CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc
------------------------------------------.., Ngy..thng.nm
BI N B N
HI N TR N G V PH T S IN H KHI L N G
( Lu : Bin bn pht sinh khi lng ch c gi tr khi Nh thu c cng vn c TVTK ng
v Ch u t ph duyt cho vic thay i, pht sinh trong qu trnh thi cng so vi thit k).
Cng trnh: ..................................................................
Hng mc : ..........................................
M trm/ m tuyn:
a ch: ........................
- Thi cng theo Hp ng s.
- Hm nay, ngy . Thng .. nm ., ti :
I. Thnh phn tham gia:
a). i din ch u t: Nu cng trnh thuc Cng ty VTNet k hp ng, i din ch u t
l Ban Gim c Cng ty Vtnet. Nu cng trnh thuc CNVT tnh/tp k hp ng, i din ch
u t l Ban Gim c CNVT.
ng:
Chc v:
b). i din b phn c giao nhim v gim st: Nu cng trnh thuc Cng ty VTNet k
hp ng, i din b phn c giao nhim v gim st l: Gim c CNVT Tnh/TP v
Trng Phng XDHT ca CNVT (Ph trch b phn gim st thi cng). Nu cng trnh thuc
CNVT k hp ng, i din b phn c giao nhim v gim st l: Phng XDHT ca CNVT
(Ph trch b phn gim st thi cng).Trng hp thu nh thu t vn gim st, thnh phn
tham gia nghim thu l Gim c nh thu TVGS v Ph trch b phn gim st.
ng:
Chc v: Th trng n v
ng:
Chc v:
c). i din Nh thu thi cng: Cng ty c phn xy dng v t vn cc gii php truyn thng
CTIS.
ng:
Chc v: Th trng n v
ng:
Chc v:
d). i din n v t vn thit k: Gim c nh thu thit k v ch nhim thit k.
ng:
Chc v: Th trng n v
ng:
Chc v:

II. Ni dung:
- Chng ti cng c mt ti hin trng xc nhn s vic:........................................
..........................................................................................................................................
..........................................................................................................................................
- Cn c vo thc t thi cng so vi thit k (sai lch hay khng sai lch so vi thit
k) ..........................................................................................................................................
........................................................................................................................................
- Cc kin khc:............................................................................................................
Biu mu BM_TCNT_011 Km theo quyt nh s 2079/Q-VTQ-XD ngy 23/09/2013

..........................................................................................................................................
- Kt lun (ng trin khai tip hay dng thi cng? Hng x l tip theo):..............
..........................................................................................................................................
III. Khi lng pht sinh:
STT

Ni dung pht sinh

n v

Khi lng
Thit k

I
1

Vt t pht sinh
Vt t do bn A cp

..
Vt t do bn B cp
..

II
1
2

Chnh lch

Thc t

Tng

Gim

Ghi ch

Khi lng pht sinh

cng vic ngoi hp
ng

Chng ti cng nhau thng nht lp bin bn ny lm c s php l theo quy nh ca nh nc.
Bin bn lp cng ngy v thng qua cc thnh phn c tn trn nht tr k tn./.
I DIN CH U T
(k, ng du, ghi r h tn)

N V C GIAO NHIM V GIM ST THI CNG

TH TRNG N V

PH TRCH GIM ST THI CNG

(K, ghi r h tn, ng du)

(K, ghi r h tn)

I DIN NH THU THI CNG

GIM C

PH TRCH THI CNG TRC TIP

(K, ghi r h tn, ng du)

(K, ghi r h tn)

N V T VN THIT K
GIM C
(K, ghi r h tn, ng du)

CH NHIM THIT K
(K, ghi r h tn)

Biu mu BM_TCNT_011 Km theo quyt nh s 2079/Q-VTQ-XD ngy 23/09/2013