Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120142   Estimate Number: 0014 , Final     Spec Year: 2009
Primary JP: 25744(04)   Residency: ATKINS NORTH AMERICA, INC. (AKA PBS & J) (08010)     Contract No: 711071
Date Created: 09/18/2014   Contractor FEI: 731603183     Account No: 436800

Project Number(s): BRF-166C(219)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-45): OVER DOG CREEK 1.9 MILES EAST OF SH-66. PROJECT LENGTH = 0.235 MILE.
Primary County: ROGERS              
Name of Road: COUNTY ROAD              
Prime Contractor: BELK BRIDGE, INC.           Time Charged: 142.00
    4 RIVER RIDGE ROAD           Time Allowed: 128.00
    BROKEN ARROW , OK   74014           Percent Time: 110.94 %

  Paid To Date: $1,225,159.44 Payable This Statement: $5,083.63

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.                                
BELK BRIDGE, 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:    09/18/2014
Contract ID: 120142   Estimate Number: 0014     Contract No: 711071
Residency: ATKINS NORTH AMERICA, INC. (AKA PBS & J) (08010)   Estimate Type: Final     Account No: 436800

Project Number(s): BRF-166C(219)CI
Primary Job Piece No: 25744(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-45): OVER DOG CREEK 1.9 MILES EAST OF SH-66. PROJECT LENGTH = 0.235 MILE.
Primary County: ROGERS              
Name of Road: COUNTY ROAD              
Prime Contractor: BELK BRIDGE, INC.              
    4 RIVER RIDGE ROAD              
    BROKEN ARROW , OK   74014              
Surety Company: OHIO CASUALTY INSURANCE COMPANY              

Date Let: 03/15/2012 NTP Effective Date: 07/02/2012 Pay Period: 05/01/2014  TO  09/01/2014
Date Awarded: 04/02/2012 Date Work Began: 05/14/2012 Original Contract Time: 120
Date Contract Executed: 04/12/2012 Date Time Stopped: 02/25/2013 Current Time Charged: 142.00
Date NTP Issued: 04/18/2012 Completion Date: 02/25/2013 Current Time Allowed: 128.00
General Liability Expires: 08/27/2015 Workman's Comp Expires: 09/01/2015 Percent Time Used: 110.94 %
Specification Year: 2009        

Bid Amount: $1,261,116.57 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $1,261,116.57 Participating: $1,233,409.44 $1,228,325.81 $5,083.63
Percent Complete: 97.15 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $35,957.13 Total Earnings: $1,233,409.44 $1,228,325.81 $5,083.63
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $1,233,409.44 $1,228,325.81 $5,083.63
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $-8,250.00 $-8,250.00 $0.00
TOTAL: $1,225,159.44 $1,220,075.81 $5,083.63

Estimate Adjustment Detail

Contract ID: 120142   Estimate Number: 0014     Primary JP: 25744(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Time adjustments due to design change Approved 03/13/2013 8.0 $0.00
002 Quantity reduction due to site conditions Approved 06/13/2013 0.0 $-4,301.00
003 Change order to address settlement at approach slabs Approved 04/11/2014 0.0 $-2,685.00
004 FQCO Approved 08/25/2014 0.0 $-20,721.15


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 0008 --14 $750.00 $-10,500.00
System Application of Liquidated Damages 0009 --5.0 $750.00 $-3,750.00
System Application of Liquidated Damages 0013 -8.0 $750.00 $6,000.00
Subtotals For Liquidated Damages $-8,250.00


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
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: 120142   Estimate Number: 0014     Primary JP: 25744(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:    BRF-166C(219)CI Project:    25744(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $16,000.00 $0.00 $16,000.00
0002 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 2,243.000 2,243.000   2,243.000 $5.50 $0.00 $12,336.50
0003 UNCLASSIFIED BORROW 202(D) 0184 CY 13,109.000 13,109.000   13,109.000 $5.25 $0.00 $68,822.25
0004 TYPE A-SALVAGED TOPSOIL 205(A) 4229 LSUM 1.000 1.000   1.000 $12,000.00 $0.00 $12,000.00
0005 TEMPORARY SILT FENCE 221(C) 2801 LF 2,458.000 500.000 500.000 500.000 $1.10 $550.00 $550.00
0006 TEMPORARY SILT DIKE 221(F) 0100 LF 224.000 0.000   0.000 $9.00 $0.00 $0.00
0007 SOLID SLAB SODDING 230(A) 2806 SY 14,017.000 13,447.060 -166.120 13,447.060 $1.55 $-257.49 $20,842.94
0008 VEGETATIVE MULCHING 233(A) 2817 AC 2.900 0.000   0.000 $850.00 $0.00 $0.00
0009 AGGREGATE BASE TYPE B 303(B) 2110 CY 1,046.000 1,078.030 4.070 1,078.030 $39.02 $158.81 $42,064.73
0010 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 262.000 354.030   354.030 $18.00 $0.00 $6,372.54
0011 TACK COAT 407(B) 0250 GAL 240.000 400.000   400.000 $2.70 $0.00 $1,080.00
0012 PRIME COAT 408 5774 GAL 1,342.000 1,473.000   1,473.000 $5.00 $0.00 $7,365.00
0013 SUPERPAVE, TYPE S3(PG 64-22 OK) 411(B) 5945 TON 1,526.000 1,602.080   1,602.080 $62.50 $0.00 $100,130.00
0014 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 529.000 511.830   511.830 $83.00 $0.00 $42,481.89
0015 CLASS C CONCRETE 509(D) 0325 CY 24.000 13.850   13.850 $275.00 $0.00 $3,808.75
0016 18" CORR. GALV. STEEL PIPE 613(B) 0689 LF 239.000 199.000 -40.000 199.000 $35.00 $-1,400.00 $6,965.00
0017 TYPE A4 CULVERT END TREATMENT 613(M) 7186 EA 6.000 6.000   6.000 $1,000.00 $0.00 $6,000.00
0018 STANDARD BEDDING MATERIAL, CLASS C 613(T) 1187 CY 65.000 65.490   65.490 $35.00 $0.00 $2,292.15
0019 TRENCH EXCAVATION 613(V) 1180 CY 91.000 91.190   91.190 $10.00 $0.00 $911.90
0020 REMOVAL OF STRUCTURES & OBSTRUCTIONS 619(A) 0920 LSUM 1.000 1.000   1.000 $3,000.00 $0.00 $3,000.00
0021 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 1,348.000 2,650.510   2,650.510 $5.00 $0.00 $13,252.55
0022 SAWING PAVEMENT 619(C) 0924 LF 42.000 42.000   42.000 $5.00 $0.00 $210.00
Subtotals For Category     0100/ROADWAY    $-948.68 $366,486.20
Fed/State Project Number:    BRF-166C(219)CI Project:    25744(04) Category:    0200/BRIDGE 'A'
0023 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 2,464.000 2,464.000   2,464.000 $5.50 $0.00 $13,552.00
0024 AGGREGATE BASE TYPE A 303(A) 2100 CY 557.000 557.000   557.000 $45.00 $0.00 $25,065.00
0025 GEOGRID REINFORCEMENT 326(B) 0100 SY 954.000 954.000   954.000 $3.50 $0.00 $3,339.00
0026 STRUCTURAL EXCAVATION UNCLASSIFIED 501(A) 1306 CY 312.000 662.000 10.000 662.000 $60.00 $600.00 $39,720.00
0027 CLASS A CONCRETE 509(B) 1328 CY 481.000 481.000   481.000 $300.00 $0.00 $144,300.00
0028 REINFORCING STEEL 511(A) 1332 LB 94,430.000 94,430.000   94,430.000 $1.00 $0.00 $94,430.00
0029 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 1,430.000 1,064.880 -30.960 1,064.880 $23.50 $-727.56 $25,024.68
0030 TYPE I-A FILTER BLANKET 601(C) 1355 TON 295.000 212.960 -6.250 212.960 $23.25 $-145.31 $4,951.32
0031 FILTER FABRIC (RIPRAP) 601(I) 6312 SY 1,195.000 1,315.280 0.010 1,315.280 $1.00 $0.01 $1,315.28
Subtotals For Category     0200/BRIDGE 'A'    $-272.86 $351,697.28
Fed/State Project Number:    BRF-166C(219)CI Project:    25744(04) Category:    0201/BRIDGE 'B'
0032 UNCLASSIFIED EXCAVATION 202(A) 1301 CY 8,016.000 7,234.000   7,234.000 $5.50 $0.00 $39,787.00
0033 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 120.000 120.000   120.000 $12.00 $0.00 $1,440.00
0034 CLSM BACKFILL 501(G) 6309 CY 86.000 86.000   86.000 $90.00 $0.00 $7,740.00
0035 PRESTRESSED CONCRETE BEAMS (TYPE IV) 503(A) 1313 LF 439.000 439.000   439.000 $205.00 $0.00 $89,995.00
0036 APPROACH SLAB 504(A) 1304 SY 142.000 142.220   142.220 $100.00 $0.00 $14,222.00
0037 CONCRETE RAIL (TR3) 504(D) 6239 LF 285.000 285.000   285.000 $75.00 $0.00 $21,375.00
0038 STRUCTURAL STEEL 506(A) 1322 LB 250.000 250.000   250.000 $4.00 $0.00 $1,000.00
0039 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 8.000 8.000   8.000 $750.00 $0.00 $6,000.00
0040 CLASS AA CONCRETE 509(A) 0319 CY 223.000 223.000   223.000 $400.00 $0.00 $89,200.00
0041 CLASS A CONCRETE 509(B) 1328 CY 54.000 54.000   54.000 $400.00 $0.00 $21,600.00
0042 REINFORCING STEEL 511(A) 1332 LB 32,823.000 32,823.000   32,823.000 $1.00 $0.00 $32,823.00
0043 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 684.000 684.000   684.000 $20.00 $0.00 $13,680.00
0044 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 684.000 681.060   681.060 $10.00 $0.00 $6,810.60
0045 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 4,560.000 2,462.230 47.010 2,462.230 $23.50 $1,104.74 $57,862.42
0046 TYPE I-A FILTER BLANKET 601(C) 1355 TON 820.000 855.130 103.720 855.130 $23.25 $2,411.49 $19,881.78
0047 FILTER FABRIC (RIPRAP) 601(I) 6312 SY 4,015.000 3,729.160 1,313.940 3,729.160 $1.00 $1,313.94 $3,729.16
0048 6" PERFORATED PIPE UNDERDRAIN ROUND 613(H) 6204 LF 66.000 66.000   66.000 $40.00 $0.00 $2,640.00
0049 6" NON-PERF.PIPE UNDERDRAIN RND. 613(I) 6207 LF 40.000 40.000   40.000 $30.00 $0.00 $1,200.00
0050 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $6,000.00 $0.00 $6,000.00
0051 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 1418 LF 300.000 300.000   300.000 $18.00 $0.00 $5,400.00
0052 GUARDRAIL END TREATMENT (GET) 623(G) 8571 EA 4.000 4.000   4.000 $2,250.00 $0.00 $9,000.00
8010 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 0.000 1.000   1.000 $1,430.00 $0.00 $1,430.00
8011 CONSTRUCTION MISCELLANEOUS 104 0700 LSUM 0.000 1.000   1.000 $13,160.00 $0.00 $13,160.00
Subtotals For Category     0201/BRIDGE 'B'    $4,830.17 $465,975.96
Fed/State Project Number:    BRF-166C(219)CI Project:    25744(04) Category:    0300/TRAFFIC
0053 TRAFFIC STRIPE(PLASTIC)(4" WIDE) 855(A) 8812 LF 5,000.000 5,000.000   5,000.000 $0.65 $0.00 $3,250.00
0054 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000 0.100 1.000 $3,400.00 $340.00 $3,400.00
Subtotals For Category     0300/TRAFFIC    $340.00 $6,650.00
Fed/State Project Number:    BRF-166C(219)CI Project:    25744(04) Category:    0600/STAKING
0055 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000 0.100 1.000 $5,100.00 $510.00 $5,100.00
Subtotals For Category     0600/STAKING    $510.00 $5,100.00
Fed/State Project Number:    BRF-166C(219)CI Project:    25744(04) Category:    0640/CONSTRUCTION
0056 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $2,500.00 $625.00 $2,500.00
0057 FIELD OFFICE 640(A) 1398 EA 1.000 0.000   0.000 $2,000.00 $0.00 $0.00
0058 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $35,000.00 $0.00 $35,000.00
Subtotals For Category     0640/CONSTRUCTION    $625.00 $37,500.00
Subtotals For Project BRF-166C(219)CI /25744(04) $5,083.63 $1,233,409.44