Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110467   Estimate Number: 0005 , Final     Spec Year: 2009
Primary JP: 26811(04)   Residency: PURCELL (03200)     Contract No: 710408
Date Created: 07/29/2013   Contractor FEI: 481174311     Account No: 436300

Project Number(s): BRO-125D(173)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-318): OVER A TRIBUTARY OF RUSH CREEK, 4.0 MILES SOUTH OF THE SH-19 JUNCTION. PROJECT LENGTH = 0.167 MILES.
Primary County: GARVIN              
Name of Road: COUNTY ROAD              
Prime Contractor: KLAVER CONSTRUCTION COMPANY, INC.           Time Charged: 143.00
    P.O. BOX 272           Time Allowed: 145.00
    KINGMAN , KS   67068           Percent Time: 98.62 %

  Paid To Date: $294,990.06 Payable This Statement: $16,188.79

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:    07/29/2013
Contract ID: 110467   Estimate Number: 0005     Contract No: 710408
Residency: PURCELL (03200)   Estimate Type: Final     Account No: 436300

Project Number(s): BRO-125D(173)CI
Primary Job Piece No: 26811(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-318): OVER A TRIBUTARY OF RUSH CREEK, 4.0 MILES SOUTH OF THE SH-19 JUNCTION. PROJECT LENGTH = 0.167 MILES.
Primary County: GARVIN              
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: 01/02/2012 Pay Period: 08/01/2012  TO  06/11/2013
Date Awarded: 10/03/2011 Date Work Began: 12/06/2011 Original Contract Time: 90
Date Contract Executed: 10/17/2011 Date Time Stopped: 09/20/2012 Current Time Charged: 143.00
Date NTP Issued: 10/20/2011 Completion Date: 09/20/2012 Current Time Allowed: 145.00
General Liability Expires: 01/01/2014 Workman's Comp Expires: 01/01/2014 Percent Time Used: 98.62 %
Specification Year: 2009        

Current Contract Amount: $294,617.54 Total to Date Prev to Date This Estimate
Bid Amount: $282,307.33 Participating: $294,617.54 $286,428.75 $8,188.79
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $-372.52 Total Earnings: $294,617.54 $286,428.75 $8,188.79
Unearned Balance: $-12,682.73 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $294,617.54 $286,428.75 $8,188.79
Other Adjustments: $372.52 $18,872.52 $-18,500.00
Liq Dam/Disincentive: $0.00 $-26,500.00 $26,500.00
TOTAL: $294,990.06 $278,801.27 $16,188.79

Estimate Adjustment Detail

Contract ID: 110467   Estimate Number: 0005     Primary JP: 26811(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 To add three new pay items and delete an existing pay item. Approved 06/04/2012 0.0 $15,474.14
002 Time adjustment Approved 03/29/2013 55.0 $0.00
003 Reclassification of SWPPP Documentation Approved 05/16/2013 0.0 $-375.00
004 CO FINALIZING CONTRACT ITEMS QUANTITIES Approved 06/07/2013 0.0 $-2,788.93


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 --53 $500.00 $-26,500.00
System Application of Liquidated Damages 0005 -53.0 $500.00 $26,500.00
Subtotals For Liquidated Damages $0.00


CONTRACT ADJUSTMENTS HISTORY
Adjustment Description Estimate Nbr Adjustment Amount
LD Adjustment (Prog. Est. Only) 0003 $18,500.00
LD Adjustment (Prog. Est. Only) 0005 $-18,500.00
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
26811(04) 0009 SUPERPAVE, TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0003 380.32 $0.55 $212.05
26811(04) 0010 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0003 251.84 $0.63 $160.47
Subtotals For Line Item Adjustments $372.52


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: 110467   Estimate Number: 0005     Primary JP: 26811(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-125D(173)CI Project:    26811(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $18,945.00 $0.00 $18,945.00
0002 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0003 TEMPORARY SILT FENCE 221(C) 2801 LF 1,520.000 1,520.000 20.000 1,520.000 $1.50 $30.00 $2,280.00
0004 TEMPORARY SILT DIKE 221(F) 0100 LF 32.000 0.000   0.000 $7.00 $0.00 $0.00
0005 SOLID SLAB SODDING 230(A) 2806 SY 5,663.000 5,623.600   5,623.600 $1.40 $0.00 $7,873.04
0006 VEGETATIVE MULCHING 233(A) 2817 AC 2.340 0.000 -2.340 0.000 $200.00 $-468.00 $0.00
0007 CEMENT KILN DUST 307(B) 4210 TON 134.000 0.000   0.000 $40.50 $0.00 $0.00
0008 CEMENTITIOUS STABILIZED SUBGRADE 307(E) 4240 SY 3,085.000 3,085.500 962.940 3,085.500 $2.65 $2,551.79 $8,176.57
0009 SUPERPAVE, TYPE S3(PG 64-22 OK) 411(B) 5945 TON 371.000 380.320   380.320 $67.30 $0.00 $25,595.54
0010 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 244.000 251.840   251.840 $70.75 $0.00 $17,817.68
0011 CLASS C CONCRETE 509(D) 0325 CY 10.000 0.000   0.000 $350.00 $0.00 $0.00
8001 FLY ASH 307(A) 4200 TON 0.000 125.630   125.630 $63.08 $0.00 $7,924.74
8002 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 0.000 214.130   214.130 $49.06 $0.00 $10,505.22
8003 TYPE I-A FILTER BLANKET 601(C) 1355 TON 0.000 52.070   52.070 $52.74 $0.00 $2,746.17
Subtotals For Category     0100/ROADWAY    $2,113.79 $111,863.96
Fed/State Project Number:    BRO-125D(173)CI Project:    26811(04) Category:    0200/BRIDGE 'A'
0012 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 1,790.000 1,790.000 790.000 1,790.000 $5.00 $3,950.00 $8,950.00
0013 STRUCTURAL EXCAVATION UNCLASSIFIED 501(A) 1306 CY 141.000 141.000   141.000 $5.00 $0.00 $705.00
0014 CLASS AA CONCRETE 509(A) 1326 CY 302.000 302.000   302.000 $314.29 $0.00 $94,915.58
0015 REINFORCING STEEL 511(A) 1332 LB 49,150.000 49,150.000   49,150.000 $0.90 $0.00 $44,235.00
0016 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $9,000.00 $0.00 $9,000.00
0017 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $1,600.00 $0.00 $1,600.00
Subtotals For Category     0200/BRIDGE 'A'    $3,950.00 $159,405.58
Fed/State Project Number:    BRO-125D(173)CI Project:    26811(04) Category:    0600/STAKING
0018 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $8,585.00 $0.00 $8,585.00
Subtotals For Category     0600/STAKING    $0.00 $8,585.00
Fed/State Project Number:    BRO-125D(173)CI Project:    26811(04) Category:    0640/CONSTRUCTION
0019 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 0.000   0.000 $2,500.00 $0.00 $0.00
0020 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $12,638.00 $0.00 $12,638.00
8004 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 0.000 1.000 1.000 1.000 $2,125.00 $2,125.00 $2,125.00
Subtotals For Category     0640/CONSTRUCTION    $2,125.00 $14,763.00
Subtotals For Project BRO-125D(173)CI /26811(04) $8,188.79 $294,617.54