Recarpeting to Mattihal Malaghan Masuti Kudagi to join NH-13 road Km 13.60 to 23.00 (In selected reaches) in Basavana Bagewadi taluk H/A CMIDP (4059-80-051-0-60-132)

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 2019 Remarks (Indicate contract reference)

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

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum Physical

Others Specify Details Physical

Earthwork & Embankment in cum Physical

GSB in cum Physical

Base Course (WMM/WBM) in cum Physical

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) in cum 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 * : 2019

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2020

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2021

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2022

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2023

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

Financial in lac :

Others (Pl specify) Physical is cum/sqm :

Financial in lac :

Others (Pl specify) Physical :

Financial in lac :

Progress * : 2024

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

Earthwork & Embankment Physical in cum :

Financial in lac :

GSB Physical in cum :

Financial in lac :

Base Course (WMM/WBM) Physical in cum :

Financial in lac :

Asphalt Quantities (MSS/BM/BC/SDBC/DBM) Physical in cum :

Financial in lac :

Concrete Physical in cum :

Financial in lac :

Steel Physical in MT :

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)

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 2025-26

Attach Chartered Accountant's Yearwise Statements.

Name of Work:-Recarpeting to Mattihal Malaghan Masuti Kudagi to join NH-13 road Km 13.60 to 23.00 (In selected reaches) in Basavana Bagewadi taluk H/A CMIDP (4059-80-051-0-60-132) PWD/2025-26/RD/WORK_INDENT31182

Sl No Description Unit Quantity Rate Amount Mile Stone no.1 Mile Stone no.2 Mile Stone no.3

Ist Month IIst Month Total IIInd Month IVnd Month Total V nd Month VI nd Month Total

Physical Financial Physical Financial Physical Financial Physical Financial Physical Financial Physical Financial Physical Financial Physical Financial Physical Financial

1 Clearing and grubbing road land including uprooting rank vegetation, grass, bushes, shrubs, saplings and trees girth up to 300 mm, removal of stumps of trees cut earlier and disposal of unserviceable materials and stacking of serviceable material to be used or auctioned, including removal and disposal of top organic soil not exceeding 150 mm in thickness. In area of light jungle 100 m2 170.4

2 Construction of unlined surface drains of average cross-sectional area 0.40 m2 in soil to specified lines, grades, levels and dimensions. Excavated material to be used in embankment with a lift upto 3m and lead of 50 m (average lead 25 m) as per Technical Specification Clause 307. Mechanical Means M 26.25

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. Ref to MoRT&H m² 638

4 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 m3 517.65 0

5 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 m3 239.25

6 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/m2 using mechanical means m2 1595

7 Tack coat on Granular surface treated with primer: Providing and applying tack coat with RS1 Bituminous Emulsion using emulsion pressure distributor at the rate of 0.25 kg/m2 on Granular Surface m2 1595

8 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 m2 38225

9 Dense Graded Bituminous macadam Grading - ii for traffic <20 mSa Providing and laying Dense Graded Bituminous Macadam with 40/60 TPH capacity HMP using crushed aggregates of specified grading, premixed with bituminous binder VG-30, @ 4.5 per cent by weight of total mix and filler, transporting the hot mix to work site, laying with mechanical paver finisher to the required grade, level and alignment, rolling with smooth wheeled, vibratory and tandem rollers to achieve the desired compaction as per MoRTH specification clause No. 505 complete in all respects. (Vol-3, P.No. 33 / I.No. 5.12 (C)) m3 173.25

10 Bituminous Concrete Grading ii for traffic <20 mSa Providing and laying Bituminous Concrete with 40/60 TPH capacity hot mix plant using crushed aggregates of specified grading, premixed with bituminous binder VG-30, @ 5.4 per cent of mix and filler, transporting the hot mix to work site, laying with mechanical paver finisher to the required grade, level and alignment, rolling with smooth wheeled, vibratory and tandem rollers to achieve the desired compaction as per MORTH specification clause No. 507 complete in all respects (Vol-3, P.No. 36 / I.No. 5.16 (C)) m3 12481.35

11 Reinforced cement concrete M15grade kilometre stone of standard design as per IRC:8-1980, fixing in position including painting and printing etc Ordinary kilometer stone (precast) Each 7

12 Reinforced cement concrete M15grade kilometre stone of standard design as per IRC:8-1980, fixing in position including painting and printing etc 200 m stone (precast) Each 28

13 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 m 2 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 9444.75

14 Providing and fixing of retro- reflectorised cautionary, mandatory and informatory sign as per IRC:67:2012 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:67:2012. 60 cm equilateral triangle each 5

15 Supplying and Fixing of Molded Shank Raised Pavement Markers / Cat's Eye made of polycarbonate and ABS moulded body and reflective panels with micro prismatic lens capable of providing total internal reflection of the light entering the lens face and shall support a load of 16000 kg tested in accordance to ASTM D 4280 Type H and complying to Specifications of Category A of MORTH Circular No RW/NH/33023/10-97 DO III Dt 11.06. 1997. The height, width and length shall not exceed 50 mm, 100 mm and 102 +/- 2 mm and with minimum reflective area of 13 cm2 on each side and the slope to the base shall be 35 +/- 5 degree. The strength of detachment of the integrated cylindrical shanks, (of diameter not less than 19 +/- 2 mm and height not less than 30+/- 2 mm) from the body is to be a minimum value of 500 Kg. Fixing will be by drilling holes on the road for the shanks to go inside, without nails and using epoxy resin based adhesive as per manufacturer's recommendation and complete as directed by the engineer.The contractor shall submit a two year warranty for satisfactory field performance including stipulated retro-reflectance of the reflecting panel, to the Engineer Nos 790

16 Providing and laying of hot applied thermoplastic compound 2.5 mm thick including reflectorising glass beads @ 250 g/ m 2 area, thickness of 2.5 mm is exclusive of surface applied glass beads as per IRC:35:2015.The finished surface to be level, uniform and free from streaks and holes m2 556.5

Month wise Amount Miles Amount Fenalty

1 Month 1 Miles (1 & 2 Month) Executive Engineer

2 Month ಗುತ್ತಿಗೆದಾರರ ಸಹಿ PWD Division Viajayapur

3 Month 2 Miles (3 & 4 Month)

5 Month 3 Miles (5 & 6 Month)