Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120136   Estimate Number: 0008 , Final     Spec Year: 2009
Primary JP: 28497(04)   Residency: PSA-DEWBERRY (08012)     Contract No: 810003
Date Created: 09/13/2013   Contractor FEI: 731452899     Account No: 436800

Project Number(s): BHO-149D(148)CI
Contract Description: BRIDGE REHABILITATION COUNTY ROAD (EW-59): OVER UNION PACIFIC RAILROAD 0.30 MILES WEST OF US-69. PROJECT LENGTH = 0.052 MILES.
Primary County: MAYES              
Name of Road: COUNTY ROAD              
Prime Contractor: PBX CORPORATION           Time Charged: 145.00
    P.O. BOX 644           Time Allowed: 140.00
    SAPULPA , OK   74067           Percent Time: 103.57 %

  Paid To Date: $501,384.72 Payable This Statement: $55,349.74

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:    09/13/2013
Contract ID: 120136   Estimate Number: 0008     Contract No: 810003
Residency: PSA-DEWBERRY (08012)   Estimate Type: Final     Account No: 436800

Project Number(s): BHO-149D(148)CI
Primary Job Piece No: 28497(04)
Contract Description: BRIDGE REHABILITATION COUNTY ROAD (EW-59): OVER UNION PACIFIC RAILROAD 0.30 MILES WEST OF US-69. PROJECT LENGTH = 0.052 MILES.
Primary County: MAYES              
Name of Road: COUNTY ROAD              
Prime Contractor: PBX CORPORATION              
    P.O. BOX 644              
    SAPULPA , OK   74067              
Surety Company: WESTFIELD INSURANCE COMPANY              

Date Let: 05/17/2012 NTP Effective Date: 09/04/2012 Pay Period: 03/01/2013  TO  05/31/2013
Date Awarded: 06/04/2012 Date Work Began: 09/04/2012 Original Contract Time: 60
Date Contract Executed: 06/15/2012 Date Time Stopped: 04/01/2013 Current Time Charged: 145.00
Date NTP Issued: 06/20/2012 Completion Date: 04/01/2013 Current Time Allowed: 140.00
General Liability Expires: 10/05/2013 Workman's Comp Expires: 10/05/2013 Percent Time Used: 103.57 %
Specification Year: 2009        

Current Contract Amount: $504,015.64 Total to Date Prev to Date This Estimate
Bid Amount: $492,418.00 Participating: $504,015.64 $488,659.94 $15,355.70
Percent Complete: 99.48 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $2,630.92 Total Earnings: $504,015.64 $488,659.94 $15,355.70
Unearned Balance: $-8,966.72 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $504,015.64 $488,659.94 $15,355.70
Other Adjustments: $-130.92 $-124.96 $-5.96
Liq Dam/Disincentive: $-2,500.00 $-42,500.00 $40,000.00
TOTAL: $501,384.72 $446,034.98 $55,349.74

Estimate Adjustment Detail

Contract ID: 120136   Estimate Number: 0008     Primary JP: 28497(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 CHANGE ORDER NO 1 HWY 33 COUNTY BRIDGE OVER UNION PACIFIC RR Approved 05/02/2013 61.0 $0.00
002 Cold Milling and Tack Coat Approved 05/29/2013 7.0 $9,780.00
003 time for added bridge repair Approved 05/22/2013 12.0 $0.00
004 Final Quantity Change Order Approved 09/03/2013 0.0 $1,817.64


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 0001 --13 $500.00 $-6,500.00
System Application of Liquidated Damages 0002 --15 $500.00 $-7,500.00
System Application of Liquidated Damages 0003 --24 $500.00 $-12,000.00
System Application of Liquidated Damages 0004 --10 $500.00 $-5,000.00
System Application of Liquidated Damages 0005 --13 $500.00 $-6,500.00
System Application of Liquidated Damages 0006 --10 $500.00 $-5,000.00
System Application of Liquidated Damages 0008 -80.0 $500.00 $40,000.00
Subtotals For Liquidated Damages $-2,500.00


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
28497(04) 0004 SUPERPAVE, TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0005 130.00 $-0.96 $-124.96
28497(04) 0004 SUPERPAVE, TYPE S4(PG 70-28 OK) Asphalt Binder Adjustment 0008 4.96 $-1.20 $-5.96
Subtotals For Line Item Adjustments $-130.92


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: 120136   Estimate Number: 0008     Primary JP: 28497(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:    BHO-149D(148)CI Project:    28497(04) Category:    0100/ROADWAY ITEMS
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $1,500.00 $0.00 $1,500.00
0002 AGGREGATE BASE TYPE A 303(A) 2100 CY 80.000 15.780 15.780 15.780 $65.00 $1,025.70 $1,025.70
0003 PRIME COAT 408 5774 GAL 144.000 0.000   0.000 $8.00 $0.00 $0.00
0004 SUPERPAVE, TYPE S4(PG 70-28 OK) 411(C) 5955 TON 67.200 134.960 4.960 134.960 $200.00 $992.00 $26,992.00
0005 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 400.000 0.000   0.000 $8.00 $0.00 $0.00
0006 REMOVAL OF GUARDRAIL 619(B) 4780 LF 300.000 300.000   300.000 $2.00 $0.00 $600.00
0007 SAWING PAVEMENT 619(C) 0924 LF 42.000 42.000   42.000 $3.00 $0.00 $126.00
0008 GUARDRAIL END TREATMENT (GET) 623(G) 8571 EA 4.000 4.000   4.000 $2,300.00 $0.00 $9,200.00
0009 GUARDRAIL BRIDGE CONNECTION-TYPE A 623(I) 8675 EA 4.000 4.000   4.000 $1,300.00 $0.00 $5,200.00
8000 COLD MILLING PAVEMENT 412 5267 SY 0.000 400.000 400.000 400.000 $23.25 $9,300.00 $9,300.00
8001 TACK COAT 407(B) 0250 GAL 0.000 60.000 60.000 60.000 $8.00 $480.00 $480.00
Subtotals For Category     0100/ROADWAY ITEMS    $11,797.70 $54,423.70
Fed/State Project Number:    BHO-149D(148)CI Project:    28497(04) Category:    0200/BRIDGE ITEMS
0010 CLSM BACKFILL 501(G) 6309 CY 50.000 0.000   0.000 $250.00 $0.00 $0.00
0011 PRESTRESSED CONCRETE BEAMS (TYPE II) 503(A) 1311 LF 371.000 371.280   371.280 $325.00 $0.00 $120,666.00
0012 SEALED EXPANSION JOINT 504(C) 6250 LF 54.000 54.000 54.000 54.000 $20.00 $1,080.00 $1,080.00
0013 42" F-SHAPED PARAPET 504(E) 6190 LF 251.000 251.000   251.000 $100.00 $0.00 $25,100.00
0014 RAPID CURE JOINT SEALANT 504(G) 6390 LF 54.000 54.000   54.000 $20.00 $0.00 $1,080.00
0015 ELASTOMERIC MORTAR 504(H) 6389 CF 4.000 2.880   2.880 $650.00 $0.00 $1,872.00
0016 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 9.000 9.000   9.000 $800.00 $0.00 $7,200.00
0017 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 9.000 9.000   9.000 $800.00 $0.00 $7,200.00
0018 ELASTOMERIC BEARING PADS 507(C) 6282 EA 18.000 18.000   18.000 $400.00 $0.00 $7,200.00
0019 CLASS AA CONCRETE 509(A) 1326 CY 88.900 92.020   92.020 $900.00 $0.00 $82,818.00
0020 EPOXY COATED REINFORCING STEEL 511(B) 6010 LB 47,396.000 45,621.000   45,621.000 $1.50 $0.00 $68,431.50
0021 COLLECTION AND HANDLING OF WASTE 512(B) 6303 LSUM 1.000 0.000   0.000 $900.00 $0.00 $0.00
0022 WATER REPELLENT (VISUALLY INSPECTED) 515(A) 6013 SY 607.000 653.110   653.110 $4.00 $0.00 $2,612.44
0023 PREPARATION OF CRACKS, ABOVE WATER 520(A) 6058 LF 62.000 0.000   0.000 $20.00 $0.00 $0.00
0024 EPOXY RESIN, ABOVE WATER 520(C) 6060 GAL 40.000 0.000   0.000 $20.00 $0.00 $0.00
0025 PNEUMATICALLY PLACED MORTAR 521(A) 6210 SY 21.700 41.000   41.000 $650.00 $0.00 $26,650.00
0026 REMOVAL OF BRIDGE ITEMS 619(B) 2500 LSUM 1.000 1.000   1.000 $40,000.00 $0.00 $40,000.00
0027 FENCE-STYLE CLF (7' HIGH, CLASS B) 624(E) 4298 LF 144.000 144.000   144.000 $95.00 $0.00 $13,680.00
Subtotals For Category     0200/BRIDGE ITEMS    $1,080.00 $405,589.94
Fed/State Project Number:    BHO-149D(148)CI Project:    28497(04) Category:    0300/TRAFFIC
0028 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 1,106.000 1,102.000 1,102.000 1,102.000 $1.50 $1,653.00 $1,653.00
0029 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000 0.150 1.000 $3,000.00 $450.00 $3,000.00
Subtotals For Category     0300/TRAFFIC    $2,103.00 $4,653.00
Fed/State Project Number:    BHO-149D(148)CI Project:    28497(04) Category:    0600/STAKING
0030 CONSTRUCTION STAKING LEVEL I 642(A) 0095 LSUM 1.000 1.000 0.150 1.000 $2,500.00 $375.00 $2,500.00
Subtotals For Category     0600/STAKING    $375.00 $2,500.00
Fed/State Project Number:    BHO-149D(148)CI Project:    28497(04) Category:    0640/CONSTRUCTION
0031 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $36,849.00 $0.00 $36,849.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $36,849.00
Subtotals For Project BHO-149D(148)CI /28497(04) $15,355.70 $504,015.64