石油化工行业监理用表SHT3903监理表格.docx

1、石油化工行业监理用表SHT3903监理表格附录A Attachment A（规范性附录）(Regulatory Attachment)承包单位用表 Forms for Construction ContractorA.1 表SH/T3903A.1A.14给出了施工阶段监理工作承包单位用表格式，表号与名称：-SH/T 3903A.1 工程开工/复工报审表-SH/T 3903A.2 施工组织设计（方案）报审表-SH/T 3903A.3 包单位资格报审表-SH/T 3903A.4 报验申请表-SH/T 3903A.5 工程款支付申请表-SH/T 3903A.6 监理工程师通知回复单-SH/T 390

2、3A.7 工程临时延期申请表-SH/T 3903A.8 费用索赔申请表-SH/T 3903A.9 工程材料/构配件/设备报审表-SH/T 3903A.10 工程竣工报验单-SH/T 3903A.11 施工进度计划报审表-SH/T 3903A.12 工程质量事故处理方案报审表-SH/T 3903A.13 主要施工设备进场报审表-SH/T 3903A.14 单机试车申请表A.2 表SH/T3903A.15A.16给出了勘察/设计阶段监理工作承包单位用表格式，表号与名称：-SH/T 3903A.15 勘察/设计费用支付报审表-SH/T 3903A.16 勘察/设计进度调整报审表SH/T 3903-A

3、.1工程开工/复工报审表工程名称：中石化平顶山分公司鲁山第五加油站油气回收工程编号： 致：中石化中原 监理有限公司我单位承担的鲁山第五加油站油气回收工程，已完成了以下各项工作，具备了开工/复工条件，特此申请施工，请核查并签发开工/复工指令。附：开工报告 承包单位（章）项目经理 日 期 审查意见：项目监理机构 总监理工程师日 期 SH/T 3903-A.2施工组织设计（方案）报审表Construction Organization Design Approval Request工程名称 Works Title：编号 Item No：致 （监理单位）To （CS/CMC）我方已根据施工承包合同的有

4、关规定完成了工程施工组织设计（方案）的编制，并经我单位技术负责人审查批准，请予以审查。According to the related regulations of the construction contract, we have completed the preparation of the construction organization design , and it has been reviewed and approved by the technical responsible people of our company, please review it.附Attach

5、ed：施工组织设计/施工方案。Construction Organization Design /Construction Plan。承包单位（章）Contractor（Chop）项目经理Project Manager 日 期Date 专业监理工程师审查意见 Review comments from discipline supervision engineer：专业监理工程师Discipline Supervision Engineer 日 期Date 总监理工程师审核意见 Review comments from chief supervision engineer：项目监理机构CS/CM

6、C 总监理工程师Chief Supervision Engineer 日 期Date SH/T 3903-A.3分包单位资格报审表Subcontractor Qualification Approval Request工程名称 Works Title： 编号 Item No：致 （监理单位）To （CS/CMC）经考察，我方认为拟选择的（分包单位）具有承担下列工程的施工资质和施工能力，可以保证本工程项目按合同的规定进行施工。分包后，我方仍承担承包合同的全部责任。请予以审查和批准。After investigation, we think the proposed (subcontractor)

7、 has the qualification and capability for contracting the following works, and can assure that this works will be constructed as per the contract regulations. After subcontracting this works, we still hold the whole responsibilities of the lump sum contractor. Please review and approve it.附Attached：

8、1 分包单位资质材料 Subcontractor Qualification Documents；2 分包单位业绩材料 Subcontractor Performance Documents。分包工程名称（部位）Subcontracted works（Location）工程数量Works Quantity拟分包工程合同额Contract price of proposed subcontracted works分包工程占全部工程Percentage of subcontracted works合 计 Totals承包单位（章）Contractor （Chop）项目经理Project manag

9、er 日 期Date 专业监理工程师审查意见 Review comments from discipline supervision engineer：专业监理工程师Discipline Supervision Engineer 日 期 Date 总监理工程师审核意见 Review comments from chief supervision engineer： 项目监理机构CS/CMC 总监理工程师Chief Supervision Engineer 日 期Date SH/T 3903-A.4报验申请表Inspection Request工程名称 Works Title： 编号 Item

10、No： 致 （监理单位）To （CS/CMC）我单位已完成了工作，经自检合格,现报上该工程报验申请表，请予以审查和验收。We have completed the works, after the self inspection, the works is on spec, now we submit the inspection request for this works, please inspect and accept.附Attached：承包单位（章）Contractor （Chop）项目经理Project Manager 日 期Date 审查意见 Review comments：

11、项目监理机构CS/CMC 总/专业监理工程师 Chief/discipline supervision engineer 日 期Date SH/T 3903-A.5工程款支付申请表Works Payment Request工程名称 Works Title：编号 Item No： 致 （监理单位）To （CS/CMC）我方已完成了工作，按施工承包合同的规定，建设单位应在年月日前支付该项工程款共（大写）（小写），现报上工程付款申请表，请予以审查并开具工程款支付证书。We have completed the Works, according to the contract regulations,

12、 the owner should make the payment of total of （amount in words）, (say ) for this works before . Now we submit the Works Payment Request, please review and issue the works payment certificate.附件Attached：1 工程量清单 Quantity List；2 计算方法 Calculation Methods。 承包单位（章）Contractor（Chop）项目经理Project Manager 日 期D

13、ate SH/T 3903-A.6监理工程师通知回复单Correspondence to Supervision Engineer Notice工程名称 Works Title： 编号 Item No： 致 （监理单位）To （CS/CMC）我方接到编号为的监理工程师通知后，已按要求完成了工作，现报上，请予以复查。After we received the supervision engineer notice of , we have completed the jobs，now we submit it , please recheck.详细内容 Detailed contents：承包单

14、位（章）Contractor（Chop）项目经理Project manager 日 期Date 复查意见 Recheck comments：项目监理机构CS/CMC 总/专业监理工程师Chief/discipline supervision engineer 日 期Date SH/T 3903-A.7工程临时延期申请表Works Temporary Delay Request工程名称 Works Title：编号 Item No： 致 （监理单位）To (CS/CMC)根据承包合同条款条的规定，由于原因，我方申请工程延期，请予以批准。According to clauses of the co

15、nstruction contract clauses , due to the reasons, we request the works delay, please approve it.合同交工日期Contract As Build Date：申请延长交工日期Delayed As Build Date：附件Attached：1 工程延期的依据及工期计算 Works delay basis and working period calculation：2 证明材料 Supporting documents。承包单位（章）Contractor（Chop）项目经理Project manager

16、 日 期Date SH/T 3903-A.8费用索赔申请表Cost Claim Request工程名称 Works Title： 编号 Item No： 致 （监理单位）To （CS/CMC）根据承包合同条款条的规定，由于的原因，我方要求索赔金额（大写），请予以批准。According to clauses of the construction contract ,due to the reasons, we request the cost claim of (amount in words) ，please approve it.索赔的详细理由及经过 Detailed cause and

17、 course of the claim：索赔金额的计算 Calculation of claimed amount：附Attached：证明材料 Supporting documents承包单位（章）Contractor（Chop）项目经理Project manager 日 期Date SH/T 3903-A.9工程材料/构配件/设备报审表Works Materials/Components/Equipment Inspection Request工程名称 Works Title：编号 Item No：致 （监理单位）To (CS/CMC)我方于年月日进场的工程材料/构配件/设备数量如下（见

18、附件）。现将质量证明文件及自检结果报上，拟用于下述部位：，请予以审核。We have mobilized the following materials/components/equipment for the works on its quantity is listed below（see the attachments）.Now, we submit the quality documents and our self inspection results, The proposed locations for use as follows： ，Please review it. 附件A

19、ttached：1 数量清单 Quantity List；2 质量证明文件 Quality Documents；3 自检结果 Self Inspection Results。承包单位（章）Contractor（Chop）项目经理Project manager 日 期Date 审查意见Review comments：经检查上述工程材料/构配件/设备，符合/不符合设计文件和规范的要求，准许/不准许进场，同意/不同意使用于拟定部位。After the inspection, the above materials /components/equipment，meet/do not meet the

20、requirements of the design documents and specifications. site mobilization is allowed/site mobilization is not allowed, use for the proposed locations is allowed /not allowed.项目监理机构CS/CMC 总/专业监理工程师Chief/discipline supervision engineer 日 期Date SH/T 3903-A.10工程竣工报验单Works Completion Inspection Request工

21、程名称 Works Title： J10-32四联合油浆拔头系统消缺完善编号 Item No： 致 洛阳炼化工程建设监理有限责任公司（监理单位）To (CS/CMC)我方已按合同要求完成了四联合油浆拔头系统消缺完善(管道安装)工程，经自检合格，请予以检查和验收。We have completed the works according to the requirements of the contract，after the self check, it is on spec, please inspect and accept.附Attached：工程交工证书 1份承包单位（章）Contra

22、ctor（Chop）项目经理Project manager 日 期Date 审查意见Review comments：经初步验收，该工程：after the preliminary inspection and acceptance, this works:1 符合/不符合我国现行法律、法规要求；meet/not meet the requirements of the current state laws and regulations.2 符合/不符合我国现行工程建设标准；meet/not meet the requirements of the current national stand

23、ards.3 符合/不符合设计文件要求；meet/not meet the requirements of the design documents.4 符合/不符合施工合同要求。Meet/not meet the requirements of the construction contract.综上所述，该工程初步验收合格/不合格，可以/不可以组织正式验收。Based on the above points, the preliminary inspection and acceptance of this works is on spec/off spec, formal inspect

24、ion and acceptance can be/can not be organized .项目监理机构CS/CMC 总监理工程师Chief supervision engineer 日 期Date SH/T 3903-A.11施工进度计划报审表Construction Schedule Approval Request工程名称 Works Title：编号 Item No：致 （监理单位）To （CS/CMC）我方已根据承包合同的有关规定编制完成了年月日 至年月日的：We have completed the preparations of the following schedules

25、 from to according to the related regulations of the construction contract：1 工程施工总进度计划 Project Construction Overall Schedule；2 工程施工月进度计划 Project Construction Monthly Schedule；3 工程施工周进度计划 Project Construction Weekly Schedule；4 计划 schedule。并经我单位技术负责人审查批准，现报上，请予以审查。我们将严格按审查通过的进度计划组织施工。It has been revie

26、wed and approved by our technical responsible people. Now we submit it to you, please review. We will organize the construction by strictly following the approved schedule.附Attached：图表、说明书共页。Drawings and charts, instruction books, totally in pages.承包单位（章）Contractor（Chop）项目经理Project manager 日 期Date 审

27、查意见 Review comments：同意此进度计划。Approved this schedule.不同意此进度计划，请按以下要求修改再报：Not approved this schedule, please modify it according to the following requirements, and resubmit it：专业监理工程师Discipline supervision engineer 日 期Date 审核意见 Review comments：项目监理机构CS/CMC 总监理工程师Chief supervision engineer 日 期Date SH/T 3903-A.12工程