10.
rT
12,
43.
4
CHECK LIST
{For Sanction of Deviation Statement)
Name of the work
Details of Original A/A
Details of Agreement (Agreement No.
& Amount)
Amount of Deviation & Reasons
thereof (Attach Deviation Statement,
Original work programme and Revised
‘work programme)
Whether deviation amount exceeds
10% more than the original agreement
value.
If exceeds more than 10% reasoning
with technical report may be attached.
Whether revised A/A is necessary /
accorded? if so a copy of the A/A order.
Permission from the competent
‘authority to go ahed with the execution
may be furnished,
Is the deviation due to change of
design / site? If so a copy of the
approval order for such changes may
be furnished.
Whether recommended by
{a) Executive Engineer
(0) Superintending Engineer
Relative position of tenders at deviated
quantity (whether the position has
been altered or not)
Whether EOT has been granted up to
the required extent? If so 2 copy there
of may be furnished.
If the delay is due to change of design /
site, The circumstances for such
changes may be stated
{Permission letter may be furnished)
If the delay is due to heavy untimely
rain fail, whether 2 certificate is
furnished from the competent
authority showing the details of rain
“Revised estimate for the work "Construction and maintenance to MV76
to Bhejingiwada road in the district of Malkangiri under RCPLWEA.
Program*. (OR2ORCPL 12 PART: 1)) under the road connectivity
project of Left Wing.
‘Administrative approval has been accorded originally.
Rs 2481.72 Letter No.7854 Dt.18-05-2018 of Govt. Works department,
Odisha.
16/RCPLWEA/2018-19/EE Rs.221315886.00 (0.12% Less}
s.114.00 Attached, Deviation statement attached separately.
Na,
NA.
Yes, A/A copy Attached.
Na,
Change of design
Yes
Does not arise
Provisional £.0.T up to 31.03.2020
No
Yes, Attachedfall during the period of hindrance.
15. Reasons as to why
{() Compensation will not be levied on : Not Applicable
the contractor
{ii} benefit of price escalation will not Not Applicable
be curtailed / disallowed
16. Whether any £.0.T was granted : No
previously, If so with benefit of price
escalation of without the same.
17. Whether any Audit Para / Draft Para: No
(CRAG Para Is pending against the work.
{Attach copy of Audit Para / Draft Para
CBAG Para, if any)