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Mn/DOT TP -21659 (1 -93) STATE OF MINNESOTA - DEPARTMENT OF TRANSPORTATION SUMMARY OF DAILY FORCE ACCOUNT SUPPLEMENTAL AGREEMENT No. 1 Sheet 1 of 1 S.P. No. 02- 090-01 Fed Proj No. Contract No. 2010 -0601 Contractor / Sub. Veit Construction For Period from 7/3/2011 to 7/9/2011 Location CRT EC Maintenance during Shutdown Engineer Stantec LABOR MATERIAL EQUIPMENT RENTAL # of Men Position Title Hrs OT/Hr Pay Rate Amount No. Kind of Material Rate Amount No. Description Total Hrs Rate Amount 1 Laborer 8 0 $ 30.97 $ 247.76 1 Cat 247B Skid Loader 0.50 $ 26.34 $ 13.17 1 Superintendant 3 0 $ 33.97 $ 101.91 1 3/4 ton Pickup 3.00 $11.00 $ 33.00 • co SALES TAX $ - SUB -TOTAL $ - Total Overtime PLUS 15% $ - SUB TOTAL (Taxable Wages) $ 349.67 TOTAL OF MATERIAL $ - PLUS 62% of Taxable Wage 6:1 1904 (7) SPECIALTY CONTRACTOR SUB-TOTAL .. Invoice Cost Specialty Contractor $ - , SUB -TOTAL $ 46.17 Other Labor - related cost chargeable ? (A) $ - @5% = $ - PLUS 012 $ - to This Supplemental Agreement / Work Order (B) $ - @2% = $ - TOTAL OF EQUIPMENT $ 46.17 Health and Welfare $ 76.90 TOTAL SPECIALTY CONTR. _ $ - ' COMPUTATION OF PRIME CONTRACTOR Pension Fund $ 72.16 j 1904(4) MISC COMPENSATION I ALLOWANCE Other Fringe Benefits $ 6.58 `Type: i.e, dump fees, permits, etc. (A) No Sub @ 10 = $ _ Travel (B) No Sub ^ @ 2.% _ $ - Subsistence TOTAL ALLOWANCE (A +B) $ - TOTAL OF LABOR $ 722.11 (TOTAL MISC. COMP. $ - GRAND TOTAL 1 $ 768.2$ Send original and two copies to Central Office with Final Estimate The above report includes only items chargeable to Supplemental Agreement No. 1 All coppies must be signed by the engineer, and the Contractor or their Authorized Agent. Note: When material is billed on this sheet, receipted Engineer Stantec Contractor invoices must accompany same. See Const. Manual 5- 591.484 for instructions in preperation. By _____AO g/