ROAD PROJECT MANAGEMENT AND SUPERVISION MANUAL VOLUME II:
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: ) ________________________ Page 2 of 2 3-8 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 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. Page 1 of 2 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3-9 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__ Page 2 of 2 3 - 10 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: _________________________ Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 11 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. Page 1 of 2 3 - 12 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents This Irrevocable Standby Letter of Credit is valid until _________calendar days after the date of opening of bids for the said Contractor until ____________ (the “expiry date”), whichever comes earlier. This Irrevocable Standby Letter of Credit is being issued in favor of the said bidder in connection with your requirements of the bidding for the said contract. We are aware that any false statements issued by us make us liable to perjury. This Irrevocable Standby Letter of Credit is issued subject to the uniform customs and practice for documentary credits (2007 Revision) International Chamber of Commerce Publication no. 600. ___________________________________________ (Insurer) ____________________________ Bank’s Authorized Officer Page 2 of 2 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 13 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. Page 1 of 2 3 - 14 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 _______. Page 2 of 2 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 15 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 3 - 16 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. Page 1 of 9 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 17 b) MAINTAINED PERIOD If a maintenance period is specified in the Schedule, the liability of the Insurers during this period shall be limited to any loss or damage caused by the Insured Contactor(s) in the course of the operations carried out by him for the purpose of complying with his obligations under the Maintenance ______ of the Contract. GENERAL CONDITIONS 1) The due observance and fulfillment of the Terms of this Policy in SO FAR as they relate to anything to be done or complied with by the Insured shall ____ condition precedent to any liability of the Insurers to make any payment under this Policy; 2) The Schedule and the Section(s) shall be deemed to be incorporated and in form part of this Policy and the expression “this Policy” wherever used in contract shall be read as including the Schedule and Section(s). Any work or expression to which a specific meaning has been attached in any part of Policy or of the Schedule or of the Section(s) shall bear such meaning wherever it may appear; 3) The Insured shall give notice to the Insurers of any insurance or insurances already effected, or which may subsequently be effected, covering any of property hereby insured, and unless such notice be given and the particulars of such insurance or insurances be stated in or endorsed on this policy by or behalf of the Insurers before the occurrence of any loss or damage, all benefits under this Policy shall be forfeited; 4) The Insured shall take all reasonable precautions to prevent loss, damage or liability and to comply with sound engineering practice, statutory requirement and 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 __________; Page 2 of 9 3 - 18 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents d) Furnish all such information and documentary evidence as the Insurers may require; e) Inform the police authorities in case of loss or damage due to theft, burglary or sabotage. The Insurers shall not in any case be liable for loss, damage or liability of which no notice has been received by the Insurers within 14 days of its occurrence. Upon notification being given to the Insurers under this condition, the Insured may carry out the repairs or replacement of any minor damage; in other cases a representative of the insurers shall have the opportunity of inspecting the loss or damage before any repairs or alterations are effected. ______ thing herein shall prevent the Insured from taking such steps as are absolutely necessary for the security and continuation of the contract work. If a representative of the Insurers does not carry out the inspection with a period of time which could be considered as adequate under the circumstances insured is entitled to proceed with the repairs or replacement. 8) The Insured shall at the expense of the Insurers do and concur in doing and permit to be done all such acts and things as may be necessary or required the Insurers in the interest of any rights or remedies, or of obtaining relief for indemnity from parties (other than those insured under this Policy) to who the Insurers shall be or would become entitled or subrogated upon their paying for or making good any loss or damage under this Policy, whether ___ acts and things shall be or become necessary or required before or after the 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. Page 3 of 9 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 19 10) If a claim is in any respect fraudulent, or if any false declaration is made or used in support thereof, or if any fraudulent means or devices are used in support thereof, or if fraudulent means or devices by the Insured or anyone acting on his behalf to obtain any benefit under this Policy, or claim is made and rejected and no action or suit is commenced within twelve months after such rejection or, in case of arbitration taking place as provided herein, within twelve months after the Arbitrator or Arbitrators or Umpire have made their award, all benefit under this Policy shall be forfeited. 11) Any claim arises under the Policy there be any other insurance covering the same loss, damage of liability the Insurers shall not be liable _____ contribute more than their ratable proportion of any claim for such loss or damage. Section 1 PROPERTY INSURED (Material Damage) THE INSURERS HEREBY AGREE with the insured that if at any time during the period of insurance stated in the Schedule, or doing any further period of extension thereof the property or any part thereof described in the Schedule shall suffer any unforeseen loss or damage from any cause, other than the specifically excluded, 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; Page 4 of 9 3 - 20 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents (e) wear and tear, corrosion, oxidation, deterioration due to lack of use and normal atmospheric conditions: (f) mechanical and or electrical breakdown or derangement of construction plant, equipment and construction machinery; (g) loss of or damage to vehicles licensed for general road use or waterborne vessels or aircraft; (h) loss or damage to files, drawings, accounts bills, currency, stamps, deeds evidences of debt, notes, securities or cheques; (i) 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 Page 5 of 9 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 21 (b) In the case of a total loss – the actual value of the insured property immediately before the occurrence of the loss less salvage provided always that the provisions and conditions have been complied with. The Insurers will make payments only after being satisfied by production of the necessary bills and documents that the repairs have been effected or replacement has taken place, as the case may be. All damage which can be repaired shall be repaired, but if the cost of repairing any damage equals or exceeds the value of the Insured property immediately before the occurrence of the damage, the settlement shall be made on the basis provided for in (b) above. The cost of any provisional repairs will be borne by the Insurers if such repairs constitute part of the final repairs and do not increase the total repair expenses. The cost of any alterations, additions and/or improvements shall not be recoverable under this Policy. MEMO 3. EXTENSION OF COVER: Extra charges for overtime, night work, work on public holidays, express freight, etc. are covered by this Insurance or if previously and specially agreed upon. Section 11 THIRD PARTY LIABILITY The Insurers will indemnify the insured against all sums which the Insured shall become legally liable to pay as damages consequent upon : a) 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). Page 6 of 9 3 - 22 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents EXCLUSIONS TO SECTION 11 The Insurers will not indemnify the Insured in respect of 1. 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: ___________________________________________ Page 7 of 9 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 3 - 23 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 6-4 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 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 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 Page 1 of 2 Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents 7-5 Page 2 of 2 7-6 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents 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 Road Project Management and Supervision Manual Vol. II:Sample Forms and Documents 7-7 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 7-8 Road Project Management and Supervision Manual Vol. II: Sample Forms and Documents
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