Part II - Certificate and Signature

Name of Work : Improvement to Nudurupada – Kaliahata Road from 46/000 km to 52/550 km in District of Keonjhar under State Plan for the year 2019-20
Work Number : 587/8675/1 RA Bill Number : 13 and Date : 15/12/2022
Draft

1. The measurements on which are based the entries in columns 1 to 5 were made by

Sr.No. Record By(Section Record Date Measurement Book Details Check Checked Check% Check Checked Check% Remark
Officer) Date(SubDi By(SubDivision By(Sub Date(Divisi By(Division By(Divis
vision Officer) Division on Officer) Officer) ion
Officer) Officer) Officer)

1 Panchanana 15/12/2022 Page 46 to 50 of MB 6561, Page 45 to 48 of MB 15/12/2022 Rameswar 50 - - 0 -

Dhaunlia 6681 & Page 86 to 93 of MB 6568 Panigrahi
*2. Certified that in addition to and quite apart from the quantities of work actually executed as shown in column 4 of Account I, some works have actually been done in connection with several items and the value of
such work (after deducting therefrom the proportionate amount of secured advances, if any ultimately recoverable on account of the quantities of materials used therein) is no case, less than advance payments as
per item 2 of memorandum of payments made or proposed to be made for the convenience of the contractor in anticipation of and subject to the results of detailed measurements, which will be made as soon as
possible.

Date :

Signature of Contractor Signature of Officer Preparing the Bill $ Signature of Officer Authorising Payment

Date : Date : Date :

* This certificate must be signed by the Subdivisional or Divisional Officer.

Designed & Developed by C-DAC , Pune