Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110382   Estimate Number: 0030 , Final     Spec Year: 2009
Primary JP: 23511(04)   Residency: SALLISAW (01200)     Contract No: 710315
Date Created: 01/14/2014   Contractor FEI: 420667649     Account No: 434100

Project Number(s): CIRB-146C(085)RB
Contract Description: BRIDGE REHABILITATION AND APPROACHES COUNTY ROAD (TEXANNA ROAD): OVER DUCHESS CREEK, 3.0 MILES WEST OF THE MUSKOGEE COUNTY LINE AT LAKE EUFAULA. PROJECT LENGTH = 0.331 MILES.
Primary County: MCINTOSH              
Name of Road: COUNTY ROAD              
Prime Contractor: JENSEN CONSTRUCTION COMPANY           Time Charged: 258.00
    11301 W. 57TH PLACE S.           Time Allowed: 270.00
    SAND SPRINGS , OK   74063           Percent Time: 95.56 %

  Paid To Date: $3,429,252.68 Payable This Statement: $2,000.00

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.                                
JENSEN CONSTRUCTION COMPANY                               
 
_________________________________________________
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:    01/14/2014
Contract ID: 110382   Estimate Number: 0030     Contract No: 710315
Residency: SALLISAW (01200)   Estimate Type: Final     Account No: 434100

Project Number(s): CIRB-146C(085)RB
Primary Job Piece No: 23511(04)
Contract Description: BRIDGE REHABILITATION AND APPROACHES COUNTY ROAD (TEXANNA ROAD): OVER DUCHESS CREEK, 3.0 MILES WEST OF THE MUSKOGEE COUNTY LINE AT LAKE EUFAULA. PROJECT LENGTH = 0.331 MILES.
Primary County: MCINTOSH              
Name of Road: COUNTY ROAD              
Prime Contractor: JENSEN CONSTRUCTION COMPANY              
    11301 W. 57TH PLACE S.              
    SAND SPRINGS , OK   74063              
Surety Company: WESTERN SURETY COMPANY              

Date Let: 08/18/2011 NTP Effective Date: 11/07/2011 Pay Period: 10/26/2013  TO  01/14/2014
Date Awarded: 09/12/2011 Date Work Began: 10/31/2011 Original Contract Time: 270
Date Contract Executed: 09/28/2011 Date Time Stopped: 08/12/2013 Current Time Charged: 258.00
Date NTP Issued: 10/03/2011 Completion Date: 08/12/2013 Current Time Allowed: 270.00
General Liability Expires: 04/01/2014 Workman's Comp Expires: 04/01/2014 Percent Time Used: 95.56 %
Specification Year: 2009        

Bid Amount: $3,480,844.47 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $3,480,844.47 Participating: $0.00 $0.00 $0.00
Percent Complete: 98.52 % Non Participating: $3,428,953.05 $3,426,953.05 $2,000.00
Unearned Balance: $51,591.79 Total Earnings: $3,428,953.05 $3,426,953.05 $2,000.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $3,428,953.05 $3,426,953.05 $2,000.00
Other Adjustments: $299.63 $299.63 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $3,429,252.68 $3,427,252.68 $2,000.00

Estimate Adjustment Detail

Contract ID: 110382   Estimate Number: 0030     Primary JP: 23511(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 12/12/2013 0.0 $-51,891.43


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
23511(04) 0010 SUPERPAVE, TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0016 537.40 $0.55 $299.63
Subtotals For Line Item Adjustments $299.63


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: 110382   Estimate Number: 0030     Primary JP: 23511(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:    CIRB-146C(085)RB Project:    23511(04) Category:    0100/ROADWAY
0001 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 3,400.000 3,400.000   3,400.000 $8.00 $0.00 $27,200.00
0002 SELECT BORROW 202(E) 0186 CY 3,975.000 3,975.000   3,975.000 $11.00 $0.00 $43,725.00
0003 TYPE A-SALVAGED TOPSOIL 205(A) 4229 LSUM 1.000 1.000   1.000 $5,000.00 $0.00 $5,000.00
0004 TEMPORARY SILT FENCE 221(C) 2801 LF 2,800.000 0.000   0.000 $5.00 $0.00 $0.00
0005 SOLID SLAB SODDING 230(A) 2806 SY 2,400.000 0.000   0.000 $2.50 $0.00 $0.00
0006 AGGREGATE BASE TYPE A 303(A) 2100 CY 616.000 522.040   522.040 $43.00 $0.00 $22,447.72
0007 SEPARATOR FABRIC 325 5271 SY 7,400.000 5,264.080   5,264.080 $2.25 $0.00 $11,844.18
0008 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 200.000 69.110   69.110 $35.00 $0.00 $2,418.85
0009 PRIME COAT 408 5774 GAL 1,098.000 1,090.000   1,090.000 $4.60 $0.00 $5,014.00
0010 SUPERPAVE, TYPE S3(PG 64-22 OK) 411(B) 5945 TON 1,368.000 1,120.950   1,120.950 $77.37 $0.00 $86,727.91
0011 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 800.000 659.990   659.990 $78.77 $0.00 $51,987.41
0012 CLASS C CONCRETE 509(D) 0325 CY 15.000 0.000   0.000 $300.00 $0.00 $0.00
0013 TYPE I PLAIN RIPRAP 601(A) 0297 TON 850.000 802.590   802.590 $45.00 $0.00 $36,116.55
0014 REMOVAL OF STRUCTURES & OBSTRUCTIONS 619(A) 0920 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0015 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 0932 LF 1,887.500 1,887.500   1,887.500 $14.50 $0.00 $27,368.75
0016 GUARDRAIL ANCHOR UNIT (TYPE B) 623(F) 4447 EA 4.000 4.000   4.000 $550.00 $0.00 $2,200.00
0017 GUARDRAIL ANCHOR UNIT (TYPE D-BF) 623(F) 5686 EA 4.000 4.000   4.000 $1,225.00 $0.00 $4,900.00
0018 GUARDRAIL DELINEATORS(TYPE 2, CODE 1) 853 9069 EA 46.000 46.000   46.000 $7.00 $0.00 $322.00
Subtotals For Category     0100/ROADWAY    $0.00 $337,272.37
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0101/ROADWAY (WATERLINE)
0019 3" POLYETHYLENE PIPE 613(E) 4040 LF 550.000 550.000   550.000 $11.00 $0.00 $6,050.00
0020 4" DUCTILE IRON PIPE 616(A) 5120 LF 460.000 460.000   460.000 $35.00 $0.00 $16,100.00
0021 8" DUCTILE IRON PIPE 616(A) 5122 LF 180.000 180.000   180.000 $67.00 $0.00 $12,060.00
0022 12" DUCTILE IRON PIPE 616(A) 5124 LF 45.000 45.000   45.000 $140.00 $0.00 $6,300.00
0023 3" POLYVINYL CHLORIDE (PVC) PIPE 616(B) 5220 LF 1,350.000 1,220.000   1,220.000 $10.00 $0.00 $12,200.00
0024 6" POLYVINYL CHLORIDE (PVC) PIPE 616(B) 5223 LF 550.000 550.000   550.000 $18.00 $0.00 $9,900.00
0025 8" POLYVINYL CHLORIDE (PVC) PIPE 616(B) 5225 LF 590.000 590.000   590.000 $30.00 $0.00 $17,700.00
0026 3" VALVES 616(D) 0858 EA 2.000 2.000   2.000 $700.00 $0.00 $1,400.00
0027 8" GATE VALVE 616(D) 1080 EA 1.000 1.000   1.000 $1,500.00 $0.00 $1,500.00
0028 (SP)SUBMERSIBLE PUMP 648(A) 0125 EA 2.000 2.000   2.000 $120,000.00 $0.00 $240,000.00
Subtotals For Category     0101/ROADWAY (WATERLINE)    $0.00 $323,210.00
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0102/ROADWAY (ELECTRIC & CABLE)
0029 2" GALV. STEEL ELECTRICAL CONDUIT EXPOSED 802(A) 8310 LF 525.000 525.000   525.000 $25.00 $0.00 $13,125.00
0030 2" PVC SCH.40 PLASTIC CONDUIT TRENCHED 802(B) 8342 LF 180.000 180.000   180.000 $5.00 $0.00 $900.00
Subtotals For Category     0102/ROADWAY (ELECTRIC & CABLE)    $0.00 $14,025.00
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0200/BRIDGE
0031 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 90.000 90.000   90.000 $15.00 $0.00 $1,350.00
0032 CLSM BACKFILL 501(G) 6309 CY 40.000 40.000   40.000 $120.00 $0.00 $4,800.00
0033 (PL)FALSEWORK JACKING 502(C) 6116 LSUM 1.000 1.000 1.000 1.000 $2,000.00 $2,000.00 $2,000.00
0034 INSERTS 504 6176 EA 63.000 63.000   63.000 $30.00 $0.00 $1,890.00
0035 HANGERS 504 6224 EA 63.000 63.000   63.000 $100.00 $0.00 $6,300.00
0036 SAW-CUT GROOVING 504(B) 1305 SY 1,598.400 1,598.400   1,598.400 $4.15 $0.00 $6,633.36
0037 SEALED EXPANSION JOINT 504(C) 6250 LF 67.700 67.700   67.700 $250.00 $0.00 $16,925.00
0038 CONCRETE RAIL (TR3) 504(D) 6239 LF 954.200 954.200   954.200 $60.00 $0.00 $57,252.00
0039 STRUCTURAL STEEL 506(A) 1322 LB 233,130.000 233,130.000   233,130.000 $2.10 $0.00 $489,573.00
0040 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 4.000 4.000   4.000 $1,500.00 $0.00 $6,000.00
0041 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 8.000 8.000   8.000 $2,000.00 $0.00 $16,000.00
0042 CLASS AA CONCRETE 509(A) 1326 CY 407.000 407.000   407.000 $600.00 $0.00 $244,200.00
0043 CLASS A CONCRETE 509(B) 1328 CY 103.600 103.600   103.600 $600.00 $0.00 $62,160.00
0044 MECHANICAL SPLICES 511 6306 EA 3,040.000 3,040.000   3,040.000 $12.00 $0.00 $36,480.00
0045 REINFORCING STEEL 511(A) 1332 LB 160,090.000 160,090.000   160,090.000 $0.90 $0.00 $144,081.00
0046 PAINTING EXISTING STRUCTURES 512(A) 1323 LSUM 1.000 1.000   1.000 $60,000.00 $0.00 $60,000.00
0047 COLLECTION AND HANDLING OF WASTE 512(B) 6303 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0048 PILES, FURNISHED (HP 12X53) 514(A) 6011 LF 364.000 364.000   364.000 $30.00 $0.00 $10,920.00
0049 PILES, DRIVEN (HP 12X53) 514(B) 6294 LF 364.000 341.220   341.220 $14.00 $0.00 $4,777.08
0050 DRILLED SHAFTS 54" DIAMETER 516(A) 6095 LF 438.000 449.000   449.000 $2,200.00 $0.00 $987,800.00
0051 PREPARATION OF CRACKS, BELOW WATER 520(B) 6059 LF 10.000 0.000   0.000 $88.00 $0.00 $0.00
0052 EPOXY RESIN, BELOW WATER 520(D) 6061 GAL 1.000 0.000   0.000 $100.00 $0.00 $0.00
0053 SEALER CRACK PREPARATION 523(A) 6550 LF 1,614.000 1,614.000   1,614.000 $2.00 $0.00 $3,228.00
0054 SEALER RESIN 523(B) 6560 GAL 19.000 19.000   19.000 $100.00 $0.00 $1,900.00
0055 (PL)REPAIR BRIDGE ITEMS 540 4505 EA 3.000 3.000   3.000 $500.00 $0.00 $1,500.00
0056 (PL)INSTALLATION OF BRIDGE ITEMS 542 4605 EA 8.000 8.000   8.000 $500.00 $0.00 $4,000.00
0057 TYPE I PLAIN RIPRAP 601(A) 1351 TON 64.000 0.000   0.000 $50.00 $0.00 $0.00
0058 REMOVAL OF BRIDGE ITEMS 619(B) 2500 LSUM 1.000 1.000   1.000 $200,000.00 $0.00 $200,000.00
0059 SPECIAL SIGNS 850(D) 8121 EA 8.000 8.000   8.000 $75.00 $0.00 $600.00
Subtotals For Category     0200/BRIDGE    $2,000.00 $2,380,369.44
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0300/TRAFFIC
0060 (SP)PORTABLE TRAFFIC SIGNAL SYSTEM 823 8478 SD 270.000 269.000   269.000 $150.00 $0.00 $40,350.00
0061 TRAFFIC STRIPE(PAINT)(4" WIDE) 854(A) 8800 LF 5,000.000 0.000   0.000 $0.12 $0.00 $0.00
0062 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 10,000.000 9,540.000   9,540.000 $0.20 $0.00 $1,908.00
0063 DELIVER PORTABLE LONGITUDINAL BARRIER 877(B) 8484 LF 1,990.000 2,014.000   2,014.000 $34.16 $0.00 $68,798.24
0064 RELOCATION OF PORTABLE LONGITUDINAL BARRIER 877(C) 8486 LF 1,990.000 1,990.000   1,990.000 $5.00 $0.00 $9,950.00
0065 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $30,000.00 $0.00 $30,000.00
0066 PORT.CHANGEABLE MESSAGE SIGN 882(A) 8306 SD 540.000 538.000   538.000 $15.00 $0.00 $8,070.00
Subtotals For Category     0300/TRAFFIC    $0.00 $159,076.24
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0600/STAKING
0067 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $20,000.00 $0.00 $20,000.00
Subtotals For Category     0600/STAKING    $0.00 $20,000.00
Fed/State Project Number:    CIRB-146C(085)RB Project:    23511(04) Category:    0640/CONSTRUCTION
0068 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000   1.000 $5,000.00 $0.00 $5,000.00
0069 MOBILIZATION 641 1552 LSUM 1.000 1.000   1.000 $190,000.00 $0.00 $190,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $195,000.00
Subtotals For Project CIRB-146C(085)RB /23511(04) $2,000.00 $3,428,953.05