Infra Manual v2(Forms) - Edited(1)

8/20/2019 Infra Manual v2(Forms) - Edited(1)

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CBIM

Form

A-1

KALAHI-CIDSS NATIONAL COMMUNITY DRIVEN DEVELOPMENT PROJECT

INVENTORY OF EXISTING INFRASTRUCTURES1

Municipality : ____________________________

Classification:

________ No. of Barangays: ____________________________ Province : ____________________________ Region: _____________

A. Rural Acce!

i. Municipal Roads: Paved = ______ kms. Gravel = ______ kms.ii. Barangay Roads: Paved = ______ kms. Gravel = ______ kms.iii. Bridges: Concrete = ______ ln.m Bailey = _______ ln.m Suspension = _____ ln.miv. t!er Structures: ___________________

". S#c$al I%&ra'ruc'ure!

i. Rural "ealt! #nit: ____ $arangayii. Barangay

"ealt! Station: ____ $arangaysiii. %ay Care Center: ____ $arangays

iv. Sc!ool

Buildings:

&lementary

= ______

Barangays No. of Classrooms

= ________ "ig! Sc!ool = _____ Barangays No. of Classrooms = ________

v. Pota$le 'ater Supply: (evel ) = _____ Barangays(evel )) = _____ Barangays(evel ))) = _____ Barangays

vi. t!ers: *Brgy+ "all, _____ $arangays

C. A(r$cul'ural ) Tra*e Fac$l$'$e!

i. Post-!arvest facilities*'are!ouseStorage,: _____ $arangays

ii. /raining Center: _____ $arangays

iii. Markets /rading Center: _____ $arangaysiv.

Ra0 materials:

____________________________________

Pre+are* ,! Val$*a'e* ,!

MC/-/1 2C/-/1

50 4,380

ALEGRIA 4TH9

CEBU VII

1,100 0

2,650

0 0

Covered Courts 9!

18

99 to "ou#t4 to "ou#t099

9

41

3$%&$oo, 'e(u&es)eeds!

E*GR+ A- C+ .ERRARE* E*GR+ LEAH A/R + /A/A*A

8

Position &mployment Status

/ype of Skill No. of 3ears of 'ork&4perience

&mploymentStatus

/ype Current

Condition

Current

Capa$ility

per "our

1uel 5 P(

ProductConsumption

Prevailing

Rental Rates


2/24

CBIM

Form

A-2


INVENTORY OF AVAILA"LE TECHNICAL RESOURCES

Na/e #& "ara%(a!

Mu%$c$+al$'!

Pr#0$%ce

!

Re($#%! Mu%$c$+al Cla!

Pre+are* ,! C#%curre*!

______________________ _______________________ MC/-/1 Municipal &ngineer

6

CBIM

Form

A-2



Na/e #& "ara%(a! Mu%$c$+al$'! Pr#0$%ce ! Re($#%! Mu%$c$+al Cla!

A. Hea0 Eu$+/e%'

". Tec2%$cal a%* S3$lle* Ma%+#4er

C. La,#r F#rce 5"ara%(a6

8



&mploymentStatus

/ype Current

Condition

Current

Capa$ility

per "our

1uel 5 P(

ProductConsumption

Prevailing

Rental Rates


3/24



6

CBIM Form

A-2






A. Hea0 Eu$+/e%'



8



&mploymentStatus

/ype CurrentCondition

CurrentCapa$ility

per "our

1uel 5 P(Product

Consumption

PrevailingRental Rates

A. Hea0 Eu$+/e%'




4/24

6

CBIM Form A-2



Na/e

#&

"ara%(a! Mu%$c$+al$'! Pr#0$%ce ! Re($#%! Mu%$c$+al Cla!



6

CBIM Form A-2



8 Position &mployment Status


&mploymentStatus


CurrentCapa$ility per

"our

1uel 5 P(Product

Consumption


A. Hea0 Eu$+/e%'

".

Tec2%$cal

a%*

S3$lle*

Ma%+#4er


8



&mploymentStatus

/ype Current

Condition

Current

Capa$ility

per "our

1uel 5 P(

ProductConsumption

Prevailing

Rental Rates


5/24




6

CBIM Form A-2




A. Hea0 Eu$+/e%'



8



&mploymentStatus

/ype CurrentCondition CurrentCapa$ility

per "our

1uel 5 P(ProductConsumption



6/24



6

CBIM Form A-2



Na/e

#&


A. Hea0 Eu$+/e%'



8



&mploymentStatus


CurrentCapa$ility

per "our

1uel 5 P(Product

Consumption



7/24



6

CBIM

Form

A-2


INVENTORY

OF

AVAILA"LE

TECHNICAL

RESOURCES




A. Hea0 Eu$+/e%'





&mploymentStatus

/ype CurrentCondition CurrentCapa$ility

per "our

1uel 5 P(ProductConsumption


A. Hea0 Eu$+/e%'




8/24

6

CBIM

Form

A-2








&mploymentStatus


CurrentCapa$ility

per "our

1uel 5 P(Product

Consumption


A. Hea0 Eu$+/e%'

".

Tec2%$cal

a%*

S3$lle*

Ma%+#4er

C.

La,#r

F#rce

5"ara%(a6


9/24

6

CBIM Form A-3


INVENTORY

OF

AVAILA"LE

SERVICE

PROVIDERS7

Na/e #& "ara%(a!

Mu%$c$+al$'! Pr#0$%ce ! Re($#%! Mu%$c$+al Cla!

MATRIX OF NON-REGISTERED SUPPLIERS

Pre+are* ,! N#'e*!

__________________________ ____________________________________________________ M/1 andor 2C//1 Regional Community )nfrastructure Specialist

Note: /o $e conducted in coordination 0it! market survey of availa$le suppliers and contractors prepared $yt!eProcurement /eam

7 ne t!at can provide tec!nical assistance suc! as survey 0orks+ engineering design and plan preparations+ la$oratory testresults8 '!et!er !ard0 are store+ electrical store+ lum$eryard+ sand 5 gravel supplier+ etc

9

CBIM Form

A-3


INVENTORY OF AVAILA"LE SERVICE PROVIDERS7


Name of &sta$lis!ment Postal 2ddress Category8 ProductsMaterials Sup

Name of Supplier Postal 2ddress Category

Postal 2ddress Category Classification

Name 2ddress 1ield of &4pertise

A. ENGINEERS7ARCHITECTS

". CONTRACTORS

C. SUPPLIERS

Name of &sta$lis!ment Postal 2ddress Category8 ProductsMaterials Sup


Postal 2ddress Category Classification



10/24


Pre+are* ,! N#'e*!




9

CBIM

Form

A-3



Na/e #& "ara%(a!



Pre+are* ,! N#'e*!




9


". CONTRACTORS

C. SUPPLIERS

Postal 2ddress Category8 ProductsMaterials Sup

Name of Construction 1ir Postal 2ddress Category Classification


Name 2ddress 1ield

of &4pertise


". CONTRACTORS

C. SUPPLIERS


11/24

CBIM Form A-3

KALAHI-CIDSS

NATIONAL

COMMUNITY

DRIVEN

DEVELOPMENT

PROJECT


Na/e #& "ara%(a!



Pre+are* ,! N#'e*!

__________________________ ____________________________________________________

M/1

andor 2C//1 Regional

Community

)nfrastructure

Specialist



9

CBIM

Form

A-3



Na/e

#&







". CONTRACTORS

C. SUPPLIERS




Name 2ddress 1ield

of &4pertise


12/24


Pre+are* ,! N#'e*!




9

CBIM

Form

A-3



Na/e #& "ara%(a!

Mu%$c$+al$'!

Pr#0$%ce

!



Pre+are* ,! N#'e*!




9


". CONTRACTORS

C. SUPPLIERS




Name 2ddress 1ield

of &4pertise


". CONTRACTORS

C. SUPPLIERS


13/24

CBIM Form A-3





Pre+are* ,! N#'e*!




9

CBIM Form A-3



Na/e #& "ara%(a!

Mu%$c$+al$'!

Pr#0$%ce

!





Name 2ddress 1ield

of &4pertise


". CONTRACTORS

C. SUPPLIERS




Name 2ddress 1ield

of &4pertise


14/24


Pre+are* ,! N#'e*!




9

CBIM

Form

A-3



Na/e #& "ara%(a!


". CONTRACTORS

C. SUPPLIERS




Name 2ddress 1ield

of &4pertise


15/24



Pre+are* ,! N#'e*!




9

CBIM Form A-4


SITE VALIDATION REPORT FOR RURAL ROADS

%ate of 1ield isit: ______________ Brgy: _________________ Mun: _____________________

Name of Proposed su$-pro;ect: ____________________________________________________ (ocation: Station (imits *Sitio or Brgy,: __________________________________________ Name of contact person *PP/BR/ mem$er,: _________________________________________

No. of present

population

of t!e target

area:

_________ Male: ________ 1emale:

________ /otal No.

of "ouse!olds:

__________

2ve.

No."":

______

(For joint

barangay

proposal,

total for the

participating barangays)

Point *start or sta. ?@???, _____________________________________ *end of sta. ___, ________________________________________________________________

8. &4isting road

net0ork

for 0!ic!

t!e proposed

road

0ill connect: ______ provincial

road ______

$arangay

road _______

N)2 access road _______

private road

A. /ypes of ve!icles currently passing t!e proposed road: ______ none ______ motorcycles/ri-cycles _____ 1our-0!eel _____ 6-0!eelers truck t!ers

. 1reuency count of ve!icles currently passing t!e proposed road per day:


". CONTRACTORS

C. SUPPLIERS


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___ times for motorcycles/ri-cycles ___ times for 1our-0!eel ___times for 6-0!eeled 5t!ers

6. &4isting cost of fare from t!e area to t!e municipal proper: _____ per person _____ per sack of farm product

9. &4isting farm products 0it!in t!e influence area of t!e proposed road: *e4. Palay+ vegeta$le, _____________________________________________________________________________

D. /opograp!y of t!e proposed area *route,: ________ flat terrain ________ flat to rolling ________ rolling to !illy ________ mountainous

E. 'ill t!e proposed

road

reuire

ma;or e4cavationF

____

3es *estimated

vol.,

___

cu.m ___

No


17/24

E

CBIM Form A-5


SITE VALIDATION REPORT FOR "RIDGES7SPILL8AYS7CULVERTS

%ate of 1ield visit: ______________ Brgy: _________________ Mun: _____________________

Name of Proposed su$-pro;ect: ____________________________________________________ (ocation: Station (imits *SitioBrgy,: ________________________________________________ Name of contact person *PP/BR/ mem$er,: _________________________________________ No. of present population of t!e target area: _________ Male: ________ 1emale: ________ /otal No. of "ouse!olds: __________ 2ve. No."": ______ (For joint barangay proposal, total for the

participating

barangays)


18/24

E. t!er $arangay t!at 0ould $enefit t!e proposed structures: ____________________________


19/24


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E. 2vaila$ility

of construction materials in t!e area: *distance, ________ 0it!in t!e proposed area ______ -


21/24


22/24

egetation cover of t!e source: ____________________________________________________

2ccessi$ility of t!e source: road _______________ trail ______________ none _____________

%istance of proposed 0ater source to t!e target area: __________________________________

%istance of t!e 0ater source to t!e nearest road access: ________________________________

Presence of po0er supply in t!e area: ________ %istance of t!e nearest electric post: ________

0ners!ip

of t!e

source: __

(G# o0ned

___

Pu$lic

(and

___

Privately

o0ned

/itled

3__

N __

Name of 0ner: ___________________________

2ny potential environmental disaster risks noted on t!e proposed site: _____________________ _____________________________________________________________________________

2vaila$le construction materials in t!e area: __________________________________________

Name of e4isting association in t!e area: ____________________________________________

Status of t!e association: No. of active mem$ers ______________ in-active ________________


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Documents

Infra Manual v2(Forms) - Edited(1)