New Jersey Department of Transportation

CLAIMS COST STATEMENT

TO:		Denis Sanders
		Claims Management
		Office of the Assistant Commissioner
		
FROM:                  Region Maintenance

CLAIM #                      

SUBJECT:	Cost Repair for Guiderail & Appurtenances by Contractor                      

CONTACT #	                 

INCIDENT DATE:         

DATE PREPARED:	      

The Following is the cost breakdown for repairs to DOT Roadway properties.
 The Location:      

The costs are as follows:

1.	Supervision: $ 100.00/hour x         hours	=$0.00 	
2.	N.J.D.O.T. labor cost for field investigation of damage $ 82.00/hour x       hours	=$ 0.00	
3.	N.J.D.O.T. Equipment cost for field investigation of damage $ 13.35/hour x       	=$0.00 	
4.	Removal of Damaged Guiderail: $     /LF x       LF	=$ 0.00	
5.	Installation of new       Beam Guiderail:  $        /LF x       LF	=$ 0.00	
6.	Installation of       Rub Rail  $      /LF x       LF	=$ 0.00	
7.	Installation of       Guiderail Posts @ $      each	=$ 0.00	
8.	Installation of insert text End treatment:       @ $      each	=$ 0.00	
9.	Installation of 0.00 insert text @ $      each	=$ 0.00	
10.	Installation of 0.00 insert text @ $      each	=$ 0.00	
11.	Installation of 0.00 insert text @ $      each	=$ 0.00	
	TOTAL:	=$0.00	
	Prepared by:      		
	Estimated by: