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National Rural Infrastructure Development Agency Ministry of

Rural Development, Government of India Template Version: V3.0

Form Id 130827 Format QR Version 2021.0- Part I

Format for information to QM for Inspection of Ongoing/Completed Work

PART I– Work Information (To be filled-up by PIU)

1. GENERAL:

I. Work is: Ongoing ✔ Completed

II. Current stage of work: Stage-I Stage-II ✔ Complete

III. Date of inspection:

NQM Code
IV. Name of Quality Monitor (QM): Ramesh Kumar Sharma
✔ SQM Code

V. State: Himachal Pradesh District: Hamirpur Block: Tauni Devi

VI. Name of Road: T04-Kangoo da galu Kalahu Road

VII. Package Number: HP03157

VIII. Sanctioned length: 6.756 km, Flexible pavement: 6.732 km,Rigid/Semi-Rigid pavement: 0.024 km

IX. Executed length: 6.756 km, Flexible pavement: 6.732 km, Rigid/Semi-Rigid pavement: 0.024 km
(in case of completed works only)
NA
X. Reasons for deviation (if any):
XI. Name of new technology (if used)
✔ Cold Mix Technology RD from 1.00 km to 1.500 km
Select new technology used RD from km to km
Select new technology used RD from km to km

XII. Estimated cost (as cleared by GOI): Rs. 461.67 Lakh

XIII. Technical sanction cost: * Rs. 580.78 Lakh

XIV. Awarded cost: Rs. 418.21 Lakh

XV. Expenditure: (if work is ongoing)

a. Expenditure done: Rs. Lakh

b. Bills pending: Rs. Lakh

Total expenditure (a+b)

Rs. 0.00 Lakh

XVI. Completion cost: (if work is completed) Rs. 417.14 Lakh

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XVII. The work is a case of (check✓boxes as applicable)

A) New Connectivity Total length: km

(i) Carriageway width (m): 3m 3.75m 5.5m 7m

B) ✔ Up-gradation Total length: 9.756 km

(i) Carriageway width and length:

Existing width 3.05 m
✔ With widening Length 9.756 km
Proposed width 3.75 m

Without widening Proposed width m Length km

XVIII. Terrain: (check ✓ anyone box) Plain Rolling ✔ Hilly Steep

XIX. Date of award of work: (date/ month/ year) 22/06/2020

XX. Date of start of work:(date/ month/ year) 08/07/2020

XXI. Stipulated date of completion:(date/ month/ year)

07/07/2021

XXII. Actual date of completion: (date/ month/ year)* 01/05/2022

(in case of completed work)
2. PHYSICAL PROGRESS: (Ongoing/Completed)*
I. Construction Programme and Physical Progress:
Item of work Unit Quantity Quantity Completed Fill in start and completion dates Delay in
(length/ As per executed percentage months
number) DPR of item Progress Start Completion
status Date Date
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Due 08/07/2020 31/10/2020
✔ i) Preparatory Work Km 6.756 6.756 100.00 0
Actual 08/07/2020 31/10/2020
ii) Earth Work& Due 08/07/2020 30/11/2020
✔ Km 6.756 6.756 100.00 0
Subgrade Actual 15/08/2020 30/11/2020
Due 15/08/2020 31/12/2020
✔ iii) CD Works No's 2.000 2.000 100.00 0
Actual 20/08/2020 31/12/2020
Due 15/08/2020 31/03/2021
✔ iv) Protection works m 1782.56 2101.28 117.88 12
Actual 20/08/2020 31/03/2022
Due 01/09/2020 31/12/2020
✔ v) Sub Base including Km 6.732 6.732 100.00 1
shoulders Actual 15/09/2020 31/01/2021
vi) WBM/ WMM Base Due 30/09/2020 31/01/2021
✔ Km 6.732 6.732 100.00 1
Course Actual 01/11/2020 14/02/2021
vii) Bituminous Due 01/10/2020 31/03/2021
✔ Base/Wearing Km 6.732 6.732 100.00 0
Actual 25/02/2021 31/03/2021
Course
viii) Bituminous Surface Due 15/10/2020 15/04/2021
✔ Course Km 6.732 6.732 100.00 0
Actual 01/03/2021 20/04/2021
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Due 15/04/2021 30/06/2021
✔ ix) CC Pavement Km 0.024 0.024 100.00 1
Actual 20/04/2021 31/07/2021
Due 30/04/2021 07/07/2021
✔ x) Signage etc. No's 4.000 4.000 100.00 10
Actual 31/05/2021 01/05/2022

3. QUALITY CONTROL:
I. Location of field laboratory:

II. Geo-tagged photograph of laboratory uploaded on: (date/ month/ year)

III. Reason for delay in establishment of field laboratory(if so): NA

IV. Details of contractor, executing the work:

Name of contractor PAN number Mobile number E-mail ID.

✔

V. Details of contractor’s engineer available at site: (Responsible for maintaining quality control register part-1)
Sl. Name of contractor’s Duration of posting at site
no. Identity number Mobile number
engineer at site From To
✔ 1
2
3
VI. Details of contractor’s lab technician:
Sl. Name of contractor’s Duration of posting at site
no. Identity number Mobile number
lab technician From To
✔ 1
2
VII. Details of Head of PIU supervising the work: *
Sl. Head of PIU Duration of posting at site
no. Employ number
(Executive engineer) From To
✔ 1 Er. A S Bhatia IP0312554 22/06/2020 14/10/2020
✔ 2 Er. V S Guleria 9418008735 15/10/2020 14/11/2021
✔ 3 Er Arvind Lakhanpal 9418145600 15/11/2021 31/08/2022

*
VIII. Details of Assistant engineer supervising the work and maintaining quality control register Part-II:

Sl. Duration of posting at site

Name of Assistant
no. Employ number Mobile number
engineer From To
✔ 1 Er. Rattan Kaundal IP0710503 8626952506 01/06/2018 28/04/2021
✔ 2 Er Baldev Rana IP0715472 7018448612 30/04/2021 27/08/2021
✔ 3 Er Nitish Bhardwaj IP3820404 9736440960 28/08/2021 01/05/2022
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IX. Details of the Junior engineer supervising the work: *

Sl.
Name of Junior Duration of posting at site
no. Employ number Mobile number
engineer
From To
✔ 1 Er. Vijay Kumar IP0716543 9418603699 22/06/2020 14/08/2021
✔ 2 Er. Satish Kumar IP0215555 9625931496 15/08/2021 01/05/2022
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X. List of equipments available in field lab:

Table (IX) a

Available equipments that are in working condition Available equipments that are not in working
(1) condition (2)

XI. List of equipments not available in field lab

XII. Reasons put forth by PIU for non availability of equipments in field lab:
NA

XIII. Equipments and documents ready to be made available to QM before or during the inspection:*
LIST ATTATCHED AS PER ANNEXURE EQP-B

4. DETAILS OF MIX DESIGN(s) (if provided in the sanctioned project):

(Manadatory in case of “Yes”)
If applicable (check✓ the box) Yes ✔ No

Sl. Mix Design Institute/laboratory where mix Date

Mix Design
No. Strength design was done
i. Cement Concrete M20
ii. Cement Concrete M 30
✔ iii. Dense Bituminous Macadam 2.303 gm/cc GeoTech Engineers and Consultants 24/03/2021

✔ iv. Semi Dense Bituminous Concrete 2.229 gm/cc GeoTech Engineers and Consultants 24/03/2021

v. Bituminous Concrete
5. EARLIER INSPECTIONS BY NQM, SQM or SENIOR DEPARTMENTAL 5
OFFICERS (SEs & CEs) AND ACTION TAKEN STATEMENT:
(Details about departmental officers who inspected the work should be added after the NQM/SQM details.):

Date Name and Road distance Level of Major observations Action taken by PIU
of Designation of (RD) work at the with date
visit inspecting officer time of
(NQM/SQM/CE/ From To inspection
(1) SE)(2) (3) (4) (6) * (7) *
(5) *
Harbans Singh Negi, The overall grading was No action was required as
22/10/2020
SE Retired 0.000 3.000 Preparatory work satisfactory the work was graded
satisfactory
Ramesh Kumar The overall grading was No action was required as
18/08/2021
Sharma, Retd E.E. 0.000 3.000 Base Course satisfactory the work was graded
satisfactory
Bimal Kumar tickoo , The overall grading was No action was required as
19/09/2021
NQM 3.000 6.000 Bituminous Surface Course satisfactory the work was graded
satisfactory
The overall grading was No action was required as
21/11/2021
Rajeev Swami , CE 0.000 3.000 Bituminous Surface Course satisfactory the work was graded
satisfactory
The overall grading was No action was required as
21/05/2022
Shri Pal Singh , SE Retired
3.756 6.756 Bituminous Surface Course satisfactory the work was graded
satisfactory

The overall grading was The ATR after rectification

25/06/2022
Bhupendra Singh Kaira, C3.756
E Retired
6.756 Signages
UN-satisfactory(DBM has been verified on
fails in gradation) 24/09/2022 by SQM ER
Vinod Gupta.

Select Level Of Work

Select Level Of Work

-SD-
Signature of the Head of PIU……………………………………….……….
Er. Krishan Kumar Bhardwaj(Executive Engg.)
Seal of PIU Name and Designation of the Head of PIU*………………….…………….
* 7018792143
Mobile Number of the Head of PIU……………….……………………
eepwd-bhoranj-hp@nic.in
E-mail of the Head of PIU……………….……………………………
Executive Engineer HP,PWD Division Bhoranj
*
Address of the PIU…………………………………………………………..
* 26/04/2023
Date:……………………………………………………………..…………..