tulsa county web site | tulsa, oklahoma...950,000.00 950,000.00 s % a. recipient b representative...

OUTLAY REPORT ANO REQUEST FOR REIMBURSEMENT PAGE OF FOR CONSTRUCTION PROGRAMS

OMB APPROVAL NO . 0348· 0002 1 I PAGES 1 TYPE OF AEOUEST 2. BASIS OF AEOUEST

(See instructions on back) 12] FINAL O PARTIAL 0CASH 12] ACCRUAL 3. FEDERAL SPONSOR I NG AGENCY ANO ORGAN IZATI ONAL ELEMENT TO • · FEDERAL GAANT QA OTHEA 5. PARTIAL PAYMENT AEOUEST NO

WHICH THIS AEPOAT IS SUBMITTED IDENTIFYING NUMBER

Economic Development Administration ASSIGNED BY FEDERAL AGENCY

08-79-04973 2

6. EMPLOYER IDENTIFICATION 17. REC IPIENT 'S ACCOUNT NUMBER PERIOD COVERED BY THIS REQUEST NUMB EA QA IDENTIFY ING NUMBER FROM (Month, day, year) TO (Month, day, year)

73-6006419 20014027 03/01/2015 09/30/2015 9. RECIPIENT ORGANIZAT ION 1 0. PAYEE ( Where check is to be s1nt ii di fferent than item 9)

Name: Tulsa County Name:

No. and Street: 500 S Denver Av No. and Street:

City, State and City, State and ZIP Code: Tulsa , OK 74103 ZIP Code:

11. STATUS OF FUNDS

CLASSIFICATION

a. Ad minis1rative expense

b. Prelimina ry expense

c. Land, structures . riaht-of-wav

d. Architectura l enaineerina basic fees

e. Other architectural engineering fee

f. Project inspection fees

a. Land development

h. Relocation expense i. Relocation payments to individuals

and businesses

j. Demolition and removal

k. Construction and project improvement cost

I. Equipment

m. Miscellaneous cosl

n. Total cu mu lative to date(sum of lines a thrum

o. Deductions for program income

p. Net cumulative to date (linen minus line o)

q. Federa l share to date

r. Rehabilitation granls (100% reimbursement)

s. Tota l Federal share (sum of lines q and r)

t. Federal payments previously req uesled

u. Amount req uested for reimbursement

v. Percentage ol physical comp letion of project

12. CERTIFIC ATION

I certify that to the best of my knowledge and belief the billed costs or disbursements are in accordance with the terms of the project and that the reimbu rsement re presents the Federal share due which has not been previously requested and that an inspection has been performed and all work is in accordance with the terms of the award .

AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION USABLE 271-103

PROGR AM S .. (a)

Budget Approved per G(anl Offer or as Amended

$ 30,000.00

10,000.00

1,913,648.00

1,953,648.00

1,953,648.00

950,000.00

950,000.00

s

%

a. RECIPIENT

b REPRESENTATIVE CERT IFYING TO LI NE 11V

FUNCTIO NS -- ACTI VITIE S (b) (c) TOTAL

Latest ReVl5ed Budget Expenditures Thrs Penod Expendrtures To Date

$ $ 25,000.00 s 25,000.00

20, 110.50

640,986.00 2,179,184.00

0.00 665,986.00 2,224,294.50

0.00 665,986.00 2,224,294.50

950,000.00

0.00 0.00 950,000.00

763,571 .00

$ $ s 186,429.00

% % 100 % SIGNATURE OF AUTHORIZED CERT IFYING OFFICIAL CATE REPORT SUBM ITTED

September 28, 2015

TYPED QA PAINTED NAME ANO TITLE TELEPHONE (Area code, number, and utension)

John Smaligo, Dist 3 Commissioner 918-596-5020

~ H~AI ~ DATE SIGNED

September 28, 2015

TYPHJ' QA PAINTED NAM AND TITLE TELEPHONE (Ar,a code, numb,r, and extension)

Julie Miner, Principal ED Planner 918-579-9493

STANDARD FORM 271 (Rev 7·97)

Prescribed by OMB Circular A-102 and A-110

EDA PROJECT NO. 08-79-04973 Tulsa County

PROJECT DESCRIPTION: Roadway Improvements

LAND& BASIC ADMIN RIGHTS- A/E FEES OF-WAY FEES

'ROVED EDA BUDGET=-- - - ----- -=> $30,000 $0 $0 'ISED EDA BUDGET --------=---> $0 $0 $0

(After Bid Award) INVOICE DATE

Paragon Contractors - 1 10/25/14 Paragon Contractors - 2 11/25/14

Paragon Contractors - 3 12/25/14 Paragon Contractors - 4, 5 02/25/15

Crafton Tull 09125/14 Crafton Tull 10/31 /14

CALCULATIONS FOR EDA PAYMENT #1 CURRENT PERIOD $0.00 $0.00 $0.00 CUMULATIVE TOTALS $0.00 $0.00 $0.00

IINCOG 05/27/15 $10,000.00 Paragon Contractors - 6 03/25/15 Paragon Contractors - 7 04/25/15 INCOG 07/31 /15 $15,000.00

CALCULATIONS FOR EDA PAYMENT #2 CURRENT PERIOD $25,000.00 $0.00 $0.00 CUMULATIVE TOTALS $25,000.00 $0.00 $0.00

~ALCULATIONS FOR EDA PAYMENT #3 CURRENT PERIOD $0.00 $0.00 $0.00 CUMULATIVE TOTALS $25,000.00 S0.00 $0.00

• EDA Share of Admin istration Paid@ 100% ($25,000 Tota l Project)

EDA FUNDING: OWNER FUNDING:

TOTAL FUNDING:

OTHER A/E PROJECT

FEES INSPECTION $0 $10,000 $0 $0

$12,259.00 $7,851 .50

$0.00 $20,110.50 $0.00 $20,110.50

CURRENT CUMULATIVE

$0.00 $0.00 $0.00 $20,110.50

CURRENT"

CUMULATIVE'

$0.00 $0.00 $0.00 $20,110.50

CURRENT CUMULATIVE

$950,000 $1 ,003,648

$1 ,953,648

RE-LOCATION EXPENSE

$0 $0

$0.00 $0.00

EDA SHARE Ill! EDA SHARE Ill!

$0.00 $0.00

EDA SHARE Ill! EDASHAREC

$0.00 $0.00

EDA SHARE fl! EDA SHARE fl!

49% 51 %

100.00%

CONSTRXN

$1,91 3,648 $0

$71,886.91 $508, 182.02

$645,660.35 $312,468.58

$1 ,538,197.86 $1 ,538,197.86

49.00%

49.00%

$519,367.00 $121 ,619.00

$640,986.00 $2,179,183.86

49.00%

49.00%

$0.00 $2, 179, 183.86

49.00%

49.00%

EQUIPMENT CONTINGXY

$0 $0 $0 $0

$0.00 $0.00 $0.00 $0.00

>>>>>>>

>>>>>>>

$0.00 $0.00 $0.00 $0.00

>>>>>>>

>>>>>>>

$0.00 $0.00 $0.00 $0.00

>>>>>>>

>>>>>>>

TOTAL BUDGET

$1 ,953,648 $0

$71 ,886.91 $508, 182.02

$645,660.35 $312,468.58

$12 ,259.00 $7,851 .50

$0.00

$1 ,558,308.36 $1 ,558,308.36 $763,571.10

$763,571.10

$10,000.00 $519,367.00 $121 ,619.00 $15,000.00

$0.00 $0.00 $0.00 $0.00

$339,083.14 $1 ,897,391 .50 $186,428.90

$950,000.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0 00

$0.00 $1 ,897,391 .50

$0.00

$929, 721 .84

TOTALS CHECK

$1 ,558,308. $1 ,558,308. $763,571 .1

$763,571 .1

$665,986.C $2,224,294. $186,428.!

$950,000.C

$0.00 $2,224,294.

$0.00

$950,ooo.c

6 6

6

36

EDA PROJECT NO. 08-79-04973 Tulsa County

PROJECT DESCRIPTION:

CONTRACT NAMEfTYPE

ORIGINAL CONTRACT AMOUNT CHANGE ORDER #1

CHANGE ORDER #2 CHANGE ORDER #3 CHANGE ORDER #4 CHANGE ORDER #5

TOTAL CHANGE ORDERS TOTAL ADJUSTED CONTRACTS

PAYMENT#1 PAYMENT#2 PAYMENT #3

PAYMENT #5 PAYMENTS TO DATE BALANCE TO DATE

CONSTRUCTION BUDGET CONTINGENCY TOTAL CONSTRUCTION (W/EQUIPl TOTAL ADJUSTED CONTRACTS

PROJECT UNDERRUN(+l/OVERRUN(-l NON CONSTRUCTION BUDGET NON CONSTRUCTION ACTUALS

NON CONSTRUCTION BALANCE EDA PAYMENT HISTORY:

PAYMENT #1 PAYMENT#2 --PAYMENT#J - -- --PAYMENT #4 PAYMENT#5

PAYMENT#7

PAYMENT• L ·------ --------------PAYMENT#9

PAYMENT#10

CONTRACT#1

$0.00

$0.00 $0.00

$0.00 $0.00

BEFORE BIDS

$1 ,913,648.00 $0.00

$1 ,913,648.00 $0.00

$1 ,913,648.00

$40,000.00

$45,110.50

($5, 110.50) DATE

03131115 09/28/15

------

CONTRACT#2

$0.00

$0.00 $0.00

$0.00 $0.00

AFTER BIDS

$0.00 $0.00 $0.00 $0.00

$0.00

$0.00

$45,110.50

($45, 110.50) AMOUNT

$763,571 .10 $186,428.90

~--

9/2812015

CONTRACT#3

$0.00

$0.00 $0.00

$0.00 $0.00

CUMUL. $0

$763,571 .10 $950,000.00 $950,000.00 $950,000.00 $950,000.00

$950,000.00 III0,000.00

$950,000.00 $950,000.00

Regional Partners - Regional Solutions 2 West Second Stree t Suite 800 I Tulsa, OK 74103 [ 918.584.7526 I www.lNCOG.org

BILL TO:

Tulsa County Attn: Accounts Payable 500 South Denver Tulsa, OK 74103

Quantity Description

EDA Grant Scope of Work Services associated with funding an Economic Adjustment Assistance Project for Macy's

Invoice Number: 220692 Date: July 31 , 2015

Customer Award No: 08-79-04973 Customer Number: 132132

Unit Price Extended Price

Completion of remaining sixty percent (60%) of the scope of work $15,000.00

REMIT TO: AMOUNT $15,000.00 INCOG DUE TWO WEST SECOND STREET, SUITE 800 TULSA, OK 74103-3116

Please reference above invoice number on the remittance advice or return a copy of invoice with payment.

• TULSA COUNTY GOVERNMENT ADMINISTRATION BUILDING

500 SOUTH DENVER-TULSA, OKLAHOMA 74103 REQUISITION/PURCHASE ORDER/RECEIVING REPORT/CLAIM

Page 1 of 1

O EMERGENCY P.O. O BLANKET P.O.

REQUISITION NO. 158664

VENDOR NO.

254 DATE

08/21 /2015 FISCAL YEAR

2016 P.O. NO.

1604706

BILL TO: DELIVERY POINT:

TULSA COUNTY ENGINEERING DEPT. 500 S DENVER, RM 311 TULSA, OK 74103-3832

ISSUED TO:

INDIAN NATIONS COUNCIL OF GOVERNMENTS TWO WEST SECOND ST ST 800 TULSA OK 74103

08/20/2015 TOM RAINS ~ Date Requisitionina Officer ~~gg~~~

0u;,e ,l;~~f.:;~~ng

11it~8~.\i't••• request and the encumbering on the designated

08/20/2015 MICHAEL WILLIS Date Official/Requesting Officer

QUANTITY QTY. QTY. UOM PART NUMBER ORDERED DEL B.O.D. DESCRIPTION 75000200780


I hereby approve the issuance and encumbrance of this purchase order.

~~~~ 08/21/2015 Date Purchasing Agent

LRD Initials

I hereby cert~y that the amount of this encumbrance has been entered agalnsl the designated appropriation accounts and that this encu~e Is within the authorized available balance of said appropriation. 'ai ~

08/21/2015 GG Date County Clerk/Deputy Initials

BLANKET P.O. APPROVAL BY GOVERNING BOARD This blanke1 Purchase Order is approved for issuance and encumbrance against ihe designated appropriation account.

Date

Member Member

UNIT PRICE AMOUNT TOBE ADJUSTMENT APPROVAL ENCUMBERED AMOUNT

2.0 l EA EDA GRAN1fADMINISTRATION ON MACY'S PROJECl $10,000.000 $20,000.00 -;,. (t'li>. ~ l~&O{)_a,

PC SQ ORG·ACCT AMOUNT ADJUSTMENT APPROVED AMl

~ 1 30002475 - 505849 - HMACP $20,000.00 • $" [Vt>.()() t ~ tr "~.b/)

This Purchase Order/Claim and the attached documentation have been checked for conformity and accuracy. Total $20,000.00 -'5. Ar,"' ~ IJS'".IJOIJ .Ai

~ookkeeper s lnit1~~.../?1 'Adjustments Onlv)

T}:lec§ Oft1cia1 s lnitals Adiustments Only)

Date County Clerk/Deputy Delivered by: Date: j Received by: Payment Record

R:s)\ (, # ~ r· Warrant No. AMT. - , INVOICE NO./COMMENTS

I hereily certify that I have full knowledqe of this purchase and th~t the merchandise and/or services

(CLOCK-IN STAMP) descnbed have been satisfactorily received. Th,s purchase order 1s therefore presented for consideraUon of payment.

g,-~-t .. S o!te Official/Deputy

APPROVAL BY GOVERNING BOARD This claim is apprnved In the amount Indicated.above.

COPY 1 - ORIGINAL

. . . :·. ·. · .

. Tulsa ~c:iu.nfy. C.IEirk : ACCOUNTSRAYABLE . •· 500 S. Denver Ave., Sie 120 Tidsa. 01(74103,~32 . {~1 ~J ·59q.~583$ F#:Jsta) 596-5~3 . · '

. . .

Pay Fifteen Thousa~d. ~oHarsafid 00 cents1 ****** .

To Th~. Order bf

l\llnk.o( Oklahoma rulsa, OK

: '. •. .. : :: .••.••••. · • . ••.• 004854~5 .•. INOIAN NATIONS COUNCIL OF GOVliRNMENTS

TWdWEST SECONO ST ST'8Db . . . TUl,SA OK .741 o~

Tulsa County, Tulsa, OK 74103

: . . . . . . . . .

!3y.Order pfJhe Board of C~unty Commissio~rs ..•.

,,~" ..-0.-~ ~r; . / ·. i/t} ·-~-~~~~~~~-:----MP

:. \,'. .. ··-· ... "'· '> ... --~~ .. J..: ··~·· ZJ~:.cll~~.;~~~~~_...; ·---"--~,..,. . MP•

Warrant/Check Number: 00485425

07/31/2015 220692 PASS THROUGH FUNDS GL-3000247550584

:~i~r706

254 INDIAN NATIONS COUNCIL OF GOVERNMENTS 00485425 09/08/2015 $15,000.00

Date 09/10/2015

Account Number 600022948

• Tulsa County Clerk ACCOUNTS PAYABLE 600 S. Denver Ave., Ste 120 Tulsa. OK 74103-3832 (918) 698-683&fax (t18) 598-5843

Pay Fifteen Thousand Dollars and 00 cents --·

To 11le OrderOf

ll,enli;d~ T~QC

00485425 INOIAN NATIONS COUNCIL OF GOVERNMENTS TWO WEST SECOND ST ST800 TULSA OK 74103

Serial Number 485425

Vend« ~

254

Amount $15,000.00

~ 09toel2015

Warranl/Oledt Nwnber

00485425 VOID aft8r June 30, 2017

$16,000.00

.. ar Order or The Boetd at County Commlaeklnffl

- f?at ~ --IIP ,-, ·~ , ·, ( } -:--~~~ci~Cull'(---~~----~---MP

\_,.- 4Lt!!2... :..::~ IIP

~00~85~~5~ ·=~03~0003~~ ~000~~~~8~

0

3:

© 0

~ ~

0 0 ......

. c:

0 =

o

O

o.

e II')

<;;;

Sp

iritBa

nk <

In

dia

n N

atio

r F

or De

po

sit 8

00

35

85

0

ncil O

f Gove

Date Q4t22QQ) 5

Account Number 6QQQ22948

Serial Number 478838

Amount $519 366 87

00 NOT ACCEPT UNLESS THIS CHECK IS PHINTl:O Wflli A COLOR BACKGROUND, CONTAINS A VOID P4NTOGRAPtt, I.IICROPRIHTINO FACE ANO BACK. UV FIBERS ANO A WATERUA

.. ••

Tulsa County Cle'rk ·ACCOUNTS PAYABLE 500 s. Denver Ave .• sie 120 Tulsa, OK 74103·3832 (~18) 596-5839 F~.ii (9,.8) 596-5843

VendOr Number

25493

Warrant/Check Warra Oate Nl

04/20/2015 004 VOID after June 30, 2016

Pay Five Hundred Nineteen Thousand Three Hundred Sixty Six Dollars and 87 cents ........

To The · Order Of

Banl

.......

--

, ,. ·-

---

c.,.;,_

-,

-·-

---

I --

-·-·

ID

---

--:

l :

I ~

I -I

-~

-I

..!1

~----

__.;:

==~-

-.:::!

I 0

,

O'I v O'I

/\

3' .n

'.lr

i..

•'l.

..J _

, _

_

··~

:U

t,I

.1.

• J

>

n n Q = =

..... z =

a i ., r.,, tD ., -· s:o - z = a er tD ., > a Q = = .....

DO NOT ACCEPT UNLESS THIS CHECK IS,PIIINTED wmt A COLOR BACKQROIJND, CONTAJNS A VOID PAHTOORAPH, IIICROPRIHTlNC FACE ANO BACK, UV FIBERS 'AND A WATERIIARK'ON THE REVERSE SIDE

• Tuf sa County Clerk ACCOUNTS PAYABLE 500 S. Denver Ave., Ste 120 Tulsa, OK 74103-3832 {918} 596.-5839 Fax (918} 596-5843

V!!ndor Number

25493

Warrant/Check Date

05/26/2015

Warranl/Ct,eck Number

00480469 VOID after June 30, 2016

$121,619.10

Pay One Hundred Twenty One Thousand Six Hundred Nineteen Dollars and 10 cents.,. ....

To The Order Of

Bank of Oklahoma Tulsa. OK

PARAGON CONTRACTORS LLC 2108 N 129TH EAVE TULSA OK 741 16-1729

00480469

B~ Order of The Board of County Commissiooers

M __ M ___ Mf?at._ ~-... --.M--...MP a,,t.,, crcie;:_ --~-,,,.~~-;;,----MP

·-M- · ~sie I c. (. .., L. , 1 .... O~°'~ f1l I ~ .. ll I :; ~'< ;,,;~

i.1 I • (/) ... 'E "" 0

.j

I I rl r: • I ,,

L.

~ r5 r > ;]) ··~ m I m :n rn

TULSA COUNTY GOVERNMENT ADMINISTRATION BUILDING 500 SOUTH DENVER· TULSA, OKLAHOMA 74103

REQUISITION/PURCHASE ORDER/RECEIVING REPORT/CLAIM

Page 1 of 1

O EMERGENCY P O D BLANKET P.O.

BILL TO:


TULSA COUNTY ENGINEERING DEPT. 500 S DENVER, RM 311 TULSA, OK 7 4103-3832

ISSUED TO:

PARAGON CONTRACTORS LLC 2108 N 129TH EAVE TULSA OK 74116-1729

VENDOR NO. 25493

DATE 03/13/2015

FISCAL YEAR 2015

DELIVERY POINT:


I hereby approve the Issuance and encumbrance of this purchase order.

P.O.NO. 1517883

~l&~ 03/13/2015 LRD Date Purchasing Agent Initials

I hereby certify that the amount of this encumbrance has been entered against the designated

03/13/2015 HARRY CREECH f/( appropriation accounts and that this encu~/ Is within the authorized available balance of said appropriation . a ~

03/13/2015 CEA Date Reauisitionina Officer Initials Date County Clerk/Deputy Initials

~~g:;;,r~o~e~~':.;~~ngf ~J~ttJcttse request and the encumbering on the designated BLANKET P.O. APPROVAL BY GOVERNING BOARD This blanket Purchase Order Is approved tor issuance and encumbrance against the designated appropriation account.

03/13/2015 MARK LIOTTA Date

Date Official/Requesting Officer Member Member

QUANTITY QTY QTY. UOM PART NUMBER UNff PRICE AMOUN~TOBE ADJUSTMENT APPROVAL ORDERED oa. 80.D DESCRIPTION ENCUM EREO AMOUNT 16750740001 f,'-- • ....

9.0 I EA 76TH STREET NORTH ROAD CONSTRUCTION $50.000.000 $450,000.00 "' flf ..;d, . i'7 t.O ~ I .L.,£ 1 PC SQ ORG·ACCT .· .: AMOUNT '

ADJUSTMENT !4PPROVEO AM1

ti 1 30002475 - 505849- HMACP $450,000.00 ~- . -CMF 232624 INVOICE NO /COMMENTS -

I nereby certify that I have full knowledQe of th,s purchase and that the merchandise and/or sennces

(CLOCK-IN STAMP) described have been satisfactorily received This purchase order is therefore presented for cons ideration of payment

~.,-Lr:---Date Official/Deputv

APPROVAL BY GOVERNING BOARD This claim is approved in the amount indicated above.

COPY 1 • ORIGINAL

A~PLICATION AND CERTIFICATE FOR PAYMENT TO: Tulsa County

500 South Denver Tulsa, OK 74103

FROM: Pa ragon C ontractors LLC

2108 N. ! 29th E. Ave. Tulsa, OK 74116

CONTRACT FOR:

CONTRACTOR'S APPLICATION FOR PAYMENT

CHANGE ORDER SUMMARY

PROJECT :

!

Change Orders approved in ADDITIONS DEDUCTIONS

previous months by Owner TOTAL $0.00

Approved this Month

Number Date Approved

TOTALS $0.00

Net change by Chanee Orders

The undersigned Contractor certifi es that to the best of the Constractor's knowledge, infonnation. and belief the work covered by thi s Application for Payment has been

completed i11 acwrdance with the Contract Documents, that all amounts have been paid by the Contractor fo r Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown

herein is now due

$0.00

$0.00 I

$0.00

$0.00

I

APP# 6 76th Street North a11d 75th Street lntersection, 76th Street North a11d Sheridan Road

Intersection Extending Sheridan Road

Approximately 1550 Feet

PEltlOD T O: 03/25/15

Application is made for Payment, as shown below, in connection wi th

the Contract. Continuation Sheet, is attached.

1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders

3. CONTRACT SUM TO DATE (Line 1 +2)

4. TOTAL COMPLETED & STORED TO DATE

5. RETAINAGE: a. 5% of Completed Work

(Column L on Continuation Sheet) b. 5% of Stored Material

Total Retalnage

6. TOTAL EARNED LESS RETAINAGE 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 8. CURRENT PAYMENT DUE

9. BALANCE TO FINISH, PLUS RETAINAGE (Line 3 - Line 6)

State of: OKLAHOMA County of: TULSA

I

$ 2,286,286.00 I $ 2,286,286.00

$ 2, 165,836.56

$ 108,291 .83

I $ 108,291 .83 $ 2,057,544.73 $ 1,538,177.86 $ 519,366.87

$ 228,741 .27

CONTRACTOR: Paragon Contra cto rs LLC !

By~£~ Date: 3/30/15 I

Subscribed and sworn to before me this 30 day of Marci120 ! L __

Nota ry Public::µ ~ l /~~~;~,;;;:\ POLLY OENN ETI ~ • ', 5[ 1\L' .

MAN AGER

CERTIFICATE FOR PAYMENT ln accordance with the Contract Documents. based on on-site: observations and the

data conpn smg th~ above application, the Owner's Representative

Manager). cert ifies to the Ov.11er that to the best of the Owner Representative's

knowledge, 111forrnat1on and belief the Work has progressed

as md1catcd, the quali tv of the Wo,k 1s m accordance with the Contract Documents,

and the Contractor" enntled to payment of the AMOUNT CERTIFIED

OWN~R'S REPRESENTATIVE 0/; By:Jv;~~ Date: ~ 'S"

~ - --- ,,..,..- - ----- --, ---., rev. date 317198

; \ ,.. .... i Notary Public My Commission exp / 18/20 15 : ···· . .li_T1\ :'!-·· Sta te of Oklat1omiJ ,

: ~

Item Onglnal Scheduled Quantity Amount Quantity

I Amount I Quantity I Amount # Descnpt1on Contract Unit Unit Prlce Value Previous Previous This This to to ~ Quant,tv : Estimate Estimate Estimate Estimate Date Date

Roadw•y & Drainage

1 Clearing & Grubbin0: I LS 33 000 $ 33 000.00 1.00 $33,000.00 s 1.00 s 33000.00 100% 2 Eanhworl.. I LS 245000 $ 245 000.00 o.e4 $205 800.00 016 $ 39 200.00 1.00 s 245 000.00 100% 3 Solid Slab Soddin• 3 678 SY 3.1 5 $ 11 585.70 0.00 $0.00 $ $ . 0% 4 Hydromulch 7 502 SY 1.5 $ 11 253.00 0.00 S0.00 $ $ ·0% 5 Demolit,on I LS 79000 $ 79000.00 0.99 $78 21 0.00 001 $ 790.00 1.00 s 79000.00 100% 6 Erosion Control I LS 20000 $ 20 000.00 0.90 $18,000.00 0.10 $ 2000.00 1.00 $ 2000000 100%

7 9" Lime Modified SubQ.rade 15 027 SY 8 $ 120,21 6.00 14590.77 $116 726.16 436.20 s 3 489.60 15,026.97 $ 120 215.76 100•1, 9 Senarator Fabnc 16,768 SY 1.45 $ 24 313.60 16341.44 $23695.09 426 56 $ 618.51 16 768.00 $ 24 313.60 100%

10 10• AR_qregate Base (Tvoe Al 4 175 CY 41 $ 171175.00 4054.82 $166 247.62 120 18 $ 4 927.38 4 175.00 $ 171 175 00 100%

11 2" Type 54 1 422 TON 95 $ 135 090.00 271 .31 $25 774.45 1 253 90 $ 119,120.50 1 525.21 $ 144 894.95 107%

12 l"TypeSl 2 133 TON 74 $ 157,842.00 620.69 $45931.06 1 529.77 s 113 202.98 2 150.46 s 159,134.04 101% 13 l' Tvnc 52 2 llJ TON 60 $ 127 980.00 590.34 $35 420.40 1,390.83 s 83 449.80 1,981 17 $ 118 870.20 93% 14 ConstnKtton Traffic Con1rol I LS 22000 $ 22 000 00 0 75 $16 500.00 0.15 $ 3 300.00 0.90 $ 19,800.00 90% 15 Mailbox Relocanon 1 EA 210 $ 210.00 1 00 $210.00 $ 1.00 $ 21 0.00 100% 16 School Sum Relocat1on I EA 965 $ 965.00 0.00 $0.00 1.00 $ 96500 1.00 $ 965.00 100% 17 Concrere Driveway Replacement 174 SY 60 $ 1044000 17400 $10,440.00 $ 174.00 $ 10 440.00 100%

18 Temoorarv Traffic S111.nals I LS 2100 $ 2 100 00 0.00 $0.00 $ s 0% 19 Temoora,v Rudlt ofWav fence 315 LF 3 5 S 1 102.50 31500 $1 102.50 $ 315.00 $ 1102.50 100% 20 Permanent Riv.ht of Wav Fence 468 Lf 7.6 $ 3 558.80 90.00 $684.00 220.00 $ 1 672.00 310.00 $ 2 356.00 66% 21 Type I - Rip Ran 90 SY 48 S 4 320.00 90.00 $4 320.00 $ 90.00 $ 4 320.00 100% 22 Tvoc rv Gromed Rio Rao 224 SY 99 $ 22,176.00 223 74 $22 150.26 $ 223 74 $ 22 150 26 100% 23 2~ Miii and Overlav 4 092 SY 15 $ 61 380.00 000 $0.00 4 092.00 $ 61,380.00 4,092.00 $ 61 380.00 100% 24 Remove Ex1s1imr. Pavement Section 538 SY 80 $ 43 040.00 821.20 $65696.00 453.55 $ 36,284 .00 1 274.75 $ 101 980.00 237% 25 Concrete Curb & Guuer 4 454 LS 17 $ 75,71 8.00 3878.00 $65 926.00 507.00 s 8 619.00 4 385.00 $ 74 545.00 98% 26 Tack Coat 3 669 GAL 3.75 $ 13 758.75 700.00 $2 625.00 1 300.00 $ 4 87500 2 000.00 $ 7 500.00 55% 28 Mob1hu11on 1 LS 30395 95 $ 30 39595 1 00 $30 395.95 $ 1.00 s 30395.95 100% 29 Stakin!,1; I LS 31000 $ 31 000.00 0 95 $29 450.00 $ - 0.95 $ 29 450.00 95% 30 Pond Undercumnr. I 060 CY 10 $ 10 600.00 1273.00 $12 730.00 $ . 1,273.00 $ 12,730.00 120% 31 Saw1n2 Pavement 4 965 LF 1.8 $ 8 937 00 44"6.00 $8 002.80 519.00 $ 934.20 4,965.00 $ 8 937 00 100% 32 Consoan Bridi.c Extension 1 LS 67000 $ 67,000 00 1 00 $67 000.00 $ 1.00 $ 67 000.00 100% 33 Double 6'x5' Box Culverv w/lleadwalls & W1nQ.v.'llls I LS 63000 $ 63 000.00 1.00 $83,000.00 $ 1.00 $ 63 000.00 100% 34 Junction Box ~'xY I EA 4000 $ 4 000.00 1.00 $4,000.00 $ 1 00 $ 4 000.00 100% 35 OOOT Gra1ed lnle1 R· 77f. 1 EA 4000 $ 4 000.00 1 00 $4,000.00 $ 1.00 $ 4000.00 100% 36 4' Recessed Curb Inlet I EA 4000 $ 4 000.00 1 00 $4 000.00 $ 1 00 $ 4000.00 100% 37 6' Recessed Curb Inlet 4 EA 4700 $ 16 800.00 4 00 $18 800.00 $ 4.00 $ 18 800.00 100% 38 8' Recessed Curb lnlc1 I EA 5300 $ 5 300.00 1 00 $5,300.00 $ 1 00 $ 5 300.00 100% 39 8' x 4' Box Culvert E:oc1en51on I LS 8400 $ 8,400.00 1 00 $8,400.00 $ 1 00 s 6 400.00 100% 40 36" Pipe Headwall wuh U·Tvve Win P: wa11 I LS 3100 $ 3100.00 100 $3,100.00 $ 1.00 $ 3100.00 100% 41 18' RCP 162 LF 69 $ 14 418.00 161 .00 $16 109.00 $ 181 .00 $ 16,109.00 112% 42 36' RCP 31 Lf 144 95 $ 4,493.45 40.00 $5798.00 $ 40.00 $ 5,798.00 129% 43 18" Concrete Flared End Section I EA 620 $ 62000 1 00 $62000 $ 100 $ 62000 100% 44 l3ollards l EA 800 $ 2 400.00 0.00 $0.00 $ $ 0% 45 4• Concrete Slooewal l 4 SY 535 $ 2 140.00 000 $0.00 26.00 $ 13 910.00 26.00 $ 13 910.00 650% 46 Ret.arn1111,1.Wall 9 SY 500 $ 4600.00 9 20 $4 600.00 . $ 9 20 s 4 600.00 100% 47 Mult1-Polvmer Pavement Mark111g:s Tvoc B Broken White 6 123 LF 1.05 $ 6,429.15 0.00 $0.00 $ $ 0% 48 Muh1·Pol 1ner Pavement Mark.nuts Tvoe C Solid Whue 4,760 LF 1.05 $ 4 998.00 000 $0.00 $ $ 0% 49 Mult1-Polvmer Pavement Markmlls Tvoe C Solid Double Yellow 6 195 Lf 2.15 $ 13,319.25 0.00 $0.00 $ $ 0% 50 Mult1-Polvmer Pavement Mark,mzs Tvoe G Solid Stoo Bar 255 LF 6.45 $ 1644.75 0.00 $0.00 $ $ 0% 51 Multt-Polvmer Pavement Mark,nw. Tvoc I Solid Yellow 976 LF 1.05 $ 102480 0.00 $000 $ $ 0% 52 Multt-Polymer Pav~rnent MarkmRS Directional and Tum Arrows JO l!A 107 $ 3 210.00 0.00 $0.00 $ $ 0% 53 Mulu-Polvmer Pa\lement Markings Rad,oad Pavement Markina I EA 805 s 805.00 0.00 $0.00 s $ 0% 54 SinA.le Beam Guard Rail 1 482 LF 19 $ 28 158 00 0.00 S0.00 s $ 0% 55 Guard full End Trf'.atment 4 EA 2400 ' 9,600.00 0.00 $0.00 $ $ 0% SSA 8' Clav Pond Cao 141 CY 27 $ 3 807.00 141.00 $3 807.00 $ 141.00 $ 3 807 .00 100%

Item Original Scheduled Quantity Amount Quantity Amount Quantity Amoun t # Description Contract Unit Unit Price Value Previous Previous This This to to %

Quantitv Estimate Estimate Estimate Est imate Date Date Waterline Relocat ion

56 24" Class 51 DtP Unrestrained 429 LF 128 $ 54 ,912.00 320.00 $40 960.00 $ 320.00 $ 40 960.00 75% 57 24" Class 51 DfP Restrained 360 LF 164 $ 59,040.00 135.00 $22 140.00 91 .00 $ 14 924. 00 226.00 $ 37,064.00 63% 58 24" Hanson Concrete Adaptor 4 EA 8800 $ 35 200.00 0.00 $0.00 2 .00 $ 17 600.00 2.00 $ 17 600.00 "50% 59 24" ~ 22.5' Bend 10 EA 1930 $ 19 300.00 0.00 $0.00 8.00 $ 15,440.00 8.00 $ 15 440.00 '80% 60 4" Air Relief Valve and Vault 2 EA 9200 $ 18 400.00 1.00 $9,200.00 $ 1.00 $ 9,200.00 50% 61 24" x 24 '' x 24" Tee I EA 2900 $ 2,900.00 0.00 $0.00 $ $ 0% 62 42" Steel Casma 219 LF 184 $ 40,296.00 143.00 $26 312.00 $ 143.00 $ 26,312.00 65% 63 Fire Hvdrant Assemblv 2 EA 5000 $ 10,000.00 1.00 $5,000.00 $ 1.00 $ 5,000 00 50% 64 Tvnc: A A !fileQ.atc Backfill for Strettt Crossine Sheridan & 15th St. N. 107 CY 32 $ 3,424.00 80.00 $2,560.00 $ 80.00 $ 2,560.00 75%

i

Traffic SI nal

63 2" PVC SCH 40 Plast,c Conduit Trenched 250 LF 5.35 $ 1 337 .50 250.00 $1 337 .50 $ 250.00 $ 1,337.50 100% 64 3'' PVC SCH 40 Plastic Conduit Bored 485 LF 25.2 $ 12,222.00 485.00 $12,222.00 $ 485.00 $ 12,222.00 100% 65 3" PVC SCH 40 Plasttc Conduit Trenched 150 LF 16.1 $ 2,4 15.00 150.00 $2,415.00 $ 150.00 $ 2,4 15.00 100% 66 Pull Box Size 1 5 EA 365 $ 1 825.00 5.00 $1,825.00 $ 5.00 $ 1,825.00 100% 67 Pull Box Size ll 2 EA 450 $ 900.00 2.00 $900.00 $ 2 .00 $ 900.00 100% 68 Structural Concrete 21 CY 500 $ 10 300.00 20.60 $10 300.00 $ 20.60 $ 10,300.00 100% 69 Reinforc1n~ Sreel l,137 LB 1.4 $ 4 ,391 .80 3137.00 $4,391 .80 $ 3 ,137.00 $ 4 391 .80 100% 70 Removal of Traffic Suma! EauiDment I LS 5400 $ 5 400.00 1.00 $5 400.00 $ 1.00 $ 5400.00 100% 74 32' MH Pole 30' TS & IO" LMA G. STL l EA 8500 $ 8 500.00 1.00 $8,500.00 $ 1.00 $ 8,500.00 100% 76 32' MH Pole 45 ' TS & l O" LMA G. STL l EA 9700 $ 9,700.00 - 1.00 $9,700.00 $ - 1.00 $ 9,700.00 100% 78 32' MH Pole 40' TS & lo· LMA G. STL 3 EA 9700 $ 29100.00 3 .00 $29100.00 $ 3.00 $ 29100.00 100% 79 32' Mil Pole 50' TS & NO LMA G. STL I EA 12900 $ 12 900.00 1.00 $12,900.00 - $ 1.00 $ 12,900.00 100% 80 32' MH Pole Twin TS & 10' LMA G STL I EA 16300 $ 16,300.00 1.00 $16 300.00 $ 1.00 $ 16 300.00 100% 81 Roadwav Luminaue 6 EA 540 $ 3 240.00 6.00 $_3,240.00 $ 6.00 $ 3,240.00 100% 82 Service Pole 2 EA 550 $ 1100.00 2.00 $1 100.00 $ 2.00 $ 1,100.00 100% 83 I IC No 6 Electncal Conductor 400 LF 2 $ 800.00 ·- 400.00 $800.00 $ 400.00 $ 800.00 100% 84 l!C No. 10 Electrical Conductor 2 140 LF 1.05 $ 2,247.00 2140.00 $2,247.00 $ 2 140.00 $ 2,247 .00 100% 85 Traffic S111nal Con troller Assernblv 2 EA 25000 $ 50,000.00 2.00 $50,000.00 $ 2.00 $ 50,000.00 100% 86 Detecuon Svstem (Video) l LS 60000 $ 60,000.00 1.00 $60,000.00 $ 1.00 $ 60,000.00 100% 87 l Wav 3Sec ADJ SIG HD S-6 16 EA 625 s 10,000.00 16.00 $10 000.00 $ 16.00 $ 10 000.00 100% 88 I Wav 3Sec ADJ STO HD S-9 2 EA 610 $ 1,220.00 2.00 $1 220.00 $ 2.00 $ 1.220.00 100% 89 I Wav 4Sec ADJ SIG HD A- IJ 5 EA 750 $ 3,750.00 5.00 $3 750.00 $ 5.00 $ 3,750.00 100% 90 I Wav 5Sec ADJ AlG HD S-19 l EA 1050 $ 1 050.00 1.00 $1,050.00 $ 1.00 $ 1,050.00 100% 91 Backplate 24 EA 95 $ 2 280.00 24.00 $2 280.00 $ 24.00 $ 2,280.00 100% 92 5/C Traffic Signal Electrical Cable 890 LF 1.4 $ 1,246.00 890.00 $1 ,246.00 $ 890.00 $ 1.246.00 100% 93 7/C Traflic Su:mal Electrical Cable 340 LF 1.8 $ 612.00 - 340.00 $612 .00 $ 340.00 $ 612.00 100% 94 2 l/C Traffic Signal Electrica l Cab le 1,325 LF 4 .8 $ 6,360.00 1325.00 $6,360.00 $ 1,325.00 $ 6,360.00 100% 95 Mast Ann Mounled Si'!ns Aluminum 175 SF 35.4 $ 6,195.00 175.00 $6,195.00 $ 175.00 $ 6,195.00 100%

' !

TOTAL CONTRACT AMOUNT $ 2,286,286.00 $1 ,619, 134.59 $ 546,701 .97 $ 2, 165,836.56 95%

• TULSA COUNTY GOVERNMENT ADMINISTRATION BUILDING

500 SOUTH DENVER - TULSA, OKLAHOMA 74103 REQUISITION/PURCHASE ORDER/RECEIVING REPORT/CLAIM

Page 1 of 1

O EMERGENCY P.O. O BLANKET P .0 .


VENDOR NO. 25493

DATE 05/01/2015

FISCAL YEAR 2015

P.O.NO. 1520701

BILL TO: DELIVERY POINT:


ISSUED TO:

PARAGON CONTRACTORS LLC 2108 N 129TH EAVE TULSA OK 74116-1729

05/01/2015 HARRY CREECH Date Requisitioning Officer

~~~~~~~~d~·,,r;:f~~~~~ "Jfo~.c~:~re reauesl and th& encumbering on !he designated

05/01 /2015 MARK LIOTTA Date Official/Requesting Officer

~/ ~Initials

QUANTITY QTY. QTY. UOM PART NUMBER OROERED [')EL. B.O.D. DESCRIPTION 16750740001


I hereby approve the Issuance anc er,cumbrance of tnls purchase order

~l&~ 05/01/2015 Date Purchasing Agent

LRD Initials

I hereby certify 1ha1 the amount of this eocumb•ance has been enl.ered a9a1ns1 lhe designated ap~ropriatlon accounts and that this encu~e Is within the authorized available balance of se appropMatlon. CJf ~

05/01/2015 CEA Date Countv Clerk/Deputy Initials

BLANKET P.O. APPROVAL BY GOVERNING BOARD This blanket Purchase Order Is approved for Issuance and oncumbrance against the deslgnaled aopropriallon accounl.

Date

Member Member

. UNIT P~I.CE AMOUNT TO BE ADJUSTMENT .APPROVAL: ENCUMBERED . AMOUNT

4.0 ( EA 76TH STREET NORTH ROAD CONSTRUCTION $50,000.000 $200,000.00 ii9,,e;.o

PC SQ ORG··ACCT AMO.LINT AOJU~TMENT . ~PPROVEO AMT

(!_ 1 30002475 • 505849 • HMACP $200,000.00 I ,I/ /JJl'J ./() I

This Purchase Order/Claim and t~e eUacned documenlation hava been Cllec

APPLICATION AND CERTIFICATE FOR PAYMENT -'--- .,,

TO: Tulsa County 500 South Denver Tulsa, OK 741U3

FROl\-1: Paragon Contractors LLC 2108 N. 129tb E. Ave. Tulsa, OK 74116

CONTRACT FOR:

CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY

PROJECT:

Change Orders approved in ADDITIONS DEDUCT!ONS previous months by Owner

TOTAL $0.00 Approved this Month Number Date Approved

TOTALS $0.00 Net change by Change Orders

The undersigned Contractor certifies that to the best of the Constractor's knowledge, information, and belief lhe work covered hy this Application for Payment has heen completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received ftom lhe Owner, and that current payment shown

herein is now due.

aOntractors 1,LC

By: LLA'U / / A/" rrry Date:

CERTIFICATE FOR PAYMENT \rt accordance with the Contract Documents, based un on·sile obaerv~tious anrl che data conprising the above application, the Owne~s RepreseutAtivc

Manager) certifies to the Owner that to the best of the Owner Representative's

knowledge, infonnation HJ1d bclieftt.e Wu,k has progressed

as indicated. the quality of the:: Wo,k is in accord.Mee with the Contract Documents,

•nd d,c Conuacto, is entitled lo pa)'Ulent of tho AMOUNT CERTlFlED.

OWNER'S REPRESENTATIVE

4/28/15

. By:C::~.,:',& Date: ,:s_::;/~ /JS., - , - _/ rev. date 317/98

$0.00

$0.00

so_oo $0.00

.'J'PN 7 76th Street North and 75tb Street fntersection, 76th Stred North and Sheridan Road

lntersectiou Extending Sheridan Road Approximately 1550 Feet

PERIOD TO: 04/25/15

Application is made for Payment, as shown below, in connection with

the Contract. Continuation Sheet, is attached.

1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE

(Line 1+2)

4. TOTAL COMPLETED & STORED TO DATE

5. RETAINAGE: a 5% of Completed Work

(Column Lon Continuation Sheet)

b. 5% or Stored Material

Total Retainage 6. TOTAL EARNED LESS RETAINA.GE 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 8. CURRENT PAYMENT DUE

9. BALANCE TO FINISH, PLUS RETAINAGE (Line 3 - Line 6)

State of: OKLAHOMA County of: TIJLSA

Subscribed 1111d sworn lo berore me this 28 day of April 2015

$ 2,286,286.00 $

$ 2,286,286.00

$ ~?,293,856.66

$ 1141692.83

$

$ 114,692.83 $ 2, 179, 163.83 $ 2.057,544.73 $ 121,619.10

l_ _1_07,122.17

NotaryP~c: t -- •- ------------------------I ! ,m;:·,\ POU.Y BENNETT : MyCommiss~p~

: \ SEAL , Notary Public ! I ~ - I t : ~.!:.)' Sta1e of Oklahoma : ! Commission I 03006379 Expires 04118/19 !

AMOUNTCEIUIFIED -~~~~~ - $121,619.10 (Attach explanation if amounl certified differs from the amount applied far.}

This Cel11ficale is not negotiable. The AMOUNT CERTIFIED Is payable only lo the

Conlraclor named herein. Issuance, payment and acceptance or payment are Without Prejudice lo any lights of the Owner or Conlractor under this Corllract.

By:d~ - Date: S-- /::?,.-/ L Fie Name: App~cation ror Payment

•l•m . , Original ScheGlJed Quan lily Amount Quantity Amo1Jnt Quantity AlllOllnl # Desctiption Conlracl Untt UnttPnce Value Previous Previous This This ta lo %

Quantlv Estimate Estimale Es~mate Estimate Data Dale ,adw•y & Draln111•

1 Clcuina: & Giubl,ia11 I LS 33,000 $ 33,000,00 1.00 533.000.00 . $ 1.00 $ 33 000.00 100% 2 Eorthwmk I I.S 245,000 $ 245 000.00 1.00 $215 000.00 . $ 1.00 $ 245,000.00 100% 3 Solid Slob Sodd""' 3,678 SY 3.15 S 11,!,85.70 0.00 $0.00 6.220.00 $ 19593.00 6 ,220.00 $ 19 59l.OO 169% 4 u-dcomulch 7,502 SY 1.5 S 11 253.00 0.00 $0.00 14,400.00 $ 21600,00 14 400.00 $ 21600.00 192',1, 5 Demolition t LS 79000 $ 79000.00 1.00 179,000.00 . s 1.00 $ 79000.00 100% 6 Erosion Control I I.S 20 000 $ 20000.00 1.00 $20 ODO.DO - s 1.00 $ 20 000.00 100% 7 9' Lime Modified Suborade IS 027 SY 8 $ 120 216.00 15026.97 $120 215.76 s 15,02ll.97 s 120 215.76 100% 9 Seoarator Fabric 16.768 SY 1.45 $ 24.313.60 16768.00 $24 31J.60 $ . 16,768.00 $ 24 313.60 100%

10 to• Aoerc111tc Base rr-.-.) 4,175 CY 41 $ 171175.00 4175.00 $171175.00 228.00 $ 93'16.00 4.403.00 $ 160,523,00 105% 11 Z-T\ll'll!S'1 l 422 TON 95 $ 135090.00 1525.21 $144 894.95 - $ 1 525.21 $ 144 894.95 107% 12 l' TY1JCS3 2 llJ TON 74 S 157,842.00 2150.46 $159,134.04 . $ 2,150.46 $ 159134.Q.4 101% 13 l ' TvoeS2 2,133 TON 60 $ 121 genoo 1961 .17 $118,870.20 $ . 1,981.17 s 118 870.20 93% 14 Corum .. 11 .. "tion Traffic Control I LS 22000 $ 22000.00 0.90 $19800.00 0.10 $ 2 200.00 1.00 $ 22,000.00 100% 15 Mailbo• Relocation l EA 210 S 210.00 1.00 ~10.00 . s 1.00 $ 210.00 100% 16 School Si11m luloc.al..ion 1 EA 965 $ 965.00 1.00 $L'65.00 - s 1.00 $ 005.00 100% 17 Ccnccete Drivawiv R.eol11eemcnl 174 SY 60 $ 10,4

;)em O~glnal Scltcdulod Quanlity Amount a uanllty Amount OuanUty Amounl # Oascription Contract Unit Unil Price Val.Jg P!evial.Js Previous This This lo to %

QuanUlY E•tima\e EsUrnste Estimate Estimate Dale Dale 1lertint Relocation

56 24• Cla:i~ Sl Otr Unrastra.iocd 4Z9 LF 128 $ 54,Q12.00 320.00 $40,960.00 $ 320.00 $ 40,960.00 75% 57 24' Clim SI lllP Restn.ined 360 u· 1114 $ 59 o«J.00 226.00 $37,064 .00 s 226.00 s 37 064.00 63% 511 2A" Hanson Cona1:te Ad.lntar 4 EA 9800 $ 35 200.00 2.00 $17 600.00 $ 2.00 $ 17,600.00 50% 59 24" - 22. ~' Bend ,o EA 1930 $ 19,300.00 e.oo $16,4-40.00 $ 8.00 I 15,-4'40.DO 81lli 60 4~ Air R.cliefV,Jvc a:nd Viwlt 2 EA 9200 $ 18,400.00 1.00 $9,200.00 s 1.00 $ 9.200.00 50% 61 24 .. x: 24" x z4· Tee l EA 2900 $ 2,900.00 0.00 $0.00 $ . $ . 0% 62 42• Steel Cuin11. 219 LF 18" $ 40,296.00 143.00 $2fl 312.00 . $ . 143.00 s 26,312.00 85% 63 Fire Hvdnnt An emblv 2 EA 5000 $ 10,000.00 1.00 $5,000,00 $ 1.00 s 5 000.00 50% 64 TvneA ••"••Ilk BACliill farSt,mct Crossin• Sbcridm& Jltb SL N 107 CV 32 $ 3424.00 60.00 $2 560.00 $ B0.00 $ 2,560.00 75%

-affic SI oal

63 2' PVC SCH 40 Plastic Conduit Trenched 250 LF 5.3.5 $ 1337.50 250.00 $1 337.50 $ 250.00 s 1 337.50 100% 64 3 .. PVC SCH 40 J'lutie Conduit BQred 445 I.F 25.2 S 12 222.00 485.00 $12 222.00 $ 485.00 s 12 222.00 100% 65 l" PVC SCH 40 Pl&Sric Conduit Trooched ISO LF 16.1 s 2 415.00 150.00 52,415.00 $ 150.00 $ 2,415.00 100% 66 Pvll Ba• Siu: I s 61\ 385 $ 1,625.00 5.00 S1 825.00 . s . 5.00 $ 1,825.00 100% 67 Pull Bo• Size n i EA 450 S 900.00 2.00 5900.0D s . 2.00 s 900.00 100% 68 Struct..inl Concrtle 11 CV SOD S 10,300.00 20.50 $10,300.00 $ 20.60 s 10.300.00 100% 69 Reinforcing Stec-I J 137 LB 1.4 $ 4 391.BO 3137.00 $4391 .IIO s 3 137.00 $ 4.391.80 100% 70 RomoV>l oCTntffic Sil!IIJI\ Eouinmcnt I LS 5-400 $ 5 400.00 1.00 $5,400.00 s 1.00 s 5 o4CO.OD 100·~ 74 32' MH Pole JO' TS&. 10" LMJ\ G. sn. \ EA 8500 $ 850000 1.00 SB 500.00 $ . 1.00 $ B,500.00 100'!4, 76 32' MH Pole 43' TS & 10" LMA G. STI. I EA 9700 S 9.700.00 1.00 $9 700.00 s 1.00 s 9700.00 -~ 78 32' MH Pole 40' TS & IO' LJ,(A G. STL l EA 9700 S 29,100.00 3.00 $29,100.00 . s J .00 s 29 100.00 100% 79 12' MH Pole 511 TS .t. NO IMA G. STL I EA 12900 s 12 900.0D 1.00 S12 900.00 . $ 1.00 $ 12900.00 100% -80 l2' MH Pole 1"win TS & 10' LMA G. STI. I EA 16300 $ 16300.00 1.00 $16 300.00 $ 1.00 $ 16 300.00 100% 81 R.oachw,; Lumitwre 6 EA 540 s 3,240.00 6.00 $~ 240.00 . s . 6.00 s 3 240.00 100% 82 Service l'ole 2 EA 550 $ 1,100.00 2.00 $1 ,100.00 $ . 2.00 s 1, 100.00 100% B3 1/C No 6 Eloctrical Conductor 400 Lf 2 $ 800.00 400.00 $800.00 5 400.00 $ 800.00 I~ 84 IIC Na. ID Electrical Conductor 2 l lO LF 1.05 s 2 247.0D 2140.00 S2 247.00 $ 2 140.00 $ 2 , 47.00 100% 85 Traffic Sion,I Controller Assemblv 2 EA 25000 s 50,000.00 2.00 $50,000.00 . s 2.00 $ 50 DOD.OD 100% 86 Dcteclion Sn tem IVidea) I I..S 60000 s 60000,00 1.00 $60000.00 . s 1.00 $ 60000.00 100'h 87 I Wey JS«: ADJ SIG HD S-6 16 El\ 625 s 10 000.00 16.00 $10,000.00 $ . 16.00 $ 10,000.00 100% 88 !Wav 3Stc /I.DJ SIO HD S-9 2 EA 610 s 1,220.00 2.00 $1 ,220.00 $ . 2.00 $ 1,220.00 100% 80 I W1v 4Soc ADJ SIG HD A-I J 5 EA 750 s 3 750.00 5.00 $3 760.00 5i 5.00 s 3,750.00 100% 90 l Wav , s ec AJJJ AIG HD S· l 9 I EA 1050 $ 1050.00 1.00 $1 050.00 $ 1.00 s 1 050.00 100% 91 Backolale 24 EA 95 $ 2,280.00 24.00 $2260.00 $ 24.00 $ 2.280.00 100% 92 SIC Tnffic SiAt1ol El,..ricol Coble K90 Lf 1.4 $ 1,246.00 890.00 $1 .246.00 s 890.00 S 1,246.00 100% 93 7/C Traffic Sian, I Electxic.al (."able . 140 LF 1.8 $ 612.00 340.00 $612.00 $ . 340.00 s 012.00 1~ 94 2 I IC Tnillic Si ... l Electrical Cable t.l 2S LF 4.8 S 6 360.00 1325.00 $G 360.00 s 1 325.00 $ 6,360.00 100%

I 95 Ma.'J: Ann Mountt:J Simu Aluminum 175 SF 36.4 s 6.195.00 175.00 $6,195.00 s . 175.00 $ ___ 6,1 95.00 100%

TOTAL CONTRACT AMOUNT s z,a,.288.00 $2,155 836.lifi $ 128 020.10 $ 2,293,H6." 100%

AFFIDAVIT FOR CONTRACTS a PAYMENTS

STATE OF OKLAHOMA SI

COUNTY OF TULSA

The &Rlersigned (lffltlltact, connctDr. supplier or engineer), of lawful age, being first duly sworn. on

oath says that tttls contract Is true and conect. Afflant further atatn lhat the (work, aemcas or material&) wiR be

(completad or BtJpplled) in accordance wilh tha plans. specificationa, on:lers or requa,ts furnished the affiant

Afflant further statn that (a)he has made no payment dlrac:Uy or indifllCtly to any alect8d afflcial, officer or

eq,toyae of 1ha Sla18 of Oldahoma. any oowrtv or local subclvisiOn of the state, of money or any Dlher thing of

value to cbtaln or procun, the contract or pun:hase order.

PAttA6oN aotJfRRato~S, lLC BU&IN!SS NAME 0, QON'fflACT'OA, AACHl'T2CT. SUPPUEA OR ENCJINE!:R

av Di~ ~tE Fdll.flE$f, tnAI.Jllt;i~

20...ll Atlll8tad to before me lhls 28 day of ~

P@i PtJwit ! ~~-~µ:... PoLiv-aENNm----, ATTESTa> BV : \ \.5~L Notaiy Public !

: '