1. business and industrial
2. business operations
3. management
4. project management

IMPROVEMENT OF QUALITY MANAGEMENT FOR
HIGHWAY AND BRIDGE CONSTRUCTION AND
MAINTENANCE, PHASE II
ROAD PROJECT MANAGEMENT
AND SUPERVISION MANUAL
VOLUME II:
SAMPLE FORMS AND DOCUMENTS
2014
Department of Public Works and Highways
IMPROVEMENT OF QUALITY MANAGEMENT FOR
HIGHWAY AND BRIDGE CONSTRUCTION AND
MAINTENANCE, PHASE II
ROAD PROJECT MANAGEMENT AND
SUPERVISION MANUAL
VOLUME II:
SAMPLE FORMS AND DOCUMENTS
SECOND EDITION
SEPTEMBER 2014
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
JAPAN INTERNATIONAL COOPERATION AGENCY
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE SECRETARY
Manila
TABLE OF CONTENTS
FOREWORD………………………………………………………………………. ..
i
TABLE OF CONTENTS..................................................................................
ii
ACKNOWLEDGEMENT .................................................................................
vi
Chapter 1
Introduction ...............................................................................
1- 1
1.1
Background ................................................................................................
1- 1
1.2
Purpose ......................................................................................................
1- 1
Chapter 2
Plans and Drawings...................................................................
2- 1
2.1
Original Plan ...............................................................................................
2- 1
2.2
As-Staked Plan ...........................................................................................
2- 3
2.3
As-Built Plan ...............................................................................................
2- 3
2.4
Typical Title Block .......................................................................................
2- 3
Chapter 3
Procurement..............................................................................
3- 1
3.1
Invitation to Bid ...........................................................................................
3- 1
3.2
Program of Work ........................................................................................
3- 3
3.3
Detailed Unit Price Analysis ........................................................................
3- 4
3.4
Approved Budget Cost ...............................................................................
3- 5
3.5
Bill of Quantities..........................................................................................
3- 6
3.6
Resolution...................................................................................................
3- 7
3.7
Contract Agreement....................................................................................
3- 9
3.8
Notice of Award ..........................................................................................
3-11
3.9
Bid Security ................................................................................................
3-12
3.10
Performance Security .................................................................................
3-14
3.11
Surety Bond ................................................................................................
3-16
3.12
Contractor's All Risks Insurance .................................................................
3-17
Chapter 4
Contract Implementation............................................................
4- 1
4.1
Notice to Proceed .......................................................................................
4- 1
4.2
Variation Order ...........................................................................................
4- 2
4.3
Suspension Order.......................................................................................
4- 4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
ii
4.4
Resume Order ............................................................................................
Chapter 5
4- 5
Field Inspection and Quality Control ...........................................
5- 1
5.1
Quality Control Program .............................................................................
5- 1
5.2
Material Test Reports ..................................................................................
5- 2
5.2.1
Status of Tests.........................................................................................
5- 2
5.2.2
Summary of Laboratory/Field Control Tests ............................................
5- 3
5.3
Certificate of Quality Control Assurance Report .........................................
5- 4
5.4
Laboratory/Field Control Test Reports ........................................................
5- 5
5.4.1
California Bearing Ratio Test...................................................................
5- 5
5.4.2
Grading Test ............................................................................................
5- 9
5.4.3
Atterberg Limit Test .................................................................................
5-10
5.4.4
Laboratory Compaction Test ...................................................................
5-11
5.4.5
Field Density Test ....................................................................................
5-12
5.4.6
Soil Aggregates .......................................................................................
5-13
5.4.7
Bituminous Material Test .........................................................................
5-15
5.4.8
Bituminous Mix........................................................................................
5-18
5.4.9
Pre-formed Expansion Joint Filler ...........................................................
5-19
5.4.10 Portland Cement .....................................................................................
5-20
5.4.11 Reinforcing Steel Bar ..............................................................................
5-21
5.4.12 Concrete Joint Sealant ............................................................................
5-22
5.4.13 Paint ........................................................................................................
5-23
5.4.14 Thermoplastic Traffic Paint......................................................................
5-24
5.5
Accreditation ...............................................................................................
5-25
5.5.1 Application for Accreditation of Asphalt/Concrete Batching Plant ...............
5-25
5.5.2 Application for Accreditation of Materials Engineer.....................................
5-26
5.5.3 Application for Accreditation of DPWH Materials Engineer.........................
5-27
5.5.4 Instructions for Application for Accreditation of Materials Engineers...........
5-28
Chapter 6
Payments...................................................................................
6- 1
Advance Payment ......................................................................................
6- 1
6.1.1
Disbursement Voucher............................................................................
6- 1
6.1.2
Background Information ..........................................................................
6- 2
6.1.3
Executive Summary ................................................................................
6- 3
6.1
iii
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.1.4
Billing Summary ......................................................................................
6- 4
6.1.5
Request for the Release of 15% Advance Payment ...............................
6- 5
6.1.6
Required Certification for Processing of Payments.................................
6- 6
6.1.7
List of Minimum Required Equipment .....................................................
6- 7
6.1.8
Checklist of Supporting Document..........................................................
6- 8
First Progress Billing...................................................................................
6- 9
6.2.1
Background Information ..........................................................................
6- 9
6.2.2
Executive Summary ................................................................................
6-10
6.2.3
Billing Summary ......................................................................................
6-11
6.2.4
Request for Release of First Partial Billing..............................................
6-12
6.2.5
Certificate of Payment.............................................................................
6-13
6.2.6
Contractor's Statement of Work Accomplished .......................................
6-14
6.2.7
Statement of Time Elapsed .....................................................................
6-15
6.2.8
Certification of Clearance for Equipment Rental and/or Lease ...............
6-16
6.2.9
Certification of Labor and Materials Payment .........................................
6-17
6.2.10 Detailed Quantity Calculation..................................................................
6-18
6.2.11 Checklist of Supporting Documents and Attachments for DoTS .............
6-19
6.2
6.3
Interim Progress Billing...............................................................................
6-20
6.3.1
Request for Release of Interim Billing .....................................................
6-20
6.3.2
Checklist of Supporting Documents and Attachments for DoTS .............
6-21
Final Billing .................................................................................................
6-22
6.4.1
Property Clearance .................................................................................
6-22
6.4.2
Regional Equipment Clearance ..............................................................
6-23
6.4.3
Certificate of Completion.........................................................................
6-24
6.4.4
Inspection Report ....................................................................................
6-25
6.4.5
Checklist of Supporting Documents and Attachments for DoTS .............
6-26
Retention Money ........................................................................................
6-27
6.5.1
Description ..............................................................................................
6-27
6.5.2
Request for the Release of Retention .....................................................
6-28
6.5.3
Statement of 10% Retention ...................................................................
6-29
6.5.4
Checklist of Supporting Documents and Attachments for DoTS .............
6-30
6.4
6.5
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
iv
Chapter 7
Project Completion and Acceptance ...........................................
7- 1
Final Inspection for Completion ..................................................................
7- 1
7.1.1
QAU or Regional Inspectorate Team Report...........................................
7- 1
7.1.2
Pre-final Inspection (Punch List) .............................................................
7- 2
7.1.3
Final Inspection Report ...........................................................................
7- 3
7.2
Certificate of Completion ............................................................................
7- 4
7.3
Post-evaluation Report (Post-audit)............................................................
7- 5
7.4
Acceptance Report .....................................................................................
7- 7
7.5
Certificate of Acceptance ............................................................................
7- 8
7.1
v
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. MEÑEZ, 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.
*
Guidebook for Road Construction and Maintenance Management in the Republic of
the Philippines,
*
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
Plans and Drawings
2.1 Original Design Plan
Original design plan is prepared to determine the approximate amount of the road project
for procurement processes. It is a Detailed Engineering Design (DED) plan prepared by the
implementing office (RO/DEO) or by the Consultant after the conduct of feasibility or
preliminary engineering study, in accordance with the DPWH Design Guidelines, Criteria and
Standards, and DPWH Standard and Specifications.
It should include survey plan, horizontal and vertical alignments (plan and profile),
typical roadway section, detailed cross-sections, drainage cross-sections, detailed drawings
and schedule of all proposed structures, design standard drawings, among others.
Original/DED plan may be approved by the Secretary, Undersecretary/Assistant Secretary for
technical services, Regional Director and District Engineer, depending on the amount of the
project and/or delegated level of authority of each approving official. With the exception of
plans approved by concerned RO/DEO, all original plans shall be subject for review by the
Bureau of Design (BOD) and should be supported with documents as contained in the BOD
Checklist of Requirement shown in the following page.
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
2-1
Checklist of Supporting Document as per Requirement of Bureau of Design
BOD Ref No. __________
Date: _________________
MEMORANDUM
FOR
: _______________
This Bureau
SUBJECT:
____________________________________________
____________________________________________
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
2.2 As-Staked Plan
As-Staked plan is prepared when, as a result of “as-stake” survey conducted jointly by
the Implementing Office and the Contractor, there was noted big discrepancy between what
was reflected in the original plan and the actual field condition that would result to major
changes in the original design and quantities of original items of work.
The As-Staked plan should reflect both the original and as-staked design and quantities,
and duly supported with detailed technical justification for all the changes from the original. If
there are no major changes between the original plan and actual field condition, it is no longer
necessary to prepare As-Staked plan. The approved As-Staked plan will be the basis in the
processing/issuance of variation order.
2.3 As-Built Plan
All the completed scope of works within the contract, as well as the changes (Variation
Orders, Extra Works, Supplemental Works) encountered and necessary for the completion of
the project are reflected in the As-Built plan.
It should be approved by the implementing office or the concerned/delegated
Undersecretary/Assistant Secretary. As-built plan shall be the basis for final billing of the
Contractor.
2.4 Typical Title Block
The following page shows a typical title block utilized in the preparation of Original
Design, As-Staked and As-Built plans. All plans shall be prepared in accordance with D.O. No.
56, Series of 1995 regarding Quality of Plans.
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:
PROJECT ENGINEER (DPWH-RO)
CHECKED:
PROJECT ENGINEER (CONTRACTOR
)
PREPARED:
REVIEWED:
OIC-ASST. CHIEF PLANNING & DES. DIV.
OIC-CHIEF PLANNING & DESIGN DIVISION
DATE:
ASSISTANT REGIONAL DIRECTOR
S U B M I T T E D:
DATE:
REGIONAL DIRECTOR
DATE:
CHIEF, HIGHWAYS DIVISION, B.O.D
REVIEWED AS PRESENTED:
DATE:
DIRECTOR IV, B.O.D
RECOMMENDING APPROVAL:
DATE:
ASSISTANT SECRETARY
DATE:
UNDERSECRETARY
APPROVED:
SET NO.
SHEET NO.
Chapter 3
Procurement
3.1 Invitation to Bid
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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.
Bidding will be conducted through open competitive bidding procedures using
nondiscretionary pass/fail criterion as specified in the Revised Implementing Rules and
Regulations (IRR) of Republic Act 9184 (RA 9184), otherwise known as the “Government
Procurement Reform Act”. Bidding is restricted to Filipino citizens/sole proprietorships,
partnerships, or organizations with at least seventy five percent (75%) interest or
outstanding capital stock belonging to citizens of the Philippines.
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. Contractor’s 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
Chairman, BAC for _______________ Project
“Implementing Office, Address and Contact Details”
Page 2 of 2
3-2
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3.2 Program of Work
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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:
Description of Works to be done
Item No.
% of Total
Description
Number
Equipment
Unit
Qty.
Unit Cost
Needed
Available
Total Cost
Adjusted
Cost
Breakdown of Estimated Expenditures:
1) Labor (Man-days): _________________________
A. Material, Fuel, Oil: _________________________
2) Materials:
B. Equipment, Labor
_________________________
_________________________
3) Equipment, Rental: _________________________
C. OCM, Profit (15%): _________________________
4) OCM, Profit (15%): _________________________
D. VAT 12% (ABC):
_________________________
5) Overhead (3.50%): _________________________
E. Total Const. Cost:
_________________________
6) VAT (12%):
_________________________
F. Overhead (3.50%): _________________________
Total:
_________________________
G. Total Estimated Cost: _________________________
Say:
_________________________
Say:
Prepared by:
___________________________
_________________________
Checked by:
Submitted by:
___________________________
Reviewed as to Unit Cost:
__________________________
___________________________
Approved:
__________________________
Regional Director/District Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3-3
3.3 Detailed Unit Price Analysis
Detailed Unit Price Analysis (DUPA)
Item No./Description:
_______________________________
Unit of Measurement:
_______________________________
Output per hour:
_______________________________
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
Sub - Total for A
Name and Capacity
B.
Equipment
Sub - Total for B
C.
Total (A+B)
D.
Output per hour =
E.
Direct Unit Cost ( C ÷ D )
F.
Name and Specification
Materials
Sub - Total for F
G.
Direct Unit Cost ( E + F )
H.
Overhead, Contingencies & Miscellaneous (OCM)
%
of G
I.
Contractor's Profit (CP)
%
of G
J.
Value Added Tax (VAT)
12 %
K.
Total Unit Cost
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
Contract Duration: _____________________________
Recommending Approval:
Estimated Direct
Unit
Cost
_____________________________
Length:
Item
No.
_____________________________
Station:
Approved Budget for the Contract
_____________________________________________
Project Name and Location
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
3.4 Approved Budget Cost
3-5
3.5 Bill of Quantities
Contract ID No.: ____________________________________
Contract Name:
____________________________________
BILL OF QUANTITIES
Item
No.
Description
Unit
Qty
Unit Cost
Total Cost
(PhP)
(PhP)
Subtotal:
____________
Subtotal:
____________
Total:
____________
Total Amount in Words:
3-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3.6 Resolution
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
RESOLUTION
RESOLUTION DECLARING
(Name of Construction Firm)
WITH THE LOWEST
CALCULATED RESPONSIVE BID AND RECOMMENDING AWARD FOR THE
Project)
(Name of
.
WHEREAS, the Department of Public Works and Highways advertised the Invitation to Bid
for the
(Name of Project)
in the (No. or Vol.) issue of
(Name of Leading Newspaper)
(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
Read-out Bid Prices (Php)
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)
Variance vs. EPC
(%)
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:
)
________________________
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3.7 Contract Agreement
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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.
Bidding Documents for the Contract (Annex “_”)
(1) General Conditions of Contract
(2) Special Conditions of Contract
(3) Drawings
(4) Specifications
(5) Invitation to Apply for Eligibility and to Bid
(6) Instructions to Bidders
(7) Bid Data Sheet
(8) Supplemental/Bid Bulletins (Addenda)
CONTRACTOR’s Calculated Bid in the Form of Bid including its Technical and
Financial Proposals (Annex “_”)
CONTRACTOR’s Letter of Intent for Eligibility and Contractor’s Information
from the DPWH Registry (Annex “_”)
Notice of Award of Contract and the CONTRACTOR’s “Conforme” (Annex
“_”)
Performance Security (Annex “_”)
Credit Line or Cash Deposit Certificate (Annex “_”)
PERT/CPM diagram and bar chart with S-curve (Annex “_”)
In consideration of the payments to be made by the ENTITY to the CONTRACTOR as
hereinafter mentioned, the CONTRACTOR hereby covenants with the ENTITY to execute
and complete the Works and remedy any defects therein in conformity with the provisions
of this CONTRACT AGREEMENT in all respects.
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4.
The ENTITY hereby covenants to pay the CONTRACTOR in consideration of the
execution and completion of the Works, the unit prices in the CONTRACTOR’s
Calculated Bid as applied to the actual quantities accomplished as certified by the
PROCURING ENTITY under the provisions of this CONTRACT AGREEMENT at the
times and in the manner prescribed by this CONTRACT AGREEMENT.
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)
Binding Signature of the PROCURING ENTITY
________________________________________________
Binding Signature of Contractor
____________________________________________
[Addendum showing the corrections, if any, made during the Bid evaluation to arrive at the Calculated Bid should
be attached with this CONTRACT AGREEMENT]
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__
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Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3.8 Notice of Award
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Contract ID No.: ________________________________________________
Contract Name:
________________________________________________
Location of the Contract:
________________________________________
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.
Very truly yours,
_____________________________
Regional Director/District Engineer
Received by:
_________________________
Date Received:
_________________________
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3.9 Bid Security
BID SECURITY: IRREVOCABLE STANDBY LETTER OF CREDIT
Reference No. ______Date: __________
Department of Public Works and Highways
___________________________________
___________________________________
SUBJECT:
Irrevocable Standby Letter Of Credit No. _______
(Name of Project and Location)
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
specified in the instructions to bidders.
2.
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.
WHEREAS, we have agreed to guarantee this obligation of the bidder,
THEREFORE, We (Insurer and Address) hereby affirm that we are guarantors and
responsible to you on behalf of the bidder thus, we hereby issue our Irrevocable Standby Letter of
Credit up to the total amount of Pesos: (Coverage Amount in Words ) (Php (Coverage Amount in
Figures)) and we undertake to pay you, upon your first notarized written demand declaring the bidder
to be in default under the instructions to bidders and without cavil or argument, any sum or sums
within the limits of Pesos ________________________________ (Php __________ ) as aforesaid,
without your needing to prove or show grounds or reasons for your demand for the sum specified
therein.
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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)
____________________________
Bank’s Authorized Officer
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3.10 Performance Security
PERFORMANCE SECURITY: IRREVOCABLE STANDBY LETTER OF CREDIT
Date: __________
(Name of the Head of the Procuring Entity)
(Position of the Head of the Procuring Entity)
(Name of the Procuring Entity)
(Address of the Procuring Entity)
(Facsimile Number of the Procuring Entity)
Irrevocable Letter of Credit No. __________
For
(Contract Number and Name)
WHEREAS, (Name of Contractor), hereinafter called “Contractor” has undertaken to enter
into a contract with you to execute (Contract Number and Name) and whereas you have stipulated in
the said Contract that the Contractor shall furnish you with an irrevocable standby Letter of Credit for a
sum specified therein as Performance Security for the faithful compliance of the Contractor’s
obligations in accordance with the Contract.
WHEREAS, we have agreed to guarantee this obligation by the Contractor.
THEREFORE, we hereby affirm that we are guarantors and responsible to you, on behalf of
the Contractor, up to the total amount of (Amount of Guarantee) and we undertake to pay you, upon
first written demand declaring the Contractor to be in default under the Contract and without cavil, or
argument, any sum or sums within the limits of (Amount of Guarantee) as aforesaid without you
needing to prove or to show grounds or reasons for your demand for the sum specified therein.
The right to institute action on this guarantee pursuant to Act No. 3688 of any individual,
firm, partnership, corporation and association supplying the Contractor with labor and materials for the
prosecution of the works is hereby acknowledged and confirmed.
This irrevocable guarantee is valid until the issuance by you of the Certificate of Acceptance
of the completed works.
This certification is being issued in favor of the said Contractor in connection with the
requirements of the bidding by (Name of the Procuring Entity) for the above-mentioned Contract.
We are aware that any false statements issued by us make us liable for perjury.
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Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Name and Signature of Authorized
Financing Institution Officer:
_____________________________
Official Designation:
_____________________________
Concurred By:
Name & Signature of Contractor’s
Authorized Representative:
_____________________________
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 _______.
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3.11 Surety Bond
PSIS Bond No. _______
PERFORMANCE BOND (SURETY BOND)
KNOW ALL MEN BY THESE PRESENTS:
That, we (Name of Construction Firm) of (Address) as PRINCIPAL and (Name of Insurance
Company), a corporation duly organized and existing under and by virtue of the laws of the Philippines, with
principal office at _____________________________ Philippines, as SURETY, are held and firmly bound
unto (Contracting Party) in the sum of _______________________ (Php ______).
Philippine currency, for the payment of which sum well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.
The conditions of this obligation are as follows:
WHEREAS, the above bounded Principal has a contract with the Obligee to fully & faithfully
guarantee the Contract for (Complete description of project and location).
“THIS BOND IS CALLABLE ON DEMAND”
Provided, however, that the liability of the surety under this bond shall in no case exceed the sum of
_______________________ (Php ________) Philippine Currency.
WHEREAS, the Obligee requires the above bounded principal to give a good and sufficient bond in the
above stated sum to secure the full and faithful performance on its part of said Obligee.
NOW, THERFORE, if the above bounded Principal shall in all respects duly and fully observe and
perform all and singular the aforesaid covenant conditions and agreements to the true intent and meaning thereof,
then this obligation shall be null and void, otherwise to remain in full force and effect.
Liability of surety on this bond will expire on co-terminus with the final acceptance of the project.
This bond will be considered automatically cancelled ten (10) days after expiration, unless surety is notified by any
existing obligations thereunder and the latter signifies in wrong in content to act as surety for the continuance of
any existing obligations hereunder.
IN WITNESS WHEREOF, we have set our hands and signed our names on this (Date) day of (Month),
20_____.
WITNESSES:
BY: (Name of Construction Company)
ATTESTED:
______________________________
Principal
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Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
3.12 Contractor's All Risks Insurance
CONTRACTOR’S ALL RISKS POLICY
WHEREAS THE INSURED named in the Schedule hereto has made to the
________________ (hereinafter called “the Insured” a written proposal by completing a
Questionnaire which together with any other statements made in writing by the Insured for
the purpose of this Policy deemed to be incorporated herein.
NOW THIS POLICY OF INSURANCE WITNESSETH that in consideration of the Insured
having paid to the Insurers the premium mentioned in the Schedule and subject to the
exclusions, provisions and condition contained herein or endorsed hereon the Insurers will
indemnify the insured in the manner and to extent hereinafter provided.
GENERAL EXCLUSIONS
The Insurers will not indemnify the insured in respect of loss, damage or liability directly or
indirectly caused by or raising out of
a)
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)
nuclear reaction, nuclear radiation or radioactive contamination;
c)
willful act of willful negligence of the Insured;
d)
cessation of work whether total or partial,
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 Insurer’s 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.
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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
manufacturer’s 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)
Immediately notify the Insurers by telephone or telegram as well as in writing;
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 __________;
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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 Insured’s 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.
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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,
in a manner necessitating repair or
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;
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(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)
loss discovered only at the time of taking an inventory.
PROVISIONS APPLYING TO SECTION 1
MEMO1. SUM INSURED
It is a requirement of this insurance that the amounts of
insurance stated in the Schedule shall:
Not be less than for item 1
The full value of the contract works at the completion of
the construction, inclusive of materials, wages, freight,
custom duties, dues and materials or items supplied by the
Principal;
For items 2 & 3:
The replacement value of construction plant, equipment
and construction machinery;
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
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(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)
Accidental bodily injury of illness (whether fatal or not) to third parties
b)
Accidental loss or damage to property belonging to third parties occurring in direct
connection with the performance of the contract insured by this Policy and happening
on or in the immediate vicinity of the Contract Site during the Period of Insurance.
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).
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EXCLUSIONS TO SECTION 11
The Insurers will not indemnify the Insured in respect of
1.
Expenditure incurred in doing or redoing or making good or repairing or replacing
any work or property covered or coverable under Section 1 of the Policy.
2.
Damage to any property or land or building caused by subsidence collapse, vibration
or by the removal or weakening of support or injury or damage to any person or
property occasioned by or resulting from any such damage.
3.
Liability consequent upon
(a) Bodily injury to or illness of employees or workmen of the Contractor(s) or the
Principal or any other firm connected with the contract work or members of their
families;
(b) Loss of or damage to property belonging to or held in care, custody or control of
the Contractor(s), the Principal or any other firm connected with the contract
work or an employee or workman of anyone of the aforesaid.
(c) Any accident caused by vehicles licensed for general road use or by waterborne
vessels or aircraft;
(d) Any agreement by the Insured to pay any sum by way of indemnity or otherwise
unless such liability would have attached in the absence of such agreement.
SPECIAL CONDITIONS APPLYING TO SECTION 11
1.
No admission, offer, promise, payment or indemnity shall be made or given by or on
behalf of the Insured without the written consent of the Insurers who shall be entitled if
they so desire to take over and conduct in the name of the insured the defense or
settlement of any claim or to prosecute for their own.
CAR DCB/CAR NO. ___________________________ Issued at ______________
Name of Contract: ___________________________________________________
Name(s) and address(es) of Insured ______________________________________
a)
Principal ________________________________________________________
b)
Contractor(s) _____________________________________________________
c)
Location of Contract Site: ___________________________________________
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Description of the Insured Items
Section 1 - Property Insured
Sum Insured
1. Contract Works
1.
Permanent and Temporary Works, including all
Materials to be incorporated therein)
(a) Contract Price
(a) ____________
(b) Materials or items supplied by the Principal
(b) ____________
2. Construction Plant and Equipment
2.
3. Construction Machinery according to attached list
3.
4. Installation of Machinery and Equipment forming
4.
part of Permanent Contract Work.
TOTAL
Limit of indemnity under this Policy in respect of Clearance of Debris
DEDUCTIBLES:
Amounts to be borne by the Insured in respect of each
and every occurrence for loss of or damage to contract
works and/or construction plant and equipment
(Schedule Section 1 Items 1 and 2) arising out of
(a) earthquake, storm, typhoon, cyclone, flood,
the first
inundation, subsidence, landslide, collapse
(b) any other cause, except fire lightning and
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
inundation, subsidence, landslide, collapse
(b) any other cause, except fire lightning and
the first
explosion
1. Limit of indemnity in respect of any one accident or
1.
series of accidents arising out of one event
(a) for bodily injury to any one person
(a)
(b) for property damage
(b)
2. Total limit of indemnity under this policy
2.
PERIOD OF INSURANCE (subject to the Provision concerning the Period of Cover)
(a) Construction Period
From :
To:
(b) Maintenance Period
From:
To:
Premium
(Subject to adjustment in accordance with the Provisions and Conditions of the Policy)
Note:
NO KNOWN LOSS PRIOR TO THE ISSUANCE OF THIS POLICY
Page 8 of 9
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
4.1 Notice to Proceed
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Contract ID No.: ________________________________________________
Contract Name:
________________________________________________
Location of the Contract:
________________________________________
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.
Very truly yours,
_____________________________
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
4.2 Variation Order
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Variation Order No.: __________
Change Order ( __ )
Extra Work Order ( __ )
Project:
________________________________________________
Station Limit:
________________________________________________
Location:
________________________________________________
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
ITEMIZED OUANTITIES AND COST REVISION
Original Contract Amount (S.C #1)
_________________________
Revised Contract Amount by Reason of this proposed
variation order No. _____
_________________________
Difference in cost of this revision
_________________________
Additional Contract Time Granted
_________________________
Effectivity of this variation order
_________________________
Approval Recommended:
___________________________
Asst. Regional Director
Approved by
Prepared by:
Submitted by
________________________
________________________
Project Engineer
Chief, Construction Division
________________________
Regional Director
Note: Form's orientation can be changed to "landscape".
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
___________________________
Original sum involved in the revision: ____________________
New Sum involved in this change: ____________________
Difference in cost: ____________________
Total Cost
Deductive
Asst. Regional Director
Recommending Approval:
Quantity
Additive
___________________________
Total Cost
Chief, Construction Division
Submitted by:
Unit Price in
Pesos
_______________________
Quantity
Project Engineer
Unit
Change Order No.1
________________________
Prepared by:
Description
Approved Original Contract
ITEMIZED COST OF REVISION
4.3 Suspension Order
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Suspension Order No. _____
Project Name & No.:
Location:
Station:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Date:
______________________________________________
Contractor:
______________________________
______________________________
______________________________
You are hereby directed to suspend all construction activities effective ___________
due to ___________________________________________________________ .
Contract time including extension
Days used to date
Days remaining
_______________ calendar days
_______________ calendar days
_______________ calendar days
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
I HEREBY ACKNOWLEDGE RECEIPT OF THE ABOVE NOTICE.
________________________
Contractor
Date: ___________________
4-4
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
4.4 Resume Order
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Resume Order No. _____
Project Name & No.:
Location:
Station:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
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
I HEREBY ACKNOWLEDGE RECEIPT OF THE ABOVE NOTICE.
________________________
Contractor
Date: ___________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
4-5
Chapter 5
Field Inspection and
Quality Control
5.1 Quality Control Program
Letterhead of the Contractor
QUALITY CONTROL PROGRAM
NAME OF PROJECT
:
STATION LIMITS
LOCATION
APPROPRIATION
:
:
:
ITEM NO.
DESCRIPTION
UNIT
QTY.
KIND OF TEST
B. COMPUTATION, BREAKDOWN AND APPORTIONMENT OF QUALITY CONTROL COST
1. Quality Control Cost:
a. Programmed Direct / Indirect Cost in Pesos
b. % Q.C. (per Department Order # 10 s.2009), 0.20*(2.75%)
c. Total Quality Control Cost (1a x 1b)
d. TOTAL COST in PESOS
PREPARED BY:
NOTED BY:
_____________________________________________
_____________________________________________
Materials Engineer (Contractor)
Project Engineer (DPWH)
CHECKED BY:
APPROVED BY:
_____________________________________________
_____________________________________________
Materials Engineer (DPWH)
Chief, QAD/QAS (DPWH)
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 Tests　Performed
Test Balance Required
Chief, QAD/QAS (DPWH)
_____________________________________
SUBMITTED BY:
For the Month of :
_____________________________________
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
MONTHLY STATUS OF TESTS OF MATERIALS
QUALITY ASSURANCE DIVISION/SECTION
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
5.2 Material Test Reports
5.2.1 Status of Tests
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Material Enginer (Contractor)
Materials Engineer (DPWH)
_____________________________
Original Source of Materials
_____________________________
Quantity
Represented
CERTIFIED CORRECT:
Kind of
Materials
PREPARED BY:
Laboratory
Number
Name of Project and Location :
Implementing Office
:
Project Duration
a) Date Started
:
b) Target Completon Date :
Contractor
:
Spec.
Item No.
By
Project Engineer (DPWH)
At
REMARKS
Chief, QAD/QAS
_____________________________
NOTED BY:
Sampled and Tested
Date
_____________________________
ATTESTED BY::
Kind of
Test
SUMMARY REPORT OF FIELD TESTS
For the month of : ________________
Letterhead of the Contractor
5.2.2 Summary of Laboratory/Field Control Tests
5-3
5.3 Certificate of Quality Control Assurance Report
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
QUALITY ASSURANCE DIVISION/QUALITY ASSURANCE SECTION
CERTIFICATE OF QUALITY CONTROL ASSURANCE
DATE: __________________
PROJECT:
_______________________________________________________________
STATION:
_______________________________________________________________
CONTRACTOR: _______________________________________________________________
WE HEREBY CERTIFY that we have conducted an inspection and verification on work
accomplished on the above mentioned for the period __________ THAT we have found that the
quality of the materials in the following items of work corresponding to the quantity accomplished
conforms with the Standard Specifications and Special Provisions of the Contract., viz.
ITEM No.
5-4
DESCRIPTION
OUANTITY ACCOMPLISHED
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4 Laboratory/Field Control Test Reports
5.4.1 California Bearing Ratio Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR CBR TEST (1/4)
Project
:
Location
:
Kind of Material
:
Tested By
:
Computed By
:
Lab. No.
:
(Name and Designation)
(Date)
(Name and Designation)
(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
Moisture Content Determination
10
Number of Blows
Before
COMPACTION
AFTER
COMPACTION
Trial 1
Trial 1
After
PENETRATION
Trial 1
Trial 2
3
kg/m
=
SOAKED COMPACTED VALUES
Penetration
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
CBR Value @ 0.20
0.00
Swell
I.R. =
F.R. =
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
Letterhead of the Accredited Laboratory
WORKSHEET FOR CBR TEST (2/4)
Project
:
Location
:
Kind of Material
:
Tested By
:
Computed By
:
Lab. No.
:
(Name and Designation)
(Date)
(Name and Designation)
(Date)
Density Determination
Number of Blows
Test Sample
Number of Blows
30
Trial 1
Trial 2
Test Sample
Moisture Content Determination
30
Before
AFTER
COMPACTION
COMPACTION
Trial 1
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
=
SOAKED COMPACTED VALUES
Penetration
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
CBR Value @ 0.20
0.00
Swell
I.R. =
F.R. =
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
Letterhead of the Accredited Laboratory
WORKSHEET FOR CBR TEST (3/4)
Project
:
Location
:
Kind of Material
:
Tested By
:
Computed By
:
Lab. No.
:
(Name and Designation)
(Date)
(Name and Designation)
(Date)
Moisture Content Determination
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
=
SOAKED COMPACTED VALUES
Penetration
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
CBR Value @ 0.20
0.00
Swell
I.R. =
F.R. =
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
Letterhead of the Accredited Laboratory
WORKSHEET FOR CBR TEST (4/4)
Project
:
Location
Kind of Material
:
:
Tested By
:
Computed By
:
Lab. No.
:
No. of Blows
(Name and Designation)
(Date)
(Name and Designation)
(Date)
CBR Value @ 0.10
CBR Value @ 0.20
UW DRY
10 Blows
@ 0.10
MS
@ 0.20
30 Blows
@ 0.10
65 Blows
@ 0.10
@ 0.20
@ 0.20
CBR Value @ MDD
@ 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
Dry Density, kg/m3
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Page 4 of 4
5-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.2 Grading Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR SIEVE ANALYSIS
Project:
Kind of Material:
Sampled at:
Original Source:
Spec's Item No.
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
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5-9
5.4.3 Atterberg Limit Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR LIQUID AND PLASTIC LIMIT TEST
Project
Sampled at
Original Source
Proposed Use
Quantity Represented
Spec's Item No.
Date
Date
Sampled By
Tested By
Laboratory Report No.
DETERMINATION NUMBER
LIQUID LIMIT
2
3
1
4
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
6
20
15
NUMB ER OF BLOWS
10
Remarks/Recommendations:
25
30
35
40
___________________________________________________________
___________________________________________________________
___________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 10
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.4 Laboratory Compaction Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR COMPACTION TEST
Lab. Report No.
Project:
Sampled at:
Original Source:
Proposed use:
Quantity Represented
-
-
Spec's Item No.
-
Sampled by:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(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
1
2
4
3
Dry Density, kg/m 3
2000
5
6
7
Method used
Weight of hammer, kg,
Volume of mold, cu. m.
Number of layers
1950
Number of Blows per lay er
Maximum dry density,
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
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 11
5.4.5 Field Density Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR FIELD DENSITY TEST
Project
(Number)
(Name)
(City/Province)
Spec's Item No.
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)
(Name and Designation)
(Office)
(Date)
Computed by
Lab. No.
Moisture Content obtained by using Speedy Moisture Tester
Unit weight of air-dry sand
Actual moisture content
1.
2.
3.
4.
5.
11.
12.
13.
14.
15.
16.
Container full of water, kg
Container, kg
Water, kg (1) - (2)
Container, m3 (3) / 1000
Container filled with air
dry sand, kg
6. Air-dry sand, kg (5) - (2)
7. Unit weight of dry sand,
kg/m3(6)/(4)
Container + wet soil, g
Container + dry soil, g
Moisture, g (11) - (12)
Container, g
Dry soul, g (12-(14)
Actual moisture content, %
(13)/(15)x100
17. Average actual moisture
content, %
Mass of Sand to Fill Funnel
8. Mass of Jar + Sand, kg
9. Mass of Jar + Sand, kg
(after pouring)
10. Sand in Funnel, kg (8) - (9)
FIELD DENSITY
18.
19.
20.
21.
22.
23.
24.
25.
Total materials taken from hole, kg
Mass of Jar + Sand, kg
Mass of Jar + Sand, Kg (after pouring)
Sand to fill hole, kg (19)-(20)-(10)
Volume of hole, m3 (21)/(7)
Wet unit weight, kg/m3 (18)/(22)
Dry unit weight, kg/m3 (23)/(17)/(100) +1
Laboratory compaction test data:
(a) Maximum dry density, kg/m3
(b) Optimum moisture content, %
26. Degree of compaction, % (24)/(25a)x100
Remarks/Recommendations:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Prepared by:
Submitted by:
Verified Correct:
Concurred by:
__________________
__________________
__________________
__________________
Laboratory Technician
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 12
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.6 Soil Aggregates
5.4.6.1
Abrasion Test
Letterhead of the Accredited Laboratory
WORKSHEET FOR ABRASION TEST
Lab. Report No.
Project:
(Name)
(Number)
(City/Province)
Kind of Materials:
Spec's Item No.
Source of Mixture:
(Give accurate location as possible)
Original Source:
(Pit, Quarry, River, etc., location)
Sampled By:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(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
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 13
5.4.6.2
Composite Aggregates
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON COMPOSITE AGGREGATES
Project
:
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Name and Designation)
(Office)
(Date)
(Date Received)
Lab. No. ___________________
TESTS
REQUIREMENTS
Sieve Analysis: Cumulative % Passing
Sieve Size, mm
19.0
12.5
9.5
4.75
2.36
1.18
0.600
0.300
0.150
0.075
Specific Gravity
Abrasion Loss (LAM), %
Liquid Limit, %
Plasticity Index, %
Stripping
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Representative (DPWH)
Project Engineer (DPWH)
5 - 14
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.7 Bituminous Material Test
5.4.7.1
Asphalt Cement
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON ASPHALT CEMENT
Project
:
Sample identification
Quantity represented
Sampled at
Original source
Grade
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Name & Designation)
(Office)
(Date)
(Date Received)
Lab. No. ___________________
TESTS
Original sample
o
Penetration 25 C, 100 g, 5s
o
Flash Point, Cleveland Open Cup, C
Ductility, 25 o C, 5 cm/min, cm
Solubility in trichloroethylene, %
Loss on heating, %
Residue:
Penetration , % of original
Ductility, 25 o C, 5 cm/min, cm
Spot Test, 25% xylene - heptane
Specific Gravity
REQUIREMENTS
RESULTS
-
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 15
5.4.7.2
Emulsified Asphalt
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON EMULSIFIED ASPHALT
Project
:
Sample Identification
Quantity represented
Sampled at
Type and Grade
Original Source
Supplied by
Proposed Use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Name & Designation)
(Office)
(Date)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
Emulsion:
Viscosity ( Saybolt-furol), 25 o C, s
Storage Stabililty, %
Cement Mixing, %
Sieve Test, %
Residue, %
Specific Gravity, %
Residue:
Penetration, 25 o C, 100g, 5's
Ductility, 25 o C, 5 cm/min, cm
Solubility in trichloroethylene, %
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 16
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.7.3
Cutback Asphalt
Letterhead of the Accredited Laboratory
WORKSHEET FOR TEST OF CUTBACK ASPHALT
Project Name:
____________________________________________________
Laboratory No.:
___________________
Date Tested:
o
__________________
I.
Viscosity (Kinematic) at _______ C, cSt:
_____________________
II.
Flash Point (TOC):
___________________ C
o
III. Specific Gravity
a.
Mass of Pycnometer, g.:
_____________________
b.
Mass of Pycnometer + water, g.:
_____________________
c.
Mass of Pycnometer + sample, g.:
_____________________
Specific Gravity = (c-a)/(b-a):
_____________________
IV. Distillation
Volume of Sample, ml. = mass of sample/sp. Gravity: _____________________
Temperature
o
o
o
o
o
o
Volume of Distillate
% by volume
190 C (374 F)
225 C (437 F)
260 C (500 F)
o
o
315 C (600 F)
o
o
360 C (680 F)
Residue, % by volume:
V.
_____________________
Test on Residue
1.
o
Penetration at 25 C, 100g, 5s:
o
_____________________
2.
Ductility at 25 C, 5cm/min, cm:
_____________________
3.
Solubility in Trichloroethylene:
_____________________
a.
Mass of sample, g:
_____________________
b.
Mass of crucible, empty, g:
_____________________
c.
Mass of crucible + residue, g:
_____________________
Solubilty, % = 100- [(c-b)/A x 100]:
_____________________
4.
Spot Test:
_____________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 17
5.4.8 Bituminous Mix
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON BITUMINOUS MIX
Project
:
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
:
:
:
:
:
:
:
Sampled by
:
Submitted by
:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
Sieve Analysis: Cumulative % Passing
(After Extraction)
Sieve Size, mm
19.0
12.5
9.5
4.75
2.36
1.18
0.600
0.300
0.075
Bitumen Content, % by wt. of aggregate
Bulk Specific Gravity
Immersion/Compression Test, KPa
Dry
Wet
REQUIREMENTS
RESULTS
Index of Retained Strength, %
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 18
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.9
Pre-formed Expansion Joint Filler
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON PREFORMED EXPANSION JOINT FILLER
Project
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Name & Designation)
(Office)
(Date)
(Date Received)
Lab. No. ___________________
TESTS
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 19
5.4.10 Portland Cement
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON PORTLAND CEMENT
Project
:
Sample identification
Quantity represented
Sampled at
Manufactured by
Brand
Supplied by
Spec's Item No.
Sampled by:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Name & Designation)
(Office)
(Date)
(Date Received)
Lab. No. ___________________
TESTS
Magnesium Oxide (MgO), %
Sulfur Trioxide (SO 3 ), %
Loss on Ignition, %
Insoluble Residue, %
Air Content of Mortar, %
Fineness : Amount Passing
No. 0.075 mm, Sieve, %
Autoclave Expansion, %
Time of Setting : Vicat Test, mins.
Compressive Strength, Avg. mortar
cubes, Mpa:
3 days
7 days
28 days
Specific Gravity
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 20
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.11 Reinforcing Steel Bar
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON REINFORCING STEEL BAR
Project
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
Tensile Properties:
Yield Point, Mpa
Tensile Strength, Mpa
Elongation, %
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 21
5.4.12 Concrete Joint Sealant
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON CONCRETE JOINT SEALANT
Project
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
REQUIREMENTS
o
Safe heating temperature, C
-
o
Pour point temperature, C
211 Max.
Flow at 60 o C, mm
o
RESULTS
5 Max.
Penetration at 25 C, 150g, 5 sec.
90 Max.
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
5 - 22
Attested by:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.4.13 Paint
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON PAINT
Project
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
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:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 23
5.4.14 Thermoplastic Traffic Paint
Letterhead of the Accredited Laboratory
Date:
_____________________
Lab. Report No.:
_____________________
TEST REPORT ON THERMOPLASTIC PAINT
Project
Kind of material
Sample identification
Quantity represented
Sampled at
Original source
Supplied by
Proposed use
Spec's Item No.
Sampled by
:
:
:
:
:
:
:
:
:
:
Submitted by
:
(Name & Designation)
(Office)
(Date)
(Name & Designation)
(Office)
(Date Received)
Lab. No. ___________________
TESTS
A. Physical Properties
1. Condition in Container
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
Shall be free from all skins,
dirts & foreign objects
2.15 Max.
10 Max.
102.5 + 9.5
10 Min.
42 Max.
18 Min.
30-40
100
75-95
15-35
0-5
Remarks: __________________________________________________________________________
__________________________________________________________________________
Tested by:
Checked by
________________________
________________________
Laboratory Technician
Laboratory Supervisor
Witnessed by:
Attested by:
________________________
________________________
________________________
Materials Engineer (Contractor)
Materials Engineer (DPWH)
Project Engineer (DPWH)
5 - 24
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.5
Accreditations
5.5.1 Application for Accreditation of Asphalt/Concrete Batching Plant (Per
DO. No. 253, series of 2003)
BRS Form No. 2
APPLICATION FOR ACCREDITATION OF BATCHING PLANT
The Director
Bureau of Research and Standards
Department of Public Works and Highways
EDSA, Quezon City
Sir:
In accordance with the “Guidelines for the Accreditation of Asphalt and Portland Cement
Concrete Batching Plants” issued by DPWH, we hereby apply for assessment as a DPWH accredited
_________ batching plant.
1.
2.
3.
4.
5.
6.
7.
8.
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 for Accreditation of Materials Engineer (Per D.O. No. 184,
Series of 1999)
Department of Public Works and Highways
ACCREDITATION OF MATERIALS ENGINEERS
APPLICATION FORM
□□□□
Application Number
□
□
2" x 2" Photo
New Applicant
Accredited Materials Engineer I,
Indicate accreditation number
□□□□
Name: ____________________ ____________________ ____________________
(Last)
(First)
(Middle)
PRC License Number: ___________________
Valid until __________________
Home Address:
________________________________________________
________________________________________________
Office Name:
________________________________________________
Office Address:
________________________________________________
Position Title:
________________________________________________
Home Tel No.:
________________________________________________
Office Tel No.:
________________________________________________
Mobile No.:
________________________________________________
Nationality: ___________ Birthday:
____________ Sex: _____ Civil Status: ________
Education (Limit to Tertiary Level up)
Degree
School
Year Graduated
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
I certify to the correctness of the foregoing.
________________________________
Signature over printed name
________________________________
Date
Preferred Venue of Examination
□Manila
□Cebu City
□Davao City
Date of Examination(Do not fill up) : ______________________________________
5 - 26
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5.5.3
Application for Accreditation of DPWH Materials Engineer (Per D.O.
No. 12, Series of 2013)
Department of Public Works and Highways
ACCREDITATION OF DPWH MATERIALS ENGINEERS
APPLICATION FORM
＿＿＿＿＿＿＿＿＿＿＿＿
2" x 2" Photo
Date of Examination
Application Number
Accredited as Contractors' Materials Engineer
Name:
□□□□
□ Yes Accreditaion No. ____
□ No
____________________ ____________________ ____________________
(Last)
(First)
(Middle)
PRC License Number:
___________________
Valid until __________________
Home Address:
________________________________________________
________________________________________________
Regional/District Office:
________________________________________________
Office Address:
________________________________________________
Position Title:
________________________________________________
Home Tel No.: ______________ Office Tel No.: ______________ Mobile No.: _______________
Nationality: ___________ Birthday:
____________ Sex: _____ Civil Status: ________
Education (Limit to Tertiary Level up)
Degree
School
Year Graduated
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
I certify to the correctness of the foregoing.
________________________________
Signature over printed name
________________________________
Date
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
5 - 27
5.5.4
Instructions for Application for Accreditation of Materials Engineers
1.
Type or print the data on each space clearly.
2.
Attach to this Application Form the following requirements:
a.
Xeroxed copy of valid Professional Regulation Commision (PRC) Identification
Card
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
Submit the Application Form and the requirements to:
The Chief
Quality Assurance Division
Any Regional Office of the Department of Public Works and Highways
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,
materials quality control terminologies/practices, duties and responsibilities of
materials engineers, and quality control implementation/documentation.
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 ________________ -
P
12 % VAT
P
Net Amount Due to - - - - - - - - - A. Certified
□
□Cash Available
□Subject to ADA (where applicable)
□Supporting documents complete
E
A
Signature:
Printed Name:
Position:
＿＿＿＿＿＿＿＿＿＿＿＿_
＿＿＿＿＿＿＿＿＿＿＿＿_
Accountant
U
E
E
A
A
-
A
Signature:
Printed Name:
Position:
(Head Accounting Unit/Authorized Representative)
Date:
＿＿＿＿＿＿＿＿＿＿＿＿_
C. Received Payment:
□
Signature: ____________ Date:
_____________
Printed Name: ____________________________
P
B. Approved for Payment
□
A
U
＿＿＿＿＿＿＿＿＿＿＿＿_
＿＿＿＿＿＿＿＿＿＿＿＿_
Regional Director
(Agency Head/Authorized Representative)
Date:
＿＿＿＿＿＿＿＿＿＿＿＿_
Check/ADA No.:
_______________________
Date: _____________ JEV No.: ______________
Bank Name: _____________ Date: ___________
OR No./Other relevant documents issued: __________________
FOR ACCOUNTING USE ONLY
JEV No.:＿＿＿＿＿＿＿＿＿＿
OR. #
P.P.A
ACCOUNTING ENTRY
ACCOUNT
CODE
DEBIT
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
CREDIT
6-1
6.1.2 Background Information
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
6.1.3 Executive Summary
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Reference No.: ____________________
Date: ____________________
EXECUTIVE SUMMARY
_________________________________
FOR:
The Regional Director/District Engineer
---------------------------------------------------------------------1. Subject
15% Cash Advance payment in the amount of
P_____________________ for the ____________________.
2. Period Covered
________________________________________________
3. Action Recommended
________________________________________________
4. Implementing Office
________________________________________________
5. Reviewing Office
________________________________________________
6. Contractor
________________________________________________
7. Contract Data
________________________________________________
8. Amount
________________________________________________
9. Duration
________________________________________________
10. Starting Date
________________________________________________
11. Expiration
________________________________________________
12. Percent Time Elapsed
________________________________________________
13. Physical Accomplishment
________________________________________________
14. Scheduled
________________________________________________
15. Actual
________________________________________________
16. Slippage
________________________________________________
17. Contractor’s Surety Bond in lieu of 15% Cash Advance money, if needed.
________________________________________________
18. Kind
Bank Guarantee____________________________________
19. Amount
________________________________________________
20. Issued By
________________________________________________
21. Expiration
Until fully recouped_________________________________
22. Validated By
DPWH Action Committee____________________________
23. Is Performance Bank Guarantee or Letter of Credit still valid?
________________________________________________
24. Remarks
________________________________________________
U
U
U
U
U
U
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-3
6.1.4 Billing Summary
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
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Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.1.5 Request for the Release of 15% Advance Payment
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
___________________
Chief, Construction Division/Section
SUBJECT:
Request for the Release of 15% Advance Payment
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
6.1.6 Required Certification for Processing of Payments
As per D.O. 55 series of 1988
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
CERTIFICATION
U
In connection with the implementation of the Contract ID#__________:
_________________________________, this is to certify that (Contractor’s Name) has
submitted all the documentary requirements necessary for the processing of its
_________________ in the amount of _________________________ (P ______________).
This is to certify further that all requirements and supporting papers pursuant to
Department Order No. 55 series of 1988 have been complied with, reviewed and found to be in
order.
______________________________
Chief, Construction Division/Section
6-6
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.1.7 List of Minimum Required Equipment
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
LIST OF EQUIPMENT ON SITE
U
Name of Project: ___________________________________________________________
___________________________________________________________
List of minimum required equipment for 15% advance payment.
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
PHOTOGRAPHS
______________________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6-7
6.1.8 Checklist of Supporting Document
6-8
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.2 First Progress Billing
6.2.1 Background Information
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
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6-9
6.2.2 Executive Summary
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Reference No.: ____________________
Date: ____________________
EXECUTIVE SUMMARY
FOR:
_________________________________
The Regional Director/District Engineer
---------------------------------------------------------------------1. Subject
First payment in the amount of
P_____________________ for the ____________________.
2. Period Covered
________________________________________________
3. Action Recommended
________________________________________________
4. Implementing Office
________________________________________________
5. Reviewing Office
________________________________________________
6. Contractor
________________________________________________
7. Contract Data
________________________________________________
8. Amount
________________________________________________
9. Duration
________________________________________________
10. Starting Date
________________________________________________
11. Expiration
________________________________________________
12. Percent Time Elapsed
________________________________________________
13. Physical Accomplishment
________________________________________________
14. Scheduled
________________________________________________
15. Actual
________________________________________________
16. Slippage
________________________________________________
17. Contractor’s Surety Bond in lieu of 15% Cash Advance money, if needed.
________________________________________________
18. Kind
Bank Guarantee____________________________________
19. Amount
________________________________________________
20. Issued By
________________________________________________
21. Expiration
Until its final acceptance_____________________________
22. Validated By
DPWH Action Committee____________________________
23. Is Performance Bank Guarantee or Letter of Credit still valid?
________________________________________________
24. Remarks
________________________________________________
U
U
U
U
U
U
_____________________
Project Engineer
6 - 10
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.2.3 Billing Summary
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
P
REMARKS:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
NOTED:
_____________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 11
6.2.4 Request for Release of First Partial Billing
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Request for the Release of First Partial Billing
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.
Very truly yours,
_________________________
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
Original Expiry Date:
Schedule Physical Progress:
Actual Physical Progress:
Slippage (+)
%
%
%
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
Total value of work to da
Total value of work previously:
Total value of work this billing
Deductions:
P
P
ORIGINAL CONTRACT AMOUNT:
REVISED CONTRACT AMOUNT
CONTRACTOR:
PROJECT NAME:
Assistant Regional Director
RECOMMENDED FOR PAYMENT:
Chief, Construction Division
CHECKED AND VERIFIED:
Payment Certificate No. __
Project Engineer (DPWH)
consistent with the requirements of the contract.
Regional Director
11. I hereby certify that the quantity of work approved for
APPROVED FOR PAYMENT:
payment in the attached statement have been
accomplished; that the quantities including materials
brought to site but not incorporated in the work are
correct and consistent with all previous recommendations
for payment and the work quantities and amounts are
Chief, QAD/QAS
10. We hereby certify that the materials incorporated in this
certificate for payment have been verified and tested
in accordance with specifications.
AMO/Contractor's Representative
9. I hereby certify that the attached statement of work is
correct and just and does not include items and/or
portions thereof for which payment has already been
received. In regard to item covering advance payment
for materials, the said materials are on site and are
properly protected.
For the period : ______________________________
CERTIFICATE OF PAYMENT
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
6.2.5 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
Recommending Approval by:
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: ____________________________
Project ID: _________________
Project Name: _________________
CONTRACTOR'S STATEMENT OF WORK ACCOMPLISHED
Period Covered: From __________ To ___________
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Cost to
Date
Balance of
Cost
__________________________
Regional Director
Approved by:
Cost of this
Billing
Payment Certificate No.: _____
6.2.6 Contractor's Statement of Work Accomplished
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.2.7 Statement of Time Elapsed
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
STATEMENT OF TIME ELAPSED AND WORK ACCOMPLISHED
PROJECT ID:
PROJECT NAME:
CONTRACTOR:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
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
6.2.8 Certification of Clearance for Equipment Rental and/or Lease
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
CERTIFICATION OF CLEARANCE FOR
EQUIPMENT RENTALS AND/OR LEASE
PROJECT ID:
NAME OF PROJECT:
___________________________________________________
___________________________________________________
LIMITS:
___________________________________________________
LOCATION:
___________________________________________________
This is to certify that as of _________________, the Contractor _______________
has no claims against him on equipment lease or rental obligations filed with this Office, or
amounts due the Department.
This certification is issued to the Contractor as a requirement in connection with
their request for first payment of Work Accomplished for the ____________________.
______________________________
Project Engineer
6 - 16
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.2.9 Certification of Labor and Materials Payment
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
CERTIFICATION OF CLEARANCE FOR
LABOR AND MATERIALS PAYMENT
PROJECT ID:
NAME OF PROJECT:
___________________________________________________
___________________________________________________
LIMITS:
___________________________________________________
LOCATION:
___________________________________________________
This is to certify that as of _________________, no written complaints have been
filed in this office on unpaid labor or unpaid materials against the Contractor
_______________________.
This certification is issued to the Contractor as a requirement in connection with
their request for first payment for __________________________.
______________________________
Project Engineer
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 17
6.2.10 Detailed Quantity Calculation
DETAILED QUANTITY CALCULATION (Accomplishment)
Agency:
Department of Public Works and Highways
Month:
Implementing Office and Address
Mo. Certificate No.:
Contractor:
Project ID:
Project Name:
Contractor's Name
Pay Item No.:
Original Quantity:
Description:
Revised Quantity:
Uni:
unit
Total Qty. Accomplished To-Date:
________________ unit
Less: Previous Accomplishment:
________________ unit
This Period Accomplishment:
________________ unit
This Certificate Quantity:
________________ 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:
_________________________
_________________________
_________________________
Authorized Managing Officer
(Contractor)
Material Engineer
(DPWH)
Project Engineer
(DPWH)
6 - 18
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.2.11 Checklist of Supporting Documents and Attachments for DoTS
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 19
6.3 Interim Progress Billing
6.3.1 Request for Release of Interim Billing
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Request for the Release of ________ Partial Billing
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
_________________________ (P _________________). We have accomplished the work
satisfactorily in accordance to the terms and conditions of the contract. Attached herewith are the
Detailed Quantity Calculation, Statement of Work Accomplished and other documents for your
review and approval.
Favorable actions on this regard will be highly appreciated.
Very truly yours,
_________________________
Contractor
6 - 20
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.3.2 Checklist of Supporting Documents And Attachments for DoTS
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 21
6.4 Final Billing
6.4.1 Property Clearance
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Reference No.: ____________________
Date: ____________________
SUPPLY AND PROPERTY CLEARANCE CERTIFICATE
ON PROPERTY ACCOUNTABILITY
(FOR CONTRACTORS)
To Whom It May Concern:
This is to certify that as per records of this office, (Name of the Contractor),
contractor of the (Project Name), has no property and/or money accountability with the
Supply and Property in Administrative Division/Section, in connection with the
above-mentioned contract.
U
U
U
U
In order to be complete, similar clearance shall be obtained from the DPWH
Implementation Office (IO) of the above mentioned project and from the Bureau of
Equipment and/or Regional Equipment Services (RES) for whatever accountabilities there
might be under their respective jurisdictions.
This certificate is issued for the purpose of final billing.
_________________________________
Supply Officer, Administrative Division/Section
_________________________________
Chief, Administrative Division/Section
6 - 22
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.4.2 Regional Equipment Clearance
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ______________
CERTIFICATE OF CLEARANCE FOR EQUIPMENT AND OTHER OBLIGATIONS
Contractor:
Project ID:
Project Name:
Description:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Location :
___________________________________________________________
1.
EQUIPMENT RENTALS, SPARE PARTS AND MATERIALS ISSUED, SERVICES RENDERED
ETC. (Attach supporting papers if necessary)
BILL NUMBER
NONE
PARTICULARS
NONE
AMOUNT
NONE
REMARKS
NONE
Note: Equipment Lease contract dated ____________ and approved by _________________________
2.
OTHER OBLIGATIONS RELATIVE TO EQUIPMENT
(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
PREPARED AND VERIFIED BY:
____________________________________
Chief Accountant
____________________________________
Chief, EMD
SUBMITTED BY:
____________________________________
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 23
6.4.3 Certificate of Completion
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
6.4.4 Inspection Report
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
INSPECTION REPORT FOR FINAL COMPLETION
NAME OF PROJECT:
___________________________________________________
CONTRACTOR:
___________________________________________________
IMPLEMENTING OFFICE:___________________________________________________
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
6.4.5 Checklist of Supporting Documents and Attachments for DoTS
6 - 26
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.5 Retention Money
6.5.1 Description
Progress payments are subject to retention of ten percent (10%) referred to as the
“retention money”. Such retention shall be based on the total amount due to the contractor
prior to any deduction and shall be retained from every progress payment until fifty percent
(50%) of the value of works, as determined by the procuring entity, are completed. If, after
fifty percent (50%) completion, the work is satisfactorily done and on schedule, no additional
retention shall be made; otherwise, the ten percent (10%) retention shall be imposed.
The total “retention money” shall be due for release upon acceptance of the works. The
contractor may, however, request the submission of the retention money for each progress
billing with irrevocable standby letters of credit from a commercial bank, bank guarantees or
surety bonds callable on demand, of amounts equivalent to the retention money substituted for
and acceptable to DPWH, provided that the project is on schedule and is satisfactorily
undertaken. Otherwise, the ten percent (10%) retention shall be made. Said irrevocable
standby letters of credit, bank guarantees and/or surety bonds, to be posted in favor of the
DPWH shall be valid for a duration to be determined by the concerned implementing
office/agency or procuring entity and will answer for the purpose of which the ten percent
(10%) retention is intended, i.e. to cover uncorrected noted defects and third party liabilities.”
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6 - 27
6.5.2 Request for the Release of Retention
CONSTRUCTION
COMPANY CO., LTD.
Date: _____________________
_______________________________________
THE REGIONAL DIRECTOR/DISTRICT ENGINEER
U
_______________________________________
Thru:
_____________________________
Chief, Construction Division/Section
SUBJECT:
Request for the Release of Retention
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.
Very truly yours,
_________________________
Contractor
6 - 28
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
6.5.3 Statement of 10% Retention
STATEMENT OF 10% RETENTION MONEY
Contractor:
__________________________________________________
Name of the Project:
__________________________________________________
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
6.5.4 Checklist of Supporting Documents and Attachments for DoTS
6 - 30
Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
Chapter 7 Project Completion and
Acceptance
7.1 Final Inspection for Completion
7.1.1 QAU or Regional Inspectorate Team Report
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
QAU/REGIONAL INSPECTORATE TEAM
PROJECT ASSESSMENT REPORT
Date of Inspection: ____________________
I.
PROJECT INFORMATION
Name of Project:
____________________________________________________
Location: ____________________________________________________
Contract Amount:
____________________________________________________
Contractor:
____________________________________________________
II.
FINDINGS AND OBSERVATIONS
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
III. RECOMMENDATIONS
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Submitted by:
QAU/RO TEAM
_________________________________
_________________________________
_________________________________
_________________________________
Noted by:
_________________________________
Chief, QAD
Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents
7-1
7.1.2 Pre-final Inspection (Punch List)
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
7.1.3 Final Inspection Report
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
7.2 Certificate of Completion
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
7.3 Post-evaluation Report (Post-audit)
Republic of the Philippines
COMMISSION ON AUDIT
TECHNICAL and INFORMATION TECHNOLOGY SERVICES
VALIDATION REPORT
FOR INFRASTRUCTURE PROJECTS
DATE
PROJECT:
LIMITS/LOCATION:
CONTRACTING PARTIES :
CONTRACT DURATION :
EFFECTIVITY DATE:
DATE OF INSPECTION:
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
2
Change Order No. 1
3
Extra Work Order No.
3.1
Revised Plans
3.2
Specifications
3.3
YY
Cost Breakdown
4
Agency Accomplishment Report
5
Agency Certificate of Complition
7
Test Results, if any
8
As-built Plans
9
Others
D. METHODOLOGY
1
2
3
4
Studied plans and specifications
Prepared inspection working paper.
Conducted physical/ocular inspection
Conducted technical evaluation (actual measurements)
E. PERSONS/PERSONNEL PRESENT AT THE TIME OF INSPECTION
NAME
POSITION AND DESIGNATION
F. CONDITIONS/CIRCUMSTANCES ATTENDANT TO INSPECTION
The name mentioned above assissted the undersigned during the conduct of inspection
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7.4 Acceptance Report
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
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
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7.5 Certificate of Acceptance
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGWAYS
Implementing Office
Date: ____________________
CERTIFICATE OF ACCEPTANCE
PROJECT/LOCATION:
___________________________________________________
___________________________________________________________
___________________________________________________________
CONTRACTOR:
___________________________________________________________
___________________________________________________________
This is to certify that the above-stated project has been accepted as of
( date )
.
Based on the Acceptance Report of the Inspectorate Team dated
( 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
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