BEFORE THE NOTARY, TALCHER

AFFIDAVIT
I, Sri Dillip Kumar Behera, aged about 43 years, S/o Ghanashyam Behera of At - Kulei, PO - Gaham,
PS - Samal, Dist - Angul (Odisha), Pin-759100 do hereby solemnly affirm as follows:
1. That, I posses a valid license for execution of works contract issued by APD-Cum-CEE, Major
Rengali Irrigation Project, Samal belong to 'C' Class (SC) & is valid upto 31.03.2022.
I am submitting tenders before the Executive Engineer, Head Works Division, Samal, Odisha for
execution of following work i.e.

Sl. No. 1 : (Aluminum painting of hoist and driving units of radial gates (bay no-1 to 6) of Samal
Barrage for the year 2020-21) (EEHWD02-2020-21) (2020_CEBBS_61172_1)

Sl. No. 2 : (Aluminum painting of hoist and driving units of radial gates (bay no. 7 to 12) of Samal
Barrage for the year 2020-21) (EEHWD02-2020-21) (2020_CEBBS_61172_2)

Sl. No. 3 : (Aluminum painting of hoist and driving units of radial gates (bay no. 13 to 18) of Samal
Barrage for the year 2020-21) (EEHWD02-2020-21) (2020_CEBBS_61172_3)
Sl. No. 4 : (Aluminum painting of hoist and driving units of radial gates (bay no. 19 to 23) of Samal
Barrage for the year 2020-21) (EEHWD02-2020-21) (2020_CEBBS_61172_4)

I am the authorized signatory on behalf of contractor for the tender for the work mentioned above.
2. That, I am swearing this affidavit that all tender documents and accompanying papers those being
submitted by me before the Executive Engineer, Head Works Division, Samal, At/PO - Samal Barrage
Township, Angul including EMD in any shape are all authentic and bonafied documents in the eyes of
the law of the land.
That, the facts stated in the affidavit are true to the best of my knowledge and belief.

Signature of Contractor/
Authorized Signatory