Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110332   Estimate Number: 0004 , Final     Spec Year: 2009
Primary JP: 28001(04)   Residency: ANADARKO (07300)     Contract No: 710401
Date Created: 10/03/2012   Contractor FEI: 731250477     Account No: 404700

Project Number(s): SSP-126C(184)SS
Contract Description: INTERSECTION MODIFICATION SH-4: FROM 2.0 MILES NORTH OF THE SH-37 JUNCTION, EXTEND NORTH. PROJECT LENGTH = 0.08 MILES.
Primary County: GRADY              
Name of Road: SH-4              
Prime Contractor: MARKWELL PAVING COMPANY, INC.           Time Charged: 27.00
    P.O. BOX 82005           Time Allowed: 30.00
    OKLAHOMA CITY , OK   73148           Percent Time: 90.00 %

  Paid To Date: $60,240.49 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.                                
MARKWELL PAVING 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:    10/03/2012
Contract ID: 110332   Estimate Number: 0004     Contract No: 710401
Residency: ANADARKO (07300)   Estimate Type: Final     Account No: 404700

Project Number(s): SSP-126C(184)SS
Primary Job Piece No: 28001(04)
Contract Description: INTERSECTION MODIFICATION SH-4: FROM 2.0 MILES NORTH OF THE SH-37 JUNCTION, EXTEND NORTH. PROJECT LENGTH = 0.08 MILES.
Primary County: GRADY              
Name of Road: SH-4              
Prime Contractor: MARKWELL PAVING COMPANY, INC.              
    P.O. BOX 82005              
    OKLAHOMA CITY , OK   73148              
Surety Company: LIBERTY MUTUAL INSURANCE COMPANY              

Date Let: 09/15/2011 NTP Effective Date: 02/06/2012 Pay Period: 07/01/2012  TO  07/28/2012
Date Awarded: 10/03/2011 Date Work Began: 02/07/2012 Original Contract Time: 30
Date Contract Executed: 10/18/2011 Date Time Stopped: 04/06/2012 Current Time Charged: 27.00
Date NTP Issued: 10/22/2011 Completion Date: 04/06/2012 Current Time Allowed: 30.00
General Liability Expires: 04/01/2013 Workman's Comp Expires: 04/01/2013 Percent Time Used: 90.00 %
Specification Year: 2009        

Current Contract Amount: $60,291.91 Total to Date Prev to Date This Estimate
Bid Amount: $56,219.31 Participating: $0.00 $0.00 $0.00
Percent Complete: 99.91 % Non Participating: $60,291.91 $60,291.91 $0.00
Funds Available: $51.42 Total Earnings: $60,291.91 $60,291.91 $0.00
Unearned Balance: $-4,021.18 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $60,291.91 $60,291.91 $0.00
Other Adjustments: $-51.42 $-51.42 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $60,240.49 $60,240.49 $0.00

Estimate Adjustment Detail

Contract ID: 110332   Estimate Number: 0004     Primary JP: 28001(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Additional Appropriations Request Approved 04/16/2012 0.0 $6,873.62
002 Final Quantity Change Order Approved 10/02/2012 0.0 $-2,801.02


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
Withhold to Funds Avail(Prog. Est. Only) 0002 $-4,021.19
Withhold to Funds Avail(Prog. Est. Only) 0003 $4,021.19
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
28001(04) 0008 SUPERPAVE, TYPE S3(PG 70-28 OK) Asphalt Binder Adjustment 0001 95.84 $-0.13 $-13.18
28001(04) 0009 SUPERPAVE, TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0001 278.04 $-0.13 $-38.24
Subtotals For Line Item Adjustments $-51.42


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: 110332   Estimate Number: 0004     Primary JP: 28001(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:    SSP-126C(184)SS Project:    28001(04) Category:    0100/ROADWAY
0001 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $1,200.00 $0.00 $1,200.00
0002 TEMPORARY SILT FENCE 221(C) 2801 LF 507.000 600.000   600.000 $1.50 $0.00 $900.00
0003 SOLID SLAB SODDING 230(A) 2806 SY 3,730.000 3,605.400   3,605.400 $1.75 $0.00 $6,309.45
0004 AGGREGATE BASE TYPE A 303(A) 2100 CY 227.000 287.810   287.810 $29.00 $0.00 $8,346.49
0005 SEPARATOR FABRIC 325 5271 SY 819.000 816.030   816.030 $1.00 $0.00 $816.03
0006 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 96.000 98.930   98.930 $20.00 $0.00 $1,978.60
0007 PRIME COAT 408 5774 GAL 168.000 0.000   0.000 $2.00 $0.00 $0.00
0008 SUPERPAVE, TYPE S3(PG 70-28 OK) 411(B) 5940 TON 74.000 95.840   95.840 $65.00 $0.00 $6,229.60
0009 SUPERPAVE, TYPE S3(PG 64-22 OK) 411(B) 5945 TON 259.000 278.040   278.040 $57.00 $0.00 $15,848.28
0010 SUPERPAVE, TYPE S4(PG 70-28 OK) 411(C) 5955 TON 78.000 94.770   94.770 $75.00 $0.00 $7,107.75
0011 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 457.000 509.110   509.110 $3.00 $0.00 $1,527.33
0012 SAWING PAVEMENT 619(C) 0924 LF 456.000 457.000   457.000 $1.00 $0.00 $457.00
Subtotals For Category     0100/ROADWAY    $0.00 $50,720.53
Fed/State Project Number:    SSP-126C(184)SS Project:    28001(04) Category:    0300/TRAFFIC
0013 (PL)REMOVE & RESET EXISTING SIGNS 805(D) 8756 EA 1.000 0.000   0.000 $66.00 $0.00 $0.00
0014 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 781.000 678.000   678.000 $0.71 $0.00 $481.38
0015 TRAFFIC STRIPE(PLASTIC)(24" WIDE) 855(A) 8825 LF 16.000 0.000   0.000 $7.05 $0.00 $0.00
0016 TRAFFIC STRIPE(PLASTIC)(ARROWS) 855(B) 8818 EA 2.000 2.000   2.000 $155.00 $0.00 $310.00
0017 TRAFFIC STRIPE(PLASTIC)(WORDS) 855(B) 8821 EA 1.000 1.000   1.000 $280.00 $0.00 $280.00
0018 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $1,400.00 $0.00 $1,400.00
Subtotals For Category     0300/TRAFFIC    $0.00 $2,471.38
Fed/State Project Number:    SSP-126C(184)SS Project:    28001(04) Category:    0600/STAKING
0019 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $1,100.00 $0.00 $1,100.00
Subtotals For Category     0600/STAKING    $0.00 $1,100.00
Fed/State Project Number:    SSP-126C(184)SS Project:    28001(04) Category:    0640/CONSTRUCTION
0020 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 0.000   0.000 $1,000.00 $0.00 $0.00
0021 MOBILIZATION 641 1552 LSUM 1.000 1.000   1.000 $6,000.00 $0.00 $6,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $6,000.00
Subtotals For Project SSP-126C(184)SS /28001(04) $0.00 $60,291.91