Technical Assistance for Supervision and Management Support during Implementation of ISPA Programme in Baia MareManual of Contract Supervision ProceduresApendix 5-2 Form of Interim Payment CertificateINTERIM PAYMENT CERTIFICATE NO.: DATE :CERTIFICAT INTERIMAR DE PLATA NR. Data:Contract : Contract CodeContract: CodulContractClient : SC APA PROD SA Consultant CodeClient : Codul consultantuluiContractor : Payee CodeAntreprenor: Codul platitoruluiContract Price EUROValoare contractLess Provisional Sums EURO Start DateMinus diverse neprevasute EURO Data inceperiiCompletion DateVariations EURO Data terminariiModificari Revised Completion DateRevised Contract Price EURO Data revizuita a terminariiValoarea revazuta a contractului Actual Completion DateData terminarii (actualizata)Performance uarantee Amount EURO E!piry DateGarantia de buna executie (valeare) Data expirarii"an#ers :Banca:$e certify t%at t%e amount due to t%e Contractor in accordance &it% '(D(C Su)*Clause +,-./ is EUROCertificam ca suma datorata Antreprenorului in conformitate cu SubClauza !"D"C #$%&' esteas s%o&n on Appendices A/ "/ C/ D and Edupa cum se arata in anexele A' B' C' D and (Total Amount of $or# Done 0App A1Cantitatea totala lucrari facuta (Anexa A)Deduct Retention 0+231Din care opreste )etinerea(#*+)Deduct Repayment of Advance Payment 0App "1Din care se opreste )etinerea avansului platit (Anexa B)Add Release of RetentionSe adau,a retinerile care trebuie returnateLess Previous Amount Certified for PaymentMinus sumele anterioare certificateNET AMOUNT CERTIFIED FOR PAYMENT0e!clusive of VAT1SUMA NETA CERTIFICATA PENTRU PLATA(fara -VA)Document 4o- TOTAL AMOUNT DUE FOR PAYMENT : EURODocument nr% (exclusive of VATSUMA TOTALA DATORATA PENTRU PLATA(exclusiv TVA)Si!"e# $% &'e E"!i"ee(Louis "er5er S-A-S- 6r-Date:E"#o(se# $% PIU 7ead of t%e P(U Office 6r- Simona Petrutiu Date:P(U 'inancial Control Date:(nternal 'inancial Audit 8 'inancial 6ana5er Date:eneral 6ana5er 6r Victor Arion Date:o"l% fo( ISPA Fi")"ce# Co"&()c&sPro9ect 6ana5er Date:Pro5ramme Aut%orisin5 Officer 6rs- Carmen Rosu Date:APA PROD PAYMENT APPROVAL*APROBARE PLATA APA PRODCFCU PAYMENT APPROVAL*APROBARE PLATA CFCUM)"u)l of Co"&()c& Su+e(visio" P(oce#u(esA++e"#ix ,.-: S&)"#)(# Fo(.s Rel)&i"! &o P)%.e"& Ce(&ific)&es )"# V)(i)&io"sP)!e - of //APPENDI0 1A1SUMMARY OF VALUE OF 2OR3S CERTIFIED ANEXA "A"LISTA VALORILOR LUCRARILOR EXECUTATE Payment Certificate 4o-Certificat de plata nr%Period Endin5 :Data curentaSu) TotalVariationsModificariDay&or#s.ilemuncaClaims)evendicariSub -otalProvisional SumsAntecalculatie6aterials on Site 0Appendi! :C:1;Materiale pe santier(Anexa /C/)0A1ustarea pretului (Anexa /D/)04 2'e(e )++lic)$lePrice Sc%eduleDescriptionDescriereTender Amount 0EURO1Valoarealicitata ((2)3)ross Contractual Value 0EURO1Valoarea totala 0inclusiv ta!e1 ((2)3)Percenta5e Completion)ealizarea in procentePreviousAnterioaraT%is 6ont%4entru luna in cursTo*date5a data curentaPreviousAnterioraT%is 6ont%4entru luna in cursTo*date5a data curentaTotal $or# DoneValoare -otala 5ucrariPrice Ad9ustment 0Appendi! :D:14To&)l A.ou"& * T!"lSi5ned )y t%e Resident En5ineerVerified )y t%e P(U Pro5ramme 6ana5erDate :Data:M)"u)l of Co"&()c& Su+e(visio" P(oce#u(esA++e"#ix ,.-: S&)"#)(# Fo(.s Rel)&i"! &o P)%.e"& Ce(&ific)&es )"# V)(i)&io"sP)!e 5 of //APPENDI0 161ANEXA "B"Payment Certificate 4o-Certificat plata nr%Period Endin5:Data curenta:PA Section ++ ++1 Slud5e %andlin5 plant LS 2-22 2 2+. Section +> +>1 Pipelines LS 2-22 2 2+, Section +. +.1 Ca)lin5 LS 2-22 2 2+A Section +, +,1 Transformers LS 2-22 2 2+B Section +A +A1 LV S&itc%)oards LS 2-22 2 2+? Section +B +B1 6onitorin5 and control system LS 2-22 2 2+C Section +? +?1 (nstrumentation LS 2-22 2 2+D Section +C +C1 "uildin5s and )uildin5 services LS 2-22 2 2>2 Section +D +D1 Ancillary &or#s LS 2-22 2 2>+ Section >2 >21 =uality assurance LS 2-22 2 2>> Section >+ >+1 La)oratory eEuipment LS 2-22 2 2>. Section >> >>1 O86 manuals and trainin5 LS 2-22 2 2>, Section >. >.1 Spare parts LS 2-22 2 2>A Section >, >,1 Special tools LS 2-22 2 2>B Provisional (tems LS 2-22 2 2>? Provisional Sum for Contin5encies LS 2-22 2 2Summary of payments 2 2 2 2 2 2 2 2 2 2 2Summary of Retentions 0+23 of Summary of payments1 2 2 2 2 2 2 2 2 2 2 2ROSS VALUE3 O' 4ET CO4TRACTSummary of &or#s completed>1 p7 ad9ustment c%emical preparation and dosin5 plant=uantity Total =uantityPrevious To Date Remains2 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 22 2 2M)"u)l of Co"&()c& Su+e(visio" P(oce#u(esA++e"#ix ,.-: S&)"#)(# Fo(.s Rel)&i"! &o P)%.e"& Ce(&ific)&es )"# V)(i)&io"sP)!e 9 of //APPENDI0 1C1SUMMARY OF MATERIALS ON SITEANEXA "C"BORDEROUL MATERIALELOR DE PE SANTIERPayment Certificate 4o-Certificat de plata nr%Period Endin5 :Data curenta:i1 (mported Plant or 6aterials C(P price"nstalatii sau materiale importate pretul conf% C"4ii1 Local Plant or 6aterials e!*factory or e!*&are%ouse price"nstalatii sau materiale indi,ene pretul la iesirea din fabricaiii1 Locally produced material stoc#pile valueMateriale produse local valoarea stocurilor de rezervaiv1 3 of "ill Rates (f applica)le to any of a)ove items * su)stitute-+ din pretul din 5ista de Cant% Daca e aplicabil oricaruia dintre articolele care le pot inlocui pe celede mai sus(TE6A)-"C35DESCR(PT(O4D(SC)"()(U4(T2%M%=UA4T(T4ropuneri de revizuire