CHECK LIST TO BE SUBMITTED ALONG WITH R.A. BILLS OF WORKS IN WHOSE CONTRACT VALUE IS MORE THEN RS.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Name of Work Name of Agency Estimate Cost and year of CR Entrustment cost as per Work order Agreement No. and date Date of commencement of Work Date of stipulated of completion Total expenditure up to previous bill Amount of present Bill Total upto date expenditure Excess quantities if any indicating item No.quantity and amount with reason Date of approval of EPF/work slip by competent authority reference and date Extension of time reference and date Whether quality of work is as per laid down specification. Is pary payement are allowed is the extent of part payement justifid As per clause 2 of the tender agreement carried out as laid down confirm reference no and date If so is the delay /apportioned between the department contractore judiciously
Repairs to damaged lining of sl-1 of lat-1 and raising of embankment of BD-3 of D-26 mbc

Sri. Golayya.C.Hiremath, Contractor Rs. 10.50 Lakh

Rs. 912804.00 TWA No. 42/2012-13 Dt ; 22-05-2012 24-05-2012 21-06-2012

Nill Rs. Rs. Dose not arise Dose not arise YES YES .

Having consider all the above issue payment of the R.A.Bill /closing measurement part date .in respect of the above work is here by recommended for acceptance and payement to party

Asst. Executive Engineer KBJNL.MBC Sub-Divn.No.4

Chigaralli.

FORM PWG 45(A)

Name of Division Name of Sub-Divn. Name of Work : : : Executive Engineer, KBJNL, MBC Division, Chigarahalli. Asst. Executive Engineer, KBJNL, MBC Sub-Dn. No. 4, Chigarahalli

Repairs to damaged lining of sl-1 of lat-1 and raising of embankment of BD-3 of D-26 mbc

Name of Agency
Estimated cost Agreement cost

:
: :

Sri. Golayya.C.Hiremath, Contractor Rs. 10.50 Lakh

Rs. 912804.00

COMPLETION CERTIFICATE

1. Certified that the work has been completed satisfactorily in all respects to the extent of work done as per terms and conditions of contract agreement and as per prescribed tender specification. 2. Certified that there are NO DUES outstanding from the contractor.

Section Officer,

Asst. Executive Engineer, KBJNL.MBC.Sub-Division.No.4 Chigarhalli

Executive Engineer, KBJNL.MBC Division, Chigarhal

FORM NO. 46 Name of Division Name of Work Name of Agency Estimated cost Agreement cost Expenditure Difference Percentage of less/ excess (if any) Date of Commencement Due date of completion Actual date of completion No. (See Paragraph 294) : Executive Engineer, KBJNL, MBC Sub Divn No.4, Chigarahalli. : Repairs to damaged lining of sl-1 of lat-1 and raising of embankment of BD-3 of D-26 mbc : Sri. Golayya.C.Hiremath, Contractor : Rs. 10.50 Lakh : Rs. 912804.00 : Rs. : Rs. : % Saving : 24-05-2012 : 21-06-2012 : Date:

Forwarded to the Accountant General of Karnataka for verification.

Executive Engineer KBJNL, MBC O & M Divn Chigarahalli Transmitted to the Superintending Engineer, KBJNL, JBC Circle, Bheemarayanagudi duly therewith.

Sl. No. 1 2 3 Sri Shivaji, EE Sri, Shivaji AEE Shivanand JE

Period of incumbency Names From 11-04-2009 20-09-2008 26-09-2009 To Till today Till today Till today

Section Officer,

Asst. Executive Engineer, KBJNL.MBC.Sub-Division.No.4 Chigarhalli

Executive Engineer, KBJNL.MBC Division, Chigarhalli

INCUMBANCY CERTIFICATE
1 2 3 4 5 6 Name of division. Name of sub division Name of Work Name of Agency Estimate Cost Amount of Agreement cost : E.E KBJNL MBC O&M DIVN., Chigarahalli : A.E.E KBJNL MBC Sub Divn-4 Chigarahalli : Repairs to damaged lining of sl-1 of lat-1 and
raising of embankment of BD-3 of D-26 mbc

: Sri. Golayya.C.Hiremath, Contractor : Rs. 10.50 Lakh : Rs. 912804.00

This is to be certifying that the above said work has been completed satisfactorily. The incumbency of the official of the officer given as under Sl. No. 1 2 3 Period officer and Designation From To 11-04-2009 Till today 20-09-2008 26-09-2009 Till today Till today

Name of the official Sri Shivaji, EE Sri, Shivaji AEE Shivanand JE

Section Officer,

Asst. Executive Engineer, KBJNL.MBC.Sub-Division.No.4 Chigarhalli

Executive Engineer, KBJNL.MBC Division, Chigarhalli.

NO DUE CERTIFICATE

1 2 3 4 5 6 7 8

Name of Division Name of Sub-Division Name of Work Name of Agency Agreement Amount Date of Mark-out Due Date of Completion Date of Actual Completion

Executive Engineer, KBJNL, MBC O&M Division, Chigarahalli Asst. Executive Engineer, KBJNL, MBC O&M Sub-division No.4, Chigarahalli
Repairs to damaged lining of sl-1 of lat-1 and raising of embankment of BD-3 of D-26 mbc

Sri. Golayya.C.Hiremath, Contractor

Rs. 912804.00 24-05-2012 21-06-2012

This is to certify that the above said work has been completed with satisfaction of the Department and there are no outstanding dues against the contractor pertaining to this work.

Section Officer

Assistant Executive Engineer KBJNL MBC Sub-Dn.No.4 Chigarhalli

Executive Engineer KBJNL MBC O &M Divn. Chigarhalli