Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120236   Estimate Number: 0014 , Final     Spec Year: 2009
Primary JP: 26980(04)   Residency: GUYMON (06200)     Contract No: 810146
Date Created: 08/05/2014   Contractor FEI: 480823590     Account No: 436600

Project Number(s): BRF-104C(068)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-148): OVER BEAVER RIVER 9.0 MILES EAST AND 11.9 MILES NORTH OF ELMWOOD. PROJECT LENGTH = 0.298 MILE.
Primary County: BEAVER              
Name of Road: COUNTY ROAD              
Prime Contractor: L & M CONTRACTORS, INC.           Time Charged: 167.00
    BOX 1171           Time Allowed: 169.00
    GREAT BEND , KS   67530           Percent Time: 98.82 %

  Paid To Date: $857,172.25 Payable This Statement: $8,175.00

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.                                
L & M CONTRACTORS, 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:    08/05/2014
Contract ID: 120236   Estimate Number: 0014     Contract No: 810146
Residency: GUYMON (06200)   Estimate Type: Final     Account No: 436600

Project Number(s): BRF-104C(068)CI
Primary Job Piece No: 26980(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (NS-148): OVER BEAVER RIVER 9.0 MILES EAST AND 11.9 MILES NORTH OF ELMWOOD. PROJECT LENGTH = 0.298 MILE.
Primary County: BEAVER              
Name of Road: COUNTY ROAD              
Prime Contractor: L & M CONTRACTORS, INC.              
    BOX 1171              
    GREAT BEND , KS   67530              
Surety Company: LIBERTY MUTUAL INSURANCE COMPANY              

Date Let: 05/17/2012 NTP Effective Date: 08/02/2012 Pay Period: 07/17/2014  TO  07/17/2014
Date Awarded: 06/04/2012 Date Work Began: 08/28/2012 Original Contract Time: 150
Date Contract Executed: 07/03/2012 Date Time Stopped: 05/07/2013 Current Time Charged: 167.00
Date NTP Issued: 08/02/2012 Completion Date: 05/07/2013 Current Time Allowed: 169.00
General Liability Expires: 01/01/2015 Workman's Comp Expires: 01/01/2015 Percent Time Used: 98.82 %
Specification Year: 2009        

Bid Amount: $846,833.10 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $857,172.25 Participating: $857,172.25 $848,997.25 $8,175.00
Percent Complete: 100 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $0.00 Total Earnings: $857,172.25 $848,997.25 $8,175.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $857,172.25 $848,997.25 $8,175.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $857,172.25 $848,997.25 $8,175.00

Estimate Adjustment Detail

Contract ID: 120236   Estimate Number: 0014     Primary JP: 26980(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Guardrail and Additional Days Approved 03/06/2013 19.0 $1,400.00
002 Additional Pipe Installation Approved 06/19/2013 0.0 $1,250.00
003 Final Quantity Change Order Approved 08/04/2014 0.0 $7,689.15


STOCKPILE PAYMENT HISTORY
Project Line Nbr Stockpile Description Adjustment Type Estimate Nbr Adjusted Amount
26980(04) 0015 PC BR ITM FABS (AML) Stockpiled Material Initial Payment 0003 $103,082.52
26980(04) 0015 PC BR ITM FABS (AML) Stockpiled Material Adjustment 0007 $-51,541.26
26980(04) 0015 PC BR ITM FABS (AML) Stockpiled Material Adjustment 0006 $-51,541.26
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
System Application of Liquidated Damages 0010 --13 $500.00 $-6,500.00
System Application of Liquidated Damages 0011 -17.0 $500.00 $8,500.00
Subtotals For Liquidated Damages $0.00


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
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: 120236   Estimate Number: 0014     Primary JP: 26980(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-104C(068)CI Project:    26980(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 TEMPORARY SILT FENCE 221(C) 2801 LF 3,000.000 1,005.000   1,005.000 $1.55 $0.00 $1,557.75
0004 TEMPORARY SILT DIKE 221(F) 0100 LF 400.000 0.000   0.000 $6.00 $0.00 $0.00
0005 SOLID SLAB SODDING 230(A) 2806 SY 4,500.000 13,185.860   13,185.860 $1.80 $0.00 $23,734.55
0006 SEEDING METHOD B 232(B) 2814 AC 0.600 2.130   2.130 $500.00 $0.00 $1,065.00
0007 VEGETATIVE MULCHING 233(A) 2817 AC 1.200 2.830   2.830 $600.00 $0.00 $1,698.00
0008 TRAFFIC BOUND SURFACE COURSE TYPE A 402(A) 0217 TON 1,353.000 1,375.140   1,375.140 $38.00 $0.00 $52,255.32
0009 CLASS C CONCRETE 509(D) 0325 CY 10.000 0.000   0.000 $250.00 $0.00 $0.00
0010 24" CORR. GALV. STEEL PIPE 613(B) 0690 LF 54.000 54.000   54.000 $35.00 $0.00 $1,890.00
0011 60" CORR. GALV. STEEL PIPE 613(B) 0696 LF 120.000 120.000   120.000 $75.00 $0.00 $9,000.00
0012 TYPE B4 CULVERT END TREATMENT 613(M) 7187 EA 2.000 2.000   2.000 $2,000.00 $0.00 $4,000.00
8001 CONSTRUCTION MISCELLANEOUS 104 0700 LSUM 0.000 1.000 1.000 1.000 $1,250.00 $1,250.00 $1,250.00
Subtotals For Category     0100/ROADWAY    $1,250.00 $153,450.62
Fed/State Project Number:    BRF-104C(068)CI Project:    26980(04) Category:    0200/BRIDGE 'A'
0013 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 180.000 180.000   180.000 $15.00 $0.00 $2,700.00
0014 GRANULAR BACKFILL 501(F) 6352 CY 66.000 66.000   66.000 $60.00 $0.00 $3,960.00
0015 PRESTRESSED CONCRETE BEAMS (TYPE II) 503(A) 1311 LF 716.000 716.000   716.000 $192.00 $0.00 $137,472.00
0016 SEALED EXPANSION JOINT 504(C) 6250 LF 58.340 58.340   58.340 $500.00 $0.00 $29,170.00
0017 CONCRETE RAIL (TR3) 504(D) 6239 LF 536.000 536.000   536.000 $70.00 $0.00 $37,520.00
0018 STRUCTURAL STEEL 506(A) 1322 LB 6,050.000 6,050.000   6,050.000 $2.25 $0.00 $13,612.50
0019 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 12.000 12.000   12.000 $750.00 $0.00 $9,000.00
0020 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 12.000 12.000   12.000 $750.00 $0.00 $9,000.00
0021 CLASS AA CONCRETE 509(A) 1326 CY 219.200 219.200 10.000 219.200 $605.00 $6,050.00 $132,616.00
0022 CLASS A CONCRETE 509(B) 1328 CY 61.200 61.200   61.200 $605.00 $0.00 $37,026.00
0023 REINFORCING STEEL 511(A) 1332 LB 59,390.000 59,390.000   59,390.000 $0.94 $0.00 $55,826.60
0024 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 172.000 172.000   172.000 $85.00 $0.00 $14,620.00
0025 PILES, FURNISHED (HP 12X53) 514(A) 6011 LF 406.000 406.000   406.000 $51.00 $0.00 $20,706.00
0026 PILES, FURNISHED (HP 14X73) 514(A) 6012 LF 1,160.000 1,160.000   1,160.000 $61.50 $0.00 $71,340.00
0027 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 172.000 172.000   172.000 $7.00 $0.00 $1,204.00
0028 PILES, DRIVEN (HP 12X53) 514(B) 6294 LF 406.000 392.000   392.000 $7.00 $0.00 $2,744.00
0029 PILES, DRIVEN (HP 14X73) 514(B) 6296 LF 1,160.000 1,146.000   1,146.000 $8.00 $0.00 $9,168.00
0030 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 460.000 417.670   417.670 $71.00 $0.00 $29,654.57
0031 TYPE I-A FILTER BLANKET 601(C) 1355 TON 78.000 87.970   87.970 $68.00 $0.00 $5,981.96
0032 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $25,000.00 $0.00 $25,000.00
0033 GUARDRAIL ANCHOR UNIT (TYPE III) 623(F) 6034 EA 4.000 0.000   0.000 $2,300.00 $0.00 $0.00
0034 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $3,300.00 $0.00 $3,300.00
8000 GUARDRAIL ANCHOR UNIT (TYPE II) 623(F) 6033 EA 0.000 4.000   4.000 $2,650.00 $0.00 $10,600.00
Subtotals For Category     0200/BRIDGE 'A'    $6,050.00 $662,221.63
Fed/State Project Number:    BRF-104C(068)CI Project:    26980(04) Category:    0600/STAKING
0035 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $10,500.00 $0.00 $10,500.00
Subtotals For Category     0600/STAKING    $0.00 $10,500.00
Fed/State Project Number:    BRF-104C(068)CI Project:    26980(04) Category:    0640/CONSTRUCTION
0036 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $3,500.00 $875.00 $3,500.00
0037 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $27,500.00 $0.00 $27,500.00
Subtotals For Category     0640/CONSTRUCTION    $875.00 $31,000.00
Subtotals For Project BRF-104C(068)CI /26980(04) $8,175.00 $857,172.25