Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110515   Estimate Number: 0017 , Final     Spec Year: 2009
Primary JP: 20622(05)   Residency: TETRA TECH (08002)     Contract No: 710694
Date Created: 06/13/2013   Contractor FEI: 420805868     Account No: 434800

Project Number(s): CIRB-121C(109)RB
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD: OVER SPAVINAW CREEK, 4.6 MILES NORTH AND 3.9 MILES WEST OF COLCORD. PROJECT LENGTH = 0.568 MILES.
Primary County: DELAWARE              
Name of Road: COUNTY ROAD              
Prime Contractor: A. M. COHRON & SON, INC.           Time Charged: 210.00
    62180 GREAT RIVER ROAD           Time Allowed: 210.00
    ATLANTIC , IA   50022           Percent Time: 100.00 %

  Paid To Date: $1,316,787.18 Payable This Statement: $179.83

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.                                
A. M. COHRON & SON, 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:    06/13/2013
Contract ID: 110515   Estimate Number: 0017     Contract No: 710694
Residency: TETRA TECH (08002)   Estimate Type: Final     Account No: 434800

Project Number(s): CIRB-121C(109)RB
Primary Job Piece No: 20622(05)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD: OVER SPAVINAW CREEK, 4.6 MILES NORTH AND 3.9 MILES WEST OF COLCORD. PROJECT LENGTH = 0.568 MILES.
Primary County: DELAWARE              
Name of Road: COUNTY ROAD              
Prime Contractor: A. M. COHRON & SON, INC.              
    62180 GREAT RIVER ROAD              
    ATLANTIC , IA   50022              
Surety Company: UNITED FIRE & CASUALTY CO.              

Date Let: 11/17/2011 NTP Effective Date: 03/05/2012 Pay Period: 12/01/2012  TO  06/13/2013
Date Awarded: 12/05/2011 Date Work Began: 03/05/2012 Original Contract Time: 210
Date Contract Executed: 12/15/2011 Date Time Stopped: 12/18/2012 Current Time Charged: 210.00
Date NTP Issued: 01/23/2012 Completion Date: 12/18/2012 Current Time Allowed: 210.00
General Liability Expires: 07/01/2013 Workman's Comp Expires: 07/01/2013 Percent Time Used: 100.00 %
Specification Year: 2009        

Current Contract Amount: $1,316,787.12 Total to Date Prev to Date This Estimate
Bid Amount: $1,328,040.72 Participating: $0.00 $0.00 $0.00
Percent Complete: 100 % Non Participating: $1,316,787.18 $1,316,607.35 $179.83
Funds Available: $-0.06 Total Earnings: $1,316,787.18 $1,316,607.35 $179.83
Unearned Balance: $11,253.54 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $1,316,787.18 $1,316,607.35 $179.83
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $1,316,787.18 $1,316,607.35 $179.83

Estimate Adjustment Detail

Contract ID: 110515   Estimate Number: 0017     Primary JP: 20622(05)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 deduction for construction Approved 06/08/2012 0.0 $-500.00
002 Steel quantity error Approved 08/06/2012 0.0 $-10,932.48
003 FQCO Approved 06/13/2013 0.0 $178.88


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
20622(05) 0027 PC BR ITM FABS (AML) Stockpiled Material Adjustment 0007 $-61,833.69
20622(05) 0027 PC BR ITM FABS (AML) Stockpiled Material Initial Payment 0006 $61,833.69
20622(05) 0031 SSTL FABS (AML) Stockpiled Material Adjustment 0007 $-7,727.40
20622(05) 0031 SSTL FABS (AML) Stockpiled Material Initial Payment 0006 $7,727.40
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
20622(05) 0004 TYPE A-SALVAGED TOPSOIL * Missing Material Certification 0015 0.50 $7,593.20 $3,796.60
20622(05) 0004 TYPE A-SALVAGED TOPSOIL * Missing Material Certification 0016 0.00 $0.00 $-3,796.60
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: 110515   Estimate Number: 0017     Primary JP: 20622(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:    CIRB-121C(109)RB Project:    20622(05) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $5,313.61 $0.00 $5,313.61
0002 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 8,444.000 8,444.000   8,444.000 $3.50 $0.00 $29,554.00
0003 UNCLASSIFIED BORROW 202(D) 0184 CY 2,955.000 2,955.000 -242.880 2,955.000 $10.66 $-2,589.10 $31,500.30
0004 TYPE A-SALVAGED TOPSOIL 205(A) 4229 LSUM 1.000 1.000 0.000 1.000 $7,593.20 $0.00 $7,593.20
0005 TEMPORARY SILT FENCE 221(C) 2801 LF 5,227.000 4,970.000   4,970.000 $1.85 $0.00 $9,194.50
0006 TEMPORARY SILT DIKE 221(F) 0100 LF 385.000 203.000   203.000 $8.95 $0.00 $1,816.85
0007 SOLID SLAB SODDING 230(A) 2806 SY 5,365.000 14,890.750 -0.003 14,890.750 $1.55 $-0.00 $23,080.67
0008 SEEDING METHOD A 232(A) 2813 AC 1.300 0.000   0.000 $795.00 $0.00 $0.00
0009 VEGETATIVE MULCHING 233(A) 2817 AC 1.300 0.000   0.000 $795.00 $0.00 $0.00
0010 OPEN-GRADED BITUMINOUS BASE 319(A) 5190 SY 1,719.000 0.000   0.000 $20.00 $0.00 $0.00
0011 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 2,101.000 2,217.450   2,217.450 $28.50 $0.00 $63,197.33
0012 DOWEL JOINTED P.C. CONCRETE PAVEMENT(PLACEMENT ) 414(B) 5725 SY 1,657.000 1,845.680   1,845.680 $28.25 $0.00 $52,140.47
0013 CLASS C CONCRETE 509(D) 0325 CY 20.000 0.000   0.000 $286.67 $0.00 $0.00
0014 TYPE I-A PLAIN RIPRAP 601(B) 0536 TON 1,257.000 1,197.510   1,197.510 $40.21 $0.00 $48,151.88
0015 TYPE I-A FILTER BLANKET 601(C) 0538 TON 419.000 377.730   377.730 $34.65 $0.00 $13,088.35
0016 24" R.C.PIPE CLASS III 613(A) 0492 LF 136.000 144.000   144.000 $31.16 $0.00 $4,487.04
0017 18" CORR. GALV. STEEL PIPE 613(B) 0689 LF 82.000 82.000   82.000 $25.45 $0.00 $2,086.90
0018 24" PREFAB. CULVERT END SECTION, ROUND 613(L) 5730 EA 4.000 4.000   4.000 $528.60 $0.00 $2,114.40
0019 18" GALV. STEEL CULVERT END SECTION ROUND 613(P) 0760 EA 2.000 2.000   2.000 $256.94 $0.00 $513.88
0020 MAILBOX INSTALLATION-SINGLE 629(A) 4958 EA 1.000 1.000   1.000 $110.00 $0.00 $110.00
0021 MAILBOX 629(C) 4960 EA 1.000 1.000   1.000 $55.00 $0.00 $55.00
0022 SHEET ALUMINUM SIGNS 850(A) 8110 SF 10.000 10.000   10.000 $12.50 $0.00 $125.00
0023 2 1/4" SQUARE TUBE POST 851(C) 8327 LF 24.000 20.000 -4.000 20.000 $8.50 $-34.00 $170.00
0024 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $7,500.00 $0.00 $7,500.00
8011 AGGREGATE BASE TYPE A 303(A) 2100 CY 0.000 205.920 0.000 205.920 $50.13 $0.00 $10,322.77
8012 FABRIC REINFORCEMENT 409(A) 4242 SY 0.000 2,197.340   2,197.340 $2.84 $0.00 $6,240.45
Subtotals For Category     0100/ROADWAY    $-2,623.10 $318,356.60
Fed/State Project Number:    CIRB-121C(109)RB Project:    20622(05) Category:    0200/BRIDGE
0025 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 86.000 86.000   86.000 $14.15 $0.00 $1,216.90
0026 UNCLASSIFIED BACKFILL 501(D) 6353 CY 68.000 68.000   68.000 $22.00 $0.00 $1,496.00
0027 PRESTRESSED CONCRETE BEAMS (TYPE II) 503(A) 1311 LF 1,177.000 1,177.000   1,177.000 $202.50 $0.00 $238,342.50
0028 APPROACH SLAB 504(A) 1304 SY 118.000 118.000   118.000 $145.65 $0.00 $17,186.70
0029 SEALED EXPANSION JOINT 504(C) 6250 LF 67.000 67.000   67.000 $204.37 $0.00 $13,692.79
0030 CONCRETE RAIL (TR1) 504(E) 1380 LF 665.170 665.170   665.170 $45.00 $0.00 $29,932.66
0031 STRUCTURAL STEEL 506(A) 1322 LB 8,660.000 8,660.000   8,660.000 $3.04 $0.00 $26,326.40
0032 CLASS AA CONCRETE 509(A) 1326 CY 228.000 228.000   228.000 $425.00 $0.00 $96,900.00
0033 CLASS A CONCRETE 509(B) 1328 CY 135.000 135.000   135.000 $395.00 $0.00 $53,325.00
0034 REINFORCING STEEL 511(A) 1332 LB 62,248.000 66,476.000   66,476.000 $0.82 $0.00 $54,510.32
0035 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 267.000 267.000   267.000 $32.60 $0.00 $8,704.20
0036 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 267.000 247.420 0.001 247.420 $5.75 $0.01 $1,422.67
0037 (PL)PILOT HOLES 514(K) 6260 LF 105.000 95.500   95.500 $315.51 $0.00 $30,131.21
0038 DRILLED SHAFTS 36" DIAMETER 516(A) 6092 LF 160.000 160.000   160.000 $1,050.00 $0.00 $168,000.00
0039 DRILLED SHAFTS 42" DIAMETER 516(A) 6093 LF 52.000 52.000   52.000 $1,171.37 $0.00 $60,911.24
0040 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 1,498.000 1,423.110 2.000 1,423.110 $40.21 $80.42 $57,223.25
0041 TYPE I-A FILTER BLANKET 601(C) 1355 TON 749.000 702.140   702.140 $34.65 $0.00 $24,329.16
0042 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $10,500.00 $0.00 $10,500.00
0043 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 1418 LF 231.300 231.300   231.300 $21.75 $0.00 $5,030.78
0044 GUARDRAIL ANCHOR UNIT (TYPE II) 623(F) 6033 EA 4.000 4.000   4.000 $2,665.00 $0.00 $10,660.00
8013 CONSTRUCTION MISCELLANEOUS 104 0700 LSUM 0.000 1.000   1.000 $262.80 $0.00 $262.80
8090 ADJUSTMENT FOR NON-CONFORMING MATERIALS 105 2100 LSUM 0.000 1.000   1.000 $-500.00 $0.00 $-500.00
Subtotals For Category     0200/BRIDGE    $80.43 $909,604.58
Fed/State Project Number:    CIRB-121C(109)RB Project:    20622(05) Category:    0600/STAKING
0045 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000 0.100 1.000 $11,600.00 $1,160.00 $11,600.00
Subtotals For Category     0600/STAKING    $1,160.00 $11,600.00
Fed/State Project Number:    CIRB-121C(109)RB Project:    20622(05) Category:    0640/CONSTRUCTION
0046 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $6,250.00 $1,562.50 $6,250.00
0047 FIELD OFFICE 640(A) 1398 EA 1.000 1.000   1.000 $5,800.00 $0.00 $5,800.00
0048 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $64,000.00 $0.00 $64,000.00
8010 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 0.000 1.000   1.000 $1,176.00 $0.00 $1,176.00
Subtotals For Category     0640/CONSTRUCTION    $1,562.50 $77,226.00
Subtotals For Project CIRB-121C(109)RB /20622(05) $179.83 $1,316,787.18