Project No.

P-OKITM07-10
PT. OKI PULP AND PAPER Document No. P-OKITM07-10-100-16-FRM-0002
TISSUE MACHINE
Revision No. 0
Page 1 of 1
QC COMPLETION CERTIFICATE
Issue Date Sept. 28, 2020

PROJECT :

CONTRACTOR : CERTIFICATE NO. :

AREA : DRAWING NO. :

DESCRIPTION : DATE :

CERTIFICATE OF : INTERMEDIATE / PARTIAL FINAL TAKE OVER

DISCIPLINE : CIVIL/BUILDING* STRUCTURAL STEEL PIPING

: TANKAGE ELECTRICAL INSTRUMENTATION

: MECHANICAL OTHERS(Please Specify) .......................................

AREA LOCATION :

SCOPE DESCRIPTION :
It is affirmed that the above discipline and scope conforms to the applicable drawings, standards and specifications
in all respects and is deemed to have met with the contract requirements, with the completion of the following:
OKITM Insp
NO. ATTACHMENTS DESCRIPTION YES NO N/A
In-char
1 COMPLETED AND SIGNED OFF PUNCH LIST (issued by all parties)
(The list may not be exhaustive, and failure to include any item on it does not
alter the responsibility of the Contractor to complete all the work in accordance
with the Contract Documents.)
2 CHECK LIST

3 ______ COPY OF SIGNED OFF INSPECTION REPORTS

4 NCR’s CLOSED

5 OTHERS (Please Specify) ....................................................................................................................................

REMARKS/EXCEPTION
The above has been inspected by the appointed Representative or Inspector of OKITM07-10 project and is considered to be
acceptable under the terms of the above contracts with the following exception (if none, state “NONE”).

SUBMITTED BY :

CONTRACTOR MANAGER IN-CHARGE

NAME SIGNATURE DATE

APPROVED BY:

OKITM AREA MANAGER

NAME SIGNATURE DATE

OKITM QA/QC COORDINATOR

NAME SIGNATURE DATE

ACKNOWLEDGED BY (When applicable):

CLIENT REPRESENTATIVE / OWNER

NAME SIGNATURE DATE

THIRD PARTY (when applicable)

NAME SIGNATURE DATE

Distribution: Client Commissioning System Ref.