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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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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$$ 2322
!# &!# S/a/,e 7e al,4en/are +u +ar;uran/ !#:6*2:3:) !#:6*2:3:) 2322
!$ &!$ S/a/,e 7e s0alare !:26!&238$ !:26!&238$ 2322
!& &!& S/an7 7e ,ns0e+/,e /e
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Page 4 of 24
Nr. Descrierea cate)oriilor "e lucrari%aloarea Lucrarilo
an/er,or 0re1en/
2 ! # $ & ( )
Cap7subcap7 nrlista "e cantitati7
obiect
%aloareacontractata
%aloare re8izuitacon9orm O.%. nr.:
!8 &!*( Ca;,na 0oar/a *6)#(3!) *6)#(3!) 2322
IV3# MONTA. UTILA.E SI ECIPAMENTE TENOLOICE :61,+/-.:: :61,+/-.:: .
#2 &!! Ins/ala/,, ele+/r,+e ,n/er,oare %uss0or/ $86!::32# $86!::32# 2322
#! &!# Ins/ala/,, ele+/r,+e ,n/er,oare s/a/,e 7e +ar;uran/ #!6)&:3## #!6)&:3## 2322
## &!$ Ins/ala/,, ele+/r,+e ,n/er,oare s/a/,e 7e s0alare 86*!(322 86*!(322 2322
#$ &!& Ins/ala/,, ele+/r,+e ,n/er,oare ITP !!62$$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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Nr. Descrierea cate)oriilor "e lucrari%aloarea Lucrarilo
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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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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(ro)res procentual
+u4ula/ an/er,or 0re1en/ +u4ula/
* : 8 !2
.
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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.
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? @@@@
8/18/2019 Formulare Pt Situatia de Lucrari
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Project ID: 7251-GPN-37026
r,oa7a 7e ra0or/are? @@@@33
@@@@..
+/3 !&3#
+u4ula/
2322
2322
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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.
Per,
"a/a +uren/a?R$TIN$RI
C$RTI&ICAT INT$RI'AR D$ (LATA
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?@@@@
8/18/2019 Formulare Pt Situatia de Lucrari
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a7a 7e ra0or/are? @@@@33
@@
/3 !&3$
+u4ula/
2322
2322
Project ID: 7251-GPN-37026
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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
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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Project ID: 7251-GPN-37026
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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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
C$RTI&ICAT INT$RI'AR D$ (LATA
%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
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Project ID: 7251-GPN-37026
ANNEX 4S.A.
Per,oa7a 7e ra0or/are? @@@@33
"a/a +uren/a? @@
loare certi9icata pentru ec0ipamente
0re1en/ Beuro +u4ula/ Beuro
( )
2322 2322
@@@@3
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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.
"a/a +uren/a?LISTA %ARIATIILOR
C$RTI&ICAT INT$RI'AR D$ (LATA
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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Project ID: 7251-GPN-37026
ANNEX 5
Per,oa7a 7e ra0or/are? @@@@33
@@@@@@.
+u4ula/ Beuro
)
2322
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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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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.
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 !
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So4a5 23(2
Fon7 7e 9aran/are 23#(
Sana/a/e (3#2
TOTAL II
C
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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.