Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110465   Estimate Number: 0006 , Final     Spec Year: 2009
Primary JP: 27486(04)   Residency: DUNCAN (07100)     Contract No: 710440
Date Created: 09/25/2014   Contractor FEI: 481174311     Account No: 436700

Project Number(s): BRO-117D(087)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-157): OVER BIRD CREEK, 1.7 MILES SOUTH OF THE US-70 JUNCTION. PROJECT LENGTH = 0.134 MILE.
Primary County: COTTON              
Name of Road: COUNTY ROAD              
Prime Contractor: KLAVER CONSTRUCTION COMPANY, INC.           Time Charged: 137.00
    P.O. BOX 272           Time Allowed: 90.00
    KINGMAN , KS   67068           Percent Time: 152.22 %

  Paid To Date: $169,118.79 Payable This Statement: $1,387.50

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.                                
KLAVER CONSTRUCTION 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:    09/25/2014
Contract ID: 110465   Estimate Number: 0006     Contract No: 710440
Residency: DUNCAN (07100)   Estimate Type: Final     Account No: 436700

Project Number(s): BRO-117D(087)CI
Primary Job Piece No: 27486(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-157): OVER BIRD CREEK, 1.7 MILES SOUTH OF THE US-70 JUNCTION. PROJECT LENGTH = 0.134 MILE.
Primary County: COTTON              
Name of Road: COUNTY ROAD              
Prime Contractor: KLAVER CONSTRUCTION COMPANY, INC.              
    P.O. BOX 272              
    KINGMAN , KS   67068              
Surety Company: TRAVELERS INDEMNITY COMPANY              

Date Let: 09/15/2011 NTP Effective Date: 11/28/2011 Pay Period: 05/01/2012  TO  09/15/2014
Date Awarded: 10/03/2011 Date Work Began: 11/14/2011 Original Contract Time: 90
Date Contract Executed: 10/17/2011 Date Time Stopped: 12/05/2013 Current Time Charged: 137.00
Date NTP Issued: 10/20/2011 Completion Date: 12/05/2013 Current Time Allowed: 90.00
General Liability Expires: 01/01/2015 Workman's Comp Expires: 01/01/2015 Percent Time Used: 152.22 %
Specification Year: 2009        

Bid Amount: $200,189.74 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $200,189.74 Participating: $192,118.79 $190,731.29 $1,387.50
Percent Complete: 84.48 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $31,070.95 Total Earnings: $192,118.79 $190,731.29 $1,387.50
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $192,118.79 $190,731.29 $1,387.50
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $-23,000.00 $-23,000.00 $0.00
TOTAL: $169,118.79 $167,731.29 $1,387.50

Estimate Adjustment Detail

Contract ID: 110465   Estimate Number: 0006     Primary JP: 27486(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 09/24/2014 0.0 $-8,070.95


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 0003 --33 $500.00 $-16,500.00
System Application of Liquidated Damages 0004 --13 $500.00 $-6,500.00
Subtotals For Liquidated Damages $-23,000.00


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
27486(04) 0003 TEMPORARY SILT FENCE * Material Discrepancy Adjustments 0001 0.00 $0.00 $-964.60
27486(04) 0003 TEMPORARY SILT FENCE * Material Discrepancy Adjustments 0002 0.00 $0.00 $964.60
27486(04) 0004 TEMPORARY SILT DIKE * Material Discrepancy Adjustments 0001 0.00 $0.00 $-239.75
27486(04) 0004 TEMPORARY SILT DIKE * Material Discrepancy Adjustments 0002 0.00 $0.00 $239.75
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: 110465   Estimate Number: 0006     Primary JP: 27486(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-117D(087)CI Project:    27486(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
0002 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $2,500.00 $0.00 $2,500.00
0003 TEMPORARY SILT FENCE 221(C) 2801 LF 1,400.000 742.000   742.000 $1.30 $0.00 $964.60
0004 TEMPORARY SILT DIKE 221(F) 0100 LF 420.000 35.000   35.000 $6.85 $0.00 $239.75
0005 SOLID SLAB SODDING 230(A) 2806 SY 4,280.000 3,365.810   3,365.810 $1.40 $0.00 $4,712.13
0006 VEGETATIVE MULCHING 233(A) 2817 AC 1.800 0.700 0.700 0.700 $500.00 $350.00 $350.00
0007 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 745.000 757.430   757.430 $23.00 $0.00 $17,420.89
0008 PRIME COAT 408 5774 GAL 460.000 480.000   480.000 $5.50 $0.00 $2,640.00
0009 CLASS C CONCRETE 509(D) 0325 CY 10.000 0.000   0.000 $245.00 $0.00 $0.00
0010 28" X 20" CORR. GALV. STEEL PIPE ARCH 613(B) 4528 LF 126.000 108.000   108.000 $25.00 $0.00 $2,700.00
0011 28" X 20" PREFAB. CULVERT END SECTION, ARCH 613(L) 4516 EA 6.000 6.000   6.000 $250.00 $0.00 $1,500.00
Subtotals For Category     0100/ROADWAY    $350.00 $37,027.37
Fed/State Project Number:    BRO-117D(087)CI Project:    27486(04) Category:    0200/BRIDGE
0012 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 500.000 500.000   500.000 $4.75 $0.00 $2,375.00
0013 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 90.000 90.000   90.000 $5.00 $0.00 $450.00
0014 CLASS A CONCRETE 509(B) 1328 CY 211.640 211.640   211.640 $364.23 $0.00 $77,085.64
0015 REINFORCING STEEL 511(A) 1332 LB 28,259.000 28,259.000   28,259.000 $0.90 $0.00 $25,433.10
0016 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 715.000 717.880   717.880 $32.00 $0.00 $22,972.16
0017 TYPE I-A FILTER BLANKET 601(C) 1355 TON 225.000 210.980   210.980 $24.00 $0.00 $5,063.52
0018 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000 0.250 1.000 $1,650.00 $412.50 $1,650.00
Subtotals For Category     0200/BRIDGE    $412.50 $135,029.42
Fed/State Project Number:    BRO-117D(087)CI Project:    27486(04) Category:    0600/STAKING
0019 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $10,250.00 $0.00 $10,250.00
Subtotals For Category     0600/STAKING    $0.00 $10,250.00
Fed/State Project Number:    BRO-117D(087)CI Project:    27486(04) Category:    0640/CONSTRUCTION
0020 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $2,500.00 $625.00 $2,500.00
0021 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $7,312.00 $0.00 $7,312.00
Subtotals For Category     0640/CONSTRUCTION    $625.00 $9,812.00
Subtotals For Project BRO-117D(087)CI /27486(04) $1,387.50 $192,118.79