Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120287   Estimate Number: 0011 , Final     Spec Year: 2009
Primary JP: 27386(04)   Residency: SALLISAW (01200)     Contract No: 810384
Date Created: 01/22/2015   Contractor FEI: 731174172     Account No: 436100

Project Number(s): BRF-131C(103)CI
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-125): OVER ELM CREEK, 0.2 MILE WEST OF SH-2. PROJECT LENGTH = 0.128 MILE.
Primary County: HASKELL              
Name of Road: COUNTY ROAD              
Prime Contractor: HUB CONSTRUCTION, INC.           Time Charged: 107.00
    ROUTE 1, BOX 350           Time Allowed: 125.00
    BOSWELL , OK   74727           Percent Time: 85.60 %

  Paid To Date: $565,871.38 Payable This Statement: $6,003.19

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.                                
HUB CONSTRUCTION, 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:    01/22/2015
Contract ID: 120287   Estimate Number: 0011     Contract No: 810384
Residency: SALLISAW (01200)   Estimate Type: Final     Account No: 436100

Project Number(s): BRF-131C(103)CI
Primary Job Piece No: 27386(04)
Contract Description: BRIDGE AND APPROACHES COUNTY ROAD (EW-125): OVER ELM CREEK, 0.2 MILE WEST OF SH-2. PROJECT LENGTH = 0.128 MILE.
Primary County: HASKELL              
Name of Road: COUNTY ROAD              
Prime Contractor: HUB CONSTRUCTION, INC.              
    ROUTE 1, BOX 350              
    BOSWELL , OK   74727              
Surety Company: OHIO CASUALTY INSURANCE COMPANY              

Date Let: 08/16/2012 NTP Effective Date: 02/18/2013 Pay Period: 06/01/2013  TO  12/12/2014
Date Awarded: 09/10/2012 Date Work Began: 11/26/2012 Original Contract Time: 120
Date Contract Executed: 09/27/2012 Date Time Stopped: 08/15/2013 Current Time Charged: 107.00
Date NTP Issued: 10/02/2012 Completion Date: 08/15/2013 Current Time Allowed: 125.00
General Liability Expires: 07/01/2015 Workman's Comp Expires: 12/31/2015 Percent Time Used: 85.60 %
Specification Year: 2009        

Bid Amount: $588,716.00 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $606,877.52 Participating: $571,874.61 $565,272.69 $6,601.92
Percent Complete: 93.24 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $41,006.14 Total Earnings: $571,874.61 $565,272.69 $6,601.92
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $571,874.61 $565,272.69 $6,601.92
Other Adjustments: $-6,003.23 $-5,404.50 $-598.73
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $565,871.38 $559,868.19 $6,003.19

Estimate Adjustment Detail

Contract ID: 120287   Estimate Number: 0011     Primary JP: 27386(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Addition of Pilot Holes for Driven Piling Approved 01/04/2013 5.0 $18,161.52
002 Final Quantity Change Order Approved 05/07/2014 0.0 $-33,502.91
003 Addition of Special Provision driven Smoothness Deduction Approved 12/11/2014 0.0 $-1,500.00


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
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
27386(04) 0013 SUPERPAVE, TYPE S3(PG 64-22 OK) Asphalt Binder Adjustment 0009 298.46 $-0.02 $-7.84
27386(04) 0014 SUPERPAVE, TYPE S4(PG 64-22 OK) Asphalt Binder Adjustment 0009 222.07 $-0.03 $-6.66
27386(04) 0029 CONCRETE RAIL (TR3) * CONCRETE DEDUCTION AS PER SPEC 509 0011 0.00 $0.00 $-230.23
27386(04) 0033 CLASS AA CONCRETE * SUBSTANDARD ITEM 0008 -9.80 $550.00 $-5,390.00
27386(04) 0033 CLASS AA CONCRETE * CONCRETE DEDUCTION AS PER SPEC 509 0011 0.00 $0.00 $-368.50
Subtotals For Line Item Adjustments $-6,003.23
* = 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: 120287   Estimate Number: 0011     Primary JP: 27386(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-131C(103)CI Project:    27386(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 1,480.000 1,480.000 370.000 1,480.000 $6.00 $2,220.00 $8,880.00
0003 UNCLASSIFIED BORROW 202(D) 0184 CY 2,920.000 2,920.000   2,920.000 $7.00 $0.00 $20,440.00
0004 TEMPORARY SILT FENCE 221(C) 2801 LF 1,120.000 904.000   904.000 $3.00 $0.00 $2,712.00
0005 TEMPORARY SILT DIKE 221(F) 0100 LF 80.000 0.000   0.000 $6.00 $0.00 $0.00
0006 SOLID SLAB SODDING 230(A) 2806 SY 3,010.000 3,604.500   3,604.500 $2.50 $0.00 $9,011.25
0007 VEGETATIVE MULCHING 233(A) 2817 AC 0.620 0.000   0.000 $350.00 $0.00 $0.00
0008 AGGREGATE BASE TYPE A 303(A) 2100 CY 373.000 283.770 -0.010 283.770 $42.00 $-0.42 $11,918.34
0009 SEPARATOR FABRIC 325 5271 SY 2,517.000 2,102.920 2,102.920 2,102.920 $2.00 $4,205.84 $4,205.84
0010 TRAFFIC BOUND SURFACE COURSE TYPE E 402(E) 0225 TON 400.000 340.160 6.000 340.160 $25.00 $150.00 $8,504.00
0011 TACK COAT 407(B) 0250 GAL 130.000 100.000 0.000 100.000 $4.00 $0.00 $400.00
0012 PRIME COAT 408 5774 GAL 890.000 900.000 0.000 900.000 $1.00 $0.00 $900.00
0013 SUPERPAVE, TYPE S3(PG 64-22 OK) 411(B) 5945 TON 310.000 298.460   298.460 $100.00 $0.00 $29,846.00
0014 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 250.000 222.070   222.070 $110.00 $0.00 $24,427.70
0015 CLASS C CONCRETE 509(D) 0325 CY 20.000 1.570   1.570 $250.00 $0.00 $392.50
0016 TYPE I PLAIN RIPRAP 601(A) 0297 TON 336.000 0.000   0.000 $32.00 $0.00 $0.00
0017 2'-8" COMB. CURB & GUTTER (6" BARRIER) 609(B) 1525 LF 100.000 100.000   100.000 $20.00 $0.00 $2,000.00
0018 6" CONCRETE DRIVEWAY 610(B) 0604 SY 48.000 30.200   30.200 $50.00 $0.00 $1,510.00
0019 36" CORR. GALV. STEEL PIPE 613(B) 0692 LF 42.000 42.000   42.000 $50.00 $0.00 $2,100.00
0020 36" PREFAB. CULVERT END SECTION, ROUND 613(L) 5734 EA 2.000 2.000   2.000 $500.00 $0.00 $1,000.00
0021 REMOVAL OF STRUCTURES & OBSTRUCTIONS 619(A) 0920 LSUM 1.000 1.000   1.000 $2,500.00 $0.00 $2,500.00
0022 REMOVAL OF ASPHALT PAVEMENT 619(B) 4728 SY 1,660.000 1,564.440   1,564.440 $5.00 $0.00 $7,822.20
0023 SAWING PAVEMENT 619(C) 0924 LF 170.000 48.000   48.000 $6.00 $0.00 $288.00
0024 REMOVE AND RESET MAILBOX 629(E) 5048 EA 3.000 0.000   0.000 $100.00 $0.00 $0.00
0025 TRAFFIC STRIPE(PAINT)(4" WIDE) 854(A) 8800 LF 1,360.000 1,286.000 0.000 1,286.000 $0.60 $0.00 $771.60
Subtotals For Category     0100/ROADWAY    $6,575.42 $144,629.43
Fed/State Project Number:    BRF-131C(103)CI Project:    27386(04) Category:    0200/BRIDGE 'A'
0026 SUBSTRUCTURE EXCAVATION COMMON 501(B) 1307 CY 168.000 168.000   168.000 $15.00 $0.00 $2,520.00
0027 CLSM BACKFILL 501(G) 6309 CY 64.000 64.000 4.980 64.000 $125.00 $622.50 $8,000.00
0028 SAW-CUT GROOVING 504(B) 1305 SY 249.800 249.800   249.800 $10.00 $0.00 $2,498.00
0029 CONCRETE RAIL (TR3) 504(D) 6239 LF 258.400 258.400 3.120 258.400 $75.00 $234.00 $19,380.00
0030 STRUCTURAL STEEL A709 GR50 506(A) 6010 LB 89,860.000 89,860.000   89,860.000 $1.80 $0.00 $161,748.00
0031 WEATHERING STEEL FIXED BEARING ASSEMBLY 507(A) 6172 EA 3.000 3.000   3.000 $1,500.00 $0.00 $4,500.00
0032 WEATHERING STEEL EXPANSION BEARING ASSEMBLY 507(B) 6176 EA 3.000 3.000   3.000 $1,500.00 $0.00 $4,500.00
0033 CLASS AA CONCRETE 509(A) 1326 CY 74.800 74.800 0.000 74.800 $550.00 $0.00 $41,140.00
0034 CLASS A CONCRETE 509(B) 1328 CY 62.800 62.800   62.800 $500.00 $0.00 $31,400.00
0035 REINFORCING STEEL 511(A) 1332 LB 26,540.000 26,540.000   26,540.000 $1.00 $0.00 $26,540.00
0036 PILES, FURNISHED (HP 10X42) 514(A) 6010 LF 84.000 86.000   86.000 $35.00 $0.00 $3,010.00
0037 PILES, FURNISHED (HP 12X53) 514(A) 6011 LF 182.000 182.000 -2.000 182.000 $40.00 $-80.00 $7,280.00
0038 PILES, DRIVEN (HP 10X42) 514(B) 6292 LF 84.000 70.250   70.250 $15.00 $0.00 $1,053.75
0039 PILES, DRIVEN (HP 12X53) 514(B) 6294 LF 182.000 175.670   175.670 $15.00 $0.00 $2,635.05
0040 TYPE I-A PLAIN RIPRAP 601(B) 1353 TON 1,440.000 1,270.390   1,270.390 $30.00 $0.00 $38,111.70
0041 TYPE I-A FILTER BLANKET 601(C) 1355 TON 290.000 285.970   285.970 $28.00 $0.00 $8,007.16
0042 6" PERFORATED PIPE UNDERDRAIN ROUND 613(H) 6204 LF 52.000 52.000   52.000 $5.00 $0.00 $260.00
0043 6" NON-PERF.PIPE UNDERDRAIN RND. 613(I) 6207 LF 60.000 60.000   60.000 $5.00 $0.00 $300.00
0044 REMOVAL OF EXISTING BRIDGE STRUCTURE 619(D) 1397 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
0045 GUARDRAIL ANCHOR UNIT (TYPE D-BF) 623(F) 5686 EA 4.000 4.000 0.000 4.000 $1,950.00 $0.00 $7,800.00
0046 GUARDRAIL END TREATMENT (GET) 623(G) 8571 EA 4.000 4.000 0.000 4.000 $2,300.00 $0.00 $9,200.00
0047 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000 0.100 1.000 $4,500.00 $450.00 $4,500.00
8000 (PL)PILOT HOLES 514(K) 6260 LF 0.000 78.000   78.000 $232.84 $0.00 $18,161.52
8001 PAVEMENT/BRIDGE SMOOTHNESS ADJUSTMENT 430 5010 LSUM 0.000 1.000 1.000 1.000 $-1,500.00 $-1,500.00 $-1,500.00
Subtotals For Category     0200/BRIDGE 'A'    $-273.50 $411,045.18
Fed/State Project Number:    BRF-131C(103)CI Project:    27386(04) Category:    0600/STAKING
0048 CONSTRUCTION STAKING LEVEL II 642(B) 0096 LSUM 1.000 1.000   1.000 $5,000.00 $0.00 $5,000.00
Subtotals For Category     0600/STAKING    $0.00 $5,000.00
Fed/State Project Number:    BRF-131C(103)CI Project:    27386(04) Category:    0640/CONSTRUCTION
0049 SWPPP DOCUMENTATION AND MANAGEMENT 220 2800 LSUM 1.000 1.000 0.250 1.000 $1,200.00 $300.00 $1,200.00
0050 MOBILIZATION 641 1399 LSUM 1.000 1.000   1.000 $10,000.00 $0.00 $10,000.00
Subtotals For Category     0640/CONSTRUCTION    $300.00 $11,200.00
Subtotals For Project BRF-131C(103)CI /27386(04) $6,601.92 $571,874.61