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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION STATE FORCE AND CONTRACT COST DOCUMENTATION FORM 850-005-02 MAINTi:NANCE 07199 Richard Clarke FOREMAN (For reporting repair of damage to state property or equipment or other state force work) WORK PERFORMED Clean Washout LOCATION US 301 and Pretty Pond at Wal-Mart Construction site STATE ROAD NO, 39 COUNTY PASCO DATE OF ACCIDENT 6-5-2002 DATE OF REPAIRS 6"5-2002 Employee Name and Title Richard Clarke Operation & Maintenance Support / Level V Michael Carter Operation & Maintenance Support I Level III Michael Dewey Operation & Maintenance Support / Level III COST CENTER NO, 798 Hourly(l) Hours (2) Rate Amount $20,49 x 3,00 $61,47 $13,57 x 4,50 = $61,07 $12,46 x 4,50 = $56,07 x = x = x = ---- x = ----- x = ---- x = --- x LABOR COST: Benefits = $ Overhead = $ No, Inmates SUb-Total = $178,61 178,61 (3) x 0,5488 (current factor) = $98.02 178,61 (3) x 0,2220 (current factor) = $39,65 x (hours) x _ Ihr(rate) = LABOR COST: $316,28 (\) Divide bi-weekly rate by 80 (hours), (2) Include overtime hours if applicable, Show exempt employees at actual hours, straight time, (3) Enter above, 'EQUIPMENT: Trailer FB - 9 ton 8 yard dump Tractor Loader Sweeper, Tractor Mount 3/4 ton Pickup Type DOT No, (Miles/Hours) Unit Cost 24676 4 hours x 1,60 = $6.40 24911 75 miles x 0,78 = $58,50 11311 2 hours x 15,81 = $31.62 11612 4 hours x 1,62 = $6.48 27108 80 miles x == 0,3:1:=== $27,20 x = ----- x = ---- x = EQUIPMENT COST: $130,20 No, Each x = ----- x = ----- x = ----- -----.- x = ----- ---- x = ---- x = MATERIALS COST: MATERIALS: Item CONTRACT COST: Item No, Each x = x = ---- x = ----- x ---- x = -- x CONTRACT COST: TOTAL COST: $446,48 RECYCLED PAPER @