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Annexure 3

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RULES FOR ENLISTMENT OF CONTRACTORS IN CPWD, 2022

Annexure- III
(Refer to Rule 6.0)

Details of Completed Works: Eligible works completed during the last seven years

1 Name of work/project & location


2 Name of agency
3 Agreement number
4 Agreement amount
5 Gross value of completed work
6 Stipulated date of start
7 Date of completion
(a) Stipulated date of completion
(b) Actual date of completion
(c) Justified extended date of completion, if any
8 Details and cost of services included
(a) Civil (water supply, sanitary installation, drainage and water proofing
work, etc.)
(b) Electrical (internal electrical installation, firefighting, fire alarm, HVAC,
lift, electrical substation, and DG set, etc.)
(c) Number of storeys constructed.
10 Details of compensation levied for delayed completion, if any
(a) Whether case of levy of compensation for delay has been decided or
not? Owner department officers are requested to only mention either Yes
or No against this option. Option of writing “Not applicable” is only
acceptable where work is completed before stipulated date of completion.
(b) If EOT case has been decided i.e answer to (a) above is Yes, then
please intimate amount of compensation levied for delayed completion.
11 Details of Conciliation/Mediation/Arbitration/Court Cases (from start of work
till issue of this certificate), if any
12 Details of owner
(a) Name
(b) Address
(c) Phone
(d) e-mail

Owner’s Signature with seal and designation


(Project Manager or Executive Engineer or Equivalent

32 168 Years of CPWD's dedicated service to the Nation


RULES FOR ENLISTMENT OF CONTRACTORS IN CPWD, 2022

Certificate: This is to certify that no adverse action has been taken by the department concerned
against me/us. I/We understand that if any information is found incorrect, our enlistment is liable
to be cancelled.

Self-attestation by Applicant

Notes:-
1. Scan of original documents to be uploaded in the portal
2. This proforma shall be filled up separately for all three (maximum) eligible works proposed for works
experience.
3. Annexure-III without valid signature of owner is invalid. Owner means department who owns the
project/work executed by the applicant.

168 Years of CPWD's dedicated service to the Nation 33

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