORARY SILT FENCE 223 2801 LF 200.000 180.000   180.000 $5.00 $0.00 $900.00
0002 SOLID SLAB SODDING 230(A) 2806 SY 1,650.000 1,649.280   1,649.280 $3.00 $0.00 $4,947.84
0003 PROCESSING EXISTING BASE & SURFACE, METHOD B 311(B) 0152 STA 25.000 25.810   25.810 $540.00 $0.00 $13,937.40
0004 (SP)FLY ASH 327(A) 4200 TON 550.000 0.000 -416.980 0.000 $50.00 $-20,849.00 $0.00
0005 TRAFFIC BOUND SURFACE COURSE TYPE E 403(E) 0225 TON 50.000 39.710   39.710 $20.00 $0.00 $794.20
0006 TACK COAT 407 0250 GAL 950.000 491.880   491.880 $2.00 $0.00 $983.76
0007 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) 411(S3) 5945 TON 1,205.000 1,164.950   1,164.950 $57.00 $0.00 $66,402.15
0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) 411(S4) 5955 TON 1,065.000 1,028.720 0.000 1,028.720 $75.00 $0.00 $77,154.00
0009 COLD MILLING BITUMINOUS PAVEMENT 417 4267 SY 800.000 714.680   714.680 $2.00 $0.00 $1,429.36
0010 SAWING PAVEMENT 619(C) 0924 LF 100.000 76.000   76.000 $1.00 $0.00 $76.00
0011 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 13,000.000 11,368.000   11,368.000 $0.32 $0.00 $3,637.76
0012 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $2,500.00 $0.00 $2,500.00
0013 (PL) PRECOATED FABRIC MEMBRANE(STRIP) 931.57 5706 LF 1,100.000 0.000   0.000 $2.80 $0.00 $0.00
Subtotals For Category     0100/ROADWAY    $-20,849.00 $172,762.47
Fed/State Project Number:    STP-STIM(298)AG Project:    26727(04) Category:    0640/CONSTRUCTION
0014 MOBILIZATION 641 1552 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $4,000.00
Fed/State Project Number:    STP-STIM(298)AG Project:    26727(04) Category:    0850/NON ARRA FUNDING
8001 (SP)CEMENT KILN DUST 327(B) 4210 TON 0.000 416.980 416.980 416.980 $50.00 $20,849.00 $20,849.00
Subtotals For Category     0850/NON ARRA FUNDING    $20,849.00 $20,849.00
Subtotals For Project STP-STIM(298)AG /26727(04) $0.00 $197,611.47