USUAL FORMS FOR CONTRACTOR'S INTERIMAR PAYMENT REQUESTS

IPR - Value of Works

Annex 1 - RETURN OF ADVANCE
Annex 2 - RETENTIONS
Annex 3 - ADDITIONAL AND DEDUCTABLE VALUES
Annex 4 - CERTIFIED VALUES FOR DELIVERY MACHINE AND EQUIPMENTS
Annex 5 - LIST OF VARIATIONS
Annex 6 - MEASUREMENT FORM
Annex 7 - LIST WITH QUANTITIES AND PRICES

SIL - Valoarea lucrarilor

Anexa 1 - RESTITUIREA AVANSULUI
Anexa 2 - RETINERI
Anexa 3 - SUME CE SE ADAUGA SAU DEDUCERI
Anexa 4 - VALOAREA CERTIFICATA PENTRU LIVRAREA UTILAJELOR SI ECHIPAMENTELOR
Anexa 5 - LISTA VARIATIILOR
Anexa 6 - MASURATORI
Anexa 7 - LISTE DE CANTITATI SI PRETURI

R SI ECHIPAMENTELOR

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

VALOAREA CERTIFICATA A LUCRAILOR

CERTIFICAT INTERIMAR DE PLATA NR.

Nr.

Cap/subcap/ nr
lista de cantitati/
obiect

Descrierea categoriilor de lucrari

1 CAP. I
3
4
CAP. II
5
6
7
8

II.1
II.2
II.3
II.4

Amenajarea terenului
1.2 Amenajarea terenulu
1.3 Amenajari pentru protectia mediului
Cheltuieli cu utilitatile
2.11 Alimentare cu apa
2.12 Canalizare
2.13 Alimentare cu gaze naturale
2.15 Alimentare cu energie electrica

II.5

2.16 Alimentare cu energie electrica - curenti slabi

10

11
12
13
14
15
16
17
18

I.2
I.3

II.6
CHAPTER IV
IV.1

6.16 Utilitati
EXPENSES WITH INVESTMENT
CONSTRUCTII SI INSTALLATII
411 Bussport
412 Statie de alimentare cu carburant
413 Statie de spalare
414 Stand de inspectie tehnica periodica ITP
415 Atelier intretinere
416 Cladire administrativa
4171 Drumuri de acces si platforme
4174 Imprejmuiri si porti

Page 3 of 24

Valoarea
contractata

Valoarea Lucrarilor

Valoare revizuita
conform O.V. nr.1
anterior
5

prezent
6

3
48,063.54
27,700.47
20,363.07
569,699.78
74,432.56
192,077.65
4,452.60
130,970.90

4
48,063.54
27,700.47
20,363.07
569,699.78
74,432.56
192,077.65
4,452.60
130,970.90

98,654.09

98,654.09

0.00

69,111.98

69,111.98

0.00

3,309,530.04
844,088.82
128,708.86
180,140.93
190,034.61
423,757.18
1,030,079.20
437,712.16
67,383.12

3,299,573.55
834,132.33
128,708.86
180,140.93
190,034.61
423,757.18
1,030,079.20
437,712.16
67,383.12

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Cap/subcap/ nr
lista de cantitati/
obiect

Nr.

1
19

Valoarea
contractata

Descrierea categoriilor de lucrari

3
7,625.16

4175 Cabina poarta

IV.2

MONTAJ UTILAJE SI ECHIPAMENTE TEHNOLOGICE

Valoarea Lucrarilor

Valoare revizuita
conform O.V. nr.1
anterior
5

prezent
6

7,625.16

0.00

129,856.11

129,856.11

0.00

20

411 Instalatii electrice interioare Bussport

39,188.02

39,188.02

0.00

21

412 Instalatii electrice interioare statie de carburant

21,648.22

21,648.22

0.00

22

413 Instalatii electrice interioare statie de spalare

9,715.00

9,715.00

0.00

23

414 Instalatii electrice interioare ITP

11,033.37

11,033.37

0.00

24

415 Instalatii electrice interioare atelier de intretinere

47,858.24

47,858.24

0.00

25

416 Instalatii electrice interioare cladire administrativa

413.26

413.26

0.00

520,153.86

520,153.86

0.00

5,049.66
1,937.75
1,970.79
4,182.47
12,466.74
494,546.45
18,417.64
18,417.64
4,595,720.97

5,049.66
1,937.75
1,970.79
4,182.47
12,466.74
494,546.45
22,187.52
22,187.52
4,589,534.36

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00

IV.3
26
27
28
29
30
31
CAP V
32

ACHIZITIA DE UTILAJE SI ECHIPAMENTE

TEHNOLOGICE
411 Bussport
412 Statie de alimentare cu carburant
413 Statie de spalare
414 Stand de inspectie tehnica periodica ITP
415 Atelier intretinere
416 Cladire administrativa
ORGANIZARE DE SANTIER
5.1 Organizare de santier
TOTAL GENERAL al Lucrarilor (fara TVA)
Avans restituit

459,572.10

0.00

0.00

Retineri (10% din valoarea de contract)

459,572.10

0.00

0.00

Deduceri

0.00

0.00

Utilaje si echipamente tehnologice 80%

0.00

0.00

Page 4 of 24

Nr.

Cap/subcap/ nr
lista de cantitati/
obiect

Descrierea categoriilor de lucrari

TOTAL DE PLATA (fara TVA)

Reprezentant Antreprenor:

Valoarea
contractata

Valoarea Lucrarilor

Valoare revizuita
conform O.V. nr.1
4

anterior
5

prezent
6
0.00
Date:

Page 5 of 24

0.00

Proiect ID: 7251-GPN-37026

Valoarea lucrarilor
Perioada de raportare: ..
Data curenta:

ucrarilor

Progres procentual
cumulat
7
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

anterior
8
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

prezent
9
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

cumulat
10
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

Page 6 of 24

ucrarilor

Progres procentual
cumulat
7
0.00

anterior
8
0.00%

prezent
9
0.00%

cumulat
10
0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

0.00

0.00%

0.00%

0.00%

Page 7 of 24

ucrarilor

Progres procentual
cumulat
7

anterior
8

prezent
9

cumulat
10

0.00

Page 8 of 24

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

Perioada de raportare
Data curenta:

RESTITUIREA AVANSULUI
CERTIFICAT INTERIMAR DE PLATA
Valoare Contractata
Valoare maxima avans conform Anexa la Oferta
Pos.

Perioada de raportare

4,595,720.97 Euro
459,572.10 Euro

CIP nr.

Valoare lucrari
1

TOTAL
Reprezentant Antreprenor:

0.00

0.00
.

anterior
0.00

Plati Avans conform Anexa la Contract pct. 14.2

prezent
0.00

0.00
Date:

Page 9 of 24

0.00

Project ID: 7251-GPN-37026

Perioada de raportare: ..
..

Plati Avans conform Anexa la Contract pct. 14.2

cumulat
0.00

0.00

Page 10 of 24

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.
Perioada de raportare: ..
Data curenta:

RETINERI
CERTIFICAT INTERIMAR DE PLATA
Valoare Contractata
Valoare maxima retineri conform Anexa la Oferta
Pos.

Perioada de raportare

CIP nr.

Valoare lucrari
1

TOTAL
Reprezentant Antreprenor:

4,595,720.97 Euro
459,572.10 Euro

0.00

0.00
.

anterior
0.00

Retineri conform Anexa la Contract pct. 14.3

prezent
0.00

0.00
Date:

0.00

Project ID: 7251-GPN37026

Perioada de raportare: ..

Contract pct. 14.3

cumulat
0.00

0.00

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

SUME CE SE ADAUGA SAU DEDUCERI

1

CERTIFICAT INTERIMAR DE PLATA

Descrierea categoriilor de lucrari/ descrierea

echipamentelor
2
-

Reprezentant Antreprenor:

Valoare certificata plata (dupa

Valoare contractata (euro)

3
-

anterior (euro)
4
0.00

Date:

Project ID: 7251-GPN-37026

ANNEX 3

S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

Perioada de raportare: ..
Data curenta:

Valoare certificata plata (dupa retineri)

prezent (euro)
5

cumulat (euro)
6
0.00

..

0.00

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

VALOAREA CERTIFICATA PENTRU LIVRAREA UTILAJELOR SI ECHIPAMENTELOR

0

CERTIFICAT INTERIMAR DE PLATA

Descrierea categoriilor de lucrari/ descrierea

echipamentelor
2
-

Reprezentant Antreprenor:

Valoare certificata pentru echipamente

Valoare contractata (euro)

3
-

anterior (euro)
4
0.00

Date:

Project ID: 7251-GPN-37026

ANNEX 4

SINECON S.A.

Perioada de raportare: ..
Data curenta:

Valoare certificata pentru echipamente

prezent (euro)
5

cumulat (euro)
6
0.00

0.00

Contract :
Beneficiar:
Consultant:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.

Antreprenor:

Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.
Data curenta:

LISTA VARIATIILOR
CERTIFICAT INTERIMAR DE PLATA

Descrierea VARIATIILOR

O.V. nr.1 contractat valoare

Valoare certificata plata

anterior (euro)
4

prezent (euro)
5
0

Reprezentant Antreprenor:

..

Date: ..

Page 17 of 24

0.00

Project ID: 7251-GPN-37026

ANNEX 5
Perioada de raportare: ..
.

Valoare certificata plata

cumulat (euro)
6
0.00

Page 18 of 24

Contract : CONSTRUCTION OF A NEW BUS DEPOT FOR S.C. TURSIB S.A.

Beneficiary: S.C. TURSIB S.A.
Consultant: S.C. DAN CON S.R.L.
Antreprenor: Joint venture between: S.C. CON-A S.R.L as lider & S.C. SINECON S.A.

Measurements
Object: 411 Busport
List: 01 Infrastructura modificata conform dispozitie de santier nr.3

Pos.

Item

Description of activity

TSC02B1

SAPATURA MECANICA CU EXCAVATOR PE PNEURI DE 0.21-0.39 MC,CU CO

HIDRAULICA,IN :...PAMANT CU UMIDITATE NATURALA DESCARCARE IN DE
TEREN CATG 1

calcule

Signatures list
On Site Supervisor

Contractor representative

Name/ signature

Name/ signature

PNEURI DE 0.21-0.39 MC,CU COMANDA

NATURALA DESCARCARE IN DEPOZIT

Project ID: 7251-GPN-37026

ANNEX 6
.
Current date: .

MU

100 mc

Contracted Q-ty
Realised Q-ty
Progress %
Contracted Q-ty

Realised Q-ty

Progress %

Stamp

Stamp

.
.
.

#DIV/0!

Contract :
Beneficiar:
Consultant:
Antreprenor:

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

S.C. TURSIB S.A.
S.C. DAN CON S.R.L.
Asocierea intre: S.C. CON-A S.R.L in calitate de lider & S.C. SINECON S.A.

LISTA DE CANTITATI SI PRETURI

Ob.
List:

411 Busport
01 Infrastructura modificata conform dispozitie de santier nr.3
COSTURI CONTRACTATE cf O.M.

Nr.

Simbol

Descrierea activitatii

UM

Cantitate
contractata

Pret unitar
Total
Material
Manopera
Utilaj
Transport

COSTURI ANTERIOARE

Valoare
Total
Material
Manopera
Utilaj
Transport

Cantitate

SECTIUNEA TECHNICA
0
1

1
TSC02B1

SECTIUNEA FINANC
2

SAPATURA MECANICA CU EXCAVATOR PE PNEURI 100 mc

DE 0.21-0.39 MC,CU COMANDA HIDRAULICA,IN
:...PAMANT CU UMIDITATE NATURALA DESCARCARE
IN DEPOZIT TEREN CATG 1

3
36.62000

5
4,880.75

0.00

0.00

0.00

0.00

133.28

4,880.75

0.00

0.00

Material
Manopera
Utilaj
Transport
TOTAL I
CAS
Fond de risc
Concedii si indemnizatii

133.28

15.80%
0.27%
0.85%

0.00

Somaj
Fond de garantare
Sanatate
TOTAL II
Cheltuieli indirecte
Profit
TOTAL euro fara TVA

Lista semnaturi:
Reprezentant Antreprenor: .

0.50%
0.25%
5.20%
3.25%
2.00%

Project ID: 7251-GPN-37026

ANNEX 7
Perioada de raportare: ..
Data curenta: .

COSTURI ANTERIOARE

COSTURI CURENTE

Valoare
Cantitate
Total
Material
Manopera
Utilaj
Transport
SECTIUNEA FINANCIARA
7
8
0.00

0.00

COSTURI CUMULATE

Valoare
Total
Material
Manopera
Utilaj
Transport
9
0.00

Cantitate

Valoare
Total
Material
Manopera
Utilaj
Transport

10

11

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00