‫ﻧﻣﻭﺫﺝ ﺭﻗﻡ ‪30 :‬‬

‫ﺗﺎﺭﻳﺦ ﺍﻟﺗﻘﺩﻳﻡ‪16/8/2023-:‬‬ ‫ﻧﻣﻭﺫﺝ ﺍﻋﺗﻣﺎﺩ‬ ‫ﺃﻟﺭﻗﻡ ﺍﻟﺗﺳﻠﺳﻠﻲ ‪-:‬‬

‫ﺍﻟﺷﺭﻛﺔ ﺍﻟﻣﻧﻔﺫﺓ‬ ‫ﻣﻬﻧﺩﺳﻲ ﺍﻟﻣﺷﺭﻭﻉ‬ ‫ﺑﻳﺎﻧﺎﺕ ﺍﻟﻣﺷﺭﻭﻉ‬ ‫ﺍﻟﻣﻠﻙ‬
‫ﺍﺳﻢ ﺍﻟﻤﺸﺮﻭﻉ‪-:‬ﺗﻄﻮﻳﺮ ﻣﻮﻻﺕ ﺍﻟﻌﺜﻴﻢ ﻣﻮﻝ‬
‫ﺷﺮﻛﺔ ﻋﺒﺪ ﷲ ﺍﻟﻌﺜﻴﻢ ﻟﻼﺳﺘﺜﻤﺎﺭ ‪ -‬ﻣﺸﺮﻭﻉ ﺗﻄﻮﻳﺮ‬
‫ﺷﺭﻛﺔ ﺑﻼﺩ ﺍﻟﺷﺎﻡ ﻟﻠﻣﻘﺎﻭﻻﺕ‬ ‫ﺍﻟﻤﻮﻗﻊ‪-:‬ﺍﻹﺣﺴﺎء ﻭﺣﺎﺋﻞ‬
‫ﻣﻮﻻﺕ ﺍﻹﺣﺴﺎء ﻭﺣﺎﺋﻞ‬

‫ﻁﻠﺏ ﺍﻋﺗﻣﺎﺩ‪submittal-:‬‬
‫‪FOR INFORMATION‬‬ ‫ﻟﻠﻌﻠﻡ‬ ‫‪FOR APPROVA‬‬ ‫ﻟﻺﻋﺗﻣﺎﺩ‬ ‫‪FOR CONSTRUCATION‬‬ ‫ﻟﺗﻧﻔﻳﺫ ‪ /‬ﻟﻠﺗﺻﻧﻳﻊ‬

‫ﺃﺧﺭﻯ‬ ‫ﻋﻳﻧﺔ ﻣﻣﺛﻠﺔ‬ ‫ﻛﺗﺎﻟﻭﺟﺎﺕ‬ ‫ﻣﺧﻁﻁ‬ ‫ﻧﻭﻉ ﺍﻻﻋﺗﻣﺎﺩ‬

‫‪OTHARS‬‬ ‫ﺃﺧﺭﻯ‬ ‫‪ELCTRICAL‬‬ ‫ﻛﻬﺭﺑﺎء‬ ‫‪MECHANICAL‬‬ ‫ﻣﻳﻛﺎﻧﻳﻛﺎ‬ ‫‪STRUCTURAL‬‬ ‫ﺇﻧﺷﺎﺋﻲ‬ ‫‪ARCHITECTURAL‬‬ ‫ﻣﻌﻣـﺎﺭﻱ‬

‫ﺭﻗﻡ ﺍﻟﺑﻧﺩ‬ ‫ﺍﻟﻣﺎﺩﺓ‬ ‫ﺭﻗﻡ‬

‫ﺭﻣﺯ ﺍﻹﻋﺗﻣﺎﺩ‬ ‫ﻣﻛﺎﻥ‬ ‫ﺍﻟﻛﻣﻳﺔ‬ ‫ﺍﻟﻭﺣﺩﺓ‬
‫ﺍﻟﻣﻭﺭﺩ‬ ‫ﻣﻛﺎﻥ ﺍﻟﺻﻧﺎﻋﺔ‬ ‫ﺍﻟﺷﺭﻛﺔ ﺍﻟﺻﺎﻧﻌﺔ‬ ‫ﻓﻲ ﺟﺩﻭﻝ ﺍﻟﻛﻣﻳﺎﺕ‬
‫ﺍﺳﺗﻌﻣﺎﻝ ﺍﻟﻣﺎﺩﺓ‬
‫‪CODS‬‬ ‫‪QUANTITY‬‬ ‫‪UNIT‬‬ ‫‪UNIT NO.IN BCQ‬‬ ‫‪ITAM‬‬ ‫‪NO‬‬
‫ﺍﻛﺴﺴﻮﺍﺭﺍﺕ ﻟﻤﻮﺍﺳﻴﺮ‬
‫ﺍﻟﺳﻌﻭﺩﻳﺔ‬ ‫ﺍﺑﻠﻛﻭ‬ ‫‪1‬‬
‫ﺍﻟﺼﺮﻑ)ﺍﻛﻮﺍﻉ ﻭﺟﻠﺐ ﻭﻗﺴﺎﻣﺎﺕ (‬
‫ﺗﻄﻮﻳﺮ ﺩﻭﺭﺍﺕ ‪1-‬‬
‫‪2‬‬
‫ﺍﻟﻤﻴﺎﺓ ‪ -2‬ﺗﻐﻴﺮ‬
‫ﻣﻮﺍﺳﻴﺮ ﺍﻟﻤﻮﻝ‬ ‫‪3‬‬
‫‪4‬‬
‫ﺍﻟﺗﻭﻗﻳـــﻊ ﻭﺧﺗــﻡ ﺍﻟﻣﻘﺎﻭﻝ ‪:CONTRACTOR SIGNATURE & STAMP :‬‬ ‫ﻳﺗﻌﻬـﺩ ﺍﻟﻣﻘـﺎﻭﻝ ﺑﺻﺣــﺔ ﺍﻟﺑﻳـﺎﻧﺎﺕ ﺍﻟﻣـﺩﻭﻧﻪ ﻭﺑﺄﻥ ﺍﻟﻣــﻭﺍﺩ ﺍﻟﻣﺗﻘـﺩﻣﺔ ﺃﻋــﻼﻩ‬

‫ﻣﻁﺎﺑﻘﺔ ﻟﻠﻣﻭﺍﺻﻔﺎﺕ ﻭﺭﺳﻭﻣﺎﺕ ﺍﻟﻌﻘﺩ ﻣﺎﻟﻡ ﻳﺫﻛﺭ ﻏﻳﺭ ﺫﻟﻙ‬

‫‪PROJECT MANAGER :‬‬ ‫ﻣﺣﻣﺩ ﺩﺑﺟﻥ‬ ‫ﻣﻬﻧﺩﺱ ﺍﻟﻣﺷﺭﻭﻉ‪ :‬ﻡ ‪/‬‬ ‫‪THE CONTRACTOR CERTIFY THAT ABVE SUBMITTED ITEMS‬‬
‫‪ARE CORRECT AND STRICT CONFORMANCE DRAWINGS‬‬

‫‪A = APPROVED‬‬ ‫‪B = APPROVED AS NOTED C = RESUBMIT‬‬ ‫‪D = REJECT‬‬ ‫‪AND SPECS WITH CONTRACT EXCEPT OTHAR WISE STATED‬‬

‫ﺗﻭﺻﻳﺎﺕ ﻛﺎﺩﺭ ﺍﻻﺷﺭﺍﻑ‪CONSULTANT Comments:‬‬ ‫ﺍﻟﻛﺎﺩﺭ ﺍﻟﻣﺷﺭﻑ ‪CONSULTANT :‬‬

‫‪1.‬‬ ‫ﺍﻻﺧﺗﺻﺎﺹ‬ ‫ﺍﻻﺳﻡ‬ ‫ﺍﻟﺗﻭﻗﻳﻊ‬
‫‪2.‬‬ ‫‪ARCHITECTURAL‬‬ ‫ﺍﻟﻣﻌﻣـﺎﺭﻱ ‪:‬‬

‫‪3.‬‬ ‫‪STRUCTURAL‬‬ ‫ﺍﻹﻧﺷﺎﺋﻲ ﺍﻟﻣﺩﻧﻲ ‪:‬‬

‫‪4.‬‬ ‫‪MECHANICA‬‬ ‫ﻣﻳﻛﺎﻧﻳﻛﺎ ‪:‬‬
‫‪5.‬‬ ‫‪ELECTRICAL‬‬ ‫ﻛﻬــﺭﺑﺎء ‪:‬‬

‫ﺗﻭﺻﻳﺎﺕ ﻟﺟﻧﺔ ﺍﻻﻋﺗﻣﺎﺩ‪End User Comments:‬‬ ‫ﻟﺟﻧﺔ ﺍﻋﺗﻣﺎﺩ ﺍﻟﻌﻳﻧﺎﺕ‬

‫ﺍﻟﺗﻭﻗﻳﻊ‬ ‫ﺍﻻﺳﻡ‬

‫ﺭﺋﻳﺱ ﺍﻟﻠﺟﻧﺔ ‪-:‬‬

‫ﻋﺿﻭﺍ ‪-:‬‬

‫ﻋﺿﻭ ‪-:‬‬

‫ﻋﺿﻭﺃ ‪-:‬‬

‫ﻣﻼﺣﻅﺎﺕ ﻣﻬﻣﺔ‬