MONTHLY ASPHALT CEMENT COST ADJUSTMENT WORKSHEET

Est Date:
Ave AC price index for the calendar month prior to the calendar month in which bids are
opened (BP), $/Ton
Ave AC price index for the calendar month prior to the calendar month in which the partial
estimate pay period ends (EP), $/Ton
Quantities paid on current month estimate
403 - Hot Mix Asphalt
HMA/SMA Tons
% AC (PA) Placed this pay
Item Code Item Description (decimal)** period

Total Cost Adjustment for Pay Period

403 - Stone Matrix Asphalt
HMA/SMA Tons
% AC (PA) Placed this pay
Item Code Item Description (decimal)** period (Q)

Total Cost Adjustment for Pay Period

411- Asphalt Cement
Asphalt Cement
placed this pay
Item Code Item Description period (Tons) (Q)

Total Cost Adjustment for Pay Period

Total HMA Cost Adjustment (FA) for Estimate
Prepared by:
Date: Reference #
Instructions: Enter data in the yellow cells to calculate the Asphalt Cement cost adjustment
- Enter the estimate cutoff date and estimate number
- Ave AC price index for the calendar month prior to the calendar month in which bids are opened (BP).
- Ave AC price index for the calendar month prior to the calendar month in which the partial estimate pay period
ends(EP).
- Enter the item code, description and the quantity paid for each item on the current estimate that is included in
the Asphalt Cement Cost Adjustment Project Special Provision . **(Follow instructions for "PA" in specification if
RAP is used)
- This form automatically calculates the +/- 5% "trigger" shown in the specification.
- If the total AC cost adjustment is positive or negative, enter the amount shown as an asphalt cement cost
adjustment pay item on the estimate (negative numbers are red and in parentheses). Use Plan Force Account 700-
70019.
 - Enter the Date Prepared and the Reference # (The reference number is determined by the Project Engineer to
reference the report).
- Print this form, sign it, or save it electronically and include it in your project documentation.
NT WORKSHEET

mate

AC Cost Adjustment
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

AC Cost Adjustment
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

AC Cost Adjustment
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

adjustment

h bids are opened (BP).

h the partial estimate pay period

rent estimate that is included in

tions for "PA" in specification if

on.
n as an asphalt cement cost
es). Use Plan Force Account 700-
mined by the Project Engineer to

cumentation.