Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110055   Estimate Number: 0012 , Final     Spec Year: 2009
Primary JP: 26656(04)   Residency: CIRCUIT ENGR. DISTRICT # 7 (05005)     Contract No: 611127
Date Created: 02/20/2013   Contractor FEI: 900035257     Account No: 436500

Project Number(s): BRO-105D(179)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-118): OVER SHORT CREEK, 2.3 MILES WEST OF THE I-40 JUNCTION. PROJECT LENGTH = 0.123 MILES.
Primary County: BECKHAM              
Name of Road: COUNTY ROAD              
Prime Contractor: MUNOZ CONSTRUCTION, INC.           Time Charged: 136.00
    1020 S.W. 27TH           Time Allowed: 129.00
    OKLAHOMA CITY , OK   73109           Percent Time: 105.43 %

  Paid To Date: $339,978.75 Payable This Statement: $3,925.00

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.                                
MUNOZ CONSTRUCTION, 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:    02/20/2013
Contract ID: 110055   Estimate Number: 0012     Contract No: 611127
Residency: CIRCUIT ENGR. DISTRICT # 7 (05005)   Estimate Type: Final     Account No: 436500

Project Number(s): BRO-105D(179)CI
Primary Job Piece No: 26656(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-118): OVER SHORT CREEK, 2.3 MILES WEST OF THE I-40 JUNCTION. PROJECT LENGTH = 0.123 MILES.
Primary County: BECKHAM              
Name of Road: COUNTY ROAD              
Prime Contractor: MUNOZ CONSTRUCTION, INC.              
    1020 S.W. 27TH              
    OKLAHOMA CITY , OK   73109              
Surety Company: MID-CONTINENT CASUALTY COMPANY              

Date Let: 02/17/2011 NTP Effective Date: 07/05/2011 Pay Period: 02/01/2012  TO  11/02/2012
Date Awarded: 03/07/2011 Date Work Began: 07/05/2011 Original Contract Time: 120
Date Contract Executed: 03/16/2011 Date Time Stopped: 09/14/2012 Current Time Charged: 136.00
Date NTP Issued: 03/18/2011 Completion Date: 09/14/2012 Current Time Allowed: 129.00
General Liability Expires: 02/01/2012 Workman's Comp Expires: 02/01/2012 Percent Time Used: 105.43 %
Specification Year: 2009        

Current Contract Amount: $343,478.75 Total to Date Prev to Date This Estimate
Bid Amount: $345,334.75 Participating: $343,478.75 $342,188.73 $1,290.02
Percent Complete: 98.98 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $3,500.00 Total Earnings: $343,478.75 $342,188.73 $1,290.02
Unearned Balance: $5,356.00 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $343,478.75 $342,188.73 $1,290.02
Other Adjustments: $0.00 $-2,634.98 $2,634.98
Liq Dam/Disincentive: $-3,500.00 $-3,500.00 $0.00
TOTAL: $339,978.75 $336,053.75 $3,925.00

Estimate Adjustment Detail

Contract ID: 110055   Estimate Number: 0012     Primary JP: 26656(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Add Contract Time Approved 01/20/2012 8.0 $0.00
002 Undercut/Subgrade Work Approved 01/20/2012 1.0 $3,000.00
003 Final Quantity Change Order & Asphalt Binder Adjustment Approved 10/30/2012 0.0 $-4,856.00


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
System Application of Liquidated Damages 0008 --7.0 $500.00 $-3,500.00
System Application of Liquidated Damages 0009 --9.0 $500.00 $-4,500.00
System Application of Liquidated Damages 0011 -9.0 $500.00 $4,500.00
Subtotals For Liquidated Damages $-3,500.00


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
26656(04) 0002 TEMPORARY SILT FENCE * Missing Material Certification 0003 -436.00 $1.80 $-784.80
26656(04) 0002 TEMPORARY SILT FENCE * Missing Material Certification 0004 436.00 $1.80 $784.80
26656(04) 0008 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0009 330.69 $3.92 $1,298.42
26656(04) 0012 TYPE B4 CULVERT END TREATMENT * COMPRESSIVE STRENGTH 0009 -4.00 $800.00 $-3,200.00
26656(04) 0012 TYPE B4 CULVERT END TREATMENT * COMPRESSIVE STRENGTH 0011 4.00 $800.00 $3,200.00
26656(04) 0013 TRAFFIC STRIPE(PLASTIC)(4" WIDE) * Missing Material Certification 0010 -1,202.80 $3.00 $-3,608.40
26656(04) 0013 TRAFFIC STRIPE(PLASTIC)(4" WIDE) * Missing Material Certification 0012 1,202.80 $3.00 $3,608.40
26656(04) 0022 CONSTRUCTION STAKING LEVEL II * Missing Material Certification 0011 -0.05 $4,000.00 $-200.00
26656(04) 0022 CONSTRUCTION STAKING LEVEL II * Missing Material Certification 0012 0.05 $4,000.00 $200.00
26656(04) 0023 SWPPP DOCUMENTATION AND MANAGEMENT * Missing Material Certification 0011 -0.25 $500.00 $-125.00
26656(04) 0023 SWPPP DOCUMENTATION AND MANAGEMENT * Missing Material Certification 0012 0.25 $500.00 $125.00
26656(04) 8001 ASPHALT BINDER PRICE ADJUSTMENT * Asphalt Binder Adjustment 0012 0.00 $0.00 $-1,298.42
Subtotals For Line Item Adjustments $0.00
* = User applied Line Item Adjustments


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: 110055   Estimate Number: 0012     Primary JP: 26656(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-105D(179)CI Project:    26656(04) Category:    0100/ROADWAY
0001 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $50,000.00 $0.00 $50,000.00
0002 TEMPORARY SILT FENCE 221(C) 2801 LF 1,500.000 1,157.000   1,157.000 $1.80 $0.00 $2,082.60
0003 SOLID SLAB SODDING 230(A) 2806 SY 5,800.000 8,998.770   8,998.770 $1.40 $0.00 $12,598.28
0004 VEGETATIVE MULCHING 233(A) 2817 AC 1.330 0.000   0.000 $500.00 $0.00 $0.00
0005 AGGREGATE BASE TYPE A 303(A) 2100 CY 250.000 247.920   247.920 $45.00 $0.00 $11,156.40
0006 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 265.000 307.320   307.320 $28.00 $0.00 $8,604.96
0007 TACK COAT 407(B) 0250 GAL 154.000 0.000   0.000 $3.00 $0.00 $0.00
0008 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 340.000 330.690   330.690 $71.00 $0.00 $23,478.99
0009 CLASS C CONCRETE 509(D) 0325 CY 89.000 42.370   42.370 $200.00 $0.00 $8,474.00
0010 48" CORR. GALV. STEEL PIPE 613(B) 0694 LF 180.000 180.000   180.000 $40.00 $0.00 $7,200.00
0011 28" X 20" CORR. GALV. STEEL PIPE ARCH 613(B) 4528 LF 120.000 120.000   120.000 $35.00 $0.00 $4,200.00
0012 TYPE B4 CULVERT END TREATMENT 613(M) 7187 EA 4.000 4.000   4.000 $800.00 $0.00 $3,200.00
0013 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 1,200.000 1,200.000 -2.800 1,200.000 $3.00 $-8.40 $3,600.00
8000 EARTHWORK 202(H) 0185 LSUM 0.000 1.000   1.000 $3,000.00 $0.00 $3,000.00
8001 ASPHALT BINDER PRICE ADJUSTMENT 109 1150 LSUM 0.000 1.000 1.000 1.000 $1,298.42 $1,298.42 $1,298.42
Subtotals For Category     0100/ROADWAY    $1,290.02 $138,893.65
Fed/State Project Number:    BRO-105D(179)CI Project:    26656(04) Category:    0200/BRIDGE 'A'
0014 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 2,340.000 2,340.000   2,340.000 $5.00 $0.00 $11,700.00
0015 STRUCTURAL EXCAVATION UNCLASSIFIED 501(A) 1306 CY 183.000 183.000   183.000 $10.00 $0.00 $1,830.00
0016 CLASS A CONCRETE 509(B) 1328 CY 339.900 339.900   339.900 $260.00 $0.00 $88,374.00
0017 REINFORCING STEEL 511(A) 1332 LB 66,575.000 66,575.000   66,575.000 $0.85 $0.00 $56,588.75
0018 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 336.000 338.610   338.610 $35.00 $0.00 $11,851.35
0019 TYPE I-A FILTER BLANKET 601(C) 1355 TON 75.000 72.600   72.600 $35.00 $0.00 $2,541.00
0020 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $8,000.00 $0.00 $8,000.00
0021 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $4,200.00 $0.00 $4,200.00
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $185,085.10
Fed/State Project Number:    BRO-105D(179)CI Project:    26656(04) Category:    0600/STAKING
0022 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000 0.000 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-105D(179)CI Project:    26656(04) Category:    0640/CONSTRUCTION
0023 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.000 1.000 $500.00 $0.00 $500.00
0024 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $15,000.00 $0.00 $15,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $15,500.00
Subtotals For Project BRO-105D(179)CI /26656(04) $1,290.02 $343,478.75