PROVISIONAL ACCEPTANCE FORM

PROJECTS NAME: FROM UPPER HERITAGE UPTO HAMERSA

REGION: HARAR
ZONE: HARAR
WOREDA :
CONSULTANT: HPNRS -HARAR MUC.ULGDP

CONTRACTOR: መሊካ እና አብዱናሲር የገጸምድር ማስዋብ ህ/ሽ/ማ

IDA CREDIT NO.: __________________________________________________________

AMOUNT
CONTRACTS DATE ETH.BIRR
A. MAIN CONTRACT _____________ 606,500.00

B. SUPPL. AGREEMENT No. 1 ______________ ____________

C. SUPPL. AGREEMENT No. 2 _____________

D. VARIATION ORDER No.1 ____________

E. VARIATION ORDER No.2

F. VARIATION ORDER No.3

G. VARIATION ORDER No.4

H. AUTHORIZED LETTERS

TOTAL SUM 606,500.00

This NOV day of 10, 2020 by the order of the ___________________ Municipality and after due

notification to all concerned parties, we the undersigned.

Name Signature Representing

1. ____________________________ __________ __________________________________

2. ____________________________ __________ __________________________________

3. ______________________________ __________ ____________________________________

4. ____________________________ __________ __________________________________

5.____________________________ __________ __________________________________

6. ______________________________ __________ ____________________________________

7. ______________________________ __________ ____________________________________

8. _______________________________ ___________ ____________________________________

Have Examined

1 Contracts, Specification and Drawings

2 The final Certificate of Measurements
3 The worksand have proceeded with the temporary acceptance of the above project on the bases of
the following information.
(a) Date when the contractor took possession of site
(b) Agreed length of completion time 90 calendar days.
(Working days)
(c) Commencing date
(d) Completion date according to contract
(e) Actual completion date
(f) Total Number of delay
(g) Number of Justified days of delay
(h) Number of unjustified days of delay
(I) Penalty of day Eth. Birr
Per Day Eth. Birr
ACCOUNT Eth.Birr
Total Value Of Work Executedand or 603,914.80
material Supplied................

DEDUCTIONS Eth.Birr
1. Previous Payments................... 262,682.21
2. Penality...................................
3. Rebate.....................................
4. Retention................................ 15,097.87
5. Material Diduction.................
6. Advance Repayments................ 181,950.00

Total Deduction........................... 459,730.08 459,730.08

Total amount due to theContractor…… 144,184.72

Retention money 2.5 % of the total value of work executed payable on the final
acceptance
Net Sum Payable to the Contractor 144,184.08
Performance Bonds
Remarks
 ________________________________________________________________________
________________________________________________________________________

CONCLUSION
The date for final acceptance will be NOVEMBER 11 ,2021 after
thorough investigation of the works in all its parts except those of invisible & latent defects.
However we declare that the work had been executed in accordance with the drawings and
the specifications in an acceptable manner.

In witness thereof, we have written and signed on this temporary acceptance form out of
which one copy is to be issued to the contractor for all practical applications after due
approval.

CONSULTANT CLIENT CONTRACTOR

ATTENDING PARTIES/WITNESSES
NAME TITLE SIGNATURE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)____________________________ ___________________ _____________
DATE
N.B. This form will be filled in eleven original copies.