Form CA-D-11

State of Ohio

Department of Transportation

Contractor Progress Payment Certification

Project Number: / 11-0002 / County/Route/Section: / ALL-309-8.35
PID: / 24247 / Federal Project Number: / E050(026)
Contractor: / S E T Inc.
Estimate Number: / 6 / Estimate Date: / 05/30/11
I, John DeSantis , a duly authorized representative of the Prime Contractor for the reference Project, hereby verify based on personal knowledge or reasonable investigation and good faith belief that all items represented by this estimate were constructed in reasonably close conformity with the Contract Documents.
Pursuant to C&MS 109.09, this document acknowledges full, fair and timely compensation for the work represented by this estimate.
Contractor signature / Title / Date
Instructions:
Project Number: Show the project number on the contract.
PID:Show the PID
Federal Proj Number: Show the Federal Project number
County/Route/Section:Show the County Route and Section
Contractor: Show the prime Contractor's full company name.
Estimate Number: Show the estimate number that this certification corresponds to.
Estimate Date: Show the estimate date that this certification corresponds to.
The first sentence should denote the printed or typed name of the authorized Contactor’s project representative (as listed on the form CA-D-10).
The same authorized representative will provide the signature, title and dates on the form.
Only the duly authorized Contractor personnel (as provided by the form CA-D-10) are approved to sign the Contractor Progress Payment Certification.
EST ESTIMATE INFORMATION 06/04/11 10:53
Act: U D01JS1 CMCAS030
Proj: 11 0002 ALL SR 309 008.35 PE/PS: SHANAHA J1 Dist: 01
Est: 6 PE/PS Approval: N
Period End: 05/30/11 Dist Approval: N
Final Est: N Deficient Payrolls: Y Fed Acpt Type:
Contractor: S E T INC
Tax ID: 341597270 Contractor Certification Date:
Previous ($) This Period ($) Total ($)
Retainage: 0.00 0.00 0.00
Auto Liq Damages: 0.00 0.00 0.00
Man Liq Damages: 0.00 0.00 0.00
Thin Pavement: 0.00 0.00 0.00
Liens: 0.00 0.00 0.00
Incentive: 0.00 0.00 0.00
Disincentive: 0.00 0.00 0.00
Other Deductions: 0.00 0.00 0.00
Reference Total: 957,709.26 100,933.94 1,058,643.20
Warrant Amt: 957,709.26 100,933.94 1,058,643.20
F4 LIST F5 LIQID F6 LIENS F9 RMKS F11 ESTR F12 PRNT
ESTR ESTIMATE REFERENCES 06/04/11 10:54
Act: U D01JS1 CMCAS031
Proj: 11 0002 ALL SR 309 008.35 PE/PS: SHANAHA J1 Dist: 01
Est: 6 Period End: 05/30/11
Starting At: 1
Matls ------This Estimate ------
A Ref EW PC ADJ Available DlvTst Quantity Rev Amount ($) Rmk
1 01 6,405.000 3,202.50
2 01 2,617.000 190.000 1,445.90
12 01 72.000 11.000 2,251.81
47 01 11.500 11.000 108.57
50 01 88.500 14.000 221.76
53 01 3,328.700 Y 952.300 50,062.41 Y
54 01 501.000 Y 8.500 365.16 Y
64 01 8.000 1.000- 2,415.84-
65 01 98.000 13.000 22,320.87
67 01 11.000 4.000 5,692.32
71 01 14.000 1.000 2,974.87
92 01 22,696.900 1,150.000 14,064.50
117 01 66.000 11.000 149.16
118 01 66.000 12.000 162.72
200 01 200.000 Y 17.650 327.23 Y
F4 LIST F5 ESTRH F6 DEMAT F7 BKWD F8 FRWD F9 RMKS F11 EST F12 PBOM