formulare pt situatia de lucrari

8/18/2019 Formulare Pt Situatia de Lucrari

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USUAL FORMS FOR CONTRACTOR'S INTERIMAR PAYMENT REQUESTS

IPR - Value of Works

Anne ! - RETURN OF A"VANCE

Anne # - RETENTIONS

Anne $ - A""ITIONAL AN" "E"UCTA%LE VALUES

Anne & - CERTIFIE" VALUES FOR "ELIVERY MACINE AN" EQUIPMENTS Anne ( - LIST OF VARIATIONS

Anne ) - MEASUREMENT FORM

Anne * - LIST WIT QUANTITIES AN" PRICES

SIL - Valoarea lu+rar,lor

Anea ! - RESTITUIREA AVANSULUI Anea # - RETINERI

Anea $ - SUME CE SE A"AUA SAU "E"UCERI

Anea & - VALOAREA CERTIFICATA PENTRU LIVRAREA UTILA.ELOR SI ECI

Anea ( - LISTA VARIATIILOR

Anea ) - MASURATORI

Anea * - LISTE "E CANTITATI SI PRETURI


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AMENTELOR


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Page 3 of 24

Contract : Autobaza S.C. Tursib S.A., inprejmuire, bramsamente utilitati

Beneficiar: S.C. TURSIB S.A.

Consultant: S.C. DAN CON S.R.L.

Antreprenor: Asocierea intre S.C. CON!A S.R.L in calitate "e li"er # S.C. SIN$CON S.A.

%ALOAR$A C$RTI&ICATA A LUCRAILOR

C$RTI&ICAT INT$RI'AR D$ (LATA NR.

Nr. Descrierea cate)oriilor "e lucrari%aloarea Lucrarilo

an/er,or 0re1en/

2 ! # $ & ( )

! CA(. I Amenajarea terenului *+,-./* *+,-./* .

$ I3# !3# A4ena5area /erenulu #*6*223&* #*6*223&* 2322

& I3$ !3$ A4ena5ar, 0en/ru 0ro/e+/,a 4e7,ulu, #26$)$32* #26$)$32* 2322

CA(. II C0eltuieli cu utilitatile /-1,-11.2+ /-1,-11.2+ .

( II3! #3!! Al,4en/are +u a0a *&6&$#3() *&6&$#3() 2322

) II3# #3!# Canal,1are !8#62**3)( !8#62**3)( 2322

* II3$ #3!$ Al,4en/are +u 9a1e na/urale &6&(#3)2 &6&(#3)2 2322

: II3& #3!( Al,4en/are +u ener9,e ele+/r,+a !$268*2382 !$268*2382 2322

8 II3( #3!) Al,4en/are +u ener9,e ele+/r,+a - +uren/, sla;, 8:6)(&328 8:6)(&328 2322!2 II3) )3!) U/,l,/a/, )86!!!38: )86!!!38: 2322

C3A(T$R I% $4($NS$S 5IT3 IN%$ST'$NT

IV3! CONSTRUCTII SI INSTALLATII ,1,/.* ,611,/2.// .

!! &!! %uss0or/ :&&62::3:# :$&6!$#3$$ 2322

!# &!# S/a/,e 7e al,4en/are +u +ar;uran/ !#:6*2:3:) !#:6*2:3:) 2322

!$ &!$ S/a/,e 7e s0alare !:26!&238$ !:26!&238$ 2322

!& &!& S/an7 7e ,ns0e+/,e /e


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Page 4 of 24


an/er,or 0re1en/

2 ! # $ & ( )

Cap7subcap7 nrlista "e cantitati7

obiect

%aloareacontractata

%aloare re8izuitacon9orm O.%. nr.:

!8 &!*( Ca;,na 0oar/a *6)#(3!) *6)#(3!) 2322

IV3# MONTA. UTILA.E SI ECIPAMENTE TENOLOICE :61,+/-.:: :61,+/-.:: .

#2 &!! Ins/ala/,, ele+/r,+e ,n/er,oare %uss0or/ $86!::32# $86!::32# 2322

#! &!# Ins/ala/,, ele+/r,+e ,n/er,oare s/a/,e 7e +ar;uran/ #!6)&:3## #!6)&:3## 2322

## &!$ Ins/ala/,, ele+/r,+e ,n/er,oare s/a/,e 7e s0alare 86*!(322 86*!(322 2322

#$ &!& Ins/ala/,, ele+/r,+e ,n/er,oare ITP !!62$$3$* !!62$$3$* 2322

#& &!( Ins/ala/,, ele+/r,+e ,n/er,oare a/el,er 7e ,n/re/,nere &*6:(:3#& &*6:(:3#& 2322

#( &!) Ins/ala/,, ele+/r,+e ,n/er,oare +la7,re a74,n,s/ra/,=a &!$3#) &!$3#) 2322

IV3$ /6,:/.+- /6,:/.+- .

#) &!! %uss0or/ (62&83)) (62&83)) 2322

#* &!# S/a/,e 7e al,4en/are +u +ar;uran/ !68$*3*( !68$*3*( 2322

#: &!$ S/a/,e 7e s0alare !68*23*8 !68*23*8 2322

#8 &!& S/an7 7e ,ns0e+/,e /e */1,/26.: 2322 2322

De"uceri 2322 2322

Utilaje si ec0ipamente te0nolo)ice +? 2322 2322

ACI>ITIA "E UTILA.E SI ECIPAMENTETENOLOICE


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Page 5 of 24


an/er,or 0re1en/

2 ! # $ & ( )

Cap7subcap7 nrlista "e cantitati7

obiect

%aloareacontractata

%aloare re8izuitacon9orm O.%. nr.:

TOTAL D$ (LATA =9ara T%A> . .

Reprezentant Antreprenor @@@@@@@@. "a/e? @@@@@


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Page 6 of 24

Proiect ID: 7251-GPN-37026

aloarea lucrarilor

Per,oa7a 7e ra0or/are? @@@@33

"a/a +uren/a? @@

(ro)res procentual

+u4ula/ an/er,or 0re1en/ +u4ula/* : 8 !2

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 23222322 2322 2322 2322


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Page 7 of 24

(ro)res procentual

+u4ula/ an/er,or 0re1en/ +u4ula/

* : 8 !2

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

. .? .? .?

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322

2322 2322 2322 2322


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Page 8 of 24

(ro)res procentual

+u4ula/ an/er,or 0re1en/ +u4ula/

* : 8 !2

.


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Page 9 of 24





P

"a/a +uren/a?R$STITUIR$A A%ANSULUI

C$RTI&ICAT INT$RI'AR D$ (LATA

aloare Contractata *,/1/,26.12 $uro

aloare !a"i!a a#ans confor! Ane"a la $ferta */1,/26.: $uro

Pos3 Per,oa7a 7e ra0or/are CIP nr3 Valoare lu+rar, Pla/, A=ans +onfor4 Anea la Con/ra+/ 0

an/er,or 0re1en/

! ! 2322 2322 2322

TOTAL 2322 2322 2322

Reprezentant Antreprenor @@@. "a/e? @@@@


10/24

Page 10 of 24

Project ID: 7251-GPN-37026

r,oa7a 7e ra0or/are? @@@@33

@@@@..

+/3 !&3#

+u4ula/

2322

2322


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Per,

"a/a +uren/a?R$TIN$RI


aloare Contractata *,/1/,26.12$uro

aloare !a"i!a retineri confor! Ane"a la $ferta */1,/26.:$uro

Pos3 Per,oa7a 7e ra0or/are CIP nr3 Valoare lu+rar, Re/,ner, +onfor4 Anea la Con/ra+/ 0+

an/er,or 0re1en/

! ! 2322 2322 2322

TOTAL 2322 2322 2322

Reprezentant Antreprenor @@@@@. "a/e?@@@@


12/24

a7a 7e ra0or/are? @@@@33

@@

/3 !&3$

+u4ula/

2322

2322



13/24




Antreprenor: Asocierea intre S.C. CON!A S.R.L in calitate "e li"er # S.C. SIN$CON

C$RTI&ICAT INT$RI'AR D$ (LATA :

%aloare contractata =euro>%

an/er,or Beuro

# $ &

! ! 2322

Reprezentant Antreprenor @@@@@ "a/e?

SU'$ C$ S$ ADAU;A SAU D$DUC$RI

Descrierea cate)oriilor "e lucrari7 "escriereaec0ipamentelor


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ANNEX 3S.A.

(erioa"a "e raportare @@@@..

"a/a +uren/a? @@

loare certi9icata plata ="upa retineri>

0re1en/ Beuro +u4ula/ Beuro

( )

2322 2322

@@@@@@33


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Antreprenor: Asocierea intre S.C. CON!A S.R.L in calitate "e li"er # S.C. SIN$CON


%aloare contractata =euro>%

an/er,or Beuro

# $ &

! ! 2322

Reprezentant Antreprenor @@@@@ "a/e?

%ALOAR$A C$RTI&ICATA ($NTRU LI%RAR$A UTILA$LOR SI $C3I(A'$NT$LOR

Descrierea cate)oriilor "e lucrari7 "escriereaec0ipamentelor


16/24


ANNEX 4S.A.


"a/a +uren/a? @@

loare certi9icata pentru ec0ipamente

0re1en/ Beuro +u4ula/ Beuro

( )

2322 2322

@@@@3


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Page 17 of 24





"a/a +uren/a?LISTA %ARIATIILOR


Descrierea %ARIATIILOR O.%. nr.: contractat 8aloare%aloare certi9icata plata

an/er,or Beuro 0re1en/ Beuro

# $ & (

2 2322

Reprezentant Antreprenor @@@@@.. "a/e? @@@@@@33


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Page 18 of 24


ANNEX 5


@@@@@@.

+u4ula/ Beuro

)

2322


19/24

Contract : C$N%&'(C&I$N $) A N*+ B(% D*P$& )$' %,C, &('%IB %,A,

Beneficiar: %,C, &('%IB %,A,

Consultant: %,C, DAN C$N %,',.,

Antreprenor: /oint #enture eteen: %,C, C$N-A %,',. as lier %,C, %IN*C$N %,A,

'easurements

Object *:: Busport

List : In9rastructura mo"i9icata con9orm "ispozitie "e santier nr.

Pos3 I/e4 "es+r,0/,on of a+/,=,/D

! TSC2#%!

+al+ule @@@@@@@

Si)natures list

On S,/e Su0er=,sor Na4e s,9na/ure

SAPATURA MECANICA CU ECAVATOR PE PNEURII"RAULICA6IN ?333PAMANT CU UMI"ITATE NATURAL

TEREN CAT !


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Pro4ect ID: 7251-GPN-37026

ANN* 6

@@@@.

Current "ate @@@.

MU

Con/ra+/e7 Q-/D ….

Real,se7 Q-/D ….

Pro9ress ….

!22 4+

Con/ra+/e7 Q-/D 0

Real,se7 Q-/D 0

Pro9ress #DIV/0!

S/a40

E 23#!-23$8 MC6CU COMAN"A A "ESCARCARE IN "EPO>IT


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LISTA D$ CANTITATI SI (R$TURIOb. *:: Busport

List : In9rastructura mo"i9icata con9orm "ispozitie "e santier nr.

COSTURI CONTRACTATE cf O.M. COSTURI A

Pre/ un,/ar Valoare Can/,/a/e

Nr3 S,4;ol "es+r,erea a+/,=,/a/,, UM

To/al To/al

Ma/er,al Ma/er,al

Mano0era Mano0era

U/,la5 U/,la5

Trans0or/ Trans0or/

SECTIUNEA TECNICA

2 ! # $ & ( )

: TSC6B: : mc -.-6 :.6+ *,++.2/ 2322

2322 2322

2322 2322

!$$3#: &6::23*(

2322 2322

Ma/er,al

Mano0era

U/,la5

Trans0or/

TOTAL I

CAS !(3:2

Fon7 7e r,s+ 23#*

Con+e7,, s, ,n7e4n,1a/,, 23:(

Can/,/a/e+on/ra+/a/a

SAPATURA MECANICA CU ECAVATOR PE PNEURI"E 23#!-23$8 MC6CU COMAN"A I"RAULICA6IN?333PAMANT CU UMI"ITATE NATURALA "ESCARCAREIN "EPO>IT TEREN CAT !


22/24

So4a5 23(2

Fon7 7e 9aran/are 23#(

Sana/a/e (3#2

TOTAL II

C


23/24

Pro4ect ID: 7251-GPN-37026

ANN* 7

Perioada de raportare: …………..

"a/a +uren/a? @@@@@.

TERIOARE COSTURI CURENTE COSTURI CUMULATE

Valoare Can/,/a/e Valoare Can/,/a/e Valoare

To/al To/al To/al

Ma/er,al Ma/er,al Ma/er,al

Mano0era Mano0era Mano0era

U/,la5 U/,la5 U/,la5

Trans0or/ Trans0or/ Trans0or/

SECTIUNEA FINANCIARA

* : 8 !2 !!. 2322 . 2322 .

2322 2322 2322

2322 2322 2322

2322 2322 2322

2322 2322 2322

2322

2322

2322

2322

.

2322

2322

2322


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2322

2322

2322

.

2322

2322.

formulare pt situatia de lucrari

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