| Contract ID: | 120206 | Estimate Number: | 0005 , Final | Spec Year: | 2009 | |||
| Primary JP: | 28904(04) | Residency: | CLINTON (05100) | Contract No: | 810007 | |||
| Date Created: | 06/30/2014 | Contractor FEI: | 731452899 | Account No: | 400500 |
| Project Number(s): | BHFY-220N(012) | ||||||||
| Contract Description: | BRIDGE REPAIR I-40: EASTBOUND OFF RAMP AT MILE POST 65 IN CLINTON. | ||||||||
| Primary County: | CUSTER | ||||||||
| Name of Road: | I-40 | ||||||||
| Prime Contractor: | PBX CORPORATION | Time Charged: | 67.00 | ||||||
| P.O. BOX 644 | Time Allowed: | 45.00 | |||||||
| SAPULPA , OK 74067 | Percent Time: | 148.89 % | |||||||
| Paid To Date: | $244,073.51 | Payable This Statement: | $287.36 |
| 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 |
| Contract ID: | 120206 | Estimate Number: | 0005 | Contract No: | 810007 | |||
| Residency: | CLINTON (05100) | Estimate Type: | Final | Account No: | 400500 | |||
| Project Number(s): | BHFY-220N(012) | ||||||||||||
| Primary Job Piece No: | 28904(04) | ||||||||||||
| Contract Description: | BRIDGE REPAIR I-40: EASTBOUND OFF RAMP AT MILE POST 65 IN CLINTON. | ||||||||||||
| Primary County: | CUSTER | ||||||||||||
| Name of Road: | I-40 | ||||||||||||
| Prime Contractor: | PBX CORPORATION | ||||||||||||
| P.O. BOX 644 | |||||||||||||
| SAPULPA , OK 74067 | |||||||||||||
| Surety Company: | WESTFIELD INSURANCE COMPANY | ||||||||||||
| Date Let: | 05/17/2012 | NTP Effective Date: | 10/01/2012 | Pay Period: | 12/16/2012 TO 05/31/2014 |
| Date Awarded: | 06/04/2012 | Date Work Began: | 10/15/2012 | Original Contract Time: | 45 |
| Date Contract Executed: | 06/15/2012 | Date Time Stopped: | 01/31/2013 | Current Time Charged: | 67.00 |
| Date NTP Issued: | 06/20/2012 | Completion Date: | 01/31/2013 | Current Time Allowed: | 45.00 |
| General Liability Expires: | 10/05/2014 | Workman's Comp Expires: | 10/05/2014 | Percent Time Used: | 148.89 % |
| Specification Year: | 2009 | ||||
| Bid Amount: | $253,807.50 | Total to Date | Prev to Date | This Estimate | |||
| Funds Available (Bid + Positive C/O): | $253,807.50 | Participating: | $255,073.51 | $255,156.10 | $-82.59 | ||
| Percent Complete: | 96.16 % | Non Participating: | $0.00 | $0.00 | $0.00 | ||
| Unearned Balance: | $9,733.99 | Total Earnings: | $255,073.51 | $255,156.10 | $-82.59 | ||
| Stockpiled Materials: | $0.00 | $0.00 | $0.00 | ||||
| Gross Earnings: | $255,073.51 | $255,156.10 | $-82.59 | ||||
| Other Adjustments: | $0.00 | $-369.95 | $369.95 | ||||
| Liq Dam/Disincentive: | $-11,000.00 | $-11,000.00 | $0.00 | ||||
| TOTAL: | $244,073.51 | $243,786.15 | $287.36 | ||||
| Contract ID: | 120206 | Estimate Number: | 0005 | Primary JP: | 28904(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 | 06/27/2014 | 0.0 | $-9,733.99 |
| 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 | 0002 | --1.0 | $500.00 | $-500.00 |
| System Application of Liquidated Damages | 0003 | --15 | $500.00 | $-7,500.00 |
| System Application of Liquidated Damages | 0004 | --6.0 | $500.00 | $-3,000.00 | Subtotals For Liquidated Damages | $-11,000.00 |
| 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 |
| 28904(04) | 0002 | SUPERPAVE, TYPE S4(PG 64-22 OK) | Asphalt Binder Adjustment | 0003 | 384.88 | $-0.96 | $-369.95 |
| 28904(04) | 0002 | SUPERPAVE, TYPE S4(PG 64-22 OK) | * Asphalt Binder Adjustment | 0005 | 369.95 | $1.00 | $369.95 | 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 | $ | |||||||
| Contract ID: | 120206 | Estimate Number: | 0005 | Primary JP: | 28904(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: BHFY-220N(012) | Project: 28904(04) | Category: 0100/ROADWAY | ||||||||
| 0001 | TACK COAT | 407(B) 0250 | GAL | 95.000 | 90.000 | -90.000 | 90.000 | $3.00 | $-270.00 | $270.00 |
| 0002 | SUPERPAVE, TYPE S4(PG 64-22 OK) | 411(C) 5960 | TON | 400.000 | 384.880 | 0.000 | 384.880 | $120.00 | $0.00 | $46,185.60 |
| 0003 | COLD MILLING PAVEMENT | 412 5267 | SY | 2,300.000 | 2,300.710 | 0.710 | 2,300.710 | $8.00 | $5.68 | $18,405.68 |
| 0004 | REMOVAL OF GUARDRAIL | 619(B) 4780 | LF | 640.000 | 672.000 | 32.000 | 672.000 | $3.00 | $96.00 | $2,016.00 |
| 0005 | BEAM GUARDRAIL W-BEAM SINGLE | 623(A) 0932 | LF | 500.000 | 500.000 | 500.000 | $14.00 | $0.00 | $7,000.00 | |
| 0006 | GUARDRAIL ANCHOR UNIT (TYPE B) | 623(F) 4447 | EA | 1.000 | 1.000 | 1.000 | $600.00 | $0.00 | $600.00 | |
| 0007 | GUARDRAIL END TREATMENT (GET) | 623(G) 8571 | EA | 2.000 | 2.000 | 2.000 | $2,000.00 | $0.00 | $4,000.00 | |
| 0008 | GUARDRAIL BRIDGE CONNECTION-TYPE A | 623(I) 8675 | EA | 3.000 | 3.000 | 3.000 | $1,300.00 | $0.00 | $3,900.00 | |
| 9000 | ASPHALT BINDER PRICE ADJUSTMENT | 109 1150 | LSUM | 0.000 | 1.000 | 1.000 | 1.000 | $-369.95 | $-369.95 | $-369.95 |
| 9001 | CONSTRUCTION MISCELLANEOUS | 104 0600 | EA | 0.000 | -22.000 | 0.000 | $500.00 | $0.00 | $0.00 | |
| Subtotals For Category 0100/ROADWAY | $-538.27 | $82,007.33 | ||||||||
| Fed/State Project Number: BHFY-220N(012) | Project: 28904(04) | Category: 0200/BRIDGE A | ||||||||
| 0009 | DIAMOND GRINDING CONCRETE PAVEMENT | 425 5195 | SY | 490.000 | 489.330 | -0.670 | 489.330 | $20.00 | $-13.40 | $9,786.60 |
| 0010 | CLSM BACKFILL | 501(G) 6309 | CY | 5.000 | 1.000 | 1.000 | $625.00 | $0.00 | $625.00 | |
| 0011 | BRIDGE TRAFFIC RAIL | 504 6179 | LF | 365.500 | 368.000 | 2.000 | 368.000 | $125.00 | $250.00 | $46,000.00 |
| 0012 | ASPHALT MEMBRANE OVERLAY | 505(D) 6080 | SY | 566.000 | 563.390 | -2.610 | 563.390 | $22.00 | $-57.42 | $12,394.58 |
| 0013 | CLASS C CONCRETE | 509(D) 1331 | CY | 5.000 | 0.000 | 0.000 | $800.00 | $0.00 | $0.00 | |
| 0014 | CLASS B BRIDGE DECK REPAIR | 513(B) 6019 | SY | 50.000 | 115.220 | 115.220 | $325.00 | $0.00 | $37,446.50 | |
| 0015 | PREPARATION OF CRACKS, ABOVE WATER | 520(A) 6058 | LF | 30.000 | 0.000 | 0.000 | $20.00 | $0.00 | $0.00 | |
| 0016 | EPOXY RESIN, ABOVE WATER | 520(C) 6060 | GAL | 1.000 | 0.000 | 0.000 | $80.00 | $0.00 | $0.00 | |
| 0017 | PNEUMATICALLY PLACED MORTAR | 521(A) 6210 | SY | 30.000 | 16.930 | 0.730 | 16.930 | $550.00 | $401.50 | $9,311.50 |
| 0018 | (SP)CARBON FIBER-REINFORCED POLYMER | 524(A) 6610 | SF | 520.000 | 511.300 | -10.000 | 511.300 | $30.00 | $-300.00 | $15,339.00 |
| Subtotals For Category 0200/BRIDGE A | $280.68 | $130,903.18 | ||||||||
| Fed/State Project Number: BHFY-220N(012) | Project: 28904(04) | Category: 0300/TRAFFIC CONTROL | ||||||||
| 0019 | TRAFFIC STRIPE(PLASTIC)(4" WIDE) | 855(A) 8812 | LF | 2,000.000 | 1,500.000 | 1,500.000 | $1.00 | $0.00 | $1,500.00 | |
| 0020 | (PL)TRUCK MOUNTED ATTENUATOR | 876(A) 8482 | SD | 110.000 | 0.000 | 0.000 | $15.00 | $0.00 | $0.00 | |
| 0021 | CONSTRUCTION TRAFFIC CONTROL | 880(J) 8905 | LSUM | 1.000 | 1.000 | 1.000 | $18,000.00 | $0.00 | $18,000.00 | |
| 0022 | PORT.CHANGEABLE MESSAGE SIGN | 882(A) 8306 | SD | 90.000 | 53.000 | 5.000 | 53.000 | $35.00 | $175.00 | $1,855.00 |
| Subtotals For Category 0300/TRAFFIC CONTROL | $175.00 | $21,355.00 | ||||||||
| Fed/State Project Number: BHFY-220N(012) | Project: 28904(04) | Category: 0640/CONSTRUCTION | ||||||||
| 0023 | MOBILIZATION | 641 1399 | LSUM | 1.000 | 1.000 | 1.000 | $20,808.00 | $0.00 | $20,808.00 | |
| Subtotals For Category 0640/CONSTRUCTION | $0.00 | $20,808.00 | ||||||||
| Subtotals For Project BHFY-220N(012) /28904(04) | $-82.59 | $255,073.51 | ||||||||