Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110273   Estimate Number: 0018 , Final     Spec Year: 2009
Primary JP: 28308(04)   Residency: EDMOND (04400)     Contract No: 710188
Date Created: 08/05/2013   Contractor FEI: 731452899     Account No: 404400

Project Number(s): SBR-155N(837)SB
Contract Description: BRIDGE REHABILITATION I-40: OVER I-44, 5.4 MILES EAST OF THE CANADIAN COUNTY LINE. PROJECT LENGTH = 0.173 MILES.
Primary County: OKLAHOMA              
Name of Road: I-40              
Prime Contractor: PBX CORPORATION           Time Charged: 299.00
    P.O. BOX 644           Time Allowed: 299.00
    SAPULPA , OK   74067           Percent Time: 100.00 %

  Paid To Date: $2,084,640.91 Payable This Statement: $20,000.00

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.                                
PBX CORPORATION                                
 
_________________________________________________
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:    08/05/2013
Contract ID: 110273   Estimate Number: 0018     Contract No: 710188
Residency: EDMOND (04400)   Estimate Type: Final     Account No: 404400

Project Number(s): SBR-155N(837)SB
Primary Job Piece No: 28308(04)
Contract Description: BRIDGE REHABILITATION I-40: OVER I-44, 5.4 MILES EAST OF THE CANADIAN COUNTY LINE. PROJECT LENGTH = 0.173 MILES.
Primary County: OKLAHOMA              
Name of Road: I-40              
Prime Contractor: PBX CORPORATION              
    P.O. BOX 644              
    SAPULPA , OK   74067              
Surety Company: WESTFIELD INSURANCE COMPANY              

Date Let: 07/21/2011 NTP Effective Date: 10/03/2011 Pay Period: 08/01/2013  TO  08/05/2013
Date Awarded: 08/01/2011 Date Work Began: 10/03/2011 Original Contract Time: 100
Date Contract Executed: 08/09/2011 Date Time Stopped: 10/05/2012 Current Time Charged: 299.00
Date NTP Issued: 08/25/2011 Completion Date: 10/05/2012 Current Time Allowed: 299.00
General Liability Expires: 10/05/2013 Workman's Comp Expires: 10/05/2013 Percent Time Used: 100.00 %
Specification Year: 2009        

Current Contract Amount: $2,084,640.91 Total to Date Prev to Date This Estimate
Bid Amount: $1,384,147.70 Participating: $0.00 $0.00 $0.00
Percent Complete: 100 % Non Participating: $2,084,640.93 $2,084,640.93 $0.00
Funds Available: $0.00 Total Earnings: $2,084,640.93 $2,084,640.93 $0.00
Unearned Balance: $-700,493.21 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $2,084,640.93 $2,084,640.93 $0.00
Other Adjustments: $-0.02 $-20,000.02 $20,000.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $2,084,640.91 $2,064,640.91 $20,000.00

Estimate Adjustment Detail

Contract ID: 110273   Estimate Number: 0018     Primary JP: 28308(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 B Bid Approved 11/06/2012 0.0 $405,000.00
002 Item Overruns Approved 10/09/2012 0.0 $159,920.50
003 Additional Bridge Work Approved 02/05/2013 199.0 $166,516.07
004 Final Quantities Approved 07/24/2013 0.0 $-30,943.36


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
28308(04) 0018 Bearing Assembly Stockpiled Material Initial Payment 0010 $52,649.00
28308(04) 0018 Bearing Assembly Stockpiled Material Initial Payment 0009 $22,168.00
28308(04) 0018 Bearing Assembly Stockpiled Material Adjustment 0011 $-47,107.00
28308(04) 0018 Bearing Assembly Stockpiled Material Adjustment 0012 $-5,542.00
28308(04) 0018 Bearing Assembly Stockpiled Material Adjustment 0011 $-22,168.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0011 $-5,542.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0011 $-5,542.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0011 $-2,771.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0012 $-33,252.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0012 $-38,794.00
28308(04) 0042 Bearing Assembly Stockpiled Material Adjustment 0012 $-24,939.00
28308(04) 0042 Bearing Assembly Stockpiled Material Initial Payment 0009 $27,710.00
28308(04) 0042 Bearing Assembly Stockpiled Material Initial Payment 0009 $38,794.00
28308(04) 0042 Bearing Assembly Stockpiled Material Initial Payment 0009 $36,023.00
28308(04) 0042 Bearing Assembly Stockpiled Material Initial Payment 0009 $5,542.00
28308(04) 0042 Bearing Assembly Stockpiled Material Closure 0014 $-2,771.00
28308(04) 0042 Bearing Assembly Stockpiled Material Initial Payment 0009 $5,542.00
Subtotals For Stockpile Payments $0.00


LIQUIDATED DAMAGES HISTORY
Adjustment Description Estimate Nbr Time Units Rate Adjustment Amount
System Application of Liquidated Damages 0007 --10 $750.00 $-7,500.00
System Application of Liquidated Damages 0008 --15 $750.00 $-11,250.00
System Application of Liquidated Damages 0009 --14 $750.00 $-10,500.00
System Application of Liquidated Damages 0010 --61 $750.00 $-45,750.00
System Application of Liquidated Damages 0011 --31 $750.00 $-23,250.00
System Application of Liquidated Damages 0012 --8.0 $750.00 $-6,000.00
System Application of Liquidated Damages 0013 --53 $750.00 $-39,750.00
System Application of Liquidated Damages 0014 --7.0 $750.00 $-5,250.00
System Application of Liquidated Damages 0016 -199 $750.00 $149,250.00
Subtotals For Liquidated Damages $0.00


CONTRACT ADJUSTMENTS HISTORY
Adjustment Description Estimate Nbr Adjustment Amount
LD Adjustment (Prog. Est. Only) 0008 $7,500.00
LD Adjustment (Prog. Est. Only) 0008 $11,250.00
LD Adjustment (Prog. Est. Only) 0009 $10,500.00
LD Adjustment (Prog. Est. Only) 0010 $45,750.00
LD Adjustment (Prog. Est. Only) 0011 $23,250.00
LD Adjustment (Prog. Est. Only) 0012 $6,000.00
LD Adjustment (Prog. Est. Only) 0013 $39,750.00
Withhold to Funds Avail(Prog. Est. Only) 0013 $-68,036.15
Withhold to Funds Avail(Prog. Est. Only) 0014 $68,036.15
LD Adjustment (Prog. Est. Only) 0014 $5,250.00
Milestone Adjust. (Prog. Est. Only) 0014 $75,000.00
Milestone Adjust. (Prog. Est. Only) 0015 $-75,000.00
LD Adjustment (Prog. Est. Only) 0016 $-149,250.00
Round Error Correction (Final Est. Only) 0017 $-0.02
Milestone Adjust. (Prog. Est. Only) 0017 $-20,000.00
Milestone Adjust. (Prog. Est. Only) 0018 $20,000.00
Subtotals For Contract Adjustments $-0.02


LINE ITEM ADJUSTMENT HISTORY
Project Item Nbr Line Item Description Adjustment Type Estimate Nbr Adj Quantity Unit Price Adjusted Amount
28308(04) 0023 CLSM BACKFILL * Material Discrepancy Adjustments 0007 -17.00 $200.00 $-3,400.00
28308(04) 0023 CLSM BACKFILL * Material Discrepancy Adjustments 0010 17.00 $200.00 $3,400.00
28308(04) 0028 STRUCTURAL STEEL * Missing Material Certification 0007 -464.00 $23.00 $-10,672.00
28308(04) 0028 STRUCTURAL STEEL * Missing Material Certification 0010 464.00 $23.00 $10,672.00
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
01 TIME 'B' BID 10/02/2011 11/23/2011 75.00 DYS $15,000.00 Y


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: 110273   Estimate Number: 0018     Primary JP: 28308(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:    SBR-155N(837)SB Project:    28308(04) Category:    0200/BRIDGE 'A'
0001 DIAMOND GRINDING CONCRETE PAVEMENT 425 5195 SY 4,256.400 4,167.640   4,167.640 $8.00 $0.00 $33,341.12
0002 CLSM BACKFILL 501(G) 6309 CY 20.000 0.000   0.000 $200.00 $0.00 $0.00
0003 (PL)FALSEWORK JACKING 502 6116 LSUM 1.000 1.000   1.000 $9,000.00 $0.00 $9,000.00
0004 RAPID CURE JOINT SEALANT 504(G) 6390 LF 81.200 75.000   75.000 $16.00 $0.00 $1,200.00
0005 MULTIPLE LAYER POLYMER CONCRETE OVERLAY 505(C) 6075 SY 4,256.400 4,167.640   4,167.640 $32.00 $0.00 $133,364.48
0006 CLASS AA CONCRETE 509(A) 1326 CY 20.100 25.970   25.970 $1,200.00 $0.00 $31,164.00
0007 CLASS C CONCRETE 509(D) 1331 CY 1.100 1.980   1.980 $1,500.00 $0.00 $2,970.00
0008 REINFORCING STEEL 511(A) 1332 LB 2,680.000 2,188.240   2,188.240 $0.75 $0.00 $1,641.19
0009 EPOXY COATED REINFORCING STEEL 511(B) 6010 LB 960.000 958.520   958.520 $1.00 $0.00 $958.52
0010 CLASS B BRIDGE DECK REPAIR 513(B) 6019 SY 150.000 255.370   255.370 $250.00 $0.00 $63,842.50
0011 CLASS C BRIDGE DECK REPAIR 513(C) 6020 SY 24.000 0.000   0.000 $360.00 $0.00 $0.00
0012 WATER REPELLENT (VISUALLY INSPECTED) 515(A) 6013 SY 347.300 333.290   333.290 $5.00 $0.00 $1,666.45
0013 PREPARATION OF CRACKS, ABOVE WATER 520(A) 6058 LF 210.000 216.000   216.000 $23.00 $0.00 $4,968.00
0014 EPOXY RESIN, ABOVE WATER 520(C) 6060 GAL 8.100 6.500   6.500 $65.00 $0.00 $422.50
0015 PNEUMATICALLY PLACED MORTAR 521(A) 6210 SY 63.000 255.080   255.080 $450.00 $0.00 $114,786.00
0016 (SP)CORROSION INHIBITOR(SURFACE APPLIED) 535 6130 SY 112.900 582.670   582.670 $55.00 $0.00 $32,046.85
0017 (PL)REPAIR BRIDGE ITEM (TYPE A) 540 4515 EA 176.000 23.000   23.000 $48.00 $0.00 $1,104.00
0018 (PL)REPAIR BRIDGE ITEM (TYPE B) 540 4525 EA 35.000 35.000   35.000 $4,700.00 $0.00 $164,500.00
0019 (PL)REPAIR BRIDGE ITEM (TYPE C) 540 4535 EA 1.000 2.000   2.000 $2,500.00 $0.00 $5,000.00
0020 (PL)REPAIR BRIDGE ITEM (TYPE E) 540 4555 EA 26.000 28.000   28.000 $2,500.00 $0.00 $70,000.00
0021 REMOVAL OF BRIDGE ITEM (TYPE A) 619(B) 2515 EA 1.000 2.000   2.000 $500.00 $0.00 $1,000.00
8001 INCENTIVE FOR EARLY COMPLETION 108 0175 DAY 0.000 27.000   27.000 $15,000.00 $0.00 $405,000.00
8002 CONSTRUCTION MISCELLANEOUS 104 0700 LSUM 0.000 1.000   1.000 $134,770.67 $0.00 $134,770.67
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $1,212,746.28
Fed/State Project Number:    SBR-155N(837)SB Project:    28308(04) Category:    0201/BRIDGE 'B'
0022 DIAMOND GRINDING CONCRETE PAVEMENT 425 5195 SY 3,537.000 3,368.890   3,368.890 $8.00 $0.00 $26,951.12
0023 CLSM BACKFILL 501(G) 6309 CY 20.000 17.000   17.000 $200.00 $0.00 $3,400.00
0024 (PL)FALSEWORK JACKING 502 6116 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0025 ENGINEERED FALSEWORK 502(A) 6173 LSUM 1.000 1.000   1.000 $3,500.00 $0.00 $3,500.00
0026 RAPID CURE JOINT SEALANT 504(G) 6390 LF 81.200 75.000   75.000 $16.00 $0.00 $1,200.00
0027 MULTIPLE LAYER POLYMER CONCRETE OVERLAY 505(C) 6075 SY 3,537.000 3,368.890   3,368.890 $32.00 $0.00 $107,804.48
0028 STRUCTURAL STEEL 506(A) 1322 LB 464.000 464.000   464.000 $23.00 $0.00 $10,672.00
0029 CLASS AA CONCRETE 509(A) 1326 CY 49.900 77.050   77.050 $1,200.00 $0.00 $92,460.00
0030 CLASS C CONCRETE 509(D) 1331 CY 4.100 0.910   0.910 $1,500.00 $0.00 $1,365.00
0031 REINFORCING STEEL 511(A) 1332 LB 6,850.000 6,442.540   6,442.540 $0.75 $0.00 $4,831.91
0032 EPOXY COATED REINFORCING STEEL 511(B) 6010 LB 2,085.000 2,082.860   2,082.860 $1.00 $0.00 $2,082.86
0033 CLASS B BRIDGE DECK REPAIR 513(B) 6019 SY 350.000 186.540   186.540 $250.00 $0.00 $46,635.00
0034 CLASS C BRIDGE DECK REPAIR 513(C) 6020 SY 52.000 0.000   0.000 $360.00 $0.00 $0.00
0035 WATER REPELLENT (VISUALLY INSPECTED) 515(A) 6013 SY 330.800 320.580   320.580 $5.00 $0.00 $1,602.90
0036 PREPARATION OF CRACKS, ABOVE WATER 520(A) 6058 LF 270.000 234.420   234.420 $23.00 $0.00 $5,391.66
0037 EPOXY RESIN, ABOVE WATER 520(C) 6060 GAL 10.500 5.000   5.000 $65.00 $0.00 $325.00
0038 PNEUMATICALLY PLACED MORTAR 521(A) 6210 SY 50.500 196.980   196.980 $450.00 $0.00 $88,641.00
0039 (SP)CARBON FIBER-REINFORCED POLYMER 524(A) 6610 SF 972.400 817.300   817.300 $30.00 $0.00 $24,519.00
0040 (SP)CORROSION INHIBITOR(SURFACE APPLIED) 535 6130 SY 296.200 402.860   402.860 $55.00 $0.00 $22,157.30
0041 (PL)REPAIR BRIDGE ITEM (TYPE A) 540 4515 EA 492.000 25.000   25.000 $48.00 $0.00 $1,200.00
0042 (PL)REPAIR BRIDGE ITEM (TYPE B) 540 4525 EA 41.000 40.000   40.000 $4,700.00 $0.00 $188,000.00
0043 (PL)REPAIR BRIDGE ITEM (TYPE C) 540 4535 EA 2.000 2.000   2.000 $2,500.00 $0.00 $5,000.00
0044 (PL)REPAIR BRIDGE ITEM (TYPE D) 540 4545 EA 2.000 2.000   2.000 $5,000.00 $0.00 $10,000.00
0045 (PL)REPAIR BRIDGE ITEM (TYPE E) 540 4555 EA 21.000 22.000   22.000 $2,500.00 $0.00 $55,000.00
0046 REMOVAL OF BRIDGE ITEM (TYPE A) 619(B) 2515 EA 2.000 2.000   2.000 $500.00 $0.00 $1,000.00
8003 CLASS AA CONCRETE 509(A) 1326 CY 0.000 14.670   14.670 $-60.00 $0.00 $-880.20
Subtotals For Category     0201/BRIDGE 'B'    $0.00 $712,859.03
Fed/State Project Number:    SBR-155N(837)SB Project:    28308(04) Category:    0300/TRAFFIC
0047 (PL)TRUCK MOUNTED ATTENUATOR 876(A) 8482 SD 120.000 90.000   90.000 $4.00 $0.00 $360.00
0048 ARROW DISPLAY(TYPE C) 880(A) 8812 SD 480.000 136.000   136.000 $1.00 $0.00 $136.00
0049 CONSTRUCTION SIGNS 0 TO 6.25 SF 880(B) 8818 SD 7,050.000 760.000   760.000 $0.02 $0.00 $15.20
0050 CONSTRUCTION SIGNS 6.26 SF TO 15.99 SF 880(B) 8821 SD 4,170.000 616.000   616.000 $0.40 $0.00 $246.40
0051 CONSTRUCTION SIGNS 16.0 SF TO 32.99 SF 880(B) 8824 SD 3,600.000 526.000   526.000 $0.40 $0.00 $210.40
0052 CONSTRUCTION BARRICADES(TYPE III) 880(C) 8842 SD 1,890.000 469.000   469.000 $0.02 $0.00 $9.38
0053 WING BARRICADES 880(C) 8848 SD 480.000 2.000   2.000 $0.05 $0.00 $0.10
0054 WARNING LIGHTS(TYPE A) 880(E) 8860 SD 7,380.000 1,396.000   1,396.000 $0.02 $0.00 $27.92
0055 DRUMS 880(F) 8878 SD 8,820.000 7,486.000   7,486.000 $0.02 $0.00 $149.72
0056 TRAFFIC SURVEILLANCE, POLICE 880(L) 8911 HOUR 500.000 1,009.500   1,009.500 $65.00 $0.00 $65,617.50
0057 PORT.CHANGEABLE MESSAGE SIGN 882(A) 8306 SD 480.000 90.000   90.000 $2.00 $0.00 $180.00
Subtotals For Category     0300/TRAFFIC    $0.00 $66,952.62
Fed/State Project Number:    SBR-155N(837)SB Project:    28308(04) Category:    0640/CONSTRUCTION
0058 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $92,083.00 $0.00 $92,083.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $92,083.00
Subtotals For Project SBR-155N(837)SB /28308(04) $0.00 $2,084,640.93