Professional Documents
Culture Documents
Road Project Management and Supervision Manual Vol II Sample Forms and Document - 2nd Editoin
Road Project Management and Supervision Manual Vol II Sample Forms and Document - 2nd Editoin
2014
SEPTEMBER 2014
TABLE OF CONTENTS
FOREWORD. ..
TABLE OF CONTENTS..................................................................................
ii
ACKNOWLEDGEMENT .................................................................................
vi
Chapter 1
Introduction ...............................................................................
1- 1
1.1
Background ................................................................................................
1- 1
1.2
Purpose ......................................................................................................
1- 1
Chapter 2
2- 1
2.1
2- 1
2.2
2- 3
2.3
2- 3
2.4
2- 3
Chapter 3
Procurement..............................................................................
3- 1
3.1
3- 1
3.2
3- 3
3.3
3- 4
3.4
3- 5
3.5
Bill of Quantities..........................................................................................
3- 6
3.6
Resolution...................................................................................................
3- 7
3.7
Contract Agreement....................................................................................
3- 9
3.8
3-11
3.9
3-12
3.10
3-14
3.11
3-16
3.12
3-17
Chapter 4
Contract Implementation............................................................
4- 1
4.1
4- 1
4.2
4- 2
4.3
Suspension Order.......................................................................................
4- 4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
ii
4.4
Chapter 5
4- 5
5- 1
5.1
5- 1
5.2
5- 2
5.2.1
Status of Tests.........................................................................................
5- 2
5.2.2
5- 3
5.3
5- 4
5.4
5- 5
5.4.1
5- 5
5.4.2
5- 9
5.4.3
5-10
5.4.4
5-11
5.4.5
5-12
5.4.6
5-13
5.4.7
5-15
5.4.8
Bituminous Mix........................................................................................
5-18
5.4.9
5-19
5-20
5-21
5-22
5-23
5-24
5.5
Accreditation ...............................................................................................
5-25
5-25
5-26
5-27
5-28
Chapter 6
Payments...................................................................................
6- 1
6- 1
6.1.1
Disbursement Voucher............................................................................
6- 1
6.1.2
6- 2
6.1.3
6- 3
6.1
iii
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.1.4
6- 4
6.1.5
6- 5
6.1.6
6- 6
6.1.7
6- 7
6.1.8
6- 8
6- 9
6.2.1
6- 9
6.2.2
6-10
6.2.3
6-11
6.2.4
6-12
6.2.5
Certificate of Payment.............................................................................
6-13
6.2.6
6-14
6.2.7
6-15
6.2.8
6-16
6.2.9
6-17
6-18
6-19
6.2
6.3
6-20
6.3.1
6-20
6.3.2
6-21
6-22
6.4.1
6-22
6.4.2
6-23
6.4.3
Certificate of Completion.........................................................................
6-24
6.4.4
6-25
6.4.5
6-26
6-27
6.5.1
Description ..............................................................................................
6-27
6.5.2
6-28
6.5.3
6-29
6.5.4
6-30
6.4
6.5
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
iv
Chapter 7
7- 1
7- 1
7.1.1
7- 1
7.1.2
7- 2
7.1.3
7- 3
7.2
7- 4
7.3
7- 5
7.4
7- 7
7.5
7- 8
7.1
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
ACKNOWLEDGEMENT
JICA-TCP II would like to thank the TWG members and the regional project managers for
their patience, guidance, words of encouragement and useful critiques which really helped us
a lot in accomplishing this undertaking.
TWG Members:
Dr. Judy F. SESE, Chairperson, OIC-Director, Bureau of Research and Standards
Ms. Carolina S. CANUEL, Fmr. Vice Chairperson, Fmr. Div. Chief, DPD, P/S
Mr. Adriano M. DOROY, Asst. Director, Bureau of Design
Mr. Aristarco M. DOROY, OIC-Asst. Director, Bureau of Construction
Ms. Edna F. MEEZ, OIC-DE, Negros Occidental 4th DEO, DPWH-Region VII
Mr. Felipe S. RAMOS, Fmr. Chief, Technical Services and Evaluation Div., BRS
Mr. Nestor B. CAOILE, OIC-Division Chief, Materials Testing Division, BRS
Thank you also to the CWG Members for their efforts and collaborations.
Regional Project Managers:
Ms. Elsa T. NABOYE, Regional Project Manager, Asst. Chief, QAD, DPWH-CAR
Ms. Ramie B. DOROY, Regional Project Manager, DE, Negros Oriental 1st DEO,
DPWH-Region VII
Ms. Rowena P. JAMITO, Regional Project Manager, Engr. V, MD, RO-XI
CWG Members:
Mr. Elmer R. FIGUEROA, Engr. III, BOC
Mr. Ernante S. ANTONIO, Engr. III, BOM
Ms. Carina B. DIAZ, Engr. III, BOD
Ms. Nenita R. VALENCIA, Former Engr. III, BRS
Mr. Vicente R. VALLE, JR., Engr. IV, DPWH-Region VII
Ms. Aurora M. LACASANDILE, Engr. III, CD, DPWH-Region XI
Finally, we wish to thank our Expert, Mr. Ryoichi Yamasaki, Co-Team Leader, JICA TCP II
and his Asst. Engineer, Mr. Feliciano P. Carpio, for their support and encouragement
throughout this activity.
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
vi
Chapter 1
Introduction
1.1 Background
The Department of Public Works and Highway, hereinafter referred to as "DPWH" and
Japan International Cooperation Agency, hereinafter referred to as "JICA", agreed in 2006 to
implement the project for Improvement of Quality Management for Highway and Bridge
Construction and Maintenance, hereinafter called as " Phase I", aiming to enhance the
engineering knowledge of the Engineers of DPWH.
For the implementation of the said project, the DPWH organized the Joint Coordinating
Committee, hereinafter called as "JCC", Technical Working Group, hereinafter called as
"TWG" and Counterpart Working group, hereinafter called as "CWG" and the JICA
dispatched the JICA Technical Cooperation Project Team, hereinafter referred to as "JICA
TCP Team" from February 2007 to February 2010.
Under Phase I, the following manuals/guidelines were prepared and issued for road
construction and maintenance through the CWG's activities.
*
Road Project Management and Supervision Manual, Volume I: Main Text and
Road Project Management and Supervision Manual, Volume II: Appendices (Standard
Form, Examples and References)
From October 2011 to September 2014, the DPWH and JICA TCP Team -newly
dispatched by JICA - implemented the project for Improvement of Quality Management for
Highway and Bridge Construction and Maintenance, Phase II, hereinafter called as " Phase II"
to aim further enhancement.
This manual, Road Project Management and Supervision Manual, Volume II: Sample
Forms and Ducuments, Second Edition, was prepared under Phase II through the revision
work done by CWG based on the Road Project Management and Supervision Manual,
Volume II: Appendices (Standard Form, Examples and References), 1st Edition as mentioned
above.
1.2 Purpose
Engineers of the DPWH concerned with road construction and management are the main
targets of this Manual. The CWG made efforts to make this Manual 2nd Edition easy to
understand by the Engineers, hence, it would be an effective tool related to the above areas.
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
1-1
Chapter 2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
2-1
____________________________________________
____________________________________________
Forwarded herewith is a set of plan for the aforecited project with the following
supporting documents:
1. Pavement
a. Soil Data
b. Material Test Result
c. Traffic Data
d. Design Analysis and Calculation
e. Typical Section of Existing Pavement Structure
2. Drainage
a. Hydrologic Analysis
b. Hydraulic Design Calculation
c. Structural Analysis of Box Culverts
d. Topographic Map
3. Embankment
a. Soil/Material Test Result
b. Slope Stability Analysis
c. Foundation Stability Analysis
4. Cut Slope
a. Soil/Material Test Result
b. Slope Stability Analysis
5. Slope Protection Structures
a. Soil/Material Test Result
b. Design Analysis/Calculation
6. Road Safety Facilities
a. Traffic Design Proposal
b. Road Safety Audit Report
7. Quantity Estimates
a. Detailed Quantity Estimates of all Items of Work involved
8. Specifications
a. Material Specification of all Items of Work involved (DPWH Standards Specification
2013 Edition, Volume II Highway, Bridges and Airports)
9. Others:
_____________________________
Division Chief
2-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
2-3
2-4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
PROJECT TITLE/LOCATION:
SHEET CONTENTS:
CHECKED:
PREPARED:
REVIEWED:
DATE:
S U B M I T T E D:
DATE:
REGIONAL DIRECTOR
DATE:
REVIEWED AS PRESENTED:
DATE:
RECOMMENDING APPROVAL:
DATE:
ASSISTANT SECRETARY
DATE:
UNDERSECRETARY
APPROVED:
SET NO.
SHEET NO.
Chapter 3
Procurement
Contract ID No.:
Invitation to Bid
________________________________________________
________________________________________________
1.
The Department of Public Works and Highways (DPWH), through the General
Appropriations Act intends to apply the sum of Php ____________ being the Approved
Budget for the Contract (ABC) to payments under the contract for
_______________________________. Bids received in excess of the ABC shall be
automatically rejected at the bid opening.
2.
The Department of Public Works and Highways now invites bids for
______________________. The length of the road is _______ kms. to be made of
_____________, width of _____ meter (__ -lane at ___ m/lane) at ___ m thick.
Completion of the Works is ________ calendar days. Bidders should have completed a
single contract similar to the Project, equivalent to at least fifty percent (50%) of the ABC.
The description of an eligible bidder is contained in the Bidding Documents, particularly, in
Section II, Instruction to Bidders.
3.
4.
Contractors/applicants who are interested in the DPWH civil works are required to register
prior to the set schedule of submission of bid while those already registered shall keep their
records current and updated. Contractors eligibility to bid on the project will be
determined using the DPWH Contractor Profile Eligibility Process (CPEP) and subject to
further post- qualification. Information on registration can be obtained at DPWH website
www.dpwh.gov.ph or Central Procurement Office (CPO), ________________
_________________________, from ____________________.
5.
Interested bidders shall be required to submit PCAB License applicable to the type and cost
of this contract and classification of contractors as Large B for road, and ISO9000
Certification as part of the technical documents under Item 12.1(b) (iv) of the Bid Data
Sheet. They may obtain further information from DPWH-______ and CPO and inspect the
bidding documents at the address given below from ________________________.
Page 1 of 2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3-1
6.
A complete set of Bidding Documents may be purchased by interested Bidders from the
address below and upon payment of a non-refundable fee for the Bidding Documents in the
amount of Php _______________. It may also be downloaded free of charge from the
website of the Philippine Government Electronic Procurement System (PhilGEPS) and the
website of the DPWH, provided that bidders shall pay the fee for the Bidding Documents
not later than the submission of their bids.
7.
The Department of Public Works and Highways will hold a Pre-Bid Conference on
_____________ at ______________________________ which shall be open only to all
interested parties who have purchased the Bidding Documents.
8.
Interested bidders may obtain further information from Department of Public Works and
Highways, Central Procurement Office (CPO) and inspect the Bidding Documents at the
address given below from _________ to __________.
Bids must be delivered on or before ____________________ at
_____________________________. All bids must be accompanied by a bid security in
any of the acceptable forms and in the amount stated in ITB Clause 18.1. Bids will be
opened in the presence of the bidders representatives who choose to attend at the aforesaid
address. Late bids shall not be accepted.
9.
10. The DPWH reserves the right to accept or reject any bid, to annul the bidding process, and
to reject all bids at any time prior to contract award, without thereby incurring any liability
to the affected bidder or bidders.
11. For further information, please refer to:
______________________________
______________________________
Head of Office
3-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: _______________
Program of Work
____________
Road Width:
_______________
____________
Pavement Width:
_______________
____________
Pavement Thickness: _______________
____________
Type of Superstructure: _______________
____________
No. of Spans:
_______________
____________
Starting Date:
_______________
____________
No. of Days to Complete: _______________
District/City:
Name of Project:
Location:
Appropriation:
Source of Funds:
Limits:
Net Length:
Item No.
% of Total
Description
Number
Equipment
Unit
Qty.
Unit Cost
Needed
Available
Total Cost
Adjusted
Cost
2) Materials:
B. Equipment, Labor
_________________________
_________________________
_________________________
_________________________
6) VAT (12%):
_________________________
Total:
_________________________
Say:
_________________________
Say:
Prepared by:
___________________________
_________________________
Checked by:
Submitted by:
___________________________
___________________________
Approved:
__________________________
Regional Director/District Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3-3
_______________________________
Unit of Measurement:
_______________________________
_______________________________
No. of
No. of
Person
Hours
No. of
No. of
Unit
Hours
Unit
Quantity
Designation
A.
Hourly Rate
Amount
Hourly Rate
Amount
Unit Cost
Amount
Labor
B.
Equipment
C.
Total (A+B)
D.
E.
F.
G.
H.
of G
I.
of G
J.
12 %
K.
3-4
of (G+H+I)
(G+H+I+J)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
(2)
(1)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
(4)
______________________________
(3)
Quantity
Prepared/Submitted by:
Total
Description
(5)
(6)
OCM
(7)
Profit
Mark-ups
In Percent
(8)
______________________________
(5) x (8)
(9)
Value
Total Mark-up
(9) + (10)
(11)
Indirect Cost
Total
(5)+(11)
(12)
Total Cost
(12)/(3)
(13)
Unit Cost
______________________________
Approved:
12% x ((5)+(9)
(10)
VAT
Recommending Approval:
Estimated Direct
Unit
Cost
_____________________________
Length:
Item
No.
_____________________________
Station:
3-5
____________________________________
BILL OF QUANTITIES
Item
No.
Description
Unit
Qty
Unit Cost
Total Cost
(PhP)
(PhP)
Subtotal:
____________
Subtotal:
____________
Total:
____________
3-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3.6 Resolution
RESOLUTION
RESOLUTION DECLARING
(Name of
.
WHEREAS, the Department of Public Works and Highways advertised the Invitation to Bid
for the
(Name of Project)
(Date of Issue)
WHEREAS, bidding for the project was conducted in accordance with relevant procedures
for open competitive bidding as specified in the IRR of RA 9184 (R.A. 9184) with some amendments,
as stated in the bidding document and opened to all bidders from eligible source countries as defined in
the applicable procurement guidelines of the World Bank. The contract shall be awarded to the Lowest
Calculated Responsive Bidder (LCRB) who was determined as such during post-qualification;
WHEREAS, in response to the said Invitation, (Name of Bidder), (Name of Bidder), (Name
of Bidder) bidders and purchased bidding documents;
WHEREAS, during the submission and opening of bids on (Date of Opening), the SBAC for
Civil Works received only (No. of Bids) ( (Numeric) ) bids. (No. of Applicant Bidders) applicant
bidders, namely: (1) (Name of Applicant Bidder) , (2) (Name of Applicant Bidder) ,,, The (No. of
Applicant Bids) bids were checked as to compliance with the bidding requirements, and read, as
follows:
Bidder
Remarks
WHEREAS, the Estimated Project Cost (EPC) is PhP (Estimated Project Cost);
WEREAS, all bids submitted were referred to the SBAC-Technical Working Group (TWG)
for correction of arithmetical errors, application of the discounts offered, evaluation, examination and
comparison of bids;
WHEREAS, based on the detailed examination, and comparison of the (No. of
Bids) ((Numeric)) bids and unconditional discounts offered applied, shown in the table below were the
corrected bid prices, ranked from lowest to highest;
Bidder
Bid as Corrected/
Discounted (Php)
Rank
Page 1 of 2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3-7
WHEREAS, (Name of Construction Firm), with the lowest calculated bid, was subjected to
post-qualification evaluation based on the criteria in the bidding document, and found (Name of
Contractor) passing all the requirements for the Technical Experience, Average Annual Turnover, Net
Financial Contracting Capacity, Key Personnel and Equipment;
WHEREAS, the SBAC for Civil Works for (Implementing Office) during the meeting on (Date
of meeting), and after a careful deliberation, approved the findings of the SBAC-TWG and recommended
to award the contract for the (Name of Project) to (Winning Bidder), at its total bid price of PhP (Total Bid
Price) which is (Percentage) below the Estimated Project Cost.
NOW THEREFORE, for and in consideration of the foregoing premises, the herein Special
Bids and Awards Committee for Civil Works for (Foreign Assisted or Locally Funded Project) resolves as
it is hereby resolved the following:
a)
To declare (Name of Contractor), as the Bidder with the Lowest Calculated Responsive Bid
(LCRB) for the above mentioned Contract; and
b)
To recommend to (Approving Official), for approval, the award of the said Contract to (Name of
Contractor), at its Total Calculated Bid Price of (Amount in words and figures) .
Done in _________________________ this ________ day of ____________.
___________________________________
(Chairperson)
___________________________________
___________________________________
(Member)
(Member)
___________________________________
___________________________________
(Member)
(Member)
Approved:
___________________________________
(
Name
Date of Approval:
________________________
Page 2 of 2
3-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Contract Agreement
Contract ID No.: ________________________________________________
Contract Name:
________________________________________________
Location of the Contract:
________________________________________
THIS CONTRACT AGREEMENT, made this ______ day of ___________, _______
between____________________________________ (hereinafter called the ENTITY) and
___________________________________ (hereinafter called the CONTRACTOR).
WHEREAS, the ENTITY is desirous that the CONTRACTOR execute the Works under
__________________________________, hereinafter called the Works and the Entity has
accepted the Calculated Bid for the execution and completion of such Works calculated in the unit
prices shown in the attached Bill of Quantities, or a total Bid price of ______________________.
NOW THIS CONTRACT AGREEMENT WITNESSETH AS FOLLOWS:
1.
In this CONTRACT AGREEMENT, words and expressions shall have the same meanings
as are respectively assigned to them in the Conditions of Contract hereinafter referred to.
2.
The following documents shall be attached, deemed to form, and be read and construed as
part of this CONTRACT AGREEMENT:
a.
b.
c.
d.
e.
f.
g.
3.
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3-9
4.
IN WITNESS whereof the parties thereto have caused this CONTRACT AGREEMENT
to be executed the day and year first before written.
Signed, sealed, delivered by ___________the ___________(for the Entity)
Signed, sealed, delivered by ___________the ___________(for the Contractor)
Acknowledgement
Republic of the Philippines)
City of _______________ S.S.
BEFORE ME, this _________ day of _____________, in the City of ______________,
personally appeared _________________, ____________________ with Residence Certificate
No.
____________issued
__________
at
________
on___________
and
______________________, _________________________ with Residence Certificate No.
____________issued at _________ on ______________, known to me to be the same persons,
who executed the foregoing instrument, and they acknowledged to me that the same are their free
acts and deeds.
This instrument, consisting of ____ pages, including this page on which this
acknowledgement is written, have been signed on the margin of each and every page thereof by
____________ and ____________ and their instrumental witnesses, and sealed with my notarial
seal.
IN WITNESS WHEREOF, I have hereunto set my hand the day, month, year and place
above written.
NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No. __________
Series of 20__
Page 2 of 2
3 - 10
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Notice of Award
Date:
_______________
_______________________
_______________________
_______________________
Dear __________________:
We hereby accept your bid for the above stated Contract and therefore award the Contract to you
as the Bidder with the Lowest Calculated Responsive Bid at a total Contract Price equivalent to
___________________________________________.
You are required within ______ days from your receipt of this Notice of Award to submit to us (a)
this Notice with your signed "Conforme" thereon, (b) the required Performance Security, (c) the
required credit line or cash deposit certificate and (d) the PERT/CPM diagram and Bar Chart with
S-curve, all of which will form part of the Contract Agreement in accordance with the Bidding
Documents. You are also required, within the said ______ days, to formally sign the Contract
Agreement.
Your failure to comply with these requirements shall constitute a sufficient ground for the
cancellation of this award and the forfeiture of your Bid Security.
_____________________________
Regional Director/District Engineer
Received by:
_________________________
Date Received:
_________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 11
SUBJECT:
Gentlemen:
WHEREAS, (Name of Bidder), hereinafter called The Bidder, with address at (Address of
Bidder) has undertaken to submit to you a bid for the above stated contract and whereas, you have
stipulated in the instruction to bidders for the said contract that the bidder shall furnish you with an
irrevocable standby letter of credit for a sum specified therein as bid security for the faithful
compliance of the following obligations of the bidder:
1.
The bidder shall not withdraw its bid for the abovementioned contract during the period bid validity
The bidder shall accept the corrections to be made by the bids and awards committee on any arithmetical or
computational errors in its bid prices in accordance with the instructions to bidders.
3.
If the bidder received your Notice of Award for the contract, it shall submit to you, within ten (10) days
from receipt of the said notice, (a) its written Conforme on the Notice of Award, (b) Performance Security, (c) Credit
Line/Cash Certificate/Deposit Certificate, and (d) Pert/CPM, and shall execute the contract agreement in accordance
with the instructions to bidders and general conditions of the contract.
3 - 12
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
This Irrevocable Standby Letter of Credit is valid until _________calendar days after the
date of opening of bids for the said Contractor until ____________ (the expiry date), whichever
comes earlier.
This Irrevocable Standby Letter of Credit is being issued in favor of the said bidder in
connection with your requirements of the bidding for the said contract. We are aware that any false
statements issued by us make us liable to perjury.
This Irrevocable Standby Letter of Credit is issued subject to the uniform customs and
practice for documentary credits (2007 Revision) International Chamber of Commerce Publication no.
600.
___________________________________________
(Insurer)
____________________________
Banks Authorized Officer
Page 2 of 2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 13
3 - 14
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
_____________________________
Official Designation:
_____________________________
Concurred By:
_____________________________
Official Designation:
_____________________________
Note:
The amount committed should be machine validated.
ACKNOWLEDGMENT
SUBSCRIBED AND SWORN to before me this _____ day of _____________, 20___,
affiant exhibited to me his/her Community Tax Certificate No. ___________ issued on
_______________ at _____________________, Philippines.
Notary Public
Until 31 December 20_____
PTR No. _______________
Issued at: _______________
Issued on: _______________
TIN No. _______________
Doc. No. _______
Page No. _______
Book No. _______
Series of _______.
Page 2 of 2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 15
ATTESTED:
______________________________
Principal
3 - 16
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
war, invasion, act of foreign enemy, hostilities, (whether war be declared or not), civil
war, rebellion, revolution, insurrection, mutiny, riot, strike, lock - civil commotion,
military or usurped power, or malicious persons acting on behalf of or in connection
with any political organization, confiscation, commandeering, requisition or
destruction of or damage to property by order of the government de jure or de facto or
by any public authority;
b)
c)
d)
In any action, suit or other proceeding where the Insurers allege that by reason of the
provisions of Exclusion (a) above any loss, destruction, damage or liability is not covered by
this insurance the burden of proving that such loss, destruction, damage or liability is covered
shall be upon the Insured.
PERIOD OF COVER
a)
CONSTRUCTION PERIOD
The liability of the insurers shall commence, notwithstanding any date to the
contrary specified in the Schedule, with the unloading of the property specified in the
Schedule. The Insurers liability expired also for parts of the insured contract works
taken over or put into service by the Principal prior the expiry date specified in the
Policy whichever shall be earlier.
Page 1 of 9
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 17
b)
MAINTAINED PERIOD
If a maintenance period is specified in the Schedule, the liability of the Insurers
during this period shall be limited to any loss or damage caused by the Insured
Contactor(s) in the course of the operations carried out by him for the purpose of
complying with his obligations under the Maintenance ______ of the Contract.
GENERAL CONDITIONS
1)
The due observance and fulfillment of the Terms of this Policy in SO FAR as they
relate to anything to be done or complied with by the Insured shall ____ condition
precedent to any liability of the Insurers to make any payment under this Policy;
2)
The Schedule and the Section(s) shall be deemed to be incorporated and in form part of
this Policy and the expression this Policy wherever used in contract shall be read as
including the Schedule and Section(s). Any work or expression to which a specific
meaning has been attached in any part of Policy or of the Schedule or of the Section(s)
shall bear such meaning wherever it may appear;
3)
The Insured shall give notice to the Insurers of any insurance or insurances already
effected, or which may subsequently be effected, covering any of property hereby
insured, and unless such notice be given and the particulars of such insurance or
insurances be stated in or endorsed on this policy by or behalf of the Insurers before the
occurrence of any loss or damage, all benefits under this Policy shall be forfeited;
4)
The Insured shall take all reasonable precautions to prevent loss, damage or liability
and to comply with sound engineering practice, statutory requirement and
manufacturers recommendations and maintain in efficient condition all contract
works, construction plant, equipment and construction machine insured by this Policy;
5)
The Insured shall immediately notify the Insurers in writing of any material change in
the risk hereunder; the scope of cover and/or the premium shall, if necessary, be
adjusted accordingly;
6)
Representatives of the Insurers shall at any reasonable time have access to the site or
premises and to all pertinent data, documents, drawings, etc. and shall have the right to
inspect any property Insured;
7)
In the event of any occurrence which might give rise to a claim under this Policy, the
Insured shall:
a)
b)
Take all steps within his power to minimize the extent of the loss or damage;
c)
Preserve the damaged parts and make them available for inspection by a
representative or surveyor of the __________;
Page 2 of 9
3 - 18
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
d)
Furnish all such information and documentary evidence as the Insurers may
require;
e)
Inform the police authorities in case of loss or damage due to theft, burglary or
sabotage.
The Insurers shall not in any case be liable for loss, damage or liability of which no
notice has been received by the Insurers within 14 days of its occurrence.
Upon notification being given to the Insurers under this condition, the Insured may
carry out the repairs or replacement of any minor damage; in other cases a
representative of the insurers shall have the opportunity of inspecting the loss or
damage before any repairs or alterations are effected. ______ thing herein shall
prevent the Insured from taking such steps as are absolutely necessary for the security
and continuation of the contract work. If a representative of the Insurers does not
carry out the inspection with a period of time which could be considered as adequate
under the circumstances insured is entitled to proceed with the repairs or replacement.
8)
The Insured shall at the expense of the Insurers do and concur in doing and permit to
be done all such acts and things as may be necessary or required the Insurers in the
interest of any rights or remedies, or of obtaining relief for indemnity from parties
(other than those insured under this Policy) to who the Insurers shall be or would
become entitled or subrogated upon their paying for or making good any loss or
damage under this Policy, whether ___ acts and things shall be or become necessary or
required before or after the Insureds Indemnification by the Insurers.
9)
All differences arising out of this Policy with respect to the amount of liability shall be
referred to the decision of an Arbitrator to be appointed in writing by the parties in
difference or if they cannot agree upon a single Arbitrator to the decision of two
Arbitrators, one to be appointed in writing by each the parties, within one calendar
month after having been required in writing so to do by either of the parties, or in case
the Arbitrators do not agree, of Umpire to be appointed in writing by the Arbitrators
before entering upon the reference. The Umpire shall sit with the Arbitrators and
preside at the meetings. The Arbitrators and the Umpire shall be qualified Engineer.
The making of an award shall be a condition precedent to any right of act against the
Insurers.
Page 3 of 9
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 19
10) If a claim is in any respect fraudulent, or if any false declaration is made or used in
support thereof, or if any fraudulent means or devices are used in support thereof, or if
fraudulent means or devices by the Insured or anyone acting on his behalf to obtain
any benefit under this Policy, or claim is made and rejected and no action or suit is
commenced within twelve months after such rejection or, in case of arbitration taking
place as provided herein, within twelve months after the Arbitrator or Arbitrators or
Umpire have made their award, all benefit under this Policy shall be forfeited.
11) Any claim arises under the Policy there be any other insurance covering the same loss,
damage of liability the Insurers shall not be liable _____ contribute more than their
ratable proportion of any claim for such loss or damage.
Section 1
PROPERTY INSURED
(Material Damage)
THE INSURERS HEREBY AGREE with the insured that if at any time during the period of
insurance stated in the Schedule, or doing any further period of extension thereof the property
or any part thereof described in the Schedule shall suffer any unforeseen loss or damage from
any cause, other than the specifically excluded,
replacement, the Insurers will pay or make good all such loss or damage up to an amount not
exceed in respect of each of the items specified in the Schedule the sum set opposite thereto
and not exceeding in all the total sum expressed in the said Schedule insured hereby.
The Insurers will also reimburse the Insured for the cost of clearance of the debris of the
insured property following upon any event giving rise to a claim under this Policy but not
exceeding all the sum set opposite thereto in the Schedule.
EXCLUSIONS TO SECTON 1
The Insurers shall not, however, be liable for:
(a) the deductibles stated in the Schedule to be borne by the Insured in any one
occurrence other than fire, lightning or explosion;
(b) consequential loss of any kind or description whatsoever including penalties, losses
due to delay, lack of performance, loss of contract;
(c) loss or damage due to faulty design;
(d) cost of replacement or rectification of defective material and/or workmanship, but
this exclusion shall be limited to the items immediately affected shall not be
deemed to exclude loss or damage resulting from an accident due to such defective
material and/or workmanship;
Page 4 of 9
3 - 20
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
(e) wear and tear, corrosion, oxidation, deterioration due to lack of use and normal
atmospheric conditions:
(f) mechanical and or electrical breakdown or derangement of construction plant,
equipment and construction machinery;
(g) loss of or damage to vehicles licensed for general road use or waterborne vessels or
aircraft;
(h) loss or damage to files, drawings, accounts bills, currency, stamps, deeds evidences
of debt, notes, securities or cheques;
(i)
The Insured undertakes to notify the Insurers of any fact effecting a material increase or
decrease of the sums insured provided always that such increase/decrease take effect only
after the same has been recorded on the Policy by the Insurers, before the occurrence of any
claim hereunder.
If, in the event of loss or damage, it is found that the sum insured is less than the amount
required to be insured, then the amount recoverable by the Insured under this Policy shall,
before taking into account the deductibles stated in the Schedule, be reduced in such
proportion as the sum insured bears to amount required to be insured.
MEMO 2. BASIS OF LOSS SETTLEMENT: In the event of any loss or damage the basis of
any settlement under this Policy shall be:
(a)
In the case of any damage which can be repaired the cost of repairs necessary to
restore the insured property to its condition immediately before occurrence of the
damage less salvage, or
Page 5 of 9
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 21
(b) In the case of a total loss the actual value of the insured property immediately before
the occurrence of the loss less salvage provided always that the provisions and
conditions have been complied with.
The Insurers will make payments only after being satisfied by production of the necessary
bills and documents that the repairs have been effected or replacement has taken place, as the
case may be.
All damage which can be repaired shall be repaired, but if the cost of repairing any damage
equals or exceeds the value of the Insured property immediately before the occurrence of the
damage, the settlement shall be made on the basis provided for in (b) above.
The cost of any provisional repairs will be borne by the Insurers if such repairs constitute part
of the final repairs and do not increase the total repair expenses.
The cost of any alterations, additions and/or improvements shall not be recoverable under this
Policy.
MEMO 3. EXTENSION OF COVER: Extra charges for overtime, night work, work on
public holidays, express freight, etc. are covered by this Insurance or if previously and
specially agreed upon.
Section 11
THIRD PARTY LIABILITY
The Insurers will indemnify the insured against all sums which the Insured shall become
legally liable to pay as damages consequent upon :
a)
b)
In respect of a claim for compensation to which the indemnity provided herein applies the
insurers will in addition indemnify the Insured against.
a)
All costs and expenses of litigation recovered by any claimant from the Insured; and
b)
All costs and expenses incurred with the written consent of the insurers.
The Liability of the Insurers under this section shall not exceed the limits of indemnity stated
in the Schedule (Section 11).
Page 6 of 9
3 - 22
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
EXCLUSIONS TO SECTION 11
The Insurers will not indemnify the Insured in respect of
1.
2.
3.
1.
Principal ________________________________________________________
b)
Contractor(s) _____________________________________________________
c)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 23
Sum Insured
1. Contract Works
1.
(a) ____________
(b) ____________
2.
3.
4.
the first
the first
explosion
Amounts to be borne by the Insured in respect of each
and every occurrence for loss of or damage to
construction machinery (Schedule Section 1 item (3)
arising out of
(a) earthquake storm, typhoon, cyclone, flood
the first
the first
explosion
1. Limit of indemnity in respect of any one accident or
1.
(a)
(b)
2.
From :
To:
From:
To:
Premium
(Subject to adjustment in accordance with the Provisions and Conditions of the Policy)
Note:
3 - 24
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
IN WITNESS WHEREOF the Undersigned being duly authorized by the Insurers and on
behalf of the Insurers has/have hereunto set his/their hand(s) this (Date) Day of (Month)
at (Place) .
Documentary and National Science
stamps amounting to PhP (Amount)
are affixed and cancelled on the
Office copy of this Policy.
Examined by (Name and Signature of Representative of the Insur)
Page 9 of 9
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3 - 25
Chapter 4
Contract
Implementation
Notice to Proceed
Date:
_______________
_______________________
_______________________
_______________________
Dear __________________:
As the attached Contract Agreement with you for the above stated Contract has been approved, we
hereby instruct you to proceed with implementation of the said Contract which shall be effective
on _________________.
You shall execute the Contract works in accordance with the terms and conditions of the Contract
Agreement, including the Conditions of Contract, Specifications, Drawings, Bill of Quantities and
PERT/CPM network diagram.
Please acknowledge receipt and acceptance of this Notice by signing both copies thereof
in the space provided below. Keep one copy and return the other to us.
_____________________________
Regional Director/District Engineer
I acknowledge receipt of this Notice on ____________________.
__________________________________________________
Name and Signature of Contractor's Authorized representative
__________________________________________________
Position
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
4-1
To:
______________________________________________
Contractor
You are hereby directed to make the described changes from the Plans and Specifications,
or do the following described work as per approved revised plans and specifications.
Description of work to be done:
________________________________________________
________________________________________________
________________________________________________
Reasons for change:
________________________________________________
________________________________________________
________________________________________________
I, the undersigned contractor
representing our construction firm have given
careful consideration to the change proposed
and hereby agree, if the proposal is approved,
that I will provide the necessary equipment,
furnish all materials and labor except as may be
otherwise be noted above, perform all services
necessary for the work above specified and will
accept as full payment thereafter, the price
stipulated hereon.
By:
________________________________
Contractor's Authorized Representative
Approval Recommended:
___________________________
Asst. Regional Director
Approved by
Prepared by:
Submitted by
________________________
________________________
Project Engineer
________________________
Regional Director
4-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
4-3
ITEM
No.
Project:
Limit:
Contractor:
Total Cost
Quantity
Revised
Revised
Contract
Quantity if
Amount if C.O.
C.O. # __ is
# __ is
approved
approved
Remarked
Approved:
Regional Director
___________________________
Total Cost
Deductive
Recommending Approval:
Quantity
Additive
___________________________
Total Cost
Submitted by:
Unit Price in
Pesos
_______________________
Quantity
Project Engineer
Unit
________________________
Prepared by:
Description
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Date:
______________________________________________
Contractor:
______________________________
______________________________
______________________________
You are hereby directed to suspend all construction activities effective ___________
due to ___________________________________________________________ .
Contract time including extension
Days used to date
Days remaining
Please acknowledge receipt of this order by dating, signing and returning three (3) of the
attached copies. The other copy is for your file.
Prepared by:
Approved by:
________________________
Project Engineer
________________________
Regional Director
________________________
Contractor
Date: ___________________
4-4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Date:
______________________________________________
Contractor:
______________________________
______________________________
______________________________
You are hereby directed to resume all construction activities effective ______________ .
Please acknowledge receipt of this order by dating, signing and returning three (3) of the
attached copies. The other copy is for your file.
Prepared by:
________________________
Project Engineer
Approved by:
________________________
Regional Director
________________________
Contractor
Date: ___________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
4-5
Chapter 5
STATION LIMITS
LOCATION
APPROPRIATION
:
:
:
ITEM NO.
DESCRIPTION
UNIT
QTY.
KIND OF TEST
PREPARED BY:
NOTED BY:
_____________________________________________
_____________________________________________
CHECKED BY:
APPROVED BY:
_____________________________________________
_____________________________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5-1
5-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Quantities
Accomplished
this Month
Minimum Test
Required
(Itemized)
_____________________________________
Project Engineer
Materials Engineer
NOTED BY:
Test
Performed
this Month
Total TestsPerformed
_____________________________________
SUBMITTED BY:
_____________________________________
PREPARED BY:
Quantities as
Programmed or per
Contract
Contractor
Item No.
Contract Time :
Date Started :
End of Contract :
Contract Amount :
Project Number :
Province/City :
Source of Fund :
Appropriation :
Project :
MATERIALS
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
_____________________________
_____________________________
Quantity
Represented
CERTIFIED CORRECT:
Kind of
Materials
PREPARED BY:
Laboratory
Number
At
REMARKS
Chief, QAD/QAS
_____________________________
NOTED BY:
_____________________________
ATTESTED BY::
Kind of
Test
5-3
_______________________________________________________________
STATION:
_______________________________________________________________
CONTRACTOR: _______________________________________________________________
ITEM No.
5-4
DESCRIPTION
OUANTITY ACCOMPLISHED
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Location
Kind of Material
Tested By
Computed By
Lab. No.
(Date)
(Date)
Density Determination
Number of Blows
10
Test Sample
Trial 1
Trial 2
Test Sample
Mold ID
Can ID
Compacted
Sample + Mold
Wet Sample
+ Can
Weight of Mold
Sample
Volume of
Can + Oven
Dry Sample
Moisture
Mold
Wet Unit
Can
Oven Dry
Weight
Dry Unit
Weight
Sample
Moisture
MC
MDD
Number of Blows
Before
COMPACTION
AFTER
COMPACTION
Trial 1
Trial 1
After
PENETRATION
Trial 1
Trial 2
kg/m
Dial
Reading
LOAD
PSI
300
0.0000
0.0125
0.0250
0.0375
250
0.050
0.075
200
Load, psi
0.10
0.20
0.30
0.40
0.50
100
RESULTS :
CBR Value @ 0.10
150
Load
0.00
CBR Value
50
0
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
0.450
0.500
Penetration, in
Swell, %
Page 1 of 4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5-5
Location
Kind of Material
Tested By
Computed By
Lab. No.
(Date)
(Date)
Density Determination
Number of Blows
Test Sample
Number of Blows
30
Trial 1
Trial 2
Test Sample
Mold ID
Compacted
Sample + Mold
Weight of Mold
Can ID
Wet Sample
+ Can
Can + Oven
Sample
Volume of
Dry Sample
Moisture
Mold
Wet Unit
Weight
Can
Oven Dry
Sample
Dry Unit
Moisture
Weight
MC
MDD
Trial 1
After
PENETRATION
Trial 1
Trial 2
kg/m3
Dial
Reading
LOAD
PSI
300
0.0000
0.0125
250
0.0250
0.0375
0.050
0.075
0.10
200
Load, psi
0.20
0.30
0.40
0.50
100
RESULTS :
Load
CBR Value @ 0.10
150
CBR Value
0.00
50
0
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
0.450
0.500
Penetration, in
Swell, %
Page 2 of 4
5-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Location
Kind of Material
Tested By
Computed By
Lab. No.
(Date)
(Date)
Density Determination
Number of Blows
Test Sample
65
Trial 1
Trial 2
Number of Blows
65
Before
AFTER
After
Test Sample
COMPACTION
COMPACTION
PENETRATION
Trial 1
Trial 1
Mold ID
Can ID
Compacted
Sample + Mold
Wet Sample
Weight of Mold
+ Can
Can + Oven
Sample
Dry Sample
Volume of
Moisture
Mold
Can
Wet Unit
Weight
Oven Dry
Sample
Dry Unit
Moisture
Weight
MC
MDD
Trial 1
Trial 2
kg/m3
Dial
Reading
LOAD
300
PSI
0.0000
0.0125
250
0.075
0.10
0.20
0.30
0.40
200
Load, psi
0.0250
0.0375
0.050
150
0.50
100
RESULTS :
CBR Value @ 0.10
Load
0.00
CBR Value
50
0
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
0.450
0.500
Penetration, in
Swell, %
Page 3 of 4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5-7
Location
Kind of Material
:
:
Tested By
Computed By
Lab. No.
No. of Blows
(Date)
(Date)
UW DRY
10 Blows
@ 0.10
MS
@ 0.20
30 Blows
@ 0.10
65 Blows
@ 0.10
@ 0.20
@ 0.20
@ MDD
70.00
68.00
66.00
64.00
62.00
60.00
58.00
56.00
54.00
52.00
50.00
CBR Value, %
48.00
46.00
44.00
42.00
40.00
38.00
36.00
34.00
32.00
30.00
28.00
26.00
24.00
22.00
20.00
18.00
16.00
14.00
12.00
10.00
1940
1960
1980
2000
2020
2040
2060
2080
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Page 4 of 4
5-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Sampled by:
Tested by:
Computed by:
(Date)
(Date)
Lab. No.
Dry Unit mass, kg/m3
Loose
Rodded
Moisture Content, %
Fineness Modulus
Sieve
Size
Mass
Retained
Mass of Sample, g
Mass of Oven dried, g
Mass of washed oven
dried sample
Mass of materials passing
0.075 mm, g
C UMUL AT IVE
Mass Passing
(g)
% Passing
% Retained
Specification
75.0
63.0
50.0
37.5
25.0
19.0
12.5
9.5
6.3
4.75
2.36
2.00
1.18
0.600
0.425
0.300
0.250
0.150
0.075
Pan
Wash
TOTAL
Remarks: __________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5-9
Quantity Represented
Spec's Item No.
Date
Date
Sampled By
Tested By
Laboratory Report No.
DETERMINATION NUMBER
LIQUID LIMIT
2
3
Container Number
Container + wet soil, g
Container + dry soil, g
Moisture loss, g
Container, g
Dry Soil, g
Moisture Content. %
Number of Blows
PLASTIC LIMIT
1
2
Ave.
MOISTURE CONTENT, %
SIEVE ANALYSIS
40
Sieve size
2.0
0.425
0.75
Liquid Limit
Plastic Limit
Plasticity Index
Group Index
Soil Classification
35
30
25
20
20
15
NUMB ER OF BLOWS
10
Remarks/Recommendations:
25
30
35
40
___________________________________________________________
___________________________________________________________
___________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
5 - 10
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Quantity Represented
-
Sampled by:
(Name & Designation)
(Office)
(Date)
(Office)
(Date)
(Office)
(Date)
Tested by:
Computed by:
Trial Number
Water added in C.C,
Weight : Mold+Wet Soil
In : Mold
Kilograms : Wet Soil
Wet Density, kg/m3
Can Number
Weight : Can+Wet Soil
: Can+Dry Soil
In : Water
: Can
Grams : Dry Soil
Moisture Content, %
Dry Density, kg./m3
2000
Method used
Weight of hammer, kg,
Volume of mold, cu. m.
Number of layers
1950
1900
kg/m3
Optimum moisture
content, %
1850
Remarks/Recommendation:
1800
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Moisture Content, %
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 11
(Name)
(City/Province)
Kind of material
Test hole:Depth
Location
(Station & Reference to Center Line)
Representing
(Layer No.)
(Depth)
(Width)
(Station to Station)
Tested by
(Name and Designation)
(Office)
(Date)
(Office)
(Date)
Computed by
Lab. No.
1.
2.
3.
4.
5.
11.
12.
13.
14.
15.
16.
Remarks/Recommendations:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
5 - 12
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Abrasion Test
(Number)
(City/Province)
Kind of Materials:
Source of Mixture:
(Give accurate location as possible)
Original Source:
(Pit, Quarry, River, etc., location)
Sampled By:
(Name & Designation)
(Office)
(Date)
(Office)
(Date)
(Office)
(Date)
Tested By:
Computed By:
Original Weight of Sample - - - - - - - - - - - - - - - - Weight of Sample after Abrasion - - - - - - - - - - - - Weight of Sample loss - - - - - - - - - - - - - - - - - - % Abrasion Loss - - - - - - - - - - - - - - - - - - - - - - -
Remarks/Recommendations:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 13
5.4.6.2
Composite Aggregates
_____________________
_____________________
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Office)
(Date)
(Date Received)
REQUIREMENTS
RESULTS
100
95-100
74-92
48-70
33-53
22-40
15-30
10-20
4-9
40 Max.
6 Max.
-
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Representative (DPWH)
5 - 14
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Asphalt Cement
_____________________
_____________________
Sample identification
Quantity represented
Sampled at
Original source
Grade
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Office)
(Date)
(Date Received)
REQUIREMENTS
RESULTS
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 15
5.4.7.2
Emulsified Asphalt
_____________________
_____________________
Sample Identification
Quantity represented
Sampled at
Type and Grade
Original Source
Supplied by
Proposed Use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
RESULTS
20-100
1.0 Max.
2.0 Max.
0.10 Max.
57 Min.
40-90
40 Min.
97.5 Min.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
5 - 16
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.7.3
Cutback Asphalt
____________________________________________________
Laboratory No.:
___________________
Date Tested:
__________________
I.
_____________________
II.
___________________ C
_____________________
b.
_____________________
c.
_____________________
_____________________
IV. Distillation
Volume of Sample, ml. = mass of sample/sp. Gravity: _____________________
Temperature
o
Volume of Distillate
% by volume
190 C (374 F)
225 C (437 F)
260 C (500 F)
o
315 C (600 F)
o
360 C (680 F)
Residue, % by volume:
V.
_____________________
Test on Residue
1.
_____________________
2.
_____________________
3.
Solubility in Trichloroethylene:
_____________________
a.
Mass of sample, g:
_____________________
b.
_____________________
c.
_____________________
_____________________
4.
Spot Test:
_____________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 17
_____________________
_____________________
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
:
:
:
:
:
:
:
Sampled by
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
RESULTS
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
5 - 18
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.9
_____________________
_____________________
:
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Office)
(Date)
(Date Received)
Thickness, mm
Density, kg/m3
REQUIREMENTS
RESULTS
17.5 - 20.7
304 Min.
Water Absorption, %
2
Compression, KN/m
Recovery, %
20 Max.
689 - 5171
70 Min.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 19
_____________________
_____________________
Sample identification
Quantity represented
Sampled at
Manufactured by
Brand
Supplied by
Spec's Item No.
Sampled by:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Office)
(Date)
(Date Received)
REQUIREMENTS
6.0 Max.
3.0 Max.
3.0 Max.
0.75 Max.
12.0 Max.
RESULTS
0.8 Max.
45 - 375
12.0 Min.
19.0 Min.
28.0 Min.
-
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
5 - 20
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
_____________________
_____________________
:
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
RESULTS
Bending Properties:
Degree bent, 180 degrees
Actual Unit mass, kg/m
Variation in mass, %
Deformation, mm
Spacing, average
Height, average
Gap
Phosphorous Content, %
No cracking on outside
bent portion
6.0 Max. under nominal mass
280 Min.
420 Min.
12 Min.
11.1 Max.
0.71 Min.
6.1 Max.
0.06 Max.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 21
_____________________
_____________________
:
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
211 Max.
Flow at 60 o C, mm
o
RESULTS
5 Max.
90 Max.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
5 - 22
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.13 Paint
_____________________
_____________________
:
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
Total Solids, %
49 Min.
Non-volatile vehicle, %
by wt. of vehicle
18 Min.
Pigment, %
39 Min.
Titanium Dioxide, %
by wt.of pigment
Weight, kg/L
Drying Time:
Set to touch, mins.
Dry hard, h
RESULTS
30 Min.
1.35 Min.
10-15
1 Max.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 23
_____________________
_____________________
:
:
:
:
:
:
:
:
:
:
Submitted by
(Office)
(Date)
(Office)
(Date Received)
REQUIREMENTS
2. Specific Gravity
3. Drying Time, mins.
4. Softening Point, o C
B. Paint Composition
1. Total Dry Solids %
(Pigment & Glass Beads & Fillers)
2. Lead Chromate, %
3. Extenders (Fillers), %
4. Binders, %
5. Glass Beads, %
6. Grading, % Passing
Sieve Size No. 20 (0.850 mm)
30 (0.600 mm)
40 (0.425 mm)
50 (0.300 mm)
80 (0.180 mm)
100 (0.150 mm)
RESULTS
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
5 - 24
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.5
Accreditations
Name of Applicant:
__________________________________________________________
Address:
__________________________________________________________
Telephone Number(s): __________________________________________________________
Address of batching Plant if different from No. 2:
________________________________
Telephone Number of Batching Plant if different from No.3:
_______________________
Name of Duly Authorized Representative: ________________________________________
Position of Duly Authorized Representative: ________________________________________
Plant Machinery and Laboratory Equipment/Apparatus: _______________________________
List down all production and test facilities. Include name of equipment, its purpose/use,
manufacturer, date acquired and date placed in service (Use a separate sheet if necessary).
9. Calibration
State the program of calibration of measuring instruments/equipment (Use a separate sheet if
necessary).
10. List of personnel together with their qualifications.
a) Production Personnel
b) Quality Control Personnel
In the event that a certificate of accreditation is granted, we hereby agree to comply with the
Guidelines for the Accreditation of Asphalt and Portland cement Concrete Batching plants and to abide
by the rules and regulations promulgated by the DPWH for the accreditation of batching plants.
_________________________
(Signature)
President/Manager/Duly Authorized Representative
Subscribed and sworn to before me this ___________ day of _____________ 20__, affiant
exhibiting to me his/her Residence Certificate No. ________________ issued at ___________ on
20____.
____________________________
Notary Public
Doc. No.: ___________
Page No.: __________
Book No.: __________
Series of : __________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 25
5.5.2
APPLICATION FORM
Application Number
New Applicant
Accredited Materials Engineer I,
Indicate accreditation number
School
Year Graduated
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
________________________________
Date
Manila
Cebu City
Davao City
5 - 26
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.5.3
APPLICATION FORM
Date of Examination
Application Number
Accredited as Contractors' Materials Engineer
Name:
(First)
(Middle)
___________________
Home Address:
________________________________________________
________________________________________________
Regional/District Office:
________________________________________________
Office Address:
________________________________________________
Position Title:
________________________________________________
Home Tel No.: ______________ Office Tel No.: ______________ Mobile No.: _______________
Nationality: ___________ Birthday:
School
Year Graduated
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
________________________________
Date
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 27
5.5.4
1.
2.
b.
Two 2 x 2 photographs (one to be pasted in the Application Form and the other
is for Notice of Examination Schedule)
c.
3.
One 1 x 1 photograph
4.
Application forms must be submitted at least forty (40) days before the scheduled
accreditation examination.
5.
Applicants shall obtain the Notice of Examination Schedule from the DPWH Office
where the application was filed within, one (1) week before the scheduled examination.
The notice shall confirm the date, time and place of examination. This notice must be
presented to the DPWH examination proctor during the examination.
EXAMINATION COVERAGE
Construction materials specifications, sampling and testing procedures, test results
calculations/interpretation/evaluation,
DPWH
minimum
testing
requirements,
5 - 28
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Chapter 6 Payments
6.1 Advance Payment
6.1.1 Disbursement Voucher
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
DISBURSEMENT VOUCHER
MODE OF PAYMENT
MDS Check
Commercial Check
DV No.:
Date:
TIN/Employee No.:
OR/BUR No.:
Date:
Responsibility Center
Title:
Code:
ADA
Payment/Office:
Bank Account No.:
Address:
Others
Account
Code
Explanation
Amount
Advance to Contractors
Due to BIR
_______________ payment in connection with the Contract ID#
Contract Amount
P
_____x___________
Less:
P ________________P ________________ -
12 % VAT
P
Net Amount Due to - - - - - - - - - A. Certified
Cash Available
Subject to ADA (where applicable)
Supporting documents complete
E
Signature:
Printed Name:
Position:
_
_
Accountant
U
Signature:
Printed Name:
Position:
Date:
_
C. Received Payment:
_
_
Regional Director
(Agency Head/Authorized Representative)
Date:
_
Check/ADA No.:
_______________________
Date: _____________ JEV No.: ______________
Bank Name: _____________ Date: ___________
OR No./Other relevant documents issued: __________________
P.P.A
ACCOUNTING ENTRY
ACCOUNT
CODE
DEBIT
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
CREDIT
6-1
Date: ____________________
_________________________________
The Regional Director/District Engineer
___________________________________________
___________________________________________
___________________________________________
FOR:
FROM:
SUBJECT:
BACKGROUND:
Project ID:
________________________________________________________
Project Name:
________________________________________________________
Loan:
________________________________________________________
Contractor:
________________________________________________________
Original Contract Amount:
________________________________________________________
Revised Contract Amount:
________________________________________________________
Original Contract Time:
________________________________________________________
Revised Contract Time:
________________________________________________________
Effectivity of Contract Time: ________________________________________________________
Original Expiry Date:
________________________________________________________
Revised Expiry Date:
________________________________________________________
Percent Time Elapsed:
________________________________________________________
Percent Work Accomplished: ________________________________________________________
Percent Work Schedule:
________________________________________________________
Percent Slippage:
________________________________________________________
Date Project Completed:
________________________________________________________
Date Project Accepted:
________________________________________________________
Kind of Bank Guarantee or Letter of Credit:
______________ issued by ________________
Expiry Date of Bank Guarantee or Letter of Credit: Until fully recouped
_______________________________________
REMARKS:
__________________________________________________
__________________________________________________
_____________________
Project Engineer
6-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-3
Date: ____________________
BILLING SUMMARY
PAYEE:
_________________________________________________________
PROJECT ID:
PROJECT NAME:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
IMPLEMENTING OFFICE:
_________________________________________________________
NATURE OF CONTRACT:
_________________________________________________________
CONTRACT AMOUNT:
PREVIOUS BILLING:
THIS BILLING:
BALANCE:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
PAYMENT BREAKDOWN
15% Cash Advance: P _________________________
REMARKS:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
NOTED:
_____________________
Project Engineer
6-4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
___________________
Chief, Construction Division/Section
SUBJECT:
Project Name:
___________________________________________________________
Sir:
In accordance with the conditions of contract, we have complied with all your
guidelines and requirements, that is; a.) The Form of Agreement was executed by and between
the both parties, b.) The Performance Security was provided by us and still valid, c.) The
Warranty in a form of Bank Guarantee in the amounts equal to Advance payment.
Accordingly, may we request your good office to release advance payment, 15% of
contract amount, exclusively for the costs of mobilization of the above-mentioned project.
Your kindest attention on this matter will be highly appreciated.
Very truly yours,
_________________________
Contractor
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-5
Date: ____________________
CERTIFICATION
U
______________________________
Chief, Construction Division/Section
6-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
LIST OF EQUIPMENT ON SITE
U
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
PHOTOGRAPHS
______________________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-7
6-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
FOR:
_________________________________
The Regional Director/District Engineer
_________________________(The Project Engineer)
___________________________________________
First Billing
FROM:
SUBJECT:
U
BACKGROUND:
Project ID:
________________________________________________________
Project Name:
________________________________________________________
Loan:
________________________________________________________
Contractor:
________________________________________________________
Original Contract Amount:
________________________________________________________
Revised Contract Amount:
________________________________________________________
Original Contract Time:
________________________________________________________
Revised Contract Time:
________________________________________________________
Effectivity of Contract Time: ________________________________________________________
Original Expiry Date:
________________________________________________________
Revised Expiry Date:
________________________________________________________
Percent Time Elapsed:
________________________________________________________
Percent Work Accomplished: ________________________________________________________
Percent Work Schedule:
________________________________________________________
Percent Slippage:
________________________________________________________
Date Project Completed:
________________________________________________________
Date Project Accepted:
________________________________________________________
Kind of Bank Guarantee or Letter of Credit:
______________ issued by ________________
Expiry Date of Bank Guarantee or Letter of Credit: Until fully recouped
_______________________________________
REMARKS:
__________________________________________________
__________________________________________________
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-9
_____________________
Project Engineer
6 - 10
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
BILLING SUMMARY
PAYEE:
_________________________________________________________
PROJECT ID:
PROJECT NAME:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
IMPLEMENTING OFFICE:
_________________________________________________________
NATURE OF CONTRACT:
_________________________________________________________
CONTRACT AMOUNT:
PREVIOUS BILLING:
THIS BILLING:
BALANCE:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
PAYMENT BREAKDOWN
1st Billing: P _________________________
P
REMARKS:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
NOTED:
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 11
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Project Name:
___________________________________________________________
Sir:
We are submitting herewith our First Partial Billing for the above-mentioned project, in
the amount of _____________________________ (P______________________) only. We have
accomplished the work satisfactorily in accordance to the terms and conditions of the contract. We
also certify that the Performance Security of Contractors Comprehensive All Risk Insurance
(CARI) is valid and premiums have been paid on time. Detailed Quantity Calculation, supporting
papers and pertaining documents are hereto attached for your review and approval.
We hope that the above is in order and request your preferential attention thereof.
_________________________
Contractor
6 - 12
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
8.
5.
6.
7.
P
P
P
1.
2.
3.
4.
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
A. 10% Retention
P
Recoupment from Advance
P
Sub-Total
P
B. 2% Withholding Tax
P
5% VAT
P
Others (Specify)
Sub-total
P
TOTAL DEDUCTIONS
P
Amount received for payment:
P
Add: Request No.___ for materials currently on hand
Less: Request No.___for previous payment
materials on hand
P
Net amount Due to Contractor
P
P
P
CONTRACTOR:
PROJECT NAME:
Regional Director
Chief, QAD/QAS
AMO/Contractor's Representative
CERTIFICATE OF PAYMENT
6 - 13
6 - 14
Description
__________________________
Contractor
Submitted by:
Item
Total
Revised
Contract
Cost
Balance of
Quantity
Cost of
Previous
Billing
__________________________
Assistant Regional Director
Total Qty.
Total
Approved in
Quantity to
Previous
Date
Billing
__________________________
Chief, Construction Division
Verified by:
Unit Price in
Pesos
__________________________
Project Engineer
Checked by:
Revised
Quantity
Original
TO TAL
Unit
Contractor: ____________________________
Cost to
Date
Balance of
Cost
__________________________
Regional Director
Approved by:
Cost of this
Billing
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Period Covered:
________________________________________________
Original Contract Time:
________________________________________________
Date of Effectivity of Contract:
________________________________________________
Original Contract Amount:
________________________________________________
Revised Contract Amount due to Approved Change Order/
Extra Work Order:
________________________________________________
Original Expiry Date :
________________________________________________
Approved Time Extension:
________________________________________________
Shutdown days due to
Suspension of Work:
________________________________________________
Total Time Extension:
________________________________________________
Total Calendar Days Elapsed to Date:
________________________________________________
Contract Time Elapsed (After Suspension): _______________________________________________
Revised Expiry Date due to
Extension/Extension:
________________________________________________
Percentage of Time Elapsed:
________________________________________________
Schedule of Work Accomplished:
________________________________________________
Percentage of Work Accomplished:
________________________________________________
Actual Slippage:
________________________________________________
Certified by:
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 15
Date: ____________________
CERTIFICATION OF CLEARANCE FOR
EQUIPMENT RENTALS AND/OR LEASE
PROJECT ID:
NAME OF PROJECT:
___________________________________________________
___________________________________________________
LIMITS:
___________________________________________________
LOCATION:
___________________________________________________
______________________________
Project Engineer
6 - 16
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
CERTIFICATION OF CLEARANCE FOR
LABOR AND MATERIALS PAYMENT
PROJECT ID:
NAME OF PROJECT:
___________________________________________________
___________________________________________________
LIMITS:
___________________________________________________
LOCATION:
___________________________________________________
______________________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 17
Month:
Project ID:
Project Name:
Contractor's Name
Original Quantity:
Description:
Revised Quantity:
Uni:
unit
________________ unit
________________ unit
________________ unit
________________ unit
Cumulative Quantity:
________________ unit
We hereby certify that we have conducted inspection and verification on work accomplished on
the above-mentioned project for the period ____________. We further certify that we have found that the
quality of materials in the specified work item corresponding to the quantity accomplished conforms with
the Standard Specifications and Special Provisions of Contract.
We also certify that unacceptable work has been deducted, and not included in this calculation.
Submitted by:
Checked by:
_________________________
_________________________
_________________________
Material Engineer
(DPWH)
Project Engineer
(DPWH)
6 - 18
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 19
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Project Name:
___________________________________________________________
Sir:
With reference to our contract for the above-mentioned project, we would like to request
for
the
_______
partial
payment
of
work
accomplished
in
the
amount
of
_________________________
Contractor
6 - 20
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 21
_________________________________
Supply Officer, Administrative Division/Section
_________________________________
Chief, Administrative Division/Section
6 - 22
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ______________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Location :
___________________________________________________________
1.
PARTICULARS
NONE
AMOUNT
NONE
REMARKS
NONE
(This will include unreturned equipment, attachments and accessories, estimated cost of repairs, etc.)
REMARKS:
___________________________________________________________
___________________________________________________________
(State the present condition of the equipment together with your comment
and/or recommendation).
FOR FINAL PAYMENT
CLEARED OF EQUIPMENT ACCOUNTABILITY &
OTHER OBLIGATIONS IN THE AREA II EQUIPMENT
SERVICES
____________________________________
Chief, EMD
SUBMITTED BY:
____________________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 23
CERTIFICATION OF COMPLETION
PROJECT ID:
NAME OF PROJECT:
CONTRACTOR:
DATE:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
This is to certify that the above-stated project has been satisfactorily completed on
_____________________ in accordance with the Plans and Specifications of the Contract
based on the Final Inspection Report of the Inspectorate Team dated ___________________.
This Certificate does not relieve the Contractor of his obligations and
responsibilities in undertaking repair works on any defect or failure that may occur on any
section of the Project during the defects liability period starting from the date of completion
as herein stated. Neither is he relieved of his obligations and responsibilities pursuant to the
provisions of R.A. 9184.
______________________________
Regional Director/District Engineer
Comforme:
______________________________
Contractor
6 - 24
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
This is to certify that the above-stated project has been satisfactorily completed on
_____________________ in accordance with the Plans and Specifications of the Contract
based on the Final Inspection Report of the Inspectorate Team dated ___________________.
This Certificate does not relieve the Contractor of his obligations and
responsibilities in undertaking repair works on any defect or failure that may occur on any
section of the Project during the defects liability period starting from the date of completion
as herein stated. Neither is he relieved of his obligations and responsibilities pursuant to the
provisions of R.A. 9184.
______________________________
______________________________
Representative
Construction Division/Section
Representative
Planning & Design Division/Section
______________________________
______________________________
Representative
Maintenance Division/Section
Representative
QA Division/Section
NOTED BY:
______________________________
Asst. Regional Director/Asst. District Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 25
6 - 26
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 27
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Project Name:
___________________________________________________________
Sir:
With reference to our contract for the above-mentioned project, we would like to request
for the release of Retention in the amount of _____________________ (P _________________).
Favorable actions on this regard will be highly appreciated.
_________________________
Contractor
6 - 28
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Contractor:
__________________________________________________
__________________________________________________
No. of billing
D.V. Number
Date
Amount
Total
Certified Corrected:
_________________________________
Accountant
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 29
6 - 30
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
PROJECT INFORMATION
Name of Project:
____________________________________________________
Location: ____________________________________________________
Contract Amount:
____________________________________________________
Contractor:
____________________________________________________
II.
_________________________________
_________________________________
_________________________________
_________________________________
Noted by:
_________________________________
Chief, QAD
Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents
7-1
Date:
___________________
Pre-final Inspection
(PUNCHLIST)
NAME OF PROJECT:
STATION LIMITS :
LOCATION:
CONTRACTOR:
FINDINGS:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
1.
________________________________________________________________________
2.
________________________________________________________________________
3.
________________________________________________________________________
4.
________________________________________________________________________
5.
________________________________________________________________________
6.
________________________________________________________________________
7.
________________________________________________________________________
8.
________________________________________________________________________
9.
________________________________________________________________________
10. ________________________________________________________________________
11. ________________________________________________________________________
12. ________________________________________________________________________
13. ________________________________________________________________________
14. ________________________________________________________________________
15. ________________________________________________________________________
Prepared by:
__________________________________
Project Facilitator
__________________________________
Project Engineer
Received by:
__________________________________
Contractor
7-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
FINAL INSPECTION REPORT
PROJECT/LOCATION:
___________________________________________________
___________________________________________________________
CONTRACTOR: ___________________________________________________________
___________________________________________________________
We, the undersigned members of the Inspectorate Team, conducted a joint
inspection of the above-stated project and found the same to be satisfactorily completed on
______________________________ in accordance with Plans and Specification of the
Contract.
_____________________________________
Chief, Planning and Design Division/Section
_____________________________________
Chief, Construction Division/Section
_____________________________________
Chief, Maintenance Division/Section
_____________________________________
Chief, Quality assurance Division/Section
____________________________________________________
Assistant Regional Director/Assistant District Engineer
Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents
7-3
Date: ____________________
CERTIFICATE OF COMPLETION
PROJECT/LOCATION:
___________________________________________________
___________________________________________________________
___________________________________________________________
CONTRACTOR:
___________________________________________________________
___________________________________________________________
This is to certify that the above-stated project has been satisfactorily completed on
___________________ in accordance with the Plans and Specifications of the Contract based on
the Final Inspection Report of the Inspectorate Team dated ____________________________.
This certification does not relieve the Contractor of his obligations and responsibilities
in undertaking repair works on any defect or failures that may occur in any section of the project
during the one-year Warranty Period starting from the date of completion as herein stated.
Neither is he relieved of his obligations and responsibilities pursuant to the provisions of
PD 1759.
_____________________________________
Regional Director/District Engineer
Comforme:
_____________________________________
Contractor
7-4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
NOTICE TO PROCEED:
TARGET DATE OF COMPLETION:
ACTUAL DATE OF COMPLETION:
A. OBJECTIVE
To validate the reported accomplishment and determine compliance with plans specification
B. SCOPE
Progress accomplishment as to physical and technical aspect.
C. REFERENCE DOCUMENTS
SUBMITTED
YES
NO
DATE
DOCUMENTS
NA
1
1.1
MM
AMOUNT
DD
(PhP)
REMARKS
Original Contract
Plans
1.2
Specifications
1.3
Cost Breakdown
3.1
Revised Plans
3.2
Specifications
3.3
YY
Cost Breakdown
As-built Plans
Others
D. METHODOLOGY
1
2
3
4
Page 1 of 2
Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents
7-5
Page 2 of 2
7-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Date: ____________________
ACCEPTANCE REPORT
PROJECT/LOCATION:
___________________________________________________
___________________________________________________________
CONTRACTOR: ___________________________________________________________
___________________________________________________________
We, the undersigned members of the Inspectorate Team, conducted a inspection on
the above-stated project and found the same to be free from failures and detects that are
traceable to poor workmanship, use of poor quality materials and non-compliance with Plans
and Specification of the Contract.
_____________________________________
Chief, Planning and Design Division/Section
_____________________________________
Chief, Construction Division/Section
_____________________________________
Chief, Maintenance Division/Section
_____________________________________
Chief, Quality assurance Division/Section
____________________________________________________
Assistant Regional Director/Assistant District Engineer
Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents
7-7
Date: ____________________
CERTIFICATE OF ACCEPTANCE
PROJECT/LOCATION:
___________________________________________________
___________________________________________________________
___________________________________________________________
CONTRACTOR:
___________________________________________________________
___________________________________________________________
( date )
( date )
, the
Project is free from failures and defects which are traceable to poor workmanship, use of poor quality
materials and non-compliance with Plans and Specifications of Contract.
_____________________________________
Regional Director/District Engineer
Comforme:
_____________________________________
Contractor
7-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents