Construction of cement concrete road at SC colony Uttur plot village in Mudhol taluk of Bagalkote district (Under 4059-80-051-0-60-422 CMIDP for the year 2025-26)

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

Billed upto date during 2024-25

Attach Chartered Accountant's Yearwise Statements

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.

FORMAT FOR WORK DONE CERTIFICATE TO BE OBTAINED FROM COMPETENT AUTHORITY

This is to certify that M/s Sri / Smt.

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 2017

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

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

6 Progress 2018

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

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

6 Progress 2019

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

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

6 Progress 2020

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

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

6 Progress 2021

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

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

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.

* Monthlywise progress shall be furnished seperately.

Place : (Authorised Signatory)

Address for correspondence:

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 2017

January February March April May June July August September October November December Remarks (Indicate contract reference)

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

Names of Works Item of work Names of Employers 2018

January February March April May June July August September October November December Remarks (Indicate contract reference)

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

Names of Works Item of work Names of Employers 2019

January February March April May June July August September October November December Remarks (Indicate contract reference)

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

Names of Works Item of work Names of Employers 2020

January February March April May June July August September October November December Remarks (Indicate contract reference)

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

Names of Works Item of work Names of Employers 2021

January February March April May June July August September October November December Remarks (Indicate contract reference)

Earthwork Physical in Cum

Financial in lac

GSB Physical in Cum

Financial in lac

WBM/WMM Physical in Cum

Financial in lac

Asphalting (Including DBM/BC/BM/SDBC) Physical in Cum

Financial in lac

PCC/RCC Physical in Cum

Financial in lac

TMT Steel Physical in Tonne

Financial in lac

* Monthlywise progress shall be furnished seperately.

Place : CONTRACTOR

Address for correspondence:

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 Speified 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

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 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.

List of Machinery

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

No. Capacity Number / Capacity Age / Condition

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

Signature of the Bank Manger

along with Seal

Information on litigation in which the Tenderer is involved:

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

NAME OF WORK:Construction of cement concrete road at SC colony Uttur plot village in Mudhol taluk of Bagalkote district (Under 4059-80-051-0-60-422 CMIDP for the year 2025-26)

Sl .No Item Name Item Code Unit Qty Rate Total

1 Item Description : 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 slope and compacted to meet requirement of table No. 300-2. Ref to MoRT&H : IRC - 305 3.6 m³ 1066.06 493.00 551845.96

2 Item Description : 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. Ref to MoRT&H : IRC - 401 4.2.B.v m³ 555.60 2359.00 1376193.42

3 Item Description : 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 rollerto achieve the desireddensity. Ref to MoRT&H : IRC - 406 4.17 m³ 339.14 2559.00 911252.22

Mile stone-1 2839291.6

4 Item Description : Providing and constructing un-reinforced plain cement concrete pavement, thickness as per design, over a prepared sub base, with 43 grade cement or any other type as per Clause 1501.2.2 M30 (Grade), coarse and fine aggregates conforming to IS:383:2016:, maximum size of coarse aggregate not exceeding 25 mm, mixed in a concrete mixer of not less than 0.2 cum capacity and appropriate weigh batcher using approved mix design, laid in approved fixed side formwork (steel channel, laying and fixing of 125 micron thick polythene film, wedges, steel plates including levelling the formwork as per drawing), spreading the concrete with shovels, rakes, compacted using needle, screed and plate vibrators and finished in continuous operation including construction joints, primer, sealant, curing of concrete slabs for 14-days, and water finishing to lines and grade as per drawing and technical specification clause 1501 with all lead, lifts, loading & unloading charges, cost and conveyance of all materials, labour, equipments etc., complete. as per the directions of the Engineer-in-charge of the work. Ref to MoRT&H : IRC - 1501 16.28 m³ 678.30 6639.00 4728395.38

Mile stone-2 4728395.38

5 Item Description : Mechanical Means - 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. In all kinds of soils Depth upto 3 m 1.14.1 m³ 456.46 102.00 48886.87

6 Item Description : Providing and laying in position 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 machinery, curing, and all the other appurtenances required to complete the work as per technical specifications. - Mix 1:4:8 Using 40 mm nominal size graded crushed coarse aggregates 2.1.2 m³ 46.80 5607.00 275527.98

7 Item Description : Providing and laying in position 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 necessary, 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. - M 20 Design Mix Using 20 mm nominal size graded crushed coarse aggregates 2.4.2 m³ 188.40 6221.00 1292169.66

8 Item Description : Steel Fabrication 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. All other type of structures 2.11.h t 10.44 80019.00 877168.28

Mile stone-3 2493752.79

PCC/RCC 913.50 730.8

NAME OF WORK:Construction of cement concrete road at SC colony Uttur plot village in Mudhol taluk of Bagalkote district (Under 4059-80-051-0-60-422 CMIDP for the year 2025-26)

Milestone dates Physical works to be completed Period from the date of issue of Notice to proceed with the work Amount Liquidated damages 0.1% of the contract price per day in Rupees rounded off to nearest hundred (Rs)

1 Item Description : 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 slope and compacted to meet requirement of table No. 300-2. Ref to MoRT&H : IRC - 305 2months 2839291.60 2839.29 28.22

2 Item Description : Providing and constructing un-reinforced plain cement concrete pavement, thickness as per design, over a prepared sub base, with 43 grade cement or any other type as per Clause 1501.2.2 M30 (Grade), coarse and fine aggregates conforming to IS:383:2016:, maximum size of coarse aggregate not exceeding 25 mm, mixed in a concrete mixer of not less than 0.2 cum capacity and appropriate weigh batcher using approved mix design, laid in approved fixed side formwork (steel channel, laying and fixing of 125 micron thick polythene film, wedges, steel plates including levelling the formwork as per drawing), spreading the concrete with shovels, rakes, compacted using needle, screed and plate vibrators and finished in continuous operation including construction joints, primer, sealant, curing of concrete slabs for 14-days, and water finishing to lines and grade as per drawing and technical specification clause 1501 with all lead, lifts, loading & unloading charges, cost and conveyance of all materials, labour, equipments etc., complete. as per the directions of the Engineer-in-charge of the work. Ref to MoRT&H : IRC - 1501 2months 4728395.38 4728.40 46.99521627

3 Item Description : Mechanical Means - 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. In all kinds of soils Depth upto 3 m 2 months 2493752.79 2493.75 24.78524791

Executive Engineer

PUBLIC WORKS DEPARTMENT DIVISION

Order Item Details Floor/Lift No. Base Rate Final Rate (Excluding GST) Quantity Net Amount (Excluding GST) Actions

1 Category : Vol - 3 -Chapter -3- EARTH WORK, EROSION CONTROL AND DRAINAGE --- 493 517.65 1066.06 551845.96

Item Code : 3.6

Item Description : 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 slope and compacted to meet requirement of table No. 300-2. Ref to MoRT&H : IRC - 305

Rate Analaysis Performed ?: Yes

2 Category : Vol - 3 -Chapter -4- SUB-BASES, BASES (NON-BITUMINOUS), SHOULDERS AND STABILIZATION METHODS --- 2359 2476.95 555.6 1376193.42

Item Code : 4.2.B.v

Item Description : 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. Ref to MoRT&H : IRC - 401

Rate Analaysis Performed ?: Yes

3 Category : Vol - 3 -Chapter -4- SUB-BASES, BASES (NON-BITUMINOUS), SHOULDERS AND STABILIZATION METHODS --- 2559 2686.95 339.14 911252.22

Item Code : 4.17

Item Description : 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 rollerto achieve the desireddensity. Ref to MoRT&H : IRC - 406

Rate Analaysis Performed ?: Yes

4 Category : Vol - 3 -Chapter -16- PANCHAYATH RAJ ENGINEERING DEPARTMENT ITEMS --- 6639 6970.95 678.3 4728395.38

Item Code : 16.28

Item Description : Providing and constructing un-reinforced plain cement concrete pavement, thickness as per design, over a prepared sub base, with 43 grade cement or any other type as per Clause 1501.2.2 M30 (Grade), coarse and fine aggregates conforming to IS:383:2016:, maximum size of coarse aggregate not exceeding 25 mm, mixed in a concrete mixer of not less than 0.2 cum capacity and appropriate weigh batcher using approved mix design, laid in approved fixed side formwork (steel channel, laying and fixing of 125 micron thick polythene film, wedges, steel plates including levelling the formwork as per drawing), spreading the concrete with shovels, rakes, compacted using needle, screed and plate vibrators and finished in continuous operation including construction joints, primer, sealant, curing of concrete slabs for 14-days, and water finishing to lines and grade as per drawing and technical specification clause 1501 with all lead, lifts, loading & unloading charges, cost and conveyance of all materials, labour, equipments etc., complete. as per the directions of the Engineer-in-charge of the work. Ref to MoRT&H : IRC - 1501

Rate Analaysis Performed ?: Yes

1 Category : Vol - 1 -Chapter -I- Earth Work --- 102 107.1 456.46 48886.87

Item Code : 1.14.1

Item Description : Mechanical Means - 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. In all kinds of soils Depth upto 3 m

Rate Analaysis Performed ?: Yes

2 Category : Vol - 1 -Chapter -II- Concrete Works 0 5607 5887.35 46.8 275527.98

Item Code : 2.1.2

Item Description : Providing and laying in position 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 machinery, curing, and all the other appurtenances required to complete the work as per technical specifications. - Mix 1:4:8 Using 40 mm nominal size graded crushed coarse aggregates

Rate Analaysis Performed ?: Yes

3 Category : Vol - 1 -Chapter -II- Concrete Works 0 6221 6858.65 188.4 1292169.66

Item Code : 2.4.2

Item Description : Providing and laying in position 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 necessary, 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. - M 20 Design Mix Using 20 mm nominal size graded crushed coarse aggregates

Rate Analaysis Performed ?: Yes

4 Category : Vol - 1 -Chapter -II- Concrete Works 0 80019 84019.95 10.44 877168.28

Item Code : 2.11.h

Item Description : Steel Fabrication 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. All other type of structures

Rate Analaysis Performed ?: Yes