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Mn/DOT TP- (1 -93) STATE OF MINNESOTA - DEPARTMENT OF TRANSPORTATION SUMMARY OF DAILY FORCE ACCOUNT WORK ORDER 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 8/21 /2011 to 8/27/2011 Location CRT Sgmnt E Regrade 7228 Mill (EWA 24494) Engineer Stantec Consulting Inc. 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 4.5 0 $ 30.97 $ 139.37 1 Cat 247B Skid Loader 4.00 $ 26.34 $ 105.36 1 Foreman 2.5 0 $ 30.97 $ 77.43 1 Cat 950F Loader 2.00 $63.36 $ 126.72 N W SALES TAX S - SUB -TOTAL 5 Total Overtime PLUS 15% $ - SUB TOTAL (Taxable Wales) $ 216.79 TOTAL OF MATERIAL $ - PLUS • 't. of Taxable W. _e $ 134.41 1904 SPECIALTY CONTRACTOR SUB -TOTAL $__ 351.20 Invoice Cost S. • 'alt Contractor $ - SUB -TOTAL $ 232.08 Other Labor - related cost chargeable (A) $ - @5% = $ - PLUS Q$t _ $ - to This Supplemental Agreement / Work Order (B) $ - @2% = $ - TOTAL OF EQUIPMENT $ 2S2.08 Health and Welfare $ 46.55 TOTAL SPECIALTY CONTR. $ - COMPUTATION OF PRIME CONTRACTOR Pension Fund S 44.24 1904(4) MISC COMPENSATION ALLOWANCE Other Fringe Benefits $ 1.82 Type: i.e. dump fees, permits, etc. (A) No Sub @ MS _ $ - Travel (B) , No Sub @ 2S _ $ - Subsistence - TOTAL ALLOWANCE (A +B) $ - , TOTAL OF LABOR $ 443 -8.1 TOTAL MISC. COMP. $ - GRAND TOTAL MA- Send original and two copies to Central Office with Final Estimate The above report includes only items chargeable to Work Order 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 Consulting Inc. COnttactOt invoices must accompany same. /17j � See Const. Manual 5- 591.484 for instructions in preperation. By n