Oklahoma Department of Transportation
Final Estimate Affidavit

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                  

Oklahoma Department of Transportation
Final Estimate Summary
Created:    06/30/2014
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

Estimate Adjustment Detail

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 $

Line Item Detail

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


1 CURRENT QUANTITIES DO NOT MATCH THE QUANTITY PAID TO DATE