Repairs to Office of the Assistant Director of Land Records (ADLR) office on the Second floor of the Administrative Building at Chikodi of Belagavi Dist under the H/A 8443 Deposit Contribution.

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

Note: Minimum 50% of the required machinery should be owned by the Tenderer. Remaining 50% of the required machinery may be owned / procurred on Lease basis / Hire basis.

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

No. Capacity Number/Capacity Age/ Condition

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 :

6 Items executed :

Earth work excavation :

UCR/SSM/B.B.M :

P.C.C / R.C.C :

Alluminium & Steel work (Doors, Windows & Partition) :

Address for correspondence:

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

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

Year Name of work Name of Employer Quantity of work performed Remarks (Indicate contract reference)

2012-13 Exc & Embankment

Water Prrofing/Wall Panneling

2013-14 Exc & Embankment

Water Prrofing/Wall Panneling

2014-15 Exc & Embankment

Water Prrofing/Wall Panneling

2015-16 Exc & Embankment

Water Prrofing/Wall Panneling

2016-17 Exc & Embankment

Water Prrofing/Wall Panneling

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)

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