Improvements to road from Yalparatti Bunglow to Paramandwadi, Shiragur, Gundawad, Kudachi road KM 0.90 to 4.35 & KM 8.00 to 11.01 in Raibag Taluk of Belagavi District under 4059 CMIDP for 2025-26.

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

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Others (Pl specify) Physical is cum/sqm :

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Progress * : 2019-20

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Progress * : 2020-21

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Progress * : 2021-22

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Progress * : 2022-23

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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.

Name of Work : Improvements to road from Yalparatti Bunglow to Paramandwadi, Shiragur, Gundawad, Kudachi road KM 0.90 to 4.35 & KM 8.00 to 11.01 in Raibag Taluk of Belagavi District. (WORK INDENT NO : 31915)

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%

Improvements to Road

1 305.4.3 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 sqm 3881.250 3881.250 6.30 24451.88 0.00 0.00 Rs. 24,451.88 30% 30% 40%

2 401 B 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 (v) For Grading -V Material cum 2104.500 2104.500 2476.95 5212741.28 0.00 0.00 Rs. 5,212,741.28 30% 30% 40%

3 305 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 cum 2498.487 2498.487 517.65 0.00 0.00 1293341.80 Rs. 1,293,341.80 30% 30% 40%

4 406 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. cum 1400.000 1834.375 3234.375 2686.95 3761730.00 4928873.91 0.00 Rs. 8,690,603.91 30% 30% 40%

5 5.1 502 A Prime Coat over WMM/WBM (i) 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 per m2 using mechanical means. sqm 12937.500 12937.500 43.05 0.00 556959.38 0.00 Rs. 556,959.38 30% 30% 40%

6 503 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 the prepared bituminous surface cleaned with mechanical broom sqm 12937.500 12937.500 15.75 0.00 203765.63 0.00 Rs. 203,765.63 30% 30% 40%

7 503 Tack coat on Bituminous surface Providing and applying tack coat with VG-10 Bitumen using pressure distributor at the rate of 0.20 kg/m2 on the prepared bituminous surface cleaned with mechanical broom sqm 6225.000 6225.000 12.60 0.00 78435.00 0.00 Rs. 78,435.00 30% 30% 40%

8 5.8 504 (ii) 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 cum 400.000 558.125 958.125 8044.05 0.00 3217620.00 4489585.41 Rs. 7,707,205.41 30% 30% 40%

9 Semi Dense Bituminous Concrete 1) IRC-37:2018 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. cum 479.063 479.063 10659.60 0.00 0.00 5106614.63 Rs. 5,106,614.63 30% 30% 40%

10 805 Kilometre Stone Reinforced cement concrete M15grade kilometre stone of standard design as per IRC:8-1980, fixing in position including painting and printing etc (ii) Ordinary kilometer stone (precast) each 7.000 7.000 3033.45 0.00 0.00 21234.15 Rs. 21,234.15 30% 30% 40%

11 805 Kilometre Stone Reinforced cement concrete M15grade kilometre stone of standard design as per IRC:8-1980, fixing in position including painting and printing etc (iii) 200 m stone (precast) each 7.000 7.000 861.00 0.00 0.00 6027.00 Rs. 6,027.00 30% 30% 40%

12 8.5 801 A Retro-Reflectorised Traffic Signs 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%

13 8.5 801 A Retro-Reflectorised Traffic Signs 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 4498.20 0.00 0.00 26989.20 Rs. 26,989.20 30% 30% 40%

14 801 Direction and Place Identification Signs upto 0.9 m2 Size Board. Providing and erecting direction and place identification retro-reflectorised sign as per IRC:67:2012 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 sqm 8.640 8.640 10168.20 0.00 0.00 87853.25 Rs. 87,853.25 30% 30% 40%

15 Providing Speed Breakers/Raised pedestrian crossings in Trapezoidal section with 2.5 m Top width and transition length of 0.8 m length and height of 0.1 m as per IRC 99:2018 using Bituminous Macadam (BM) Gr II and Semi Dense Bituminous Macadam (SDBC) Gr II for entire formation width & WBM Gr II for Shoulder hump portion only (150 mm thick), completing with road marking paint with applied thermoplastic compound with reflecting glass beeds on bituminous surface and providing 2 Nos. retro reflective traffic signs as per IRC 67 -2022 Single lane with formation width of 5.75 m. each 8.000 8.000 36676.50 0.00 0.00 293412.00 Rs. 293,412.00 30% 30% 40%

Measurement and Abstract of Road maintenance for 3rd, 4th and 5th year 30% 30% 40%

1 Road Maintenance for 3rd year for road with BM+SDBC as wearing coat Maintenance of Road for 3rd year by Clearing and Uprooting Vegetation on either sides of the road. Maintenance of surface drains by clearing, cleaning reshaping, deepening of side drains. Stripping excess soil from the shoulder surface and Making up loss of material/ irregularities on shoulder wherever necessary. Maintenance & painting of 200 metre and km stones. White washing of parapet walls of CD work and tree trunks Patching of shallow and deep potholes using premixed bitumen mixes corresponding to the layers of the road and Repairs to CDs including Vent Clearance. As per SE BGM approved rate for 2023-24 per km 5.110 5.110 28630.00 0.00 0.00 146299.30 Rs. 146,299.30 30% 30% 40%

2 Road Maintenance for 4th year for road with BM+SDBC as wearing coat Maintenance of Road for 4th year by Clearing and Uprooting Vegetation on either sides of the road Maintenance of surface drains by clearing, cleaning reshaping, deepening of side drains. Stripping excess soil from the shoulder surface and Making up loss of material/ irregularities on shoulder wherever necessary Maintenance & painting of 200 metre and km stones White washing of parapet walls of CD work and tree trunks Patching of shallow and deep potholes using premixed bitumen mixes corresponding to the layers of the road and Repairs to CDs including Vent Clearance. As per SE BGM approved rate for 2023-24 per km 5.110 5.110 47010.00 0.00 0.00 240221.10 Rs. 240,221.10 30% 30% 40%

3 Road Maintenance for 5th year with BM+SDBC coat as wearing coat Maintenance of Road for 5th year by Clearing and Uprooting Vegetation on either sides of the road Maintenance of surface drains by clearing, cleaning reshaping deepening of side drains. Stripping excess soil from the shoulder surface and Making up loss.of material/ irregulanties on shoulder wherever necessary Maintenance & painting of 200 metre and km stones. White washing of parapet walls of CD work and tree trunks, Patching of shallow and deep potholes using prenixed bitumen mixes corresponding to the layers of the road and Repairs to CDs including Vent Clearance As per SE BGM approved rate for 2023-24 per km 5.110 5.110 58330.00 0.00 0.00 298066.30 Rs. 298,066.30 30% 30% 40%