Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120181   Estimate Number: 0014 , Final     Spec Year: 2009
Primary JP: 22750(04)   Residency: SAND SPRINGS (08400)     Contract No: 810014
Date Created: 07/10/2013   Contractor FEI: 731603183     Account No: 432800

Project Number(s): BRO-119D(129)CO
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-60): OVER LAGOON CREEK 2.0 MILES NORTH AND 1.0 MILES WEST OF THE SH-51/SH-99 JUNCTION. PROJECT LENGTH = 0.283 MILES.
Primary County: CREEK              
Name of Road: COUNTY ROAD              
Prime Contractor: BELK BRIDGE, INC.           Time Charged: 119.00
    4 RIVER RIDGE ROAD           Time Allowed: 120.00
    BROKEN ARROW , OK   74014           Percent Time: 99.17 %

  Paid To Date: $659,955.18 Payable This Statement: $0.00

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.                                
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:    07/10/2013
Contract ID: 120181   Estimate Number: 0014     Contract No: 810014
Residency: SAND SPRINGS (08400)   Estimate Type: Final     Account No: 432800

Project Number(s): BRO-119D(129)CO
Primary Job Piece No: 22750(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-60): OVER LAGOON CREEK 2.0 MILES NORTH AND 1.0 MILES WEST OF THE SH-51/SH-99 JUNCTION. PROJECT LENGTH = 0.283 MILES.
Primary County: CREEK              
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: 05/17/2012 NTP Effective Date: 09/04/2012 Pay Period: 07/09/2013  TO  07/10/2013
Date Awarded: 06/04/2012 Date Work Began: 07/10/2012 Original Contract Time: 120
Date Contract Executed: 06/15/2012 Date Time Stopped: 05/22/2013 Current Time Charged: 119.00
Date NTP Issued: 06/20/2012 Completion Date: 05/22/2013 Current Time Allowed: 120.00
General Liability Expires: 08/27/2013 Workman's Comp Expires: 09/01/2013 Percent Time Used: 99.17 %
Specification Year: 2009        

Current Contract Amount: $659,955.18 Total to Date Prev to Date This Estimate
Bid Amount: $620,757.75 Participating: $659,955.19 $659,955.19 $0.00
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Funds Available: $0.00 Total Earnings: $659,955.19 $659,955.19 $0.00
Unearned Balance: $-39,197.43 Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $659,955.19 $659,955.19 $0.00
Other Adjustments: $-0.01 $-0.01 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $659,955.18 $659,955.18 $0.00

Estimate Adjustment Detail

Contract ID: 120181   Estimate Number: 0014     Primary JP: 22750(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Rip Rap overrun Approved 01/28/2013 0.0 $32,643.06
002 Additional compensation for revised drilled shafts. Approved 02/21/2013 0.0 $-1,412.08
003 Final Change Order Approved 07/08/2013 0.0 $7,966.45


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) 0009 $-6,833.45
Withhold to Funds Avail(Prog. Est. Only) 0010 $6,833.45
Withhold to Funds Avail(Prog. Est. Only) 0012 $-7,488.06
Withhold to Funds Avail(Prog. Est. Only) 0013 $7,488.05
Withhold to Funds Avail(Prog. Est. Only) 0014 $0.01
Round Error Correction (Final Est. Only) 0014 $-0.01
Subtotals For Contract Adjustments $-0.01


LINE ITEM ADJUSTMENT HISTORY
Project Item Nbr Line Item Description Adjustment Type Estimate Nbr Adj Quantity Unit Price Adjusted Amount
22750(04) 0003 TYPE A-SALVAGED TOPSOIL * Missing Material Certification 0007 -0.25 $3,000.00 $-750.00
22750(04) 0003 TYPE A-SALVAGED TOPSOIL * Missing Material Certification 0009 0.25 $3,000.00 $750.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0002 -200.00 $1.25 $-250.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0003 -260.00 $1.25 $-325.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0004 -400.00 $1.25 $-500.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0005 -200.00 $1.25 $-250.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0006 200.00 $1.25 $250.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0006 200.00 $1.25 $250.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0006 400.00 $1.25 $500.00
22750(04) 0004 TEMPORARY SILT FENCE * Missing Material Certification 0006 260.00 $1.25 $325.00
22750(04) 0005 TEMPORARY SILT DIKE * Missing Material Certification 0004 -28.00 $3.00 $-84.00
22750(04) 0005 TEMPORARY SILT DIKE * Material Discrepancy Adjustments 0013 28.00 $3.00 $84.00
22750(04) 0006 SOLID SLAB SODDING * Permanent Erosion Control-Out of Season 0009 -3,458.26 $1.58 $-5,464.05
22750(04) 0006 SOLID SLAB SODDING * Permanent Erosion Control-Out of Season 0012 3,458.26 $1.58 $5,464.05
22750(04) 0011 24" CORR. GALV. STEEL PIPE * Missing Material Certification 0007 -90.00 $15.00 $-1,350.00
22750(04) 0011 24" CORR. GALV. STEEL PIPE * Missing Material Certification 0008 90.00 $15.00 $1,350.00
22750(04) 0017 SEALED EXPANSION JOINT * Missing Material Certification 0005 -33.50 $150.00 $-5,025.00
22750(04) 0017 SEALED EXPANSION JOINT * Missing Material Certification 0008 33.50 $150.00 $5,025.00
22750(04) 0019 STRUCTURAL STEEL * Missing Material Certification 0005 -686.00 $4.00 $-2,744.00
22750(04) 0019 STRUCTURAL STEEL * Missing Material Certification 0006 686.00 $4.00 $2,744.00
22750(04) 0020 WEATHERING STEEL FIXED BEARING ASSEMBLY * Missing Material Certification 0003 -4.00 $550.00 $-2,200.00
22750(04) 0020 WEATHERING STEEL FIXED BEARING ASSEMBLY * Missing Material Certification 0005 -8.00 $550.00 $-4,400.00
22750(04) 0020 WEATHERING STEEL FIXED BEARING ASSEMBLY * Missing Material Certification 0008 4.00 $550.00 $2,200.00
22750(04) 0020 WEATHERING STEEL FIXED BEARING ASSEMBLY * Missing Material Certification 0008 8.00 $550.00 $4,400.00
22750(04) 0021 WEATHERING STEEL EXPANSION BEARING ASSEMBLY * Missing Material Certification 0003 -4.00 $550.00 $-2,200.00
22750(04) 0021 WEATHERING STEEL EXPANSION BEARING ASSEMBLY * Missing Material Certification 0005 -8.00 $550.00 $-4,400.00
22750(04) 0021 WEATHERING STEEL EXPANSION BEARING ASSEMBLY * Missing Material Certification 0009 8.00 $550.00 $4,400.00
22750(04) 0021 WEATHERING STEEL EXPANSION BEARING ASSEMBLY * Missing Material Certification 0009 4.00 $550.00 $2,200.00
22750(04) 0027 DRILLED SHAFTS 54" DIAMETER * Material Discrepancy Adjustments 0002 -26.10 $600.00 $-15,660.00
22750(04) 0027 DRILLED SHAFTS 54" DIAMETER * Material Discrepancy Adjustments 0003 26.10 $600.00 $15,660.00
22750(04) 0031 GUARDRAIL ANCHOR UNIT (TYPE II) * Missing Material Certification 0008 -4.00 $1,875.00 $-7,500.00
22750(04) 0031 GUARDRAIL ANCHOR UNIT (TYPE II) * Missing Material Certification 0009 4.00 $1,875.00 $7,500.00
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: 120181   Estimate Number: 0014     Primary JP: 22750(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-119D(129)CO Project:    22750(04) Category:    0100/ROADWAY
0001 CLEARING AND GRUBBING 201(A) 0102 LSUM 1.000 1.000   1.000 $7,000.00 $0.00 $7,000.00
0002 EARTHWORK 202(H) 0185 LSUM 1.000 1.000   1.000 $50,000.00 $0.00 $50,000.00
0003 TYPE A-SALVAGED TOPSOIL 205(A) 4229 LSUM 1.000 1.000   1.000 $3,000.00 $0.00 $3,000.00
0004 TEMPORARY SILT FENCE 221(C) 2801 LF 1,500.000 1,060.000   1,060.000 $1.25 $0.00 $1,325.00
0005 TEMPORARY SILT DIKE 221(F) 0100 LF 200.000 28.000   28.000 $3.00 $0.00 $84.00
0006 SOLID SLAB SODDING 230(A) 2806 SY 7,900.000 16,382.350   16,382.350 $1.58 $0.00 $25,884.12
0007 VEGETATIVE MULCHING 233(A) 2817 AC 1.700 0.000   0.000 $700.00 $0.00 $0.00
0008 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 781.000 793.690   793.690 $19.00 $0.00 $15,080.11
0009 CLASS C CONCRETE 509(D) 0325 CY 20.000 0.000   0.000 $100.00 $0.00 $0.00
0010 TYPE I PLAIN RIPRAP 601(A) 0297 TON 505.000 490.660   490.660 $29.00 $0.00 $14,229.14
0011 24" CORR. GALV. STEEL PIPE 613(B) 0690 LF 90.000 90.000   90.000 $15.00 $0.00 $1,350.00
0012 TYPE B4 CULVERT END TREATMENT 613(M) 7187 EA 4.000 4.000   4.000 $900.00 $0.00 $3,600.00
Subtotals For Category     0100/ROADWAY    $0.00 $121,552.37
Fed/State Project Number:    BRO-119D(129)CO Project:    22750(04) Category:    0200/BRIDGE 'A'
0013 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 88.000 88.000   88.000 $25.00 $0.00 $2,200.00
0014 UNCLASSIFIED BACKFILL 501(D) 6353 CY 90.000 90.000   90.000 $20.00 $0.00 $1,800.00
0015 PRESTRESSED CONCRETE BEAMS (TYPE III) 503(A) 1312 LF 728.500 728.500   728.500 $175.00 $0.00 $127,487.50
0016 SAW-CUT GROOVING 504(B) 1305 SY 552.000 552.000   552.000 $4.15 $0.00 $2,290.80
0017 SEALED EXPANSION JOINT 504(C) 6250 LF 33.500 33.500   33.500 $150.00 $0.00 $5,025.00
0018 CONCRETE RAIL (TR1) 504(E) 1380 LF 435.170 435.170   435.170 $85.00 $0.00 $36,989.45
0019 STRUCTURAL STEEL 506(A) 1322 LB 686.000 686.000   686.000 $4.00 $0.00 $2,744.00
0020 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 12.000 12.000   12.000 $550.00 $0.00 $6,600.00
0021 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 12.000 12.000   12.000 $550.00 $0.00 $6,600.00
0022 CLASS AA CONCRETE 509(A) 1326 CY 141.700 141.700   141.700 $350.00 $0.00 $49,595.00
0023 CLASS A CONCRETE 509(B) 1328 CY 101.400 101.400   101.400 $350.00 $0.00 $35,490.00
0024 REINFORCING STEEL 511(A) 1332 LB 45,400.000 45,400.000   45,400.000 $0.99 $0.00 $44,946.00
0025 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 597.000 597.000   597.000 $18.00 $0.00 $10,746.00
0026 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 597.000 432.010   432.010 $9.00 $0.00 $3,888.09
0027 DRILLED SHAFTS 54" DIAMETER 516(A) 6095 LF 156.000 50.800   50.800 $600.00 $0.00 $30,480.00
0028 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 1,170.000 1,985.460   1,985.460 $29.00 $0.00 $57,578.34
0029 TYPE I-A FILTER BLANKET 601(C) 1355 TON 165.000 539.780   539.780 $24.00 $0.00 $12,954.72
0030 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $8,000.00 $0.00 $8,000.00
0031 GUARDRAIL ANCHOR UNIT (TYPE II) 623(F) 6033 EA 4.000 4.000   4.000 $1,875.00 $0.00 $7,500.00
0032 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $2,800.00 $0.00 $2,800.00
8000 DRILLED SHAFTS 54" DIAMETER 516(A) 6095 LF 0.000 73.020   73.020 $819.61 $0.00 $59,847.92
8001 CONSTRUCTION MISCELLANEOUS 104 0600 EA 0.000 1.000   1.000 $2,340.00 $0.00 $2,340.00
Subtotals For Category     0200/BRIDGE 'A'    $0.00 $517,902.82
Fed/State Project Number:    BRO-119D(129)CO Project:    22750(04) Category:    0600/STAKING
0033 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $4,000.00 $0.00 $4,000.00
Subtotals For Category     0600/STAKING    $0.00 $4,000.00
Fed/State Project Number:    BRO-119D(129)CO Project:    22750(04) Category:    0640/CONSTRUCTION
0034 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000   1.000 $1,500.00 $0.00 $1,500.00
0035 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $15,000.00 $0.00 $15,000.00
Subtotals For Category     0640/CONSTRUCTION    $0.00 $16,500.00
Subtotals For Project BRO-119D(129)CO /22750(04) $0.00 $659,955.19