Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110289   Estimate Number: 0005 , Final     Spec Year: 2009
Primary JP: 28221(04)   Residency: ENID (04300)     Contract No: 710880
Date Created: 07/30/2013   Contractor FEI: 730626847     Account No: 404400

Project Number(s): SSR-124N(139)SR
Contract Description: RESURFACE (ASPHALT) US-81: FROM 1.0 MILES SOUTH OF US-412, EXTEND NORTH. PROJECT LENGTH = 0.92 MILES.
Primary County: GARFIELD              
Name of Road: US-81              
Prime Contractor: THE CUMMINS CONSTRUCTION CO., INC.           Time Charged: 55.00
    P. O. BOX 748           Time Allowed: 75.00
    ENID , OK   73702           Percent Time: 73.33 %

  Paid To Date: $576,284.98 Payable This Statement: $-20,104.37

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.                                
THE CUMMINS CONSTRUCTION CO., 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:    07/30/2013
Contract ID: 110289   Estimate Number: 0005     Contract No: 710880
Residency: ENID (04300)   Estimate Type: Final     Account No: 404400

Project Number(s): SSR-124N(139)SR
Primary Job Piece No: 28221(04)
Contract Description: RESURFACE (ASPHALT) US-81: FROM 1.0 MILES SOUTH OF US-412, EXTEND NORTH. PROJECT LENGTH = 0.92 MILES.
Primary County: GARFIELD              
Name of Road: US-81              
Prime Contractor: THE CUMMINS CONSTRUCTION CO., INC.              
    P. O. BOX 748              
    ENID , OK   73702              
Surety Company: HARTFORD ACCIDENT & INDEMNITY COMPANY              

Date Let: 01/19/2012 NTP Effective Date: 04/02/2012 Pay Period: 06/13/2012  TO  07/30/2013
Date Awarded: 02/06/2012 Date Work Began: 03/25/2012 Original Contract Time: 75
Date Contract Executed: 02/21/2012 Date Time Stopped: 09/27/2012 Current Time Charged: 55.00
Date NTP Issued: 02/27/2012 Completion Date: 09/27/2012 Current Time Allowed: 75.00
General Liability Expires: 09/01/2013 Workman's Comp Expires: 01/01/2014 Percent Time Used: 73.33 %
Specification Year: 2009        

Current Contract Amount: $576,284.95 Total to Date Prev to Date This Estimate
Bid Amount: $679,606.00 Participating: $0.00 $0.00 $0.00
Percent Complete: 100 % Non Participating: $574,725.59 $601,901.96 $-27,176.37
Funds Available: $-0.03 Total Earnings: $574,725.59 $601,901.96 $-27,176.37
Unearned Balance: $103,321.02 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $574,725.59 $601,901.96 $-27,176.37
Other Adjustments: $1,559.39 $-5,512.61 $7,072.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $576,284.98 $596,389.35 $-20,104.37

Estimate Adjustment Detail

Contract ID: 110289   Estimate Number: 0005     Primary JP: 28221(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Millings to the contractor Approved 06/13/2012 0.0 $-28,800.00
002 FQCO Approved 07/24/2013 0.0 $-74,521.05


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
28221(04) 0003 SUPERPAVE, TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0002 2,790.65 $0.54 $1,533.74
28221(04) 0003 SUPERPAVE, TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0003 46.67 $0.54 $25.65
28221(04) 0023 TRAFFIC STRIPE(MULTI-POLYMER)(4" WIDE) * Missing Material Certification 0002 -7,000.00 $0.37 $-2,590.00
28221(04) 0023 TRAFFIC STRIPE(MULTI-POLYMER)(4" WIDE) * Missing Material Certification 0005 0.00 $0.00 $2,590.00
28221(04) 0026 TRAFFIC STRIPE(MULTI-POLY.)(24" WIDE) * Missing Material Certification 0002 -216.00 $2.25 $-486.00
28221(04) 0026 TRAFFIC STRIPE(MULTI-POLY.)(24" WIDE) * Missing Material Certification 0005 0.00 $0.00 $486.00
28221(04) 0027 TRAFFIC STRIPE (MULTI-POLYMER)(SYMBOLS, WORDS. ETC.) * Missing Material Certification 0002 -36.00 $111.00 $-3,996.00
28221(04) 0027 TRAFFIC STRIPE (MULTI-POLYMER)(SYMBOLS, WORDS. ETC.) * Missing Material Certification 0005 0.00 $0.00 $3,996.00
Subtotals For Line Item Adjustments $1,559.39
* = 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: 110289   Estimate Number: 0005     Primary JP: 28221(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:    SSR-124N(139)SR Project:    28221(04) Category:    0200/ROADWAY
0001 SOLID SLAB SODDING 230(A) 2806 SY 20.000 0.000   0.000 $86.00 $0.00 $0.00
0002 AGGREGATE BASE TYPE A 303(A) 2100 CY 300.000 0.000   0.000 $86.00 $0.00 $0.00
0003 SUPERPAVE, TYPE S4(PG 70-28 OK) 411(C) 5955 TON 3,800.000 3,971.710   3,971.710 $102.50 $0.00 $407,100.29
0004 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 140.000 0.000   0.000 $93.00 $0.00 $0.00
0005 SUPERPAVE, TYPE S3(PATCH)(PG64-22OK) 411(H) 6210 TON 550.000 633.630   633.630 $119.50 $0.00 $75,718.79
0006 COLD MILLING PAVEMENT 412 5267 SY 35,000.000 32,833.540 -959.800 32,833.540 $1.85 $-1,775.63 $60,742.05
0007 COMBINED CURB & GUTTER (6" BARRIER) 609(B) 0383 LF 200.000 0.000   0.000 $167.00 $0.00 $0.00
0008 4" CONCRETE SIDEWALK 610(A) 0602 SY 10.000 0.000   0.000 $278.00 $0.00 $0.00
0009 TACTILE WARNING DEVICE-NEW 610(I) 4610 SF 8.000 0.000   0.000 $130.00 $0.00 $0.00
0010 INLET CI DES. 1 (A) 611(G) 5101 EA 1.000 0.000   0.000 $3,550.00 $0.00 $0.00
0011 ADD'L DEPTH IN INLET CI DES. 1 611(H) 5320 VF 1.000 0.000   0.000 $670.00 $0.00 $0.00
0012 REPLACEMENT OFINLET FRM&GRT (SSIF-FRM,CIG-GRT-VG-F) 611(I) 4488 EA 1.000 0.000   0.000 $950.00 $0.00 $0.00
0013 REPLACEMENT OF CAST IRON HOOD 611(M) 4488 EA 2.000 0.000   0.000 $670.00 $0.00 $0.00
0014 MANHOLES ADJUST TO GRADE 612(A) 0641 EA 13.000 15.000   15.000 $945.00 $0.00 $14,175.00
0015 INLET ADJUST TO GRADE 612(C) 0645 EA 4.000 0.000   0.000 $1,110.00 $0.00 $0.00
0016 VALVE BOXES ADJUST TO GRADE 612(E) 0647 EA 20.000 18.000   18.000 $725.00 $0.00 $13,050.00
0017 15" R.C.PIPE CLASS III 613(A) 0403 LF 8.000 0.000   0.000 $335.00 $0.00 $0.00
0018 18" R.C.PIPE CLASS III 613(A) 0491 LF 8.000 0.000   0.000 $400.00 $0.00 $0.00
0019 REMOVAL OF CURB AND GUTTER 619(B) 4726 LF 200.000 0.000   0.000 $8.00 $0.00 $0.00
0020 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 1,100.000 1,347.220 63.020 1,347.220 $12.75 $803.51 $17,177.06
0021 REMOVAL OF DRAINAGE INLETS 619(B) 4741 EA 1.000 0.000   0.000 $500.00 $0.00 $0.00
0022 REMOVAL OF SIDEWALK 619(B) 4792 SY 10.000 0.000   0.000 $50.00 $0.00 $0.00
8000 CONSTRUCTION MISCELLANEOUS 104 0150 TON 0.000 3,422.320 3,422.320 3,422.320 $-9.00 $-30,800.88 $-30,800.88
8001 ASPHALT BINDER PRICE ADJUSTMENT 109 1150 LSUM 0.000 1.000   0.000 $1,559.39 $0.00 $0.00
Subtotals For Category     0200/ROADWAY    $-31,773.00 $557,162.31
Fed/State Project Number:    SSR-124N(139)SR Project:    28221(04) Category:    0400/TRAFFIC
0023 TRAFFIC STRIPE(MULTI-POLYMER)(4" WIDE) 856(A) 8530 LF 15,000.000 10,874.000 3,874.000 10,874.000 $0.37 $1,433.38 $4,023.38
0024 TRAFFIC STRIPE(MULTI-POLY.)(6" WIDE) 856(A) 8535 LF 6,000.000 3,023.000 3,023.000 3,023.000 $0.40 $1,209.20 $1,209.20
0025 TRAFFIC STRIPE(MULTI-POLY.)(8" WIDE) 856(A) 8540 LF 100.000 302.000 302.000 302.000 $0.45 $135.90 $135.90
0026 TRAFFIC STRIPE(MULTI-POLY.)(24" WIDE) 856(A) 8555 LF 500.000 486.000 270.000 486.000 $2.25 $607.50 $1,093.50
0027 TRAFFIC STRIPE (MULTI-POLYMER)(SYMBOLS, WORDS. ETC.) 856(B) 8525 EA 48.000 37.000 1.000 37.000 $111.00 $111.00 $4,107.00
0028 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000 0.150 1.000 $6,850.00 $1,027.50 $6,850.00
0029 PORT.CHANGEABLE MESSAGE SIGN 882(A) 8306 SD 60.000 26.000 13.000 26.000 $5.55 $72.15 $144.30
Subtotals For Category     0400/TRAFFIC    $4,596.63 $17,563.28
Subtotals For Project SSR-124N(139)SR /28221(04) $-27,176.37 $574,725.59


1 CURRENT QUANTITIES DO NOT MATCH THE QUANTITY PAID TO DATE