Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110496   Estimate Number: 0004 , Final     Spec Year: 2009
Primary JP: 28588(05)   Residency: TETRA TECH (04002)     Contract No: 710557
Date Created: 06/19/2013   Contractor FEI: 731452899     Account No: 400400

Project Number(s): BRFY-155A(877)3B
Contract Description: JOINT SEAL/REPAIR I-240/SH-152: VARIOUS LOCATIONS IN DIVISION 4.
Primary County: OKLAHOMA              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: PBX CORPORATION           Time Charged: 213.00
    P.O. BOX 644           Time Allowed: 235.00
    SAPULPA , OK   74067           Percent Time: 90.64 %

  Paid To Date: $44,530.95 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.                                
PBX CORPORATION                                
 
_________________________________________________
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:    06/19/2013
Contract ID: 110496   Estimate Number: 0004     Contract No: 710557
Residency: TETRA TECH (04002)   Estimate Type: Final     Account No: 400400

Project Number(s): BRFY-155A(877)3B
Primary Job Piece No: 28588(05)
Contract Description: JOINT SEAL/REPAIR I-240/SH-152: VARIOUS LOCATIONS IN DIVISION 4.
Primary County: OKLAHOMA              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: PBX CORPORATION              
    P.O. BOX 644              
    SAPULPA , OK   74067              
Surety Company: WESTFIELD INSURANCE COMPANY              

Date Let: 10/20/2011 NTP Effective Date: 03/05/2012 Pay Period: 01/16/2013  TO  06/19/2013
Date Awarded: 11/07/2011 Date Work Began: 09/11/2012 Original Contract Time: 60
Date Contract Executed: 11/22/2011 Date Time Stopped: 10/29/2012 Current Time Charged: 213.00
Date NTP Issued: 11/29/2011 Completion Date: 10/29/2012 Current Time Allowed: 235.00
General Liability Expires: 10/05/2013 Workman's Comp Expires: 10/05/2013 Percent Time Used: 90.64 %
Specification Year: 2009        

Current Contract Amount: $44,530.95 Total to Date Prev to Date This Estimate
Bid Amount: $44,218.00 Participating: $44,530.95 $44,530.95 $0.00
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $0.00 Total Earnings: $44,530.95 $44,530.95 $0.00
Unearned Balance: $-312.95 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $44,530.95 $44,530.95 $0.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $44,530.95 $44,530.95 $0.00

Estimate Adjustment Detail

Contract ID: 110496   Estimate Number: 0004     Primary JP: 28588(05)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Time Extension Approved 07/27/2012 175.0 $0.00
002 Class B Reparis Approved 01/14/2013 0.0 $2,841.70
003 FQCO Approved 06/13/2013 0.0 $-2,528.75


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
No line item adjustments have been created on this contract.
Subtotals For Line Item Adjustments $0.00


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: 110496   Estimate Number: 0004     Primary JP: 28588(05)



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:    BRFY-155A(877)3B Project:    28588(05) Category:    0200/BRIDGE 'A'
0001 RAPID CURE JOINT SEALANT 504(G) 6390 LF 127.000 133.250   133.250 $25.00 $0.00 $3,331.25
0002 SILICONE CONSTRUCTION JOINT 509 6386 LF 377.000 322.500   322.500 $10.00 $0.00 $3,225.00
8001 CLASS B BRIDGE DECK REPAIR 513(B) 6019 SY 0.000 0.440   0.440 $450.00 $0.00 $198.00
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $6,754.25
Fed/State Project Number:    BRFY-155A(877)3B Project:    28588(05) Category:    0201/BRIDGE 'B'
0003 RAPID CURE JOINT SEALANT 504(G) 6390 LF 144.000 140.660   140.660 $25.00 $0.00 $3,516.50
0004 SILICONE CONSTRUCTION JOINT 509 6386 LF 344.000 334.000   334.000 $10.00 $0.00 $3,340.00
Subtotals For Category     0201/BRIDGE 'B'    $0.00 $6,856.50
Fed/State Project Number:    BRFY-155A(877)3B Project:    28588(05) Category:    0202/BRIDGE 'C'
0005 RAPID CURE JOINT SEALANT 504(G) 6390 LF 69.000 34.500   34.500 $25.00 $0.00 $862.50
0006 SILICONE CONSTRUCTION JOINT 509 6386 LF 216.000 216.000   216.000 $10.00 $0.00 $2,160.00
8002 CLASS B BRIDGE DECK REPAIR 513(B) 6019 SY 0.000 1.560   1.560 $450.00 $0.00 $702.00
Subtotals For Category     0202/BRIDGE 'C'    $0.00 $3,724.50
Fed/State Project Number:    BRFY-155A(877)3B Project:    28588(05) Category:    0203/BRIDGE 'D'
0007 RAPID CURE JOINT SEALANT 504(G) 6390 LF 74.000 69.340   69.340 $25.00 $0.00 $1,733.50
0008 SILICONE CONSTRUCTION JOINT 509 6386 LF 264.000 300.670   300.670 $10.00 $0.00 $3,006.70
0009 CLASS B BRIDGE DECK REPAIR 513(B) 6019 SY 4.000 6.150   6.150 $450.00 $0.00 $2,767.50
Subtotals For Category     0203/BRIDGE 'D'    $0.00 $7,507.70
Fed/State Project Number:    BRFY-155A(877)3B Project:    28588(05) Category:    0300/TRAFFIC CONTROL
0010 (PL)TRUCK MOUNTED ATTENUATOR 876(A) 8482 SD 30.000 16.000   16.000 $5.00 $0.00 $80.00
0011 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $15,608.00 $0.00 $15,608.00
0012 PORT.CHANGEABLE MESSAGE SIGN 882(A) 8306 SD 60.000 0.000   0.000 $5.00 $0.00 $0.00
Subtotals For Category     0300/TRAFFIC CONTROL    $0.00 $15,688.00
Fed/State Project Number:    BRFY-155A(877)3B Project:    28588(05) Category:    0640/CONSTRUCTION
0013 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $4,000.00
Subtotals For Project BRFY-155A(877)3B /28588(05) $0.00 $44,530.95