Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120158   Estimate Number: 0004 , Final     Spec Year: 2009
Primary JP: 24426(04)   Residency: CLINTON (05100)     Contract No: 711174
Date Created: 07/09/2013   Contractor FEI: 731307297     Account No: 400500

Project Number(s): BRFY-220C(006)
Contract Description: BRIDGE WATERPROOF SEAL I-40/SH-6/SH-34/SH-47/SH-54/SH-55/SH-152: AT VARIOUS LOCATIONS IN DIVISION V.
Primary County: CUSTER              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: GARY A. CRAIN, INC.           Time Charged: 45.00
    RT. 2, BOX 250           Time Allowed: 45.00
    PRAGUE , OK   74864           Percent Time: 100.00 %

  Paid To Date: $73,243.15 Payable This Statement: $1,666.00

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.                                
GARY A. CRAIN, 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:    07/09/2013
Contract ID: 120158   Estimate Number: 0004     Contract No: 711174
Residency: CLINTON (05100)   Estimate Type: Final     Account No: 400500

Project Number(s): BRFY-220C(006)
Primary Job Piece No: 24426(04)
Contract Description: BRIDGE WATERPROOF SEAL I-40/SH-6/SH-34/SH-47/SH-54/SH-55/SH-152: AT VARIOUS LOCATIONS IN DIVISION V.
Primary County: CUSTER              
Name of Road: MULTIPLE LOCATIONS              
Prime Contractor: GARY A. CRAIN, INC.              
    RT. 2, BOX 250              
    PRAGUE , OK   74864              
Surety Company: EMPLOYERS MUTUAL CASUALTY COMPANY              

Date Let: 04/19/2012 NTP Effective Date: 08/06/2012 Pay Period: 07/01/2013  TO  07/06/2013
Date Awarded: 05/07/2012 Date Work Began: 08/23/2012 Original Contract Time: 45
Date Contract Executed: 05/21/2012 Date Time Stopped: 01/31/2013 Current Time Charged: 45.00
Date NTP Issued: 05/24/2012 Completion Date: 01/31/2013 Current Time Allowed: 45.00
General Liability Expires: 07/01/2014 Workman's Comp Expires: 07/01/2014 Percent Time Used: 100.00 %
Specification Year: 2009        

Current Contract Amount: $73,243.15 Total to Date Prev to Date This Estimate
Bid Amount: $68,343.25 Participating: $73,243.15 $71,577.15 $1,666.00
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $0.00 Total Earnings: $73,243.15 $71,577.15 $1,666.00
Unearned Balance: $-4,899.90 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $73,243.15 $71,577.15 $1,666.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $73,243.15 $71,577.15 $1,666.00

Estimate Adjustment Detail

Contract ID: 120158   Estimate Number: 0004     Primary JP: 24426(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Final Quantity Change Order Approved 06/25/2013 0.0 $4,899.90


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
No liquidated damages have been assessed on this contract.
Subtotals For Liquidated Damages $


CONTRACT ADJUSTMENTS HISTORY
Adjustment Description Estimate Nbr Adjustment Amount
Withhold to Funds Avail(Prog. Est. Only) 0002 $-2,915.74
Withhold to Funds Avail(Prog. Est. Only) 0003 $2,915.74
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: 120158   Estimate Number: 0004     Primary JP: 24426(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:    BRFY-220C(006) Project:    24426(04) Category:    0200/BRIDGE 'A'
0001 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 689.000 688.460   688.460 $3.85 $0.00 $2,650.57
0002 SEALER CRACK PREPARATION 523(A) 6550 LF 145.000 175.000   175.000 $2.00 $0.00 $350.00
0003 SEALER RESIN 523(B) 6560 GAL 1.700 1.000   1.000 $60.00 $0.00 $60.00
8000 DEDUCTION FOR FAILING MATERIAL 105 2325 EA 0.000 1.000   1.000 $-296.59 $0.00 $-296.59
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $2,763.98
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0201/BRIDGE 'B'
0004 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 1,028.000 1,027.010   1,027.010 $3.85 $0.00 $3,953.99
0005 SEALER CRACK PREPARATION 523(A) 6550 LF 130.000 329.000   329.000 $2.00 $0.00 $658.00
0006 SEALER RESIN 523(B) 6560 GAL 1.500 1.000   1.000 $60.00 $0.00 $60.00
Subtotals For Category     0201/BRIDGE 'B'    $0.00 $4,671.99
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0202/BRIDGE 'C'
0007 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 552.000 551.790   551.790 $3.85 $0.00 $2,124.39
0008 SEALER CRACK PREPARATION 523(A) 6550 LF 25.000 46.000   46.000 $2.00 $0.00 $92.00
0009 SEALER RESIN 523(B) 6560 GAL 0.300 0.500   0.500 $60.00 $0.00 $30.00
Subtotals For Category     0202/BRIDGE 'C'    $0.00 $2,246.39
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0203/BRIDGE 'D'
0010 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 854.000 853.040   853.040 $3.85 $0.00 $3,284.20
0011 SEALER CRACK PREPARATION 523(A) 6550 LF 135.000 712.000   712.000 $2.00 $0.00 $1,424.00
0012 SEALER RESIN 523(B) 6560 GAL 1.500 2.000   2.000 $60.00 $0.00 $120.00
Subtotals For Category     0203/BRIDGE 'D'    $0.00 $4,828.20
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0204/BRIDGE 'E'
0013 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 3,539.000 3,540.310   3,540.310 $3.85 $0.00 $13,630.19
0014 SEALER CRACK PREPARATION 523(A) 6550 LF 2,180.000 4,067.000   4,067.000 $2.00 $0.00 $8,134.00
0015 SEALER RESIN 523(B) 6560 GAL 24.300 8.000   8.000 $60.00 $0.00 $480.00
Subtotals For Category     0204/BRIDGE 'E'    $0.00 $22,244.19
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0205/BRIDGE 'F'
0016 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 855.000 854.170   854.170 $3.85 $0.00 $3,288.56
0017 SEALER CRACK PREPARATION 523(A) 6550 LF 670.000 839.000   839.000 $2.00 $0.00 $1,678.00
0018 SEALER RESIN 523(B) 6560 GAL 7.500 2.500   2.500 $60.00 $0.00 $150.00
Subtotals For Category     0205/BRIDGE 'F'    $0.00 $5,116.56
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0206/BRIDGE 'G'
0019 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 1,352.000 1,242.880   1,242.880 $3.85 $0.00 $4,785.09
0020 SEALER CRACK PREPARATION 523(A) 6550 LF 350.000 1,237.000   1,237.000 $2.00 $0.00 $2,474.00
0021 SEALER RESIN 523(B) 6560 GAL 3.900 4.000   4.000 $60.00 $0.00 $240.00
Subtotals For Category     0206/BRIDGE 'G'    $0.00 $7,499.09
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0207/BRIDGE 'H'
0022 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 1,352.000 1,242.880   1,242.880 $3.85 $0.00 $4,785.09
0023 SEALER CRACK PREPARATION 523(A) 6550 LF 350.000 548.000   548.000 $2.00 $0.00 $1,096.00
0024 SEALER RESIN 523(B) 6560 GAL 3.900 4.000   4.000 $60.00 $0.00 $240.00
Subtotals For Category     0207/BRIDGE 'H'    $0.00 $6,121.09
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0208/'BRIDGE 'I'
0025 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 990.000 989.320   989.320 $3.85 $0.00 $3,808.88
0026 SEALER CRACK PREPARATION 523(A) 6550 LF 290.000 309.000   309.000 $2.00 $0.00 $618.00
0027 SEALER RESIN 523(B) 6560 GAL 3.300 1.500   1.500 $60.00 $0.00 $90.00
Subtotals For Category     0208/'BRIDGE 'I'    $0.00 $4,516.88
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0209/BRIDGE 'J'
0028 WATER REPELLENT (PERFORMANCE TESTED) 515(B) 6014 SY 654.000 653.710   653.710 $3.85 $0.00 $2,516.78
0029 SEALER CRACK PREPARATION 523(A) 6550 LF 210.000 304.000   304.000 $2.00 $0.00 $608.00
0030 SEALER RESIN 523(B) 6560 GAL 2.400 1.500   1.500 $60.00 $0.00 $90.00
Subtotals For Category     0209/BRIDGE 'J'    $0.00 $3,214.78
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0300/TRAFFIC CONTROL
0031 (PL)TRUCK MOUNTED ATTENUATOR 876(A) 8482 SD 45.000 2.000   2.000 $5.00 $0.00 $10.00
0032 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $1,500.00 $0.00 $1,500.00
0033 PORT.CHANGEABLE MESSAGE SIGN 882(A) 8306 SD 90.000 2.000   2.000 $5.00 $0.00 $10.00
Subtotals For Category     0300/TRAFFIC CONTROL    $0.00 $1,520.00
Fed/State Project Number:    BRFY-220C(006) Project:    24426(04) Category:    0640/CONSTRUCTION
0034 MOBILIZATION 641 1399 LSUM 1.000 1.000 0.196 1.000 $8,500.00 $1,666.00 $8,500.00
Subtotals For Category     0640/CONSTRUCTION    $1,666.00 $8,500.00
Subtotals For Project BRFY-220C(006) /24426(04) $1,666.00 $73,243.15