Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 100406   Estimate Number: 0014 , Final     Spec Year: 1999
Primary JP: 27404(04)   Residency: COBB ENGINEERING CO., INC. (08003)     Contract No: 610176
Date Created: 05/01/2012   Contractor FEI: 201717097     Account No: 400850

Project Number(s): STP-STIM(515)IG
Contract Description: PAVEMENT REHABILITATION (ASPHALT) CITY STREET (UNION AVE): FROM 71ST STREET TO 81ST STREET IN THE CITY OF TULSA. PROJECT LENGTH = 0.923 MILES.
Primary County: TULSA              
Name of Road: CITY STREET              
Prime Contractor: ELLSWORTH CONSTRUCTION, LLC           Time Charged: 275.00
    5141 S. 24TH W. AVE           Time Allowed: 280.00
    TULSA , OK   74107           Percent Time: 98.21 %

  Paid To Date: $887,740.03 Payable This Statement: $0.00

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.                                
ELLSWORTH CONSTRUCTION, LLC                               
 
_________________________________________________
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:    05/01/2012
Contract ID: 100406   Estimate Number: 0014     Contract No: 610176
Residency: COBB ENGINEERING CO., INC. (08003)   Estimate Type: Final     Account No: 400850

Project Number(s): STP-STIM(515)IG
Primary Job Piece No: 27404(04)
Contract Description: PAVEMENT REHABILITATION (ASPHALT) CITY STREET (UNION AVE): FROM 71ST STREET TO 81ST STREET IN THE CITY OF TULSA. PROJECT LENGTH = 0.923 MILES.
Primary County: TULSA              
Name of Road: CITY STREET              
Prime Contractor: ELLSWORTH CONSTRUCTION, LLC              
    5141 S. 24TH W. AVE              
    TULSA , OK   74107              
Surety Company: OKLAHOMA SURETY COMPANY              

Date Let: 06/17/2010 NTP Effective Date: 08/30/2010 Pay Period: 03/02/2012  TO  03/09/2012
Date Awarded: 07/06/2010 Date Work Began: 09/13/2010 Original Contract Time: 90
Date Contract Executed: 07/14/2010 Date Time Stopped: 05/31/2011 Current Time Charged: 275.00
Date NTP Issued: 07/16/2010 Completion Date: 05/31/2011 Current Time Allowed: 280.00
General Liability Expires: 06/10/2012 Workman's Comp Expires: 04/08/2012 Percent Time Used: 98.21 %
Specification Year: 1999        

Current Contract Amount: $897,862.87 Total to Date Prev to Date This Estimate
Bid Amount: $750,464.66 Participating: $847,093.08 $847,093.08 $0.00
Percent Complete: 98.87 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $10,122.84 Non ARRA: $50,769.79 $50,769.79 $0.00
Unearned Balance: $-137,275.37 Total Earnings: $897,862.87 $897,862.87 $0.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $897,862.87 $897,862.87 $0.00
Other Adjustments: $-10,122.84 $-10,122.84 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $887,740.03 $887,740.03 $0.00

Estimate Adjustment Detail

Contract ID: 100406   Estimate Number: 0014     Primary JP: 27404(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Remove & replace additional roadway section, Asphalt deduct Approved 05/02/2011 45.0 $143,011.05
002 Deduction for Failing Asphalt Concrete Pavement Approved 09/13/2011 0.0 $-1,895.35
003 Final Quantity Change Order Approved 03/07/2012 0.0 $6,282.51


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
27404(04) 0016 Beam Guard Rail-W-Bean Single Stockpiled Material Adjustment 0011 $-5,550.00
27404(04) 0016 Beam Guard Rail-W-Bean Single Stockpiled Material Initial Payment 0002 $5,550.00
27404(04) 0017 Type "A" Anchor - 750 Stockpiled Material Adjustment 0011 $-2,920.00
27404(04) 0017 Type "A" Anchor - 750 Stockpiled Material Initial Payment 0002 $2,920.00
Subtotals For Stockpile Payments $0.00


LIQUIDATED DAMAGES HISTORY
Adjustment Description Estimate Nbr Time Units Rate Adjustment Amount
System Application of Liquidated Damages 0006 --5.0 $500.00 $-2,500.00
System Application of Liquidated Damages 0007 --8.0 $500.00 $-4,000.00
System Application of Liquidated Damages 0008 --2.0 $500.00 $-1,000.00
System Application of Liquidated Damages 0009 --7.0 $500.00 $-3,500.00
System Application of Liquidated Damages 0010 --15 $500.00 $-7,500.00
System Application of Liquidated Damages 0011 --3.0 $500.00 $-1,500.00
System Application of Liquidated Damages 0012 -30.0 $500.00 $15,000.00
System Application of Liquidated Damages 0013 -10.0 $500.00 $5,000.00
Subtotals For Liquidated Damages $0.00


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
27404(04) 0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0003 0.00 $0.00 $-760.51
27404(04) 0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0004 0.00 $0.00 $-1,093.82
27404(04) 0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0008 2,056.87 $-1.90 $-3,919.88
27404(04) 0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0009 337.53 $-1.38 $-466.05
27404(04) 0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0013 -39.83 $1.48 $-59.18
27404(04) 0007 (SP)ASPHALT CONCRETE TYPE S3(PATCHING)(PG 64-22 OK) Asphalt Binder Adjustment 0008 32.67 $-1.90 $-62.26
27404(04) 0007 (SP)ASPHALT CONCRETE TYPE S3(PATCHING)(PG 64-22 OK) Asphalt Binder Adjustment 0009 31.60 $-1.38 $-43.63
27404(04) 0007 (SP)ASPHALT CONCRETE TYPE S3(PATCHING)(PG 64-22 OK) Asphalt Binder Adjustment 0011 5.77 $-1.38 $-7.97
27404(04) 0007 (SP)ASPHALT CONCRETE TYPE S3(PATCHING)(PG 64-22 OK) Asphalt Binder Adjustment 0013 3.46 $1.48 $5.14
27404(04) 0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0010 2,057.82 $-1.57 $-3,247.24
27404(04) 0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0013 41.68 $1.69 $70.77
27404(04) 0009 (SP)ASPHALT CONCRETE TYPE S5(PG 70-28 OK) Asphalt Binder Adjustment 0009 180.08 $-1.74 $-313.77
27404(04) 0009 (SP)ASPHALT CONCRETE TYPE S5(PG 70-28 OK) Asphalt Binder Adjustment 0010 128.81 $-1.74 $-224.44
Subtotals For Line Item Adjustments $-10,122.84


MILESTONE INFORMATION
Milestone Number Milestone Description Start Date End Date Current Time Allowed Rate Milestone Closed
No milestones exist for this contract.


MILESTONE ADJUSTMENTS
Milestone Number Milestone Adjustment Description Estimate Nbr Total
No milestones adjustments exist for this contract.
Subtotals For Milestones $

Line Item Detail

Contract ID: 100406   Estimate Number: 0014     Primary JP: 27404(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(515)IG Project:    27404(04) Category:    0100/ROADWAY
0001 CONSTRUCTION MISCELLANEOUS 104 0700 LSUM 1.000 1.000   1.000 $9,600.00 $0.00 $9,600.00
0002 CLEARING AND GRUBBING 201 0102 LSUM 1.000 1.000   1.000 $12,000.00 $0.00 $12,000.00
0003 TEMPORARY SILT FENCE 223 2801 LF 10,716.000 0.000   0.000 $2.25 $0.00 $0.00
0004 SOLID SLAB SODDING 230(A) 2806 SY 10,802.000 10,086.390   10,086.390 $1.60 $0.00 $16,138.22
0005 AGGREGATE BASE 303 0192 CY 2,400.000 2,392.510   2,392.510 $46.00 $0.00 $110,055.46
0006 (SP)ASPHALT CONCRETE TYPE S3(PG 64-22 OK) 411(S3) 5945 TON 2,580.000 3,713.150   3,713.150 $56.00 $0.00 $207,936.40
0007 (SP)ASPHALT CONCRETE TYPE S3(PATCHING)(PG 64-22 OK) 411(S3) 6210 TON 50.000 73.500   73.500 $100.00 $0.00 $7,350.00
0008 (SP)ASPHALT CONCRETE TYPE S4(PG 70-28 OK) 411(S4) 5955 TON 2,050.000 2,099.500   2,099.500 $72.50 $0.00 $152,213.75
0009 (SP)ASPHALT CONCRETE TYPE S5(PG 70-28 OK) 411(S5) 5970 TON 350.000 308.890   308.890 $90.00 $0.00 $27,800.10
0010 10" H.E.S. CONCRETE PAVEMENT 414(B) 0302 SY 280.000 338.730   338.730 $80.00 $0.00 $27,098.40
0011 FABRIC REINFORCEMENT 420(A) 4242 SY 9,929.000 7,061.330   7,061.330 $2.30 $0.00 $16,241.06
0012 BITUMINOUS DRIVEWAY (6") 610(G) 4475 SY 414.000 419.180   419.180 $55.00 $0.00 $23,054.90
0013 REMOVAL OF STRUCTURES & OBSTRUCTIONS 619(A) 0920 LSUM 1.000 1.000   1.000 $6,000.00 $0.00 $6,000.00
0014 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 10,348.000 12,065.540   12,065.540 $8.00 $0.00 $96,524.32
0015 REMOVAL OF CONCRETE DRIVEWAY 619(B) 4766 SY 280.000 338.730   338.730 $12.00 $0.00 $4,064.76
0016 BEAM GUARD RAIL-W-BEAM-SINGLE 623(A) 0932 LF 600.000 600.000   600.000 $22.50 $0.00 $13,500.00
0017 GUARD RAIL ANCHOR UNIT (TYPE A) 623(F) 4446 EA 4.000 4.000   4.000 $1,460.00 $0.00 $5,840.00
0018 GUIDE POSTS 623(G) 0936 EA 100.000 98.000   98.000 $33.00 $0.00 $3,234.00
0019 REMOVE AND RESET MAILBOX 629(E) 5048 EA 14.000 8.000   8.000 $200.00 $0.00 $1,600.00
8003 DEDUCTION FOR FAILING MATERIAL 105 2100 LSUM 0.000 0.000   0.000 $784.00 $0.00 $0.00
8004 DEDUCTION FOR FAILING MATERIAL 105 2100 LSUM 0.000 0.000   0.000 $616.00 $0.00 $0.00
8005 DEDUCTION FOR FAILING MATERIAL 105 2100 LSUM 0.000 -1.000   -1.000 $3,295.35 $0.00 $-3,295.35
Subtotals For Category     0100/ROADWAY    $0.00 $736,956.02
Fed/State Project Number:    STP-STIM(515)IG Project:    27404(04) Category:    0300/TRAFFIC
0020 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 19,572.000 19,142.000   19,142.000 $0.73 $0.00 $13,973.66
0021 CONSTRUCTION TRAFFIC STRIPE(PAINT)(4" WIDE) 856(A) 8839 LF 10,000.000 19,602.000   19,602.000 $0.14 $0.00 $2,744.28
0022 ARROW DISPLAY(TYPE A) 880(A) 8803 EA 240.000 0.000   0.000 $1.15 $0.00 $0.00
0023 CONSTRUCTION SIGNS 0 TO 6.25 SF 880(B) 8818 SD 240.000 3,341.000   3,341.000 $2.30 $0.00 $7,684.30
0024 CONSTRUCTION SIGNS 6.26 SF TO 15.99 SF 880(B) 8821 SD 240.000 5,155.000   5,155.000 $3.40 $0.00 $17,527.00
0025 CONSTRUCTION SIGNS 16.0 SF TO 32.99 SF 880(B) 8824 SD 240.000 3,546.000   3,546.000 $3.40 $0.00 $12,056.40
0026 BARRICADES(TYPE II) 880(C) 8836 SD 480.000 150.000   150.000 $0.12 $0.00 $18.00
0027 BARRICADES(TYPE III) 880(C) 8842 SD 480.000 1,525.000   1,525.000 $2.30 $0.00 $3,507.50
0028 VERTICAL PANELS 880(D) 8854 SD 480.000 4,500.000   4,500.000 $0.12 $0.00 $540.00
0029 WARNING LIGHTS(TYPE A) 880(E) 8860 SD 240.000 6,100.000   6,100.000 $0.30 $0.00 $1,830.00
0030 WARNING LIGHTS(TYPE C) 880(E) 8872 SD 240.000 23,817.000   23,817.000 $0.30 $0.00 $7,145.10
0031 DRUMS 880(F) 8881 EA 2,400.000 19,317.000   19,317.000 $0.46 $0.00 $8,885.82
0032 TUBE CHANNELIZERS 880(G) 8887 EA 6,000.000 0.000   0.000 $0.46 $0.00 $0.00
0033 FLAGGER 880(I) 8902 SD 240.000 69.000   69.000 $25.00 $0.00 $1,725.00
Subtotals For Category     0300/TRAFFIC    $0.00 $77,637.06
Fed/State Project Number:    STP-STIM(515)IG Project:    27404(04) Category:    0600/STAKING
0034 STAKING 642 0098 LSUM 1.000 1.000   1.000 $15,000.00 $0.00 $15,000.00
Subtotals For Category     0600/STAKING    $0.00 $15,000.00
Fed/State Project Number:    STP-STIM(515)IG Project:    27404(04) Category:    0640/CONSTRUCTION
0035 (SP)SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000   1.000 $2,500.00 $0.00 $2,500.00
0036 MOBILIZATION 641 1552 LSUM 1.000 1.000   1.000 $15,000.00 $0.00 $15,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $17,500.00
Fed/State Project Number:    STP-STIM(515)IG Project:    27404(04) Category:    0850/NON ARRA FUNDING
8001 REMOVAL OF GUARD RAIL 619(B) 4780 LF 0.000 764.000   764.000 $4.00 $0.00 $3,056.00
8002 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 0.000 1,395.140   1,395.140 $34.20 $0.00 $47,713.79
Subtotals For Category     0850/NON ARRA FUNDING    $0.00 $50,769.79
Fed/State Project Number:    STP-STIM(515)IG Project:    27404(04) Category:    0900/NON PARTICIPATING
Subtotals For Category     0900/NON PARTICIPATING    $0.00 $0.00
Subtotals For Project STP-STIM(515)IG /27404(04) $0.00 $897,862.87