Proforma - C

Pradhan Mantri Gram Sadak Yojana (PMGSY)

CHECK LIST FOR P.I.U & S.T.A

(For Individual Road works)

To be filled by PIU.

1. Location:- State:- District:- Block:-
2. Package No:-
3.Name of the Road: From: To:
4. Length (Km) / Total Km / In Built up area : Km / In Open Area : Km
5. Estimated Cost Rs.: Lakhs Average Cost:
Item / Cost per Km
in Lakhs
Pavement
CD
Total
6. Type of Proposal:- New connectivity/ Up gradation
  • If the proposed road is a New connectivity
- Is the road a part of core network YES / NO
- If Yes, Through / Link Route Number or
- Name of the unconnected Target Habitation (to be crosschecked with
CN-6)
-List of Habitations connected enroute
- Population sub served by the proposed road
- Does the Proposed Road lead up to the Habitation for which it is supposed to provide connectivity (In other words are you sure that the road is not being made partially?) / YES / NO
- Does the Proposed Road connect the unconnected Habitation to
(a)Another Habitation having All- weather road. (Connected status)
(b)Directly to an All weather road.
If (b), indicate the nature of road to which the proposed road leads. /

  • If the proposal is for up gradation
-Is the road a part of the core network
-Is it associated Through Route or not
-PCI value
-Age of the Road / YES / NO
YES / NO
- Is it certified that there are no other Unconnected Habitations in the district. / YES / NO
  1. a) Whether the Proposed Road has the desired carriageway width,
Roadway width and Road Land Width (RLW).
b)Indicate the actual widths adopted for the Proposed road.
a)Carriageway
b)Roadway
c)RoadLand Width / YES/NO

In the In the
Built Up Area(m) open Area (m)
INDEX MAP (Not to scale)

R
O
A H1 CD1 H2 CD2 H3
D
0.9 1.5 2.1 2.8 3.2 km
X
Y H1, H2, H3 – Habitations
Z CD1, CD2 – Cross Drainage Works

Cross Section Details

a)Cross Section of the existing road showing different component layers:
b)Cross Section of the proposed road showing different component layers:
8. Base year traffic volume
Total
Bus/ Truck / LCV/ Mini Bus/Tractor Trailer / Cars/ Vans/ jeeps / Three wheelers / Two wheelers / Cycle Rickshaw / Cycles / Bullock Carts / Motorized / Non-motorized
Laden / Unladen / Laden / Unladen
  1. Growth rate adopted (%): Projected Traffic: CVPD

  1. Sub grade CBR

Chainage
Design CBR(%)
  1. Cost Details
A. Clearing and Grubbing Cost in Rs.
B. Pavement Components
Description of the layer / Thickness (mm) / Cost (Rs).
Earth work and Subgrade Preparation *
Granular Sub Base
Soil + Aggregate Mix
WBM-1
WBM-2
WBM-3
C. Bituminous Layers
Prime Coat
Tack Coat
MPM
Surface Dressing
PMC with Seal Coat
D. Cement Concrete Road
E. CD Works No. of Existing CD Works:
Do they require any improvement Yes / No
If Yes, cost of improvement Rs.
No. of proposed CD Works with Classification
(# PC, SC, BC, MB, CW, MajorBridgeetc.)
Cost of Proposed CD Works Rs.
F. Protection Works Length: Cost:
G. Pucca Side Drains (if provided) Length: Cost:
(Kucha unlined side drains form part of Earthwork.)
H. Road Logo, other Road Furniture Cost:
I. Five Year Routine maintenance:
Year / Cost in lakhs / % of Const. Cost
I
II
III
IV
V

* In case of hill roads, the formation and cutting may be filled against Earthwork and Subgrade Preparation.

# PC- Pipe Culvert, SC- Slab Culvert, BC- Box Culvert, MB- Minor Bridge, CW- Causeway

12. Whether the road has Geometrics as per Rural Roads Manual (RRM) / YES / NO
  1. Whether CD works / Protection works are provided as per RRM
/ YES / NO
  1. Whether the Cost estimates are as per standard data analysis and S.S.R
/ YES / NO
Certified that information provided is true
Prepared By:
A.E / Checked By:
E.E / Scrutinized By:
S.E

To be filled by S.T.A

Name of the STA:

15.Is the Proposed Road entered on the OMMS:Yes / No

16.If the proposal is for new connectivity

  • Have you satisfied yourself that the proposed Yes / No

Road is a part of the Core Network

  • Is the unconnected habitation(s) part ofYes / No

list of unconnected Habitations as per CN-6

  • Does the Proposal ensure full connectivity of

the Target HabitationYes / No

a)If No, the name of Unconnected Habitation

up to which it is connected

b)Is such Unconnected Habitation eligible

Under PMGSYYes / No

17.Are you satisfied with the following

  • Engineering SurveysYes / No
  • Soil / Material InvestigationYes / No
  • Traffic Surveys / EstimationYes / No
  • Hydraulic StudiesYes / No

18.In case, Traffic is projected beyond 45 CVPD;

are you satisfied with the reason givenYes / No

19.In case, sub grade CBR is less than 3;

has Soil Stabilization etc. been proposed.Yes / No

20.Is the design of the following elements as per Rural Roads Manual:

  • Alignment & GeometricYes / No
  • Pavement DesignYes / No
  • CD works and protection MeasuresYes / No
  • Side drainsYes / No
  • Integration for Cross and Longitudinal

DrainageYes / No

21.Does the Estimation conform to Yes / No

Standard rate analysis and SSR

22.Does the proposal have provision for

  • PMGSY Logo, Sign Boards and Information BoardsYes / No
  • Km/ Hm StonesYes / No
  • Guard Stones (where necessary)Yes / No
  • Traffic Sign Boards(as necessary)Yes / No

23.Specific remarks, if any, by STA

Certified that the Design and Estimation for the Proposed Road work are based on the data and SSR provided by Engineers. The Proposal after final Correction is entered on the OMMS. The Proposal may be considered for clearance.

Technical Scrutiny:Coordinator:

Done by S.T. A

Signature Signature

Name Name

ANNEXURE: 7.2

PROFORMA-A

Pradhan Mantri Gram Sadak Yojana (PMGSY)

DISTRICT WISE SUMMARY OF THE PROPOSALS

For Phase: Years:

Sl.No. / DISTRICT / PACKAGE NO / PACKAGE WISE DETAILS
No. of Habitations covered / Length Km / Value
Rs (Lakh) / AV. Cost/Km Rs (Lakh)
1 / 1
2
3
4
Total
2 / 1
2
3
4
Total
3
4
5
etc. / |
|
|
| / |
|
|
| / |
|
|
| / |
|
|
| / |
|
|
|
N / 1
2
3
4
Total
State Summary / No of Dists. / Total Packages / Habitations Covered / Length Km / Value
Rs(Lakh) / AV. Cost/Km Rs (Lakh)

Signature:

Name:

State Secretary: