Filling Potholes to MDR-31102 Road from Hurlihalu (on SH223) connecting Katrikehatti via Chikkajogihalli, Jummobanahalli, Poojarahalli road from km km 0.00 to 17.66 in selected reachas Kudligi taluku Vijayanagara District.(HOA 3054 MDR MAINTENANCE)(Reserve for Catogery-1 )

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

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 2011 Remarks (Indicate contract reference)

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

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm Physical

Others Specify Details Physical

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm Physical

Others Specify Details Physical

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm Physical

Others Specify Details Physical

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm Physical

Others Specify Details Physical

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm Physical

Others Specify Details Physical

Earthworks in cum Physical

Grade III metalling to Road in cum Physical

Bitumenous Macadam in cum Physical

Asphalting (20 mm thick MSS) in sqm 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 :

6 Progress * : 2011

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in cum :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2012

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in Quintal :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2013

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in Quintal :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2014

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in Quintal :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2015

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in Quintal :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) Physical in cum :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2016

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

Earthwork Physical in cum :

Financial in lac :

Gr III Metalling to Road Physical in Quintal :

Financial in lac :

Bitumenous Macadam Physical in cum :

Financial in lac :

Asphalting (20mm thick MSS) 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)

N Marutheshwar Nayak Repairs and Renovation to SMK Nagar city Hospital at SMK Nagar in Davanagere city Davanagere District 9.3 Work completed

Repairs and Renovation to Basha Nagar City Hospital ( Meternity Centre) at Basha Nagar in Davanagere City Davanagere District 9.4 Work completed

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