Improvements to Magalkod -Rabakavi road road from KM 0.00 to 1.00 in Raibag Taluk of Belagavi District Under CM FUND for the year 2025-26

Name of Work : Improvements to Magalkod -Rabakavi road road from KM 0.00 to 1.00 in Raibag Taluk of Belagavi District Under CM FUND for the year 2025-26 (WORK INDENT NO : 31309)

Sl no Items Unit Milestone -1 Quantity Milestone -2 Quantity Milestone -3 Quantity Total Quantity Rate in Rs. Amount for Mile Stone 1 in Rs Amount for Mile Stone 2 in Rs Amount for Mile Stone 3 in Rs Total Amount in Rs 30% 30% 40%

Estimate for Road

1 Scarifying the existing bituminous road surface to a depth of 50 mm and disposal of scarified material by Mechanical Means using Hydraulic excavator with in all lifts and lead (P No-17 / 3.5,Vol 3) m2 1470.000 1470.000 6.30 9261.00 0.00 0.00 Rs. 9,261.00 30% 30% 40%

2 Wet Mix Macadam (Plant mix method) Providing, laying, spreading and compacting graded stone aggregate to wet mix macadam specification including premixing the Material with water at OMC in mechanical mix plant carriage of mixed Material by tipper to site, laying in uniform layers with paver/grader in sub-base / base course on well prepared surface and compacting with vibratory roller to achieve the desired density.(P No-26 / 4.17,Vol 3) m3 1225.000 1225.000 2686.95 3291513.75 0.00 0.00 Rs. 3,291,513.75 30% 30% 40%

3 Prime Coat over WMM/WBM Providing and applying primer coat with SS1 grade Bitumen Emulsion on prepared surface of granular base including cleaning of road surface and spraying primer at the rate of 0.70 kg/m2 using mechanical means..(P No-31 / 5.1 A (i),Vol 3) m2 4900.000 4900.000 43.05 0.00 210945.00 0.00 Rs. 210,945.00 30% 30% 40%

4 Tack coat on Granular surface treated with primer Providing and applying tack coat with VG-10 Bitumen using pressure distributor at the rate of 0.25 kg/m2 on Granular Surface. (43/5.33, Vol-3) m2 4900.000 4900.000 15.75 0.00 77175.00 0.00 Rs. 77,175.00 30% 30% 40%

5 Tack coat on Bituminous surface treated with primerProviding and applying tack coat with RS1 Bituminous Emulsion using emulsion pressure distributor at the rate of 0.20 kg/m2 on the prepared bituminous surface cleaned with mechanical broom m2 6405.000 6405.000 12.60 0.00 80703.00 0.00 Rs. 80,703.00 30% 30% 40%

6 Bituminous Macadam Grading - II for traffic <20 MSA Providing and laying Bituminous Macadam with 40/60 TPH capacity hot mix plant using crushed aggregates of specified grading premixed with bituminous binder VG-30 @ 3.4% by weight of mix, transported to site, laid over a previously prepared surface with mechanical paver finisher to the required grade, level and alignment and rolled as per clauses 501.6 and 501.7 to achieve the desired compaction (P No-33/5.6(i) C,Vol 3) m3 400.000 165.250 565.250 8044.05 0.00 3217620.00 1329279.26 Rs. 4,546,899.26 30% 30% 40%

7 Semi Dense Bituminous Concrete Providing and laying Semi Dense Bituminous Concrete with 40/60 TPH capacity hot mix plant batch type using crushed aggregates of specified grading premixed with bituminous binder VG-30 @ 5% by weight of mix and filler, transported to site, laid over a previously prepared surface with mechanical paver finisher to the required grade, level and alignment and rolled as per MoRTH V revision. (P No-43 / 5.31,Vol 3) m3 282.625 282.625 10659.60 0.00 0.00 3012669.45 Rs. 3,012,669.45 30% 30% 40%

8 Construction of Subgrade and Earthen Shoulders Construction of sub-grade and earthen shoulders with approved material obtained from borrow pits with all lifts &leads, transporting to site, spreading, grading to required slopeand compacted to meet requirement of table No. 300-2 (P No-17/ 3.6, Vol 3) m3 54.075 54.075 517.65 0.00 0.00 27991.92 Rs. 27,991.92 30% 30% 40%

9 Providing and erecting direction and place identification retroreflectorised sign as per IRC:67:2022 made of high intensity grade sheeting vide clause 801.3, fixed over aluminium sheeting, 2 mm thick or Aluminium composite material sheet with overall thickness of 4mm with area not exceeding 0.9 m2 fixed over back support frame of min 35 x 35 x 3mm angle mounted on a mild steel circular pipe 65 NB, firmly fixed to the ground by means of properly designed foundation with M25 grade cement concrete 45 x 45 x 60 cm, 60 cm below ground level as per approved drawing m2 3.240 3.240 9444.75 0.00 0.00 30600.99 Rs. 30,600.99 30% 30% 40%

10 Providing and fixing of retro- reflectorised cautionary,mandatory and informatory sign as per IRC:67:2022 made of Class B Type IV retro reflective sheeting fixed over 2 mm thick aluminium sheeting vide clause 803.1, 3mm/4mm thick Aluminium composite material sheet depending on the size of the sign fixed over the back support frame of min 25 x 25 x 3mm angle mounted on a mild steel circular pipe 65 NB, 3.2 mm thickness firmly fixed to the ground by means of properly designed foundation with M25 grade cement concrete 45 cm x 45 cm x 60 cm, 60 cm below ground level as per approved drawing.The sign shall be maintained as per section 12 of IRC:67:2022. Each 6.000 6.000 3740.10 0.00 0.00 22440.60 Rs. 22,440.60 30% 30% 40%

11 Road Marking with Hot Applied Thermoplastic Compound with Reflectorising Glass Beads on Bituminous Surface Providing and laying of hot applied thermoplastic compound 2.5 mm thick including reflectorising glass beads @ 250 g/m2 area, thickness of 2.5 mm is exclusive of surface applied glass beads as per IRC:35:2015.The finished surface to be level, uniform and free from streaks and holes.(P No-67 / 8.15,Vol 3) m2 378.220 378.220 556.50 0.00 0.00 210479.43 Rs. 210,479.43 30% 30% 40%

12 Supplying and Fixing of Molded Shank Raised Pavement Markers / Cat's Eye made of polycarbonate and ABS moulded body and reflective panels with micro prismatic lens capable of providing total internal reflection of the light entering the lens face and shall support a load of 16000 kg tested in accordance to ASTM D 4280 Type H and complying to Specifications of Categorybased adhesive as per manufacturer's recommendation and complete as directed by the engineer.The contractor shall submit a two year warranty for satisfactory field performance including stipulated retro-reflectance of the reflecting panel, to the Engineer. (P No-74/ 8.43,Vol 3) Nos 264.333 264.333 383.25 0.00 0.00 101305.75 Rs. 101,305.75 30% 30% 40%

13 Painting with synthetic enamel paint of approved brand and manufacture of required colour to give an even shade :One coats on old work as per specifications and as per directions of Engineer in charge.. I No:8.64 P No-51 vol No-II 877.500 877.500 79.80 0.00 0.00 70024.50 Rs. 70,024.50 30% 30% 40%

Construction of CD

1 Earth work excavation for Foundation by mechanical means for all works & depth upto 3 m, as per drawing and technical specifications, including setting out, shoring, strutting, barricading, caution lights, including dressing of excavated surfaces, disposing off or levelling the excavated earth or sorting & stacking the selected earth for reuse in a radius of 50 m and lift upto 1.5 m including cost of labour, tools, usage of machinery & other appurtenaces required to complete the work (I.N:1.14.1/PN-8,Vol-1) m3 27.450 27.450 107.10 2939.90 0.00 0.00 Rs. 2,939.90 30% 30% 40%

2 Providing and laying in position plain cement concrete for levelling course for all works in foundation. The granite/trap/basalt crushed graded coarse aggregates and fine aggregates as per relevant IS Codes machine mixed, laid in layers not exceeding 150 mm thickness, well compacted using plate vibrators, including all lead & lifts, cost of all materials of quality, labour, Usage charges of machineries, curing, and all the other appurtenances required to complete the work as per technical specifications. (The cost of steel reinforcement & formwork shall be paid eparately) Mix 1:3:6 (M10) Using 20 mm nominal size graded crushed coarse aggregates m3 2.900 2.900 6213.90 18020.31 0.00 0.00 Rs. 18,020.31 30% 30% 40%

3 Providing and laying in position Reinforced cement concrete for all Sub structures of building, Irrigation works, Sub structure works of bridges, Drain works & other parallel works from 0.50m to 3.50 m height. The granite/trap/basalt crushed graded coarse aggregates and fine aggregates as per relevant IS Codes machine mixed with super plasticisers, laid in layers, well compacted using needle vibrators, providing weep holes wherever necesary, including all lead & lifts, cost of all materials of quality, confirming to the requirements of relevant IS codes, labour, Usage charges of machinery, curing and all other appurtenances required to complete the work as per technical specifications. (The cost of steel reinforcement & formwork to be paid separately) M20 Design Mix Using 20 mm nominal size graded crushed coarseaggregates m3 24.706 24.706 6532.05 161382.26 0.00 0.00 Rs. 161,382.26 30% 30% 40%

4 Formwork for CD Headwall Addendum I – Percentage Additionalities for Formwork, Centering & Scaffolding as at 8% (P No-111 Vol 1) m3 24.706 24.706 522.56 12910.58 0.00 0.00 Rs. 12,910.58 30% 30% 40%

5 Supplying, fitting and placing TMT FE 550 / 550D Steel Reinforcement including cost of all materials, machinery, labour, cleaning, straightening, cutting, bending, hooking, laping/welding joints, tying with binding wire / soft annealed steel wire and other ancilary operations complete as per drawing and technical specification.Super structure of Bridges MT 0.298 0.298 80381.70 23953.75 0.00 0.00 Rs. 23,953.75 30% 30% 40%

6 Providing and Laying Reinforced Cement Concrete Pipe NP3 as per design in Single Row Providing and laying reinforced cement concrete pipe NP3 for culverts on first class bedding of granular material in single row including fixing collar with cement mortar 1:2 but excluding excavation, protection works, backfilling, concrete and masonry works in head walls and parapets Clause 1101.6. 1000mm dia M 10.000 10.000 8355.90 83559.00 0.00 0.00 Rs. 83,559.00 30% 30% 40%

7 Construction of Embankment Construction of Embankment by excavating the available approved Gravel/Murrum deposited at a place or borrow pits during or prior excavation with all lifts and lead, transportation to site, spreading, grading to required slope and compacting to meet the requirement complete as per specifications, including cost of labour,rolling,water,all materials,usage& all other appurtenaces required to complete the work. m3 74.427 74.427 497.70 37042.42 0.00 0.00 Rs. 37,042.42 30% 30% 40%

Name of Work : Improvements to Magalkod -Rabakavi road road from KM 0.00 to 1.00 in Raibag Taluk of Belagavi District Under CM FUND for the year 2025-26

Recapitulation Sheet

Sl. No. Item of Work Amount Rs.

2 Construction of CD 339969.00 339994.96 -25.96

3 Tender Premium 5% 709886.73 709877.74

4 Third party inspection/QC charges 0.5% 75000.00 75000.00

Assistant Executive Engineer Executive Engineer P.W.D.

PWD Sub division Raibag PWD Division CHIKODI

Name of Work : Improvements to Magalkod -Rabakavi road road from KM 0.00 to 1.00 in Raibag Taluk of Belagavi District Under CM FUND for the year 2025-26

MEASUREMENT SHEET FOR ROAD

Sl No Description of Items Unit No L(m) B(m) D(m) Quantity Rate Amount 4.1

1 Scarifying the existing bituminous road surface to a depth of 50 mm and disposal of scarified material by Mechanical Means using Hydraulic excavator with in all lifts and lead (P No-17 / 3.5,Vol 3) 15000000.00 2.1

m2 Total Quantity 1470.00 6.30 9261.00 0.2 0.9

2 Preparation and Surface Treatment of Formation. Preparation and surface treatment of formation by removing mud and slurry, watering to the extent needed to maintain the desired moisture content, trimming to the required line, grade, profile and rolling with 8-10 t smooth wheeled roller, complete as per clause 310. (P No-18 / 3.11,Vol 3)

m2 Total Quantity 0.00 4.20 0.00

2 Granular Sub-Base-By Mix in Place Method Construction of Granular Sub-Base of required grading as per design spreading in uniform layers with motor grader on prepared surface mixing by mix in place method with front end loader at OMC and compacting with vibratory roller to achieve the desired density, complete as per clause 401-For Grading -V Material (P No-23 / 4.2 B (V),Vol 3)

m3 Total Quantity 0.00 2476.95 0.00

2 Wet Mix Macadam (Plant mix method) Providing, laying, spreading and compacting graded stone aggregate to wet mix macadam specification including premixing the Material with water at OMC in mechanical mix plant carriage of mixed Material by tipper to site, laying in uniform layers with paver/grader in sub-base / base course on well prepared surface and compacting with vibratory roller to achieve the desired density.(P No-26 / 4.17,Vol 3)

m3 Total Quantity 1225.00 2686.95 3291514.00

3 Prime Coat over WMM/WBM Providing and applying primer coat with SS1 grade Bitumen Emulsion on prepared surface of granular base including cleaning of road surface and spraying primer at the rate of 0.70 kg/m2 using mechanical means..(P No-31 / 5.1 A (i),Vol 3)

m2 Total Quantity 4900.00 43.05 210945.00

4 Tack coat on Granular surface treated with primer Providing and applying tack coat with VG-10 Bitumen using pressure distributor at the rate of 0.25 kg/m2 on Granular Surface. (43/5.33, Vol-3)

m2 Total Quantity 4900.00 15.75 77175.00

5 Tack coat on Bituminous surface treated with primerProviding and applying tack coat with RS1 Bituminous Emulsion using emulsion pressure distributor at the rate of 0.20 kg/m2 on the prepared bituminous surface cleaned with mechanical broom

Junction Mughalkod math 2 20.00 7.00 280.00

m2 Total Quantity 6405.00 12.60 80703.00

6 Bituminous Macadam Grading - II for traffic <20 MSA Providing and laying Bituminous Macadam with 40/60 TPH capacity hot mix plant using crushed aggregates of specified grading premixed with bituminous binder VG-30 @ 3.4% by weight of mix, transported to site, laid over a previously prepared surface with mechanical paver finisher to the required grade, level and alignment and rolled as per clauses 501.6 and 501.7 to achieve the desired compaction (P No-33/5.6(i) C,Vol 3)

Junction Mughalkod math 2 20.00 7.00 0.050 14.00

m3 Total Quantity 565.25 8044.05 4546899.00

7 Semi Dense Bituminous Concrete Providing and laying Semi Dense Bituminous Concrete with 40/60 TPH capacity hot mix plant batch type using crushed aggregates of specified grading premixed with bituminous binder VG-30 @ 5% by weight of mix and filler, transported to site, laid over a previously prepared surface with mechanical paver finisher to the required grade, level and alignment and rolled as per MoRTH V revision. (P No-43 / 5.31,Vol 3)

Junction Mughalkod math 2 20.00 7.00 0.025 7.00

m3 Total Quantity 282.63 10659.60 3012669.00

8 Construction of Subgrade and Earthen Shoulders Construction of sub-grade and earthen shoulders with approved material obtained from borrow pits with all lifts &leads, transporting to site, spreading, grading to required slopeand compacted to meet requirement of table No. 300-2 (P No-17/ 3.6, Vol 3)

m3 Total Quantity 54.08 517.65 27992.00

9 Providing and erecting direction and place identification retroreflectorised sign as per IRC:67:2022 made of high intensity grade sheeting vide clause 801.3, fixed over aluminium sheeting, 2 mm thick or Aluminium composite material sheet with overall thickness of 4mm with area not exceeding 0.9 m2 fixed over back support frame of min 35 x 35 x 3mm angle mounted on a mild steel circular pipe 65 NB, firmly fixed to the ground by means of properly designed foundation with M25 grade cement concrete 45 x 45 x 60 cm, 60 cm below ground level as per approved drawing

CMIDP Embeled Board m2 3 1.20 0.9 3.24

Total Quantity 3.24 9444.75 30601.00

10 Providing and fixing of retro- reflectorised cautionary,mandatory and informatory sign as per IRC:67:2022 made of Class B Type IV retro reflective sheeting fixed over 2 mm thick aluminium sheeting vide clause 803.1, 3mm/4mm thick Aluminium composite material sheet depending on the size of the sign fixed over the back support frame of min 25 x 25 x 3mm angle mounted on a mild steel circular pipe 65 NB, 3.2 mm thickness firmly fixed to the ground by means of properly designed foundation with M25 grade cement concrete 45 cm x 45 cm x 60 cm, 60 cm below ground level as per approved drawing.The sign shall be maintained as per section 12 of IRC:67:2022.

60 cm equilateral triangle Each 6 6.00

Total Quantity 6.00 3740.10 22441.00

11 Road Marking with Hot Applied Thermoplastic Compound with Reflectorising Glass Beads on Bituminous Surface Providing and laying of hot applied thermoplastic compound 2.5 mm thick including reflectorising glass beads @ 250 g/m2 area, thickness of 2.5 mm is exclusive of surface applied glass beads as per IRC:35:2015.The finished surface to be level, uniform and free from streaks and holes.(P No-67 / 8.15,Vol 3)

Intermediate Painting 2 115.50 0.10 23.10

m2 Total Quantity 378.22 556.50 210479.00

12 Supplying and Fixing of Molded Shank Raised Pavement Markers / Cat's Eye made of polycarbonate and ABS moulded body and reflective panels with micro prismatic lens capable of providing total internal reflection of the light entering the lens face and shall support a load of 16000 kg tested in accordance to ASTM D 4280 Type H and complying to Specifications of Categorybased adhesive as per manufacturer's recommendation and complete as directed by the engineer.The contractor shall submit a two year warranty for satisfactory field performance including stipulated retro-reflectance of the reflecting panel, to the Engineer. (P No-74/ 8.43,Vol 3)

Cat Eyes for left side & right side Nos 1 264 264

Total Quantity 264 383.25 101306.00

13 Painting with synthetic enamel paint of approved brand and manufacture of required colour to give an even shade :One coats on old work as per specifications and as per directions of Engineer in charge.. I No:8.64 P No-51 vol No-II

Painting of Divider 3 650.00 0.45 877.50

Total Rs 11692009.50

Assistant Executive Engineer, P.W.Department Sub-Division Raibag. Executive Engineer, P.W.Dept. Divn. Chikkodi

PWD Sub division Raibag

Construction of 1 CDs @ 0.450 of 1000 dia NP 3 Pipes

Sl No Item of work Unit Qty Rate Amount Rate Wtage Total rate Amount Rate Amount

1 Earth work excavation for Foundation by mechanical means for all works & depth upto 3 m, as per drawing and technical specifications, including setting out, shoring, strutting, barricading, caution lights, including dressing of excavated surfaces, disposing off or levelling the excavated earth or sorting & stacking the selected earth for reuse in a radius of 50 m and lift upto 1.5 m including cost of labour, tools, usage of machinery & other appurtenaces required to complete the work (I.N:1.14.1/PN-8,Vol-1)

Construction of 1 CDs @ 0.450

2 Providing and laying in position plain cement concrete for levelling course for all works in foundation. The granite/trap/basalt crushed graded coarse aggregates and fine aggregates as per relevant IS Codes machine mixed, laid in layers not exceeding 150 mm thickness, well compacted using plate vibrators, including all lead & lifts, cost of all materials of quality, labour, Usage charges of machineries, curing, and all the other appurtenances required to complete the work as per technical specifications. (The cost of steel reinforcement & formwork shall be paid eparately) Mix 1:3:6 (M10) Using 20 mm nominal size graded crushed coarse aggregates

Construction of 1 CDs @ 0.450

3 Providing and laying in position Reinforced cement concrete for all Sub structures of building, Irrigation works, Sub structure works of bridges, Drain works & other parallel works from 0.50m to 3.50 m height. The granite/trap/basalt crushed graded coarse aggregates and fine aggregates as per relevant IS Codes machine mixed with super plasticisers, laid in layers, well compacted using needle vibrators, providing weep holes wherever necesary, including all lead & lifts, cost of all materials of quality, confirming to the requirements of relevant IS codes, labour, Usage charges of machinery, curing and all other appurtenances required to complete the work as per technical specifications. (The cost of steel reinforcement & formwork to be paid separately) M20 Design Mix Using 20 mm nominal size graded crushed coarseaggregates

Construction of 1 CDs @ 0.450

Duduction for pipes -1 1 I I (1.05)2/ 4 (1.00+0.65)/2 -0.72

4 Formwork for CD Headwall Addendum I – Percentage Additionalities for Formwork, Centering & Scaffolding as at 8% (P No-111 Vol 1) m3 24.71 522.56 12911.00

6 Supplying, fitting and placing TMT FE 550 / 550D Steel Reinforcement including cost of all materials, machinery, labour, cleaning, straightening, cutting, bending, hooking, laping/welding joints, tying with binding wire / soft annealed steel wire and other ancilary operations complete as per drawing and technical specification.Super structure of Bridges

Construction of 1 CDs @ 0.450

Length No of Bras Total Length in (m) Weight in kg/m Total Weight in kg

Head wall Dist Bar 8mm@200mm c/c 2.00 5.00 38 190.00 0.39 74.10 148.20

7 Providing and Laying Reinforced Cement Concrete Pipe NP3 as per design in Single Row Providing and laying reinforced cement concrete pipe NP3 for culverts on first class bedding of granular material in single row including fixing collar with cement mortar 1:2 but excluding excavation, protection works, backfilling, concrete and masonry works in head walls and parapets Clause 1101.6. 1000mm dia

Construction of 1 CDs @ 0.450

8 Construction of Embankment Construction of Embankment by excavating the available approved Gravel/Murrum deposited at a place or borrow pits during or prior excavation with all lifts and lead, transportation to site, spreading, grading to required slope and compacting to meet the requirement complete as per specifications, including cost of labour,rolling,water,all materials,usage& all other appurtenaces required to complete the work.

Construction of 1 CDs @ 0.450

For C.D portion

In between Headwall 1 5.00 (6.10+5.50)/2 2.60 75.4

Duduction for pipes -1 1 I I (1.05)2/ 4 (6.10+5.50)/2 -5.02

74.43 #REF! #REF!

Total Rs for 1 CD 339969.00

Assistant Executive Engineer Executive Engineer

PWD Sub Div Raibag PWD Div Chikkodi

Information on litigation in which the Tenderer is involved:

Other Party/Parties Employer Details of Dispute Amount involved Remarks showing Present Status

BANKER’S CERTIFICATE

This is to certify that M/s. ………………………….. is a reputed company with a good financial standing. If the contract for this work, namely ……………………………… (Name of the work) is awarded to the above firm, we shall be able to provide overdraft/credit facilities to the extent of Rs. …………… to meet the working capital requirements for executing the above contract

Name of the Bank, Senior Bank Manger

Address:…………………………

List of Machinery

Item of Equipment Requirement Owned/ Hired/Leased Owned/ Hired/Lease and available Remarks

No. Capacity Number/Capacity Age/ Condition

Information of the works for which Tenderer has submitted Tender.

Project Name Name & Address of the Employer Name of Work Amount put to Tender in Rs lac. Specified period of completion (including/excluding Monsoon Prescribed last date of submission of tender Probable date of decision on the Tender Remarks if any.

Information of the works for which Tender acceptance letters are received.

Project Name Name & Address of the Employer Name of Work Tendered Amount in Rs lac Specified period of completion (including/excluding Monsoon Probable Date of Handing over of site

Attach letters of Acceptance received.

Information on works which are yet to be completed.

Project Name Name & Address of the Employer Name of Work Contract Number Value of contract Rs. Lakhs Date of Markout /Date of Handing over of site Specified period of completion (including/excluding Monsoon cost of balance works remaining Rs. in lac Probable date of completion

Attach Certificate for each work indicated above, in Format 3, obtained from the Competent Authority

Monthly Physical and Financial Progress Achieved in all Contracts which are referred to in Format 3

Names of Works Item of Work Names of Employers 2018-19 Remarks (Indicate contract reference)

January February march April May June July August September October November December

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Concrete in cum Physical

Steel in MT Physical

Others Specify Details Physical

FORMAT FOR WORK DONE CERTIFICATE TO BE OBTAINED FROM COMPETENT AUTHORITY

has executed/ is executing(strike off which ever is not applicable) the work of .............................................

in this Organisation. The details of the work is as under:

1 Name of the Project :

2 Name of the Work :

3 Contract Amount :

4 Date of signing the Agreement :

5 Date of handing over of the Site :

Progress * : 2018-19

January February March April May June July August September October November December

Earthwork & Embankment Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2019-20

January February March April May June July August September October November December

Earthwork & Embankment Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2020-21

January February March April May June July August September October November December

Earthwork & Embankment Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2021-22

January February March April May June July August September October November December

Earthwork & Embankment Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2022-23

January February March April May June July August September October November December

Earthwork & Embankment Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

7 Stipulated Period of Completion (including monsoon)

8 Prescribed Date of completion

9 Actual Date of Completion/ Probable Date of Completion

10 Cost of balance work (if work is in progress) :

11 Reasons if any for delay in completion, if work completion is delayed :

12 Penalty if any imposed :

13 Any other information :

* Monthwise progress shall be furnished seperately.

Date: (Authorised Signatory)

Address for correspondence:

Work executed as prime contractor (in the same name) on works of similar nature during the five years specified)

Project Name Name & Address of the Employer Name of Work Contract Number Value of contract Rs. Lakhs Date of Markout /Date of Handing over of site Specified period of completion (including/excluding Monsoon Actual date of completion Remarks (appreciation letter received for early completion or reasons, if there is delay in completion)

Attach Workdone Certificate for each work indicated above, in Format 3, obtained from the Competent Authority

Financial Year Total value of Civil Engineering works executed and payments received in the last five years (in Rs. lac)

Billed upto date during 2023-24

Attach Chartered Accountant's Yearwise Statements.