Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110501   Estimate Number: 0006 , Final     Spec Year: 2009
Primary JP: 28128(15)   Residency: JACOBS (07004)     Contract No: 710407
Date Created: 03/05/2014   Contractor FEI: 730960939     Account No: 404700

Project Number(s): BTOP-116E(211)
Contract Description: SAFETY IMPROVEMENT (ITS, COMMUNICATION HUTS) I-35/US-62/US-69/US-70/US-75/US-81: AT VARIOUS LOCATIONS IN DIVISION II AND VII.
Primary County: COMANCHE              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: MIDSTATE TRAFFIC CONTROL, INC.           Time Charged: 177.00
    12501 N. SANTA FE AVE.           Time Allowed: 177.00
    OKLAHOMA CITY , OK   73114           Percent Time: 100.00 %

  Paid To Date: $987,593.74 Payable This Statement: $1,500.00

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.                                
MIDSTATE TRAFFIC CONTROL, 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:    03/05/2014
Contract ID: 110501   Estimate Number: 0006     Contract No: 710407
Residency: JACOBS (07004)   Estimate Type: Final     Account No: 404700

Project Number(s): BTOP-116E(211)
Primary Job Piece No: 28128(15)
Contract Description: SAFETY IMPROVEMENT (ITS, COMMUNICATION HUTS) I-35/US-62/US-69/US-70/US-75/US-81: AT VARIOUS LOCATIONS IN DIVISION II AND VII.
Primary County: COMANCHE              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: MIDSTATE TRAFFIC CONTROL, INC.              
    12501 N. SANTA FE AVE.              
    OKLAHOMA CITY , OK   73114              
Surety Company: LIBERTY MUTUAL INSURANCE COMPANY              

Date Let: 09/15/2011 NTP Effective Date: 11/21/2011 Pay Period: 12/16/2013  TO  01/30/2014
Date Awarded: 10/03/2011 Date Work Began: 03/12/2012 Original Contract Time: 150
Date Contract Executed: 10/17/2011 Date Time Stopped: 11/15/2013 Current Time Charged: 177.00
Date NTP Issued: 10/22/2011 Completion Date: 11/15/2013 Current Time Allowed: 177.00
General Liability Expires: 03/01/2014 Workman's Comp Expires: 03/01/2014 Percent Time Used: 100.00 %
Specification Year: 2009        

Bid Amount: $945,536.64 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $987,593.74 Participating: $0.00 $0.00 $0.00
Percent Complete: 100 % Non Participating: $987,593.74 $986,093.74 $1,500.00
Unearned Balance: $0.00 Total Earnings: $987,593.74 $986,093.74 $1,500.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $987,593.74 $986,093.74 $1,500.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $987,593.74 $986,093.74 $1,500.00

Estimate Adjustment Detail

Contract ID: 110501   Estimate Number: 0006     Primary JP: 28128(15)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Revised Tanks to 1000 gal Approved 11/19/2013 0.0 $29,088.36
002 Time Adjustment and Early Incentive Pay Approved 11/19/2013 27.0 $12,000.00
003 Final Quantity Change Order Approved 01/23/2014 0.0 $968.74


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 --12 $500.00 $-6,000.00
System Application of Liquidated Damages 0004 --15 $500.00 $-7,500.00
System Application of Liquidated Damages 0005 -27.0 $500.00 $13,500.00
Subtotals For Liquidated Damages $0.00


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
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
01 Internal Milestone 11/20/2011 04/11/2012 150.00 DYS $1,500.00 Y


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: 110501   Estimate Number: 0006     Primary JP: 28128(15)



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:    BTOP-116E(211) Project:    28128(15) Category:    0900/SAFETY
0001 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 41.000 82.230   82.230 $50.00 $0.00 $4,111.50
0002 CLASS A CONCRETE 509(B) 0321 CY 3.760 13.360   13.360 $1,000.00 $0.00 $13,360.00
0003 18" CORR. GALV. STEEL PIPE 613(B) 0689 LF 25.000 0.000   0.000 $50.00 $0.00 $0.00
0004 30" CORR. GALV. STEEL PIPE 613(B) 0691 LF 25.000 37.000   37.000 $80.00 $0.00 $2,960.00
0005 REMOVAL OF FENCE 619(B) 4725 LF 125.000 125.000   125.000 $4.00 $0.00 $500.00
0006 FENCE-STYLE CLF (6'HIGH, CLASS B) 624(E) 4293 LF 156.000 163.000   163.000 $12.00 $0.00 $1,956.00
0007 MOBILIZATION 641 1552 LSUM 1.000 1.000   1.000 $80,000.00 $0.00 $80,000.00
0008 3" HIGH DENSITY PE PIPE - BORED 802(C) 8553 LF 55.000 55.000   55.000 $30.00 $0.00 $1,650.00
0009 3" HIGH DENSITY PE PIPE - TRENCHED 802(C) 8558 LF 390.000 455.000   455.000 $8.00 $0.00 $3,640.00
0010 PULL BOX(SIZE II) 803(A) 8066 EA 4.000 4.000   4.000 $300.00 $0.00 $1,200.00
0011 GROUND BOX (R48) 803(B) 8105 EA 8.000 8.000   8.000 $2,500.00 $0.00 $20,000.00
0012 REINFORCING STEEL 804(B) 2916 LB 92.320 92.320   92.320 $2.00 $0.00 $184.64
0013 SERVICE POLE 810(A) 3118 EA 4.000 4.000   4.000 $6,000.00 $0.00 $24,000.00
0014 1/C NO.0 ELECTRICAL CONDUCTOR 811 8032 LF 1,425.000 0.000   0.000 $6.00 $0.00 $0.00
0015 (SP)COMMUNICATION HUT TYPE D 817(A) 5525 EA 4.000 4.000   4.000 $196,000.00 $0.00 $784,000.00
0016 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0017 (PL)SHIELD ISOLATION PEDESTAL 887(F) 8370 EA 4.000 0.000   0.000 $350.00 $0.00 $0.00
8001 (SP)COMMUNICATION HUT TYPE D 817(A) 5525 EA 0.000 4.000   4.000 $4,508.39 $0.00 $18,033.56
8002 1/C NO.00 ELECT.COND. 811 8030 LF 0.000 1,479.000   1,479.000 $6.76 $0.00 $9,998.04
8003 INCENTIVE FOR EARLY COMPLETION 108 0175 DAY 0.000 8.000 1.000 8.000 $1,500.00 $1,500.00 $12,000.00
Subtotals For Category     0900/SAFETY    $1,500.00 $987,593.74
Subtotals For Project BTOP-116E(211) /28128(15) $1,500.00 $987,593.74