Oklahoma Department of Transportation
Final Estimate Affidavit

Contract ID: 120299   Estimate Number: 0006 , Final     Spec Year: 2009
Primary JP: 29273(04)   Residency: ARDMORE (07200)     Contract No: 810409
Date Created: 03/02/2015   Contractor FEI: 730960939     Account No: 400700

Project Number(s): HSIPG-250A(001)TR
Contract Description: SAFETY IMPROVEMENT SH-7: AT THE I-35 INTERCHANGE.
Primary County: MURRAY              
Name of Road: SH-7              
Prime Contractor: MIDSTATE TRAFFIC CONTROL, INC.           Time Charged: 118.00
    12501 N. SANTA FE AVE.           Time Allowed: 135.00
    OKLAHOMA CITY , OK   73114           Percent Time: 87.41 %

  Paid To Date: $106,042.50 Payable This Statement: $1,432.00

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.                                
MIDSTATE TRAFFIC CONTROL, 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:    03/02/2015
Contract ID: 120299   Estimate Number: 0006     Contract No: 810409
Residency: ARDMORE (07200)   Estimate Type: Final     Account No: 400700

Project Number(s): HSIPG-250A(001)TR
Primary Job Piece No: 29273(04)
Contract Description: SAFETY IMPROVEMENT SH-7: AT THE I-35 INTERCHANGE.
Primary County: MURRAY              
Name of Road: SH-7              
Prime Contractor: MIDSTATE TRAFFIC CONTROL, INC.              
    12501 N. SANTA FE AVE.              
    OKLAHOMA CITY , OK   73114              
Surety Company: LIBERTY MUTUAL INSURANCE COMPANY              

Date Let: 08/16/2012 NTP Effective Date: 01/07/2013 Pay Period: 06/01/2014  TO  12/10/2014
Date Awarded: 09/10/2012 Date Work Began: 11/14/2013 Original Contract Time: 135
Date Contract Executed: 09/27/2012 Date Time Stopped: 08/15/2014 Current Time Charged: 118.00
Date NTP Issued: 10/02/2012 Completion Date: 08/15/2014 Current Time Allowed: 135.00
General Liability Expires: 03/01/2015 Workman's Comp Expires: 03/01/2015 Percent Time Used: 87.41 %
Specification Year: 2009        

Bid Amount: $158,280.00 Total to Date Prev to Date This Estimate
Funds Available (Bid + Positive C/O): $162,994.25 Participating: $106,042.50 $104,610.50 $1,432.00
Percent Complete: 65.06 % Non Participating: $0.00 $0.00 $0.00
Unearned Balance: $56,951.75 Total Earnings: $106,042.50 $104,610.50 $1,432.00
Stockpiled Materials: $0.00 $0.00 $0.00
Gross Earnings: $106,042.50 $104,610.50 $1,432.00
Other Adjustments: $0.00 $0.00 $0.00
Liq Dam/Disincentive: $0.00 $0.00 $0.00
TOTAL: $106,042.50 $104,610.50 $1,432.00

Estimate Adjustment Detail

Contract ID: 120299   Estimate Number: 0006     Primary JP: 29273(04)



CHANGE ORDER HISTORY
Change Order Nbr. Change Order Description Status Approval Date Contract Time Adjustment Total Change Order Amount
001 Adds 31" Guardrail Items to replace 27 3/4" Guardrail, EB Br Approved 11/08/2013 0.0 $4,714.25
002 Final Contract Item Quantities Approved 02/05/2015 0.0 $-56,951.75


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
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: 120299   Estimate Number: 0006     Primary JP: 29273(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:    HSIPG-250A(001)TR Project:    29273(04) Category:    0300/TRAFFIC
0001 MACHINE GRADING 209 0120 LF 2,010.000 0.000   0.000 $5.00 $0.00 $0.00
0002 SOLID SLAB SODDING 230(A) 2806 SY 1,113.000 0.000   0.000 $5.00 $0.00 $0.00
0003 SUPERPAVE, TYPE S4(PG 64-22 OK) 411(C) 5960 TON 231.200 0.000   0.000 $150.00 $0.00 $0.00
0004 REMOVAL OF GUARDRAIL 619(B) 4780 LF 1,757.000 836.000   836.000 $2.00 $0.00 $1,672.00
0005 SAWING PAVEMENT 619(C) 0924 LF 1,999.000 0.000   0.000 $2.00 $0.00 $0.00
0006 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 0932 LF 1,287.500 675.000 62.000 675.000 $16.00 $992.00 $10,800.00
0007 GUARDRAIL ANCHOR UNIT (TYPE B) 623(F) 4447 EA 1.000 1.000   1.000 $600.00 $0.00 $600.00
0008 GUARDRAIL ANCHOR UNIT (TYPE GE) 623(F) 4453 EA 1.000 1.000   1.000 $875.00 $0.00 $875.00
0009 GUARDRAIL ANCHOR UNIT (TYPE D-BF) 623(F) 5686 EA 4.000 2.000   2.000 $1,630.00 $0.00 $3,260.00
0010 GUARDRAIL END TREATMENT (GET) 623(G) 8571 EA 4.000 2.000   2.000 $2,550.00 $0.00 $5,100.00
0011 STRUCTURAL CONCRETE 804(A) 2915 CY 3.000 1.200   1.200 $800.00 $0.00 $960.00
0012 REINFORCING STEEL 804(B) 2916 LB 192.000 144.000   144.000 $1.25 $0.00 $180.00
0013 (PL)REMOVAL OF EXISTING SIGNS 805(A) 8724 EA 3.000 3.000   3.000 $200.00 $0.00 $600.00
0014 SOLID STATE FLASHER CONTROLLER(TYPE I) 827 8620 EA 9.000 9.000   9.000 $2,500.00 $0.00 $22,500.00
0015 1WAY 1SEC. ADJ. SIG. HD. S-22 831 8301 EA 10.000 10.000   10.000 $220.00 $0.00 $2,200.00
0016 REGULATORY OR WARNING SIGN ASSEMBLY 836 8425 EA 5.000 5.000   5.000 $3,500.00 $0.00 $17,500.00
0017 SHEET ALUMINUM SIGNS 850(A) 8110 SF 134.000 140.000 6.000 140.000 $20.00 $120.00 $2,800.00
0018 2 1/2"@5.79 GALV.STEEL PIPE POST 851(B) 3217 LF 166.000 74.800   74.800 $18.00 $0.00 $1,346.40
0019 GUARDRAIL DELINEATORS(TYPE 1, CODE 1) 853 9066 EA 32.000 32.000 32.000 32.000 $10.00 $320.00 $320.00
0020 CONSTRUCTION TRAFFIC CONTROL 880(J) 8905 LSUM 1.000 1.000   1.000 $1,000.00 $0.00 $1,000.00
0021 (PL)TRAFFIC ITEMS 890 7700 LSUM 1.000 1.000   1.000 $9,250.00 $0.00 $9,250.00
8000 GUARDRAIL BRIDGE CONN-THRIE BEAM (31") 623(I) 8700 EA 0.000 2.000   2.000 $1,725.00 $0.00 $3,450.00
8001 BEAM GUARDRAIL W-BEAM SINGLE 623(A) 0932 LF 0.000 633.000   633.000 $17.70 $0.00 $11,204.10
8002 GUARDRAIL END TREATMENT (31") 623(G) 8590 EA 0.000 2.000   2.000 $2,550.00 $0.00 $5,100.00
8003 REGULATORY OR WARNING SIGN ASSEMBLY 836 8425 EA 0.000 5.000   5.000 $1,065.00 $0.00 $5,325.00
Subtotals For Category     0300/TRAFFIC    $1,432.00 $106,042.50
Subtotals For Project HSIPG-250A(001)TR /29273(04) $1,432.00 $106,042.50