Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 100465   Estimate Number: 0010 , Final     Spec Year: 1999
Primary JP: 24612(04)   Residency: GUYMON (06200)     Contract No: 610404
Date Created: 12/06/2012   Contractor FEI: 481174311     Account No: 432600

Project Number(s): BRO-113D(055)CO, ACBRO-113D(056)CO
Contract Description: BRIDGE AND APPROACHES COUNTY ROADS: OVER LANE CANYON AND GALLINAS CANYON CREEK, 5.8 MILES AND 4.25 MILES NORTH OF THE SH-325 JUNCTION. PROJECT LENGTH = 0.264 MILES.
Primary County: CIMARRON              
Name of Road: COUNTY ROAD              
Prime Contractor: KLAVER CONSTRUCTION COMPANY, INC.           Time Charged: 682.00
    P.O. BOX 272           Time Allowed: 704.00
    KINGMAN , KS   67068           Percent Time: 96.88 %

  Paid To Date: $462,411.53 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.                                
KLAVER CONSTRUCTION COMPANY, 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:    12/06/2012
Contract ID: 100465   Estimate Number: 0010     Contract No: 610404
Residency: GUYMON (06200)   Estimate Type: Final     Account No: 432600

Project Number(s): BRO-113D(055)CO, ACBRO-113D(056)CO
Primary Job Piece No: 24612(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROADS: OVER LANE CANYON AND GALLINAS CANYON CREEK, 5.8 MILES AND 4.25 MILES NORTH OF THE SH-325 JUNCTION. PROJECT LENGTH = 0.264 MILES.
Primary County: CIMARRON              
Name of Road: COUNTY ROAD              
Prime Contractor: KLAVER CONSTRUCTION COMPANY, INC.              
    P.O. BOX 272              
    KINGMAN , KS   67068              
Surety Company: TRAVELERS INDEMNITY COMPANY              

Date Let: 07/22/2010 NTP Effective Date: 11/01/2010 Pay Period: 09/01/2012  TO  12/06/2012
Date Awarded: 08/10/2010 Date Work Began: 11/01/2010 Original Contract Time: 120
Date Contract Executed: 08/24/2010 Date Time Stopped: 09/12/2012 Current Time Charged: 682.00
Date NTP Issued: 10/06/2010 Completion Date: 09/12/2012 Current Time Allowed: 704.00
General Liability Expires: 01/01/2013 Workman's Comp Expires: 01/01/2013 Percent Time Used: 96.88 %
Specification Year: 1999        

Current Contract Amount: $462,411.53 Total to Date Prev to Date This Estimate
Bid Amount: $497,647.73 Participating: $462,411.53 $462,411.53 $0.00
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $0.00 Total Earnings: $462,411.53 $462,411.53 $0.00
Unearned Balance: $35,236.20 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $462,411.53 $462,411.53 $0.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $462,411.53 $462,411.53 $0.00

Estimate Adjustment Detail

Contract ID: 100465   Estimate Number: 0010     Primary JP: 24612(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Final Quantity Change Order Approved 11/30/2012 0.0 $-35,236.20


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.
Subtotals For Liquidated Damages $


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 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: 100465   Estimate Number: 0010     Primary JP: 24612(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-113D(055)CO Project:    24612(04) Category:    0100/ROADWAY - BRO-113D(055)CO
0001 EARTHWORK 202(G) 0185 LSUM 1.000 1.000   1.000 $9,935.56 $0.00 $9,935.56
0002 TEMPORARY SILT FENCE 223 2801 LF 250.000 74.000 11.000 74.000 $1.65 $18.15 $122.10
0003 SOLID SLAB SODDING 230(A) 2806 SY 4,360.000 2,758.940   2,758.940 $2.50 $0.00 $6,897.35
0004 VEGETATIVE MULCHING 233(A) 2817 AC 1.170 0.900   0.900 $800.00 $0.00 $720.00
0005 TRAFFIC BOUND SURFACE COURSE TYPE E 403(E) 0225 TON 226.000 219.890   219.890 $105.80 $0.00 $23,264.36
0006 CLASS C CONCRETE 509(D) 0325 CY 10.000 0.000   0.000 $350.00 $0.00 $0.00
0007 SHEET ALUMINUM SIGNS 850(A) 8110 SF 17.000 0.000   0.000 $25.00 $0.00 $0.00
0008 FLANGE CHANNEL POSTS(4 LB/FT) 851(D) 8597 LF 24.000 0.000   0.000 $20.00 $0.00 $0.00
Subtotals For Category     0100/ROADWAY - BRO-113D(055)CO    $18.15 $40,939.37
Fed/State Project Number:    BRO-113D(055)CO Project:    24612(04) Category:    0200/BRIDGE 'A' - BRO-113D(055)CO
0009 CLASS A CONCRETE 509(B) 1328 CY 333.000 333.000   333.000 $420.00 $0.00 $139,860.00
0010 REINFORCING STEEL 511(A) 1332 LB 14,574.000 14,574.000   14,574.000 $0.80 $0.00 $11,659.20
0011 TYPE I-A PLAIN RIPRAP 601(A-1)1353 TON 24.000 23.820   23.820 $124.00 $0.00 $2,953.68
0012 30" CORR. GALV. STEEL PIPE 613(D) 0691 LF 324.000 324.000   324.000 $32.00 $0.00 $10,368.00
0013 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $2,500.13 $0.00 $2,500.13
0014 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $2,700.00 $0.00 $2,700.00
Subtotals For Category     0200/BRIDGE 'A' - BRO-113D(055)CO    $0.00 $170,041.01
Subtotals For Project BRO-113D(055)CO /24612(04) $18.15 $210,980.38


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:    ACBRO-113D(056)CO Project:    24613(04) Category:    0100/ROADWAY - ACBRO-113D(056)CO
0001 EARTHWORK 202(G) 0185 LSUM 1.000 1.000   1.000 $23,750.98 $0.00 $23,750.99
0002 TEMPORARY SILT FENCE 223 2801 LF 350.000 63.000 -11.000 63.000 $1.65 $-18.15 $103.95
0003 SOLID SLAB SODDING 230(A) 2806 SY 5,945.000 3,053.060   3,053.060 $2.50 $0.00 $7,632.65
0004 VEGETATIVE MULCHING 233(A) 2817 AC 1.230 0.000   0.000 $800.00 $0.00 $0.00
0005 TRAFFIC BOUND SURFACE COURSE TYPE E 403(E) 0225 TON 324.000 196.130   196.130 $105.31 $0.00 $20,654.45
0006 CLASS C CONCRETE 509(D) 0325 CY 10.000 0.000   0.000 $350.00 $0.00 $0.00
Subtotals For Category     0100/ROADWAY - ACBRO-113D(056)CO    $-18.15 $52,142.04
Fed/State Project Number:    ACBRO-113D(056)CO Project:    24613(04) Category:    0200/BRIDGE 'A' - ACBRO-113D(056)CO
0007 CLASS A CONCRETE 509(B) 1328 CY 326.800 326.800   326.800 $421.00 $0.00 $137,582.80
0008 REINFORCING STEEL 511(A) 1332 LB 14,534.000 14,534.000   14,534.000 $0.80 $0.00 $11,627.19
0009 TYPE I-A PLAIN RIPRAP 601(A-1)1353 TON 24.000 24.000   24.000 $124.00 $0.00 $2,976.00
0010 42" X 29" CORR. GALV. STEEL PIPE ARCH 613(D) 4530 LF 191.650 191.650   191.650 $60.00 $0.00 $11,499.00
0011 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $2,504.12 $0.00 $2,504.12
0012 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $2,700.00 $0.00 $2,700.00
Subtotals For Category     0200/BRIDGE 'A' - ACBRO-113D(056)CO    $0.00 $168,889.11
Fed/State Project Number:    ACBRO-113D(056)CO Project:    24613(04) Category:    0600/STAKING - ACBRO-113D(056)CO
0013 STAKING 642 0098 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
Subtotals For Category     0600/STAKING - ACBRO-113D(056)CO    $0.00 $4,000.00
Fed/State Project Number:    ACBRO-113D(056)CO Project:    24613(04) Category:    0640/CONSTRUCTION - ACBRO-113D(056)CO
0014 (SP)SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000   1.000 $2,500.00 $0.00 $2,500.00
0015 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $23,900.00 $0.00 $23,900.00
Subtotals For Category     0640/CONSTRUCTION - ACBRO-113D(056)CO    $0.00 $26,400.00
Subtotals For Project ACBRO-113D(056)CO /24613(04) $-18.15 $251,431.15