Improvement to Terdal Sasalatti MDR (Proposed from Ch Km 0.00 to 0.50 and Ch Km 1.285 to 4.64) (3) Under H/A 5054-04-337-0-01-154

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

Billed upto date during 2026-27

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 2022

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

6 Progress 2023

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

6 Progress 2024

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

6 Progress 2025

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

6 Progress 2026

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

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 2022

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

Names of Works Item of work Names of Employers 2023

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

Names of Works Item of work Names of Employers 2024

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

Names of Works Item of work Names of Employers 2025

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

Financial in lac

Names of Works Item of work Names of Employers 2026

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

Earthwork Physical in Cum

Financial in lac

WMM/WBM Physical in Cum

Financial in lac

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

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

Improvement to Terdal Sasalatti MDR (Proposed from Ch Km 0.00 to 0.50 and Ch Km 1.285 to 4.64) (3) Under H/A 5054-04-337-0-01-154

Sl. No. Physical works to be completed Unit Qty Amount Liquidated damages 0.1% of the contract price per day in Rupees rounded off to nearest hundred (Rs)

1 Item Description : 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 : IRC - 305.4.3 m² 2271.5 14310.45 6.3

2 Item Description : Preparation and Surface Treatment of Formation. - Preparation and surface treatment of formation by removing mud and slurry, watering to the extent needed to maintain the desired moisture content, trimming to the required line, grade, profile and rolling with 8-10 t smooth wheeled roller, complete as per clause 310. Ref to MoRT&H : IRC - 310 m² 3245 13629.00 4.2

3 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 m³ 1136.25 588179.81 517.65

4 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 m³ 486.75 1307872.91 2686.95

5 Item Description : Prime Coat over WMM/WBM - 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. Ref to MoRT&H : IRC - 502 m² 3245 139697.25 43.05

6 Item Description : 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. Ref to MoRT&H : IRC - 504 m³ 929.58 7477588.00 8044.05

7 Item Description : Tack coat on Bituminous surface - Providing and applying tack coat with RS1 Bituminous Emulsion using emulsion pressure distributor at the rate of 0.20 kg/m2 on the prepared bituminous surface cleaned with mechanical broom. Ref to MoRT&H : IRC - 503 m² 21202.5 267151.50 12.6

8 Item Description : Semi Dense Bituminous Concrete - 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. Ref to MoRT&H : IRC - IRC-37:2018 m³ 530.06 5650227.58 10659.6

9 Item Description : Road Marking with Hot Applied Thermoplastic Compound with Reflectorising Glass Beads on Bituminous Surface - Providing and laying of hot applied thermoplastic compound 2.5 mm thick including reflectorising glass beads @ 250 g/m2 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. Ref to MoRT&H : IRC - 803 m² 771 429061.50 556.5

10 Item Description : Supplying and Fixing of Molded Shank Raised Pavement Markers / Cats 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 manufacturers 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. Ref to MoRT&H : IRC - MoRTH 806 No. 530 203122.50 383.25

11 Item Description : 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 - 90 cm equilateral triangle. Ref to MoRT&H : IRC - 801 each 6 29509.20 4918.2

Executive Engineer

PUBLIC WORKS DEPARTMENT DIVISION

Improvement to Terdal Sasalatti MDR (Proposed from Ch Km 0.00 to 0.50 and Ch Km 1.285 to 4.64) (3) Under H/A 5054-04-337-0-01-154

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 : 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 : IRC - 305.4.3 2 months 2063689.43 2100.00

2 Item Description : 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. Ref to MoRT&H : IRC - 504 2 months 7744739.50 7800.00

3 Item Description : Semi Dense Bituminous Concrete - 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. Ref to MoRT&H : IRC - IRC-37:2018 2 months 6311920.78 6300.00

Executive Engineer

PUBLIC WORKS DEPARTMENT DIVISION

1 Item Description : 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 : IRC - 305.4.3 m² 6 6.3 2271.5 14310.45

2 Item Description : Preparation and Surface Treatment of Formation. - Preparation and surface treatment of formation by removing mud and slurry, watering to the extent needed to maintain the desired moisture content, trimming to the required line, grade, profile and rolling with 8-10 t smooth wheeled roller, complete as per clause 310. Ref to MoRT&H : IRC - 310 m² 4 4.2 3245 13629

3 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 m³ 493 517.65 1136.25 588179.81

4 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 m³ 2559 2686.95 486.75 1307872.91

5 Item Description : Prime Coat over WMM/WBM - 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. Ref to MoRT&H : IRC - 502 m² 41 43.05 3245 139697.25

6 Item Description : 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. Ref to MoRT&H : IRC - 504 m³ 7661 8044.05 929.58 7477588

7 Item Description : Tack coat on Bituminous surface - Providing and applying tack coat with RS1 Bituminous Emulsion using emulsion pressure distributor at the rate of 0.20 kg/m2 on the prepared bituminous surface cleaned with mechanical broom. Ref to MoRT&H : IRC - 503 m² 12 12.6 21202.5 267151.5

8 Item Description : Semi Dense Bituminous Concrete - 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. Ref to MoRT&H : IRC - IRC-37:2018 m³ 10152 10659.6 530.06 5650227.58

9 Item Description : Road Marking with Hot Applied Thermoplastic Compound with Reflectorising Glass Beads on Bituminous Surface - Providing and laying of hot applied thermoplastic compound 2.5 mm thick including reflectorising glass beads @ 250 g/m2 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. Ref to MoRT&H : IRC - 803 m² 530 556.5 771 429061.5

10 Item Description : Supplying and Fixing of Molded Shank Raised Pavement Markers / Cats 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 manufacturers 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. Ref to MoRT&H : IRC - MoRTH 806 No. 365 383.25 530 203122.5

11 Item Description : 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 - 90 cm equilateral triangle. Ref to MoRT&H : IRC - 801 each 4684 4918.2 6 29509.2