Construction of bridge cum vented dam at Aramanakatti Santhyaru in Kinya village of Ullala taluk in Dakshina Kannada district

WORK DONE CERTIFICATE

Name of the Department

Name of Division

1 Name of work :

2 Estimated Cost :

3 Agreement No. :

4 Name of Contractor :

5 Tendered cost :

6 Date of work order :

7 Stipulated period of completion :

8 Intended date of Complition :

9 Final Date of completion, (For completed work) :

10 Revised amount of work (including claims/extra/arbitration amount,if any) :

11 Cost of work executed :

12 Balance cost of work :

13 Whether final bill is paid :

14 Reasons for non completion of work in schedule period of completion :

15 Whether any penalties fine/stop notice/compensation/liquidated damage imposed/Imposed & canceled :

a) Earth Excavation :

b) Embankment :

c) Providing & laying M-15 :

d) Providing & laying M-10 :

f) Rubber & Earth Filling :

g) Providing & laying M-20

16 Remarks of the Engineer performance of the Contractor working style quality consciousness tendency of claims :

Divisional Officer

Format for 3.2 (b)

SI.No Name of Work Estimated cost Tendered cost Cost of work executed Cost of work to be executed Date of agreement Stipulated period of completion Scheduled date of completion

Divisional Officer

Note:- The statement showing the value of existing commitments and On - Going works as well as the stipulated period of completion remaining for each of the works listed should be countersigned by the employer in charge, not below the rank of an Executive Engineer or equivalent.

Financial Turnover

Criteria Financial Year Value in Rs

Total value of civil engineering construction works executed and payments received in the last five years (in Rs. Lakhs) (Attach Certificate from Chartered Accountant and corresponding Balance sheet) 2021-22

Work performed as Prime Contractor (in the same name) on works of similar nature

Project Name Name of Employer Description of Work Contract Number Value of contract Rs. Lakhs Date of issue of work order Specified period of completion Actual date of completion Remarks explaining reasons for delay in completion of work

Quantities of work executed as prime contractor (in the same name)

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

Earthwork in both excavation and embankment (combined quantities) in Cum Cement concrete (including RCC and PCC) in Cum Steel works for RCC in MT FRP Needles for gates in Sqm

Existing commitments and on-going works

Description of work Place and State Contract No and Date Name & Address of Employer Value of Contract (Rs. lakhs) Stipulated period of completion Value of works remaining to be completed (Rs. lakhs) Anticipated date of completion

Attach certificates from Employer

Works for which Tenders already submitted

Description of work Place and State Name & Address of Employer Estimated Value of works (Rs. lakhs) Stipulated period of completion Date when decision is expected Remarks if any

Information on litigations in which the Tenderer is involved

Other Party (ies) Employer Details of dispute Amount involved Remarks showing present status