Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120164   Estimate Number: 0014 , Final     Spec Year: 2009
Primary JP: 15205(04)   Residency: ATKINS NORTH AMERICA, INC. (AKA PBS & J) (01010)     Contract No: 711179
Date Created: 01/14/2014   Contractor FEI: 730776271     Account No: 436100

Project Number(s): BRF-056C(253)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-390): OVER MONTEZUMA CREEK, 2.75 MILES NORTH OF I-40. PROJECT LENGTH = 0.196 MILES.
Primary County: OKMULGEE              
Name of Road: COUNTY ROAD              
Prime Contractor: SEWELL BROS., INC.           Time Charged: 151.00
    1220 E. MAIN           Time Allowed: 147.00
    CORDELL , OK   73632           Percent Time: 102.72 %

  Paid To Date: $557,040.98 Payable This Statement: $1,418.29

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.                                
SEWELL BROS., 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:    01/14/2014
Contract ID: 120164   Estimate Number: 0014     Contract No: 711179
Residency: ATKINS NORTH AMERICA, INC. (AKA PBS & J) (01010)   Estimate Type: Final     Account No: 436100

Project Number(s): BRF-056C(253)CI
Primary Job Piece No: 15205(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-390): OVER MONTEZUMA CREEK, 2.75 MILES NORTH OF I-40. PROJECT LENGTH = 0.196 MILES.
Primary County: OKMULGEE              
Name of Road: COUNTY ROAD              
Prime Contractor: SEWELL BROS., INC.              
    1220 E. MAIN              
    CORDELL , OK   73632              
Surety Company: WESTFIELD INSURANCE COMPANY              

Date Let: 04/19/2012 NTP Effective Date: 08/06/2012 Pay Period: 08/01/2013  TO  12/31/2013
Date Awarded: 05/07/2012 Date Work Began: 08/06/2012 Original Contract Time: 120
Date Contract Executed: 05/22/2012 Date Time Stopped: 07/23/2013 Current Time Charged: 151.00
Date NTP Issued: 05/29/2012 Completion Date: 07/23/2013 Current Time Allowed: 147.00
General Liability Expires: 07/01/2014 Workman's Comp Expires: 07/01/2014 Percent Time Used: 102.72 %
Specification Year: 2009        

Bid Amount: $598,213.90 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $598,213.90 Participating: $559,054.21 $557,634.63 $1,419.58
Percent Complete: 93.12 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $41,172.92 Total Earnings: $559,054.21 $557,634.63 $1,419.58
Stockpiled Materials: $0.00 $1.29 $-1.29
Gross Earnings: $559,054.21 $557,635.92 $1,418.29
Other Adjustments: $-13.23 $-13.23 $0.00
Liq Dam/Disincentive: $-2,000.00 $-2,000.00 $0.00
TOTAL: $557,040.98 $555,622.69 $1,418.29

Estimate Adjustment Detail

Contract ID: 120164   Estimate Number: 0014     Primary JP: 15205(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 To add days only as compensation for construction delays Approved 12/18/2012 27.0 $0.00
002 FQCO Approved 11/21/2013 0.0 $-39,159.70


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
15205(04) 0015 96" DIMPLE BAND COUPLER W/BOLTS Stockpiled Material Initial Payment 0001 $498.00
15205(04) 0015 96" DIMPLE BAND COUPLER W/BOLTS Stockpiled Material Adjustment 0002 $-498.00
15205(04) 0015 PIPE-CGMP Stockpiled Material Adjustment 0002 $-6,640.00
15205(04) 0015 PIPE-CGMP Stockpiled Material Initial Payment 0001 $6,640.00
15205(04) 0015 PIPE-CGMP Stockpiled Material Adjustment 0002 $-3,154.00
15205(04) 0015 PIPE-CGMP Stockpiled Material Initial Payment 0001 $3,154.00
15205(04) 0028 Stockpiled Material Closure 0014 $-1.29
15205(04) 0028 Engineering Stockpiled Material Initial Payment 0001 $962.51
15205(04) 0028 Engineering Stockpiled Material Adjustment 0005 $-961.22
15205(04) 0028 Bearing Pads Stockpiled Material Adjustment 0005 $-1,614.00
15205(04) 0028 Bearing Pads Stockpiled Material Initial Payment 0001 $1,614.00
15205(04) 0028 PC BR ITM FABS (AML) Stockpiled Material Adjustment 0005 $-43,187.56
15205(04) 0028 PC BR ITM FABS (AML) Stockpiled Material Initial Payment 0001 $43,187.56
Subtotals For Stockpile Payments $0.00


LIQUIDATED DAMAGES HISTORY
Adjustment Description Estimate Nbr Time Units Rate Adjustment Amount
System Application of Liquidated Damages 0009 --4.0 $500.00 $-2,000.00
Subtotals For Liquidated Damages $-2,000.00


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
15205(04) 0012 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0009 473.66 $-0.03 $-14.21
15205(04) 0012 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0011 -32.76 $-0.03 $0.98
15205(04) 0012 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0014 0.00 $-0.63 $0.00
Subtotals For Line Item Adjustments $-13.23


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: 120164   Estimate Number: 0014     Primary JP: 15205(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-056C(253)CI Project:    15205(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $5,000.00 $0.00 $5,000.00
0002 UNCLASSIFIED EXCAVATION 202(A) 0183 CY 10,723.000 10,723.000   10,723.000 $5.50 $0.00 $58,976.51
0003 UNCLASSIFIED BORROW 202(D) 0184 CY 2,695.000 0.000   0.000 $6.50 $0.00 $0.00
0004 TYPE A-SALVAGED TOPSOIL 205(A) 4229 LSUM 1.000 1.000   1.000 $3,500.00 $0.00 $3,500.00
0005 TEMPORARY SILT FENCE 221(C) 2801 LF 1,062.000 1,127.000   1,127.000 $1.65 $0.00 $1,859.55
0006 TEMPORARY SILT DIKE 221(F) 0100 LF 334.000 0.000   0.000 $12.00 $0.00 $0.00
0007 SOLID SLAB SODDING 230(A) 2806 SY 8,256.000 12,519.560 7.500 12,519.560 $1.60 $12.00 $20,031.30
0008 VEGETATIVE MULCHING 233(A) 2817 AC 2.000 0.000   0.000 $700.00 $0.00 $0.00
0009 AGGREGATE BASE TYPE A 303(A) 2100 CY 562.000 525.670   525.670 $35.00 $0.00 $18,398.45
0010 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 574.000 573.830   573.830 $25.00 $0.00 $14,345.75
0011 PRIME COAT 408 5774 GAL 1,223.000 400.000   400.000 $5.50 $0.00 $2,200.00
0012 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 527.000 440.900 0.002 440.900 $105.00 $0.21 $46,294.50
0013 CLASS C CONCRETE 509(D) 0325 CY 108.000 93.820   93.820 $300.00 $0.00 $28,146.00
0014 18" CORR. GALV. STEEL PIPE 613(B) 0689 LF 105.000 105.000   105.000 $20.00 $0.00 $2,100.00
0015 96" CORR. GALV. STEEL PIPE 613(B) 4819 LF 234.000 234.000   234.000 $166.00 $0.00 $38,844.00
0016 18" PREFAB. CULVERT END SECTION, ROUND 613(L) 5726 EA 6.000 6.000   6.000 $110.00 $0.00 $660.00
0017 REMOVAL OF STRUCTURES & OBSTRUCTIONS 619(A) 0920 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
0018 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 2,087.000 2,082.220   2,082.220 $2.50 $0.00 $5,205.55
0019 (PL)GUARDRAIL CURBING 623 0100 EA 4.000 4.000   4.000 $525.00 $0.00 $2,100.00
0020 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 0932 LF 425.000 150.000   150.000 $11.00 $0.00 $1,650.00
0021 GUARDRAIL END TREATMENT (GET) 623(G) 8571 EA 4.000 4.000   4.000 $2,255.00 $0.00 $9,020.00
0022 GUARDRAIL BRIDGE CONNECTION-TYPE A 623(I) 8675 EA 4.000 4.000   4.000 $1,550.00 $0.00 $6,200.00
0023 DELINEATORS(TYPE 2, CODE 1) 853 9033 EA 8.000 8.000   8.000 $9.00 $0.00 $72.00
0024 TRAFFIC STRIPE(PAINT)(4" WIDE) 854(A) 8800 LF 4,140.000 4,168.000   4,168.000 $0.35 $0.00 $1,458.80
0025 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $7,250.00 $0.00 $7,250.00
Subtotals For Category     0100/ROADWAY    $12.21 $277,312.41
Fed/State Project Number:    BRF-056C(253)CI Project:    15205(04) Category:    0200/BRIDGE
0026 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 220.000 220.000   220.000 $10.00 $0.00 $2,200.00
0027 GRANULAR BACKFILL 501(F) 6352 CY 102.000 102.000   102.000 $40.00 $0.00 $4,080.00
0028 PRESTRESSED CONCRETE BEAMS (TYPE IV) 503(A) 1313 LF 299.000 299.000 0.000 299.000 $210.00 $0.00 $62,790.00
0029 SAW-CUT GROOVING 504(B) 1305 SY 254.400 254.400   254.400 $5.00 $0.00 $1,272.00
0030 CONCRETE RAIL (TR3) 504(D) 6239 LF 281.300 281.300   281.300 $50.00 $0.00 $14,065.00
0031 STRUCTURAL STEEL 506(A) 1322 LB 330.000 330.000   330.000 $3.00 $0.00 $990.00
0032 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 3.000 3.000   3.000 $600.00 $0.00 $1,800.00
0033 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 3.000 3.000   3.000 $600.00 $0.00 $1,800.00
0034 CLASS AA CONCRETE 509(A) 1326 CY 81.400 81.400   81.400 $550.00 $0.00 $44,770.00
0035 CLASS A CONCRETE 509(B) 1328 CY 79.400 79.400   79.400 $550.00 $0.00 $43,670.00
0036 REINFORCING STEEL 511(A) 1332 LB 32,440.000 32,440.000   32,440.000 $1.00 $0.00 $32,440.00
0037 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 80.000 80.000   80.000 $28.00 $0.00 $2,240.00
0038 PILES, FURNISHED (HP 12X53) 514(A) 6011 LF 218.000 218.000   218.000 $31.50 $0.00 $6,867.00
0039 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 80.000 70.330   70.330 $12.00 $0.00 $843.96
0040 PILES, DRIVEN (HP 12X53) 514(B) 6294 LF 218.000 193.000   193.000 $13.50 $0.00 $2,605.50
0041 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 388.000 383.260 -7.570 383.260 $39.00 $-295.23 $14,947.14
0042 TYPE I-A FILTER BLANKET 601(C) 1355 TON 172.000 158.640 -4.080 158.640 $30.00 $-122.40 $4,759.20
0043 6" PERFORATED PIPE UNDERDRAIN ROUND 613(H) 0450 LF 60.000 60.000   60.000 $24.00 $0.00 $1,440.00
0044 6" NON-PERF.PIPE UNDERDRAIN RND. 613(I) 1096 LF 38.000 38.000   38.000 $24.00 $0.00 $912.00
0045 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $5,000.00 $0.00 $5,000.00
Subtotals For Category     0200/BRIDGE    $-417.63 $249,491.80
Fed/State Project Number:    BRF-056C(253)CI Project:    15205(04) Category:    0600/STAKING
0046 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000 0.100 1.000 $8,250.00 $825.00 $8,250.00
Subtotals For Category     0600/STAKING    $825.00 $8,250.00
Fed/State Project Number:    BRF-056C(253)CI Project:    15205(04) Category:    0640/CONSTRUCTION
0047 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $4,000.00 $1,000.00 $4,000.00
0048 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $20,000.00 $0.00 $20,000.00
Subtotals For Category     0640/CONSTRUCTION    $1,000.00 $24,000.00
Subtotals For Project BRF-056C(253)CI /15205(04) $1,419.58 $559,054.21