Republic of the Philippines

National Irrigation Administration

Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Himautan SIP
Location: Calbayog City, Samar
Contract Number: Himautan SIP-Solar-01-2022
Contractor: G Force Enterprise

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 10
1.1.1 With Approved Plans 5 5
1.1.2 Contract Administration Documents, PCAB license, etc. 5 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 0
No report presented
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 0
1.2 Project Site Verification Checklist 20 0
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 0
1.2.2 Canal alligned, marked with stationing, correct elevation 4 0
1.2.3 Formworks in Good Condition 4 0 No accomplishment on site
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 0
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4 0
2. MATERIALS 30 0
2.1 Cement (Portland Type I) 8 0
2.2 Aggregates are clean and well graded 8 0
2.3 Reinforced Steel Bar 8 0 No materials on site
2.4 Water used for concrete mix is clean 3 0
2.5 Suitable material for backfill and embankments 3 0
3. TIME 15 8
3.1 Project accomplishment is based on approved PERT/CPM 7.5 4 Negative slippage of 12% based on
3.2 Project is ahead/delayed 7.5 4 Status of Infra as of March 15, 2023
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 0
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3 0 Not available on site
area.
4.2 Safety and Health 4 0
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 0

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 0

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0
5. RESOURCE DEPLOYMENT 5 2
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
5.2 Contractor's Staff and workers are present at site 1 0
5.3 Materials are readily available at site 1 0 No resources deployed on site
5.4 Equipments are in good running condition 1 0
6. FACILITIES 3 0
6.1 Presence of temporary facilities for NIA and Contractor 1 0
6.2 Proper storage room for materials are available 1 0 No facilities on site
6.3 Comfort rooms for workers and staff are available. 1 0
TOTAL 100 20 Poor
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

G FORCE ENTERPRISE Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Himautan SIP
Location: Calbayog City, Samar
Contract Number: Himautan SIP-WS-02-2022
Contractor: Achrocons Corporation

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 13
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 3 No updated Variation Order
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 0 No test result presented
1.2 Project Site Verification Checklist 20 15
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 3 No logbook presented
1.2.2 Canal alligned, marked with stationing, correct elevation 4 4
1.2.3 Formworks in Good Condition 4 4
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 4
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB Absence of curing pond and cylindrical
4 0
molder
2. MATERIALS 30 30
2.1 Cement (Portland Type I) 8 8
2.2 Aggregates are clean and well graded 8 8
2.3 Reinforced Steel Bar 8 8
2.4 Water used for concrete mix is clean 3 3
2.5 Suitable material for backfill and embankments 3 3
3. TIME 15 0
3.1 Project accomplishment is based on approved PERT/CPM 7.5 0 Negative slippage of 30.93% based on
3.2 Project is ahead/delayed 7.5 0 Status of Infra as of March 15, 2023
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 3
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3 3
area.
4.2 Safety and Health 4 2.7
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 1

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0
Not available on site
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0
5. RESOURCE DEPLOYMENT 5 3
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
5.2 Contractor's Staff and workers are present at site 1 1
5.3 Materials are readily available at site 1 0 No on-going civil works due to
5.4 Equipments are in good running condition 1 0 unavailability of materials on site
6. FACILITIES 3 2
6.1 Presence of temporary facilities for NIA and Contractor 1 1
6.2 Proper storage room for materials are available 1 1
6.3 Comfort rooms for workers and staff are available. 1 0 Not available on site
TOTAL 100 68.7 Poor
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

ACHROCONS CORPORATION Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Libertad SIP
Location: Calbayog City, Samar
Contract Number: Libertad SIP-WS-01-2022
Contractor: Achrocons Corporation

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 13
1.1.1 With Approved Plans 5 5
1.1.2 Contract Administration Documents, PCAB license, etc. 5 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 3 No updated Variation Order
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 0 No test result presented
1.2 Project Site Verification Checklist 20 13
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 3 No logbook presented
1.2.2 Canal alligned, marked with stationing, correct elevation 4 3 Old formworks we're used resulting in
1.2.3 Formworks in Good Condition 4 3 bulging of canal sidings.
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 4
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4 0 Not available on site
2. MATERIALS 30 30
2.1 Cement (Portland Type I) 8 8
2.2 Aggregates are clean and well graded 8 8
2.3 Reinforced Steel Bar 8 8
2.4 Water used for concrete mix is clean 3 3
2.5 Suitable material for backfill and embankments 3 3
3. TIME 15 0
3.1 Project accomplishment is based on approved PERT/CPM 7.5 0 Negative slippage of 28.17% based on
3.2 Project is ahead/delayed 7.5 0 Status of Infra as of March 15, 2023
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 2
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal
3 2 Improper disposal of used formworks
area.
4.2 Safety and Health 4 1.7
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 0 No on-going civil work

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0
Not available on site
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0
5. RESOURCE DEPLOYMENT 5 3
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
5.2 Contractor's Staff and workers are present at site 1 1
5.3 Materials are readily available at site 1 0 No on-going civil work, lack of
5.4 Equipments are in good running condition 1 0 manpower and materials on site
6. FACILITIES 3 2
6.1 Presence of temporary facilities for NIA and Contractor 1 1
6.2 Proper storage room for materials are available 1 1
6.3 Comfort rooms for workers and staff are available. 1 0 Not available on site
TOTAL 100 64.7 Poor
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

ACHROCONS CORPORATION Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Paco SIP
Location: Quindapunan, E. Samar
Contract Number: Paco SIP-ES-01-2022
Contractor: Lobrino's Consolidaed Construction

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 20
1.1.1 With Approved Plans 5 5
1.1.2 Contract Administration Documents, PCAB license, etc. 5 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 5
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 5
1.2 Project Site Verification Checklist 20 17
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 3 No logbook presented
1.2.2 Canal alligned, marked with stationing, correct elevation 4 3 No marked stationing
1.2.3 Formworks in Good Condition 4 4
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 3
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4 4
2. MATERIALS 30 30
2.1 Cement (Portland Type I) 8 8
2.2 Aggregates are clean and well graded 8 8
2.3 Reinforced Steel Bar 8 8
2.4 Water used for concrete mix is clean 3 3
2.5 Suitable material for backfill and embankments 3 3
3. TIME 15 15
3.1 Project accomplishment is based on approved PERT/CPM 7.5 7.5
3.2 Project is ahead/delayed 7.5 7.5
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 3
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3 3
area.
4.2 Safety and Health 4 4
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 1

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0.5
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0.8
5. RESOURCE DEPLOYMENT 5 4
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
No contractor's representative during
5.2 Contractor's Staff and workers are present at site 1 0
inspection
5.3 Materials are readily available at site 1 1
5.4 Equipments are in good running condition 1 1
6. FACILITIES 3 3
6.1 Presence of temporary facilities for NIA and Contractor 1 1
6.2 Proper storage room for materials are available 1 1
6.3 Comfort rooms for workers and staff are available. 1 1
TOTAL 100 96 Very satisfactory
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

LOBRINO'S CONSOLIDAED CONSTRUCTION Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Tagudtod SIP
Location: Hernani, E. Samar
Contract Number: Tagudtod SIP-ES-02-2022
Contractor: Japz Construction

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 18
No approved plans when project
1.1.1 With Approved Plans 5 3
commenced
1.1.2 Contract Administration Documents, PCAB license, etc. 5 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 5
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 5
1.2 Project Site Verification Checklist 20 19
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 3 No logbook presented
1.2.2 Canal alligned, marked with stationing, correct elevation 4 4
1.2.3 Formworks in Good Condition 4 4
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 4
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4 4
2. MATERIALS 30 30
2.1 Cement (Portland Type I) 8 8
2.2 Aggregates are clean and well graded 8 8
2.3 Reinforced Steel Bar 8 8
2.4 Water used for concrete mix is clean 3 3
2.5 Suitable material for backfill and embankments 3 3
3. TIME 15 15
3.1 Project accomplishment is based on approved PERT/CPM 7.5 7.5
3.2 Project is ahead/delayed 7.5 7.5
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 3
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3 3
area.
4.2 Safety and Health 4 4
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 1

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0.5
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0.8
5. RESOURCE DEPLOYMENT 5 4
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
No contractor's representative during
5.2 Contractor's Staff and workers are present at site 1 0
inspection
5.3 Materials are readily available at site 1 1
5.4 Equipments are in good running condition 1 1
6. FACILITIES 3 3
6.1 Presence of temporary facilities for NIA and Contractor 1 1
6.2 Proper storage room for materials are available 1 1
6.3 Comfort rooms for workers and staff are available. 1 1
TOTAL 100 96 Very Satisfactory
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

JAPZ CONSTRUCTION Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project: Mat-e SIP
Location: Balangkayan, E. Samar
Contract Number: Mat-e SIP-ES-02-2022
Contractor: Pablo S. Labasbas Construction Corporation

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20 16
1.1.1 With Approved Plans 5 3 No updated plans as per variation order
1.1.2 Contract Administration Documents, PCAB license, etc. 5 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5 3 Reports presented are not updated
1.1.4 Materials Test Results (Concrete, RSB, FDT) 5 5
1.2 Project Site Verification Checklist 20 16
1.2.1 Project In-Charge maintaned logbook for daily activitties 4 4
No stationing and sudden drop in
1.2.2 Canal alligned, marked with stationing, correct elevation 4 2
elevations
Honeycombs are present in some
1.2.3 Formworks in Good Condition 4 2
portion of the canal lining
1.2.4 Embankment/Backfill satisfactory (attach picture) 4 4
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4 4
2. MATERIALS 30 30
2.1 Cement (Portland Type I) 8 8
2.2 Aggregates are clean and well graded 8 8
2.3 Reinforced Steel Bar 8 8
2.4 Water used for concrete mix is clean 3 3
2.5 Suitable material for backfill and embankments 3 3
3. TIME 15 12.5
3.1 Project accomplishment is based on approved PERT/CPM 7.5 7.5
3.2 Project is ahead/delayed 7.5 5 With liquidated damages
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3 3
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3 3
area.
4.2 Safety and Health 4 4
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1 1

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5 0.5
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8 0.8
5. RESOURCE DEPLOYMENT 5 4
5.1 NIA Project In-Charge/Project Inspector at project site 2 2
No contractor's representative during
5.2 Contractor's Staff and workers are present at site 1 0
inspection
5.3 Materials are readily available at site 1 1
5.4 Equipments are in good running condition 1 1
6. FACILITIES 3 3
6.1 Presence of temporary facilities for NIA and Contractor 1 1
6.2 Proper storage room for materials are available 1 1
6.3 Comfort rooms for workers and staff are available. 1 1
TOTAL 100 88.5 Satisfactory
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

PABLO S LABASBAS CONSTRUCTION Contractor's Representative

CORPORATION
Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager

 Republic of the Philippines
National Irrigation Administration
Regional Office No. Viii (Eastern Visayas)
NIA Road, marasbaras, tacloban City

CONTRACTOR'S PERFORMANCE EVALUATION FORM

Name of Project:
Location:
Contract Number:
Contractor:

WEIGHTED ACTUAL
No. PARTICULARS REMARKS
PERCENTAGE RATINGS
1. WORKMANSHIP
1.1 Contract Documents Verifiaction Checklist 20
1.1.1 With Approved Plans 5
1.1.2 Contract Administration Documents, PCAB license, etc. 5
1.1.3 Approved Reports Submitted (such as SWA & Accomplishment Report, S-Curve,
variation Order, Time Extension, Suspension/Resumption 5

1.1.4 Materials Test Results (Concrete, RSB, FDT) 5

1.2 Project Site Verification Checklist 20
1.2.1 Project In-Charge maintaned logbook for daily activitties 4
1.2.2 Canal alligned, marked with stationing, correct elevation 4
1.2.3 Formworks in Good Condition 4
1.2.4 Embankment/Backfill satisfactory (attach picture) 4
1.2.5 Concrete works satisfactory including curing pond, molds, samples, RSB 4
2. MATERIALS 30
2.1 Cement (Portland Type I) 8
2.2 Aggregates are clean and well graded 8
2.3 Reinforced Steel Bar 8
2.4 Water used for concrete mix is clean 3
2.5 Suitable material for backfill and embankments 3
3. TIME 15
3.1 Project accomplishment is based on approved PERT/CPM 7.5
3.2 Project is ahead/delayed 7.5
4. ENVIRONMENTAAL SAFETY AND HEALTH
4.1 Environmental 3
4.1.1 Waste material collected, stored and transported to approved dumpsite/disposal 3
area.
4.2 Safety and Health 4
4.2.1 Approved PPE's (helmets, safety shoes, safety belt, eye protection, dust mask,
face mask) are provided/worn by workers 1

4.2.2 Heavy equipmet operated by certified/qualified operators only. 1

4.2.3 Critical construction works done by certified/qualified skilled workers only. 0.7
4.2.4 First Aid cabinets are fully equipped and readily available for use 0.5
4..2.5 ESH signs are clearly visible to contstruction staff, workers, and public. 0.8
5. RESOURCE DEPLOYMENT 5
5.1 NIA Project In-Charge/Project Inspector at project site 2
5.2 Contractor's Staff and workers are present at site 1
5.3 Materials are readily available at site 1
5.4 Equipments are in good running condition 1
6. FACILITIES 3
6.1 Presence of temporary facilities for NIA and Contractor 1
6.2 Proper storage room for materials are available 1
6.3 Comfort rooms for workers and staff are available. 1
TOTAL 100 0
Note: Please attached separate sheet for additional comments/remarks/pictures
Ratings:
> 96% - Outstanding >75% but not ≤ 82 % - Unsatisfactory
> 89% - Very Satisfatory < 75% - Poor
> 82% - Satisfactory
Inspected by:

CPE MEMBERS Designation/Office Signature

QUEENA KRYSTELLE P. NASINOPA Engineer A, Regional Office

VIANNEY LINUS A. LERIOS Hydrologist, BNLSL IMO

GENEZA JOY S. DIMAKILING Engineer A, NS IMO

Resource Persons/Witness:

Resource Persons/Witness Designation/Office

RIZALINA B. GALLARDE Acting IMO Manager, EWSIMO

Contractor's Representative

Evaluated by:

NELTON N. SOLITE Chief, Construction Section

Approved by:

JOJO A. ARCEÑO EOD, Division Manager