Capital Projects Report

PDF Version - Fill & Print (143 Kb, 2 Pages)

Form Instructions

DCI# 460671.GCIMS (2015-2016)

Privacy Act Statement:

The information you provide in this document is collected under the authority of Capital and Facilities Maintenance Program - Payments to support Indians, Inuit and Innu for the purpose of supplying public services in capital facilities and maintenance. Information on individuals is used by Aboriginal Affairs and Northern Development Canada Capital and Facilities Maintenance Program employees who need to know the information in order to respond to your request and/or the program requirements. We do not share the personal information with other government departments. The personal information will be kept for a period of 30 years. Individuals have the right to the protection of and access to their personal information under the Privacy Act. The information collected is described under the Treasury Board Personal Information Bank INA PPU 608 which is detailed at InfoSource.

Band Name

Band Number

Contact - Given Name

Family Name

Email Address

Telephone Number

Project Name

Project Number

Site Name

Site Number

Type of Report:

Progress

Provisional

Final

Funding Arrangement Number

Schedule for Progress Report (YYYYMMDD):

Project Start Date

Project Completion Date

If Progress Report, select phase of project:

Design

Construction

Commissioning

Other

Statement of Expenditures:

Estimated Project Total

Spent to Date

Spent this Phase

Check all that apply for Progress and/or Provisional Reports:

- All details of the project are resolved and there is no flaw, omission, uncompleted work, claim or outstanding payment.

- The "As Constructed" plans are available.

- Flaws, omissions, incomplete work, claims or outstanding payments exist, and an Action Plan and either a Substantial Completion Certificate or a Certificate of Occupancy are attached.

- The construction complies with all requirements of all applicable codes, standards and AANDC Funding Arrangement.

- Official inspection report(s) or certificate(s) by qualified inspector(s) are attached.

- Check all that apply for Completed Projects:
- Building Inspection Final Report
- Septic Installation Approval
- Fire Commissioner Reports
- Electrical Inspection Final Report
- Concrete Testing Reports
- Environmental License (Provincial/Territorial)
- Survey and Soil Testing Reports
- Certificate of Occupancy
- Water/Sewage Testing Reports (Health Canada or Territorial Government)
- Workers' Compensation (Safety and Labour Conditions)
- Substantial Completion Certificate as per provincial legislation (e.g. Construction Lien Act)
- Operator's Certification for Water/Sewage Treatment Plants
- Environmental Mitigation Report, if required by Environmental Assessment
- Other(s)

Attachment(s):

Indicate the name(s) of supporting document(s) being submitted and the method of submission.

Name of Supporting Document

Method of Submission

Narrative:

I hereby certify that all work has been completed in accordance with the Terms and Conditions set out in the Funding Agreement and the Effective Project Approval, and that all specified codes and standards have been met.

Given Name

Family Name

Title

Date (YYYYMMDD)

Received at AANDC by:

Given Name

Family Name

Date (YYYYMMDD)