Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 110516   Estimate Number: 0007 , Final     Spec Year: 2009
Primary JP: 28020(04)   Residency: CIRCUIT ENGR. DISTRICT # 7 (05005)     Contract No: 710697
Date Created: 03/05/2013   Contractor FEI: 731427175     Account No: 436500

Project Number(s): BRO-129D(047)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-180): OVER TURKEY CREEK, 6.5 MILES NORTH OF THE US-62 JUNCTION. PROJECT LENGTH = 0.161 MILES.
Primary County: HARMON              
Name of Road: COUNTY ROAD              
Prime Contractor: K & R BUILDERS, INC.           Time Charged: 150.00
    P.O. BOX 656           Time Allowed: 120.00
    WHEATLAND , OK   73097           Percent Time: 125.00 %

  Paid To Date: $259,981.46 Payable This Statement: $1,198.61

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.                                
K & R BUILDERS, 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:    03/05/2013
Contract ID: 110516   Estimate Number: 0007     Contract No: 710697
Residency: CIRCUIT ENGR. DISTRICT # 7 (05005)   Estimate Type: Final     Account No: 436500

Project Number(s): BRO-129D(047)CI
Primary Job Piece No: 28020(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-180): OVER TURKEY CREEK, 6.5 MILES NORTH OF THE US-62 JUNCTION. PROJECT LENGTH = 0.161 MILES.
Primary County: HARMON              
Name of Road: COUNTY ROAD              
Prime Contractor: K & R BUILDERS, INC.              
    P.O. BOX 656              
    WHEATLAND , OK   73097              
Surety Company: OHIO CASUALTY INSURANCE COMPANY              

Date Let: 11/17/2011 NTP Effective Date: 04/02/2012 Pay Period: 11/01/2012  TO  02/15/2013
Date Awarded: 12/05/2011 Date Work Began: 04/02/2012 Original Contract Time: 90
Date Contract Executed: 12/20/2011 Date Time Stopped: 12/06/2012 Current Time Charged: 150.00
Date NTP Issued: 12/29/2011 Completion Date: 12/06/2012 Current Time Allowed: 120.00
General Liability Expires: 05/01/2013 Workman's Comp Expires: 07/01/2013 Percent Time Used: 125.00 %
Specification Year: 2009        

Current Contract Amount: $274,981.46 Total to Date Prev to Date This Estimate
Bid Amount: $279,104.42 Participating: $274,981.46 $273,782.84 $1,198.62
Percent Complete: 94.55 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $15,000.00 Total Earnings: $274,981.46 $273,782.84 $1,198.62
Unearned Balance: $19,122.96 Stockpiled Materials: $0.00 $0.01 $-0.01
Gross Earnings: $274,981.46 $273,782.85 $1,198.61
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $-15,000.00 $-15,000.00 $0.00
TOTAL: $259,981.46 $258,782.85 $1,198.61

Estimate Adjustment Detail

Contract ID: 110516   Estimate Number: 0007     Primary JP: 28020(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Add 30 Calendar Days Approved 05/02/2012 30.0 $0.00
002 Final Quantity Change Order Approved 02/14/2013 0.0 $-4,122.96


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
28020(04) 0012 Stockpiled Material Closure 0007 $-0.01
28020(04) 0012 RSTL FABS (AML)(IA) Stockpiled Material Adjustment 0002 $-11,085.41
28020(04) 0012 RSTL FABS (AML)(IA) Stockpiled Material Adjustment 0004 $-11,261.20
28020(04) 0012 RSTL FABS (AML)(IA) Stockpiled Material Initial Payment 0001 $29,195.00
28020(04) 0012 RSTL FABS (AML)(IA) Stockpiled Material Adjustment 0003 $-6,848.38
Subtotals For Stockpile Payments $0.00


LIQUIDATED DAMAGES HISTORY
Adjustment Description Estimate Nbr Time Units Rate Adjustment Amount
System Application of Liquidated Damages 0003 --1.0 $500.00 $-500.00
System Application of Liquidated Damages 0004 --12 $500.00 $-6,000.00
System Application of Liquidated Damages 0005 --17 $500.00 $-8,500.00
Subtotals For Liquidated Damages $-15,000.00


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
28020(04) 0014 TYPE I-A FILTER BLANKET * Missing Material Certification 0005 -89.00 $32.62 $-2,903.18
28020(04) 0014 TYPE I-A FILTER BLANKET * Missing Material Certification 0006 89.00 $32.62 $2,903.18
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: 110516   Estimate Number: 0007     Primary JP: 28020(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-129D(047)CI Project:    28020(04) Category:    0100/ROADWAY
0001 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $23,000.00 $0.00 $23,000.00
0002 TEMPORARY SILT FENCE 221(C) 2801 LF 850.000 600.000 -54.800 600.000 $1.85 $-101.38 $1,110.00
0003 SOLID SLAB SODDING 230(A) 2806 SY 6,500.000 8,385.110   8,385.110 $1.60 $0.00 $13,416.18
0004 VEGETATIVE MULCHING 233(A) 2817 AC 1.660 0.000   0.000 $200.00 $0.00 $0.00
0005 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 386.000 385.960   385.960 $32.90 $0.00 $12,698.08
0006 CLASS C CONCRETE 509(D) 0325 CY 20.000 0.000   0.000 $270.00 $0.00 $0.00
0007 28" X 20" CORR. GALV. STEEL PIPE ARCH 613(B) 4528 LF 66.000 66.000   66.000 $26.50 $0.00 $1,749.00
0008 TYPE B4 CULVERT END TREATMENT 613(M) 7187 EA 2.000 2.000   2.000 $995.00 $0.00 $1,990.00
Subtotals For Category     0100/ROADWAY    $-101.38 $53,963.26
Fed/State Project Number:    BRO-129D(047)CI Project:    28020(04) Category:    0200/BRIDGE
0009 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 825.000 825.000   825.000 $7.00 $0.00 $5,775.00
0010 STRUCTURAL EXCAVATION UNCLASSIFIED 501(A) 1306 CY 155.000 155.000   155.000 $10.00 $0.00 $1,550.00
0011 CLASS A CONCRETE 509(B) 1328 CY 307.600 307.600   307.600 $385.00 $0.00 $118,426.00
0012 REINFORCING STEEL 511(A) 1332 LB 60,775.000 60,775.000 0.000 60,775.000 $0.88 $0.00 $53,482.00
0013 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 320.000 310.730   310.730 $41.94 $0.00 $13,032.02
0014 TYPE I-A FILTER BLANKET 601(C) 1355 TON 106.000 89.000   89.000 $32.62 $0.00 $2,903.18
0015 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $1,850.00 $0.00 $1,850.00
Subtotals For Category     0200/BRIDGE    $0.00 $197,018.20
Fed/State Project Number:    BRO-129D(047)CI Project:    28020(04) Category:    0600/STAKING
0016 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $4,900.00 $0.00 $4,900.00
Subtotals For Category     0600/STAKING    $0.00 $4,900.00
Fed/State Project Number:    BRO-129D(047)CI Project:    28020(04) Category:    0640/CONSTRUCTION
0017 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.500 1.000 $2,600.00 $1,300.00 $2,600.00
0018 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $16,500.00 $0.00 $16,500.00
Subtotals For Category     0640/CONSTRUCTION    $1,300.00 $19,100.00
Subtotals For Project BRO-129D(047)CI /28020(04) $1,198.62 $274,981.46