2021-05-25 Certificate of Completion and ReleaseState of Nebraska Form No. 1643d
NDOT - Division of Aeronautics Sheet No. 1 of 2
Lincoln, Nebraska
CERTIFICATE OF COMPLETION AND RELEASE
FROM: State of Nebraska, NDOT-Division of Aeronautics, Agent for the Party of the
First Part to the Contract.
FROM: PSC Construction, Inc. of Blair, Nebraska , Party of the
Second Part to the Contract.
TO: Blair Airport Authority, Party of the First Part to the Contract.
RE: Contract for the Blair Municipal Airport Project No. 3-31-0109-016,
entered into on the 20th day of July, 2020 between the
Party of the First Part and the Party of the Second Part.
CERTIFICATE OF COMPLETION
THIS IS TO CERTIFY, that all of the work and materials have been inspected by duly
authorized agents of the Party of the First Part and that the Contractor has furnished all labor and
materials and services required for the above noted Contract and Project Number and performed
all work in accordance with the requirements of the plans and specifications for said Contract,
and that notification of final acceptance of the work as stated above is hereby made contingent
upon proper execution of conditions of, and the signature of acceptance by the Contractor of the
"Certificate of Release" hereinafter specified. The final payment in the amount as listed in said
"Certificate of Release" is due and payable upon the complete execution of the "Certificate of
Release".
i
Approved
(NDOT Engineer)
APPROVED
clerk or Secretary
Blair Airport Authority
Blair. Nebraska
(Party of the First Part)
By: State of Nebraska, NDOT - Division
of Aeronautics, Agent
1
rF
<fl- t (Director)
I
Ma �ii�Gfi_a_n_,,"
Date
Sheet No. 2 of 2
CERTIFICATE OF RELEASE
KNOW ALL MEN BY THESE PRESENTS:
A. The undersigned hereby certifies that there are no outstanding claims of
laborers, materialmen, subcontractors, or others arising out of the performance
of this contract, which might be asserted against the Blair Airport Authority,
Party of the First Part and the undersigned agrees that, in the event of the
assertion of any such claims against said Party of the First Part the undersigned
will indemnify and save harmless said Party of the First Part from any such claims.
B. That the undersigned hereby acknowledges receipt from the Party of the First
Part of all sums payable to the undersigned by said Party of the First Part under
or pursuant to the above-mentioned Contract, with the following exceptions:
the amount of fifteen thousand dollars and no cents ($15,000.00)
now due and payable as shown on Progress Estimate No. 6 -Final.
C. The undersigned further certifies and acknowledges that the Party of the First
Part has duly performed and fulfilled the terms, provisions and conditions on
the part of the Party of the First Part to be performed or fulfilled under or
pursuant to said Contract, with the exceptions as noted above.
D. That the undersigned, except as regards items listed in paragraph "B", does
hereby release the Party of the First Part from all claims arising under or by
virtue of said Contract.
IN WITNESS WHEREOF, the undersigned has signed and sealed this instrument this
day of 9
PSC Construction, Inc.
Y
' V l t being first duly sworn on oath, deposes and says, first,
that he/she is the X&x w,,of PSC Construction, Inc.
(Tii e) (Name of Company)
second, that he/she has read the foregoing certificate by him subscribed.
The matters and things stated therein are, to the best of his knowledge and belief, true.
Subscribed and sworn to before me on this day of C0 , z'�I:i ,2-0
GENERAL NOTARY - State of Nebraska'
LAURATOTILAS (Notary Public)
My Comm, Exp. August 24, 2024
e My Commission expires 211
(Seal)
NEBRASKA DEPARTMENT OF TRANSPORTATION
DIVISION OF AERONAUTICS
Sponsor: Blair Municipal Airport
Attn: Rod Storm
218 South 16th Street
Blair, NE 68008
Contractor: PSC Construction, Inc
1569 Washington Street
Blair, NE 68008
Blair Municipal Airport
AIP : 3-31-0109-016
Olsson: 019-3440
PROGRESS ESTIMATE
RFCEIVb0 Date: 4/14/2021
APR 2 6 2021 Estimate No. 6/FINAL
Date of Contract: 7/20/2020
NDOT-DIV OF AERONAUTICS
Original Contract: $651,607.40
Change Orders: -$18,455.58
Orginal Contract and Change Orders: $633,151.82
Item
No.
C.O.
No.
Spec
No.
Item Description
Original
Contract
Quantity
Change
Order
Quantity
Overall
' Revised
Contract
Quantity
Unit
Estimated
Quantities
To Date
Unit
Price
Amount
1
1
C-102
Temporary Seeding
3.1
-0.2
2.9
AC
0
$900.00
$0.00
2
1
C-102
Silt Fence Installation and Removal
1,467
435
1,902
LF
2,220
$5.00
$11,100.00
3
1
C-102
Erosion Control Blanket (NDOT Class 1 D)
3,645
-949
2,696
SY
2,696
$1.42
$3,828.32
4
1
C-102
Wattle Barrier Installation and Removal
192
-160
32
LF
32
$12.00
$384.00
5
C-105
Mobilization (N.T.E. 10%)
1
1
LS
1
$10,000.00
$10,000.00
6
P-101
Concrete Pavement Removal
110
110
SY
110
$11.25
$1,237.50
7
P-101
24" Corrugated Metal Pipe (CMP) Removal
49
49
LF
48
$5.00
$240.00
8
1
P-101
36" Reinforced Concrete Pipe (RCP) Removal
50
-33
17
LF
8
$5.00
$40.00
9
P-101
36" Flared End Section Removal
1
1
EA
1
$100.001
$100.00
10
P-101
Riprap Removal
1
1
LS
1
$245.00
$245.00
11
P-151
Clearing and Grubbing (Area 1)
1
1
LS
1
$1,000.00
$1,000.00
12
P-151
Clearing and Grubbing (Area 2)
1
1
LS
1
$1,000.00
$1,000.00
13
P-151
Tree Removal
5
5
EA
5
$500.00
$2,500.00
14
1
P-152
Unclassified Excavation
8,775
-1,300
7,475
CY
7,475
$12.50
$93,437.50
15
P-152
Muck Excavation
225
225
CY
32
$14.50
$464.00
16
D-701
24" Class IV Reinforced Concrete Pipe (RCP)
100
100
LF
104
$75.00
$7,800.00
17
D-701
24" Class IV RCP Flared End Section
2
2
EA
2
$550.00
$1,100.00
18
1
D-701
36" Class IV Reinforced Concrete Pipe (RCP)
176
44
132
LF
132
$175.00
$23,100.00
19
D-701
36" Class IV RCP Flared End Section
1
1
EA
1
$2,000.001
$2,000.00
20
D-701
Reinforced Concrete Pipe (RCP)
150
150
LF
152
$250.001
$38,000.00
21
D-701
Flared End Section
2
2
EA
2
$2,200.00
$4,400.00
22
D-751
IManhole Structure (60 -inch)
1
1
LS
1
$5,250.00
$5,250.00
23
1
T-901
Seeding
3.4
-0.2
3.2
AC
3.2
$2,500.00
$8,000.00
24
T-908
Mulching
2.7
2.7
AC
2.7
$1,500.00
$4,050.00
25
NDOT
423
5' Yellow Permanent Pavement Marking, Paint
79
79
LF
178
$5.00
$890.00
26
N6 O2T
Sealing Joints
7,956
7,956
LF
8,027
$2.00
$16,054.00
27
NDOOT
Rock Riprap, Type B
45
45
TON
45
$77.00
$3,465.00
28
ND OT
Reset Right -of -Way Markers
4
4
EA
4
$130.00
$520.00
29
Olsson
7-inch NDOT 4713-4000 PCC
5,032
5,032
SY
5,032.00
$59.25
$298,146.00
30
Oiss n
8 -inch NDOT 4713-4000 PCC
539
539
SY
539.0
$60.00
$32,340.00
31
Olsson
10-inch NDOT 47B-4000 PCC
244
244
SY
244
$70.00
$17,080.00
32
Isso
0101 n Construction Layout and Stakes
1
1
LS
1
$24,000.00
$24,000.00
Page 1 of 2
Blair Municipal Airport
All? : 3-31-0109-016
Olsson: 019-3440
33
,Ailoweci ..., = LD De�:s .... <.. "tD 1=ess_GatculaYel :;'
Olsson
Hwy 133 Traffic Control -
35
35
256,939.11
2
16
12 4 $8,000.00
Est. No. 4
3
18
102
See Change Order No. 1 - below
Total
69
65
607,220.32
34
olss n
Aggregate/Asphalt Milling Removal/Salvage
606
606
CY
606
$4.50
$2,727.00
35
Olsson
Salvaged Aggregate/Asphalt Milling Shouldering
1,276
1,276
SY
1,276
$2.50
$3,190.00
36
Olsson
Concrete Parking Block
8
8
EA
8
$75.00
$600.00
37
Oiss n
Stop Sign
1
1
EA
0
$500.00
$0.00
101 V307 4 -inch Foundation Course 274
33 Olsson
Hwy 133 Traffic Control - Unit Price Change 1
Workinn/(:alenriar nRv Crnint/I inuiriateri n;,manes (I r)1*
„Phase Gleed., `.
,Ailoweci ..., = LD De�:s .... <.. "tD 1=ess_GatculaYel :;'
$
1
35
35
256,939.11
2
16
12 4 $8,000.00
Est. No. 4
3
18
18
$
Total
69
65
607,220.32
274 SY 274 $18.00 $4,932.00
1 LS 1 $7,000.00 $7,000.00
*Per Special Provisions (Page SP -2) - Liquidated Damages - $2,000 per working day
As Project Engineer, I hereby state that the quantities shown above have been computed from measurements made by me or the
resident observer and that the work has been performed according to plans and specifications.
PROJECT
ENGINEER
Olsson V
APPROVED*:
NDOT Prrgt -et Engineer
* Approved for payment as per Proie t Engineer's certification
r �
APPROVED: & s
Sponsor
PreyicjusE,sttlmates�;;=° ;
Est. No. 1
$
106,655.40
Est. No. 2
$
256,939.11
Est. No. 3
$
127,688.94
Est. No. 4
$
61,176.09
Est. No. 5
$
54 760.78
Total:
$
607,220.32
Page 2 of 2
Date: 4/14/2021
Date: 4/26/2021
.- /"`
Date: z �'
Grand Total
$630,220.32
Less Retained
$0.00
Liquidated Damages
$8,000.00
Less Previous Estimates
$607,220.32
Total Due Contractor
$15,000.00
Date: 4/14/2021
Date: 4/26/2021
.- /"`
Date: z �'