Technical Sanction No. TCH/06231/DIV/PH - VII B' /07-08 for Rs. 205.

69 Lakhs
P.w.G-17

Original/Duplicate/Triplicate
Reference paras
CONTRACT CERTIFICATE
PW Account Code
(For Other Works)
Date:
Sub Divisional Cash Book Vr. No.
Date:
Divisional

Bill No. First & Part

Division SHIMOGA
Bills Received No.
Scheduled Docket No.
Head of Account: 3054-06-337-Rural roads - 01

Name of work (as per sanctioned): METALLING AND ASPHALTING OF ROAD FROM KELADI

TO T-09 ROAD IN SAGARA TLAUK, SHIMOGA DISTRICT. FROM 0.00 TO 7.450 KM

Name of Contractor and full address: Mr. Sharath J Shet, Class - I Contractor, Kumta
Reference to tender agreement No:

/200

Certified that the measurement were taken by me on

and recorded in
Pages 01 to 23 of measurement Book No. 01. That the work is satisfactorily executed.
Contractor
Officers in charge of the work
Certified that the quantities of measurement were checked by me on
and found correct the work is satisfactorily executed.
MEMORANDUM OF PAYMENT.

Sub Divisional officer.

Total value of work done or suppliers made as per Account

with in2. Deduct amount to held in reserve being
Percent Rs,
3.
Balance
4. Deduct payments.
a) Amount of previous Payment as in the office Case Book
are
S.D.No _ _ _ _ _ _ _ _ _ _ amount
adjusted towards cash advance recovery or
b) Payments cost of store of other materials supplied now
made Recovery of amount creditable to this/ other work
Amount paid in this bill Cheque/cash
1.

Total
Total amount adjusted

Contactors Signature.
Received Rs (in words).
per memorandum (in final settlement of demands)

For use in the office.

By cash by adjustment of payment as
Receipt

Signature of Contractor
Stamp
WITNESSES :
1.
2.
Dated:
Paid by me by cheque No.datedcash Rs. ..Date
Initial or Officer making payment with Date:

Signature of Contractor,

Executive Engineer.