KEEP THIS PERMIT TOGETHER APPROVED: ______ EXPIRY

Qatar Rail Dividers PTW - Infrastructure

Company Management System

KEEP THIS PERMIT TOGETHER

RO ______ Applicant __________ Activity__________

APPROVED: _______ EXPIRY: _______ RENEWAL: 3 months valid

2 WEEKS BEFORE EXPIRY WITH VALID RO

BRING THIS PERMIT TO WORK. PUT THE NEW PERMIT ON TOP + RO + SUPPORTING INFORMATION

01

LEADING EXCELLENCE │CMS Ref.: TM-215-F11, 30/10/18, Rev. 2.0 Page 2 of 14



05 Insert QR Assessment

11 Insert QR General Conditions

Guide

01 Filled out by Qatar Rail.

02 Insert QR Check list / Register

03 Write RO # & DR #

04 Insert Interface Drawing

06 Insert Applicant Drawings

07 Insert Traffic Management

08 Insert Monitoring Regime

09 Insert Support Docs

10 Insert MS / RA

12 Insert QR Contacts

13 Insert previous PTW


Qatar Rail

Permit to Work for Infrastructure/Utility Works in Rail-Protection-Zone



QR-PERMIT Ref. # ____________________ (Filled out by Qatar Rail)

First Submittal Renewal Previous QR Permit Ref. # _______________________________

Contractor / Applicant:

Stamp/signature

Contractor

Contract No

Full address

Building No. Street No. Street Name: Zone No.

Telephone/Fax

Email

Print name:

The Contractor/Applicant certifies that:

He/she fully understands the documentation associated with this work activity, the hazards, the precautions required, his/her obligations, and the procedures to carry out the work in relation to the rail interface,

He/she will provide access/egress for Qatar Rail to their land & work sites at all times and during all phases of the work.

The workforce undertaking the work activities are fully briefed and equipped and understand the safety and emergency procedures to be followed and are competent.

Others. Also refer to terms & conditions.

Date:

Name Person in Charge Email

Title Mobile No

PERMIT DURATION (maximum 3 months) FROM DATE / TIME: TO DATE / TIME:

WORK LOCATION (area, zone, street/no.)

DR No. RO No.

Project / Scheme: Work Description

TRIAL HOLE/BORE HOLE EXCAVATION LAYING CABLE(S) ELECTRICITY OHL LAYING PIPELINES PRESSURISED PIPE DRILLING WORKS FOUNDATIONS TUNNELING / PIPE JACKING PERMANENT CIVIL CONSTRUCTION BUILDING DEMOLITION TEMPORARY INSTALLATIONS (LESS THAN 6 MONTH) DEWATERING OTHERS

Type and Description of Work:

Applicant’s Client Applicant’s Consultant

Stamp/signature

Stamp/signature

Name Name

Title Title

Qatar Rail





QATAR RAILWAYS (QR) COMPANY (APPROVING ENTITY)

Red Line North EAG Red Line North UG Red Line South UG Red Line South EAG Green Line EAG Green Line UG Gold Line UG Gold Line EAG Blue Line UG Black Line UG Long Distance Commuter Line Lusail LRT

Phase _________________________________________ LOT / CORRIDOR ___________________________________________

QR CONTRACTOR RKH QITARAT - SERVICE PROVIDER ENDORSEMENT (1) I have reviewed, assessed and considered the intended work and my comments on the submission are shown below. Provided these

comments are adequately addressed I hereby endorse the acceptance of the intended third party work.

Stamp/signature

Comments / conditions: (use separate page, if required)

Name

Title

QR PMC PROGRAM MANANGEMENT CONSULTANT SERVICE DELIVERY DEPT. (RAILWAY OPERATOR) ENDORSEMENT (2) I have reviewed, assessed and considered the intended work and my comments on the submission are shown below. Provided these

comments are adequately addressed I hereby endorse the acceptance of the intended third work.

Stamp/signature


Name

Title

QR GOVENMENTAL INTERFACES & PERMITS DEPARTMENT (3) I accept that, so far as can reasonably be ascertained from the information submitted, the relevant comments and conditions stated

herein including the associated documents have been complied with properly.

QR GENERNAL CONDITIONS DETAILED DESIGN DRAWING(S) COMPLIANCE CERTIFICATE

DR – DESIGN REVIEW TRAFFIC DIVERSION & ACCESS PLAN LETTER OF AUTHORISATION (CONTR./CR/ID)

RO – ROAD OPENING PERMIT METHOD STATEMENT / RISK ASSESSEMENT UNDERTAKING&LIABILITY LETTER/ INSURANCE

INTERFACE DRAWING EMERGENCY/MONITORING/DEWATERING PLAN INTERFACE CONTROL FORM / OTHERS

Stamp/signature


Name

Title

VALID FOR MAXIMUM 3 MONTH

Qatar Rail





Terms & Conditions: 1. A Qatar Rail (QR) Permit to Work (PTW) to be filled out and submitted for every Railway Party (i.e. QR contractors, service provider, etc.) interfacing with

the Third Party Intended Work. refer to QR contact list: QR Departments, QR Contractors, QR Operator & Service Provider 2. (1) If no Qatar Rail contractor is awarded, then the Qatar Rail Civil Department to sign. 3. (2) If no Qatar Rail PMC contract is awarded, then the Qatar Rail Alignment Department to sign. 4. The QR Governmental Interfaces & Permits Department can replace/overrule Endorsement (1) & (2). 5. The applicant must submit all relevant documents. Additional comments / conditions can be attached separately. 6. All work is at the applicants risk and responsibility. 7. Qatar Rail representatives have the right to STOP WORK if any violation of the submitted documents occurs of safe working practices are compromised. 8. Contractor must apply for the Qatar Rail Permit to Work 10 working days before starting the work. 9. Contractor must submit a QR approved & valid RO permit (construction NOC). 10. Contractor must submit all associated documents, proof of coordination with the contractors of active rail projects, Qatar Rail, the PMC or any other

related department of Qatar Rail. Assessment and monitoring reports for (movements/settlements, vibration, noise/dust, etc.) as required by Qatar Rail. 11. The Rail Operator/Service Provider access- and operational requirements to be complied with. 12. All submitted documents must reflect the Qatar Rail interface and must match previous submissions. 13. The applicant must reflect the Qatar Rail interface in the method statement and risk assessment specifically for the intended works and the site specific

conditions. 14. Any damage, partially or totally, to Qatar Rail assets shall be reported to Qatar Rail immediately. All costs will be at the applicants account. 15. All costs to carry out the intended works (design & construction) are at the applicants account. 16. The Qatar Rail approval of the intended works is for the duration of the works as specified in this permit but not longer than 3 month. 17. If the intended work of the applicant requires more than 3 month or the RO permit has expired, a new Permit to Work shall be submitted. 18. Any change to the reviewed documents or design or method of work is required to be notified to Qatar Rail immediately and renders this document as

invalid. A new application has to be submitted. 19. The applicant shall comply with the law, rules and regulations of the State of Qatar as well as Qatar Rail & Operational rules & regulations & guidelines. 20. Any attachments and related documents to this PTW-document are part of the Permit to Work. 21. The QR General Conditions apply.

Access & movement around metro stations (assets) 1. The applicant shall implement active measures for any proposed activities that all access/egress to the Metro station is and Emergency access is

safeguarded and protected including unrestricted pedestrian traffic 2. This includes obtaining approval from Qatar Rail for temporary traffic- & pedestrian management schemes.

QR Inspections (QR appointed representatives) 1. Qatar Rail reserves the right to carry out site inspections announced and unannounced. Access shall be granted to Qatar Rail representatives.

2. For works with direct physical interfaces with Qatar Rail assets or land an inspection/hand-over to be arranged and fully conducted. 3. The approved permit shall be available on site at all time and readily available to Qatar Rail on request.

Work Completion 1. As built drawings and relevant quality documentation to be submitted to Qatar Rail. 2. On completion of work Qatar Rail must be notified and respective Qatar Rail assets to be formally handed over.

The applicant certifies that the information contained in this application is true and complete. The applicant confirms to undertake as follows: 1. Not to commence the proposed construction works prior to obtaining:

(a) All relevant Authority and Government consents, permissions and approvals for the works. (b) The issuance of a Permit by Qatar Railways Company.

2. To perform the works strictly in accordance with: (a) The Permit issued by Qatar Railways Company; Law 10 of 2014 (also Ministerial Circular-6-2018 Circular no. (6) of 2018). (b) All conditions stipulated in this document and related documents by Qatar Railways Company and their representatives. (c) All authority and government consents, permissions or approvals.

3. Not to vary the works without obtaining a Permit from Qatar Railways Company. 4. To implement the construction works in accordance with all approved specifications and to take responsibility for all construction safety matters.

The applicant to comply with the following: 1. Show the Permit to any Qatar Rail Inspector/ staff upon request. 2. Work only within the site boundaries as stipulated 3. Carry out all works in compliance with the instructions from Traffic Department; do not block traffic/pedestrian routes without providing save & secure

alternatives. 4. Create protective barriers around the site to guarantee the safety of the public & adjacent properties. 5. Not store any building materials or equipment outside the site boundaries. 6. Not excavate sewage utilities outside the site boundaries. 7. Not to mix building materials on the sidewalks or the public roads. 8. Clean the site, sorting remnants outside city boundaries and then transfer them to sites assigned by MMUP. 9. In case of demolition, obtain the approval from authorities to coordinate cutting utilities services (if required). 10. Not allow storage of any hazardous materials on the site, unless approved. 11. Ensure that all groundwater is pumped in accordance with PWA & MME guidelines and requirements. 12. Excavate any trial pits and carry out any surveys required to ascertain the extent of existing utilities. Use Cable Avoidance Tool CAT & Signal Generator

GENNY. 13. Be responsible for any violations. Any violation of one or more of these conditions shall invalidate the Permit. 14. It is mandatory to present detailed drawings/methods/and monitoring reports to obtain demolishing permits.

Qatar Rail – Surveying Engineers / Inspectors

Eng. Trinadha Rao [email protected]: +974 7022 6846

Eng. Qaisar [email protected]

Mobil: +974 7727 1342

Mr. Darcelon [email protected]

Mobil: +974 3316 6437

Mr. Frederick D. [email protected] Mobil: +974 5045 2539



QATAR RAIL PERMIT TO WORK

SUBMISSION CHECK LIST

(Content List)

02


Qatar Rail

Permit to Work Content List / Index Company Management System


CONTENT LIST / INDEX INFRA-

STRUCTURE PIN REMARKS

CONTENT LIST

1 Content List / Index

APPROVALS

2 Permit to Work

3 DR (approved & valid)

4 RO (approved & valid)

5 Previous Permit to Work

CONDITIONS AND CONTACTS

6 QR General Conditions

7 QR contact list

8 Site specific point of contact

9 Qatar Rail Contractor’s or PMC’s / PMCS’s conditions (specific)

10 Contractor’s and PMC’s assessment and recommendation

METHOD OF WORK, RISK & PROGRAM

11 Method Statement

12 Risk Assessment

13 Program of works

INTERFACE IDENTIFICATION – DRAWINGS

14 QATAR RAIL TID Interface drawing(s) (superimposed proposal)

15 QATAR RAIL Designer’s / Contractor’s Interface drawing(s)

16 Contractor’s mark-up drawings

17 Approval in Principle AIP

18 Interface control form

19 Location plan

20 Site set-up / site installation / laydown- and storage areas, etc.

21 Design drawings (plan, sections, levels, dimensions, etc.)

22 Protection details, material data sheets, etc.

23 Structural drawings, reports, calculations, etc.

24 Geotechnical report (as required)

25 Design and method departures, relaxations, waivers, etc.

26 As built drawings

SURVEY & & TAKING-OVER & HANDOVER

27 Survey report

28 Pre-condition survey

29 Handover documentation

Qatar Rail

Permit to Work Content List / Index Company Management System


CONTENT LIST / INDEX INFRA-

STRUCTURE PIN REMARKS

30 Temporary Land Occupation agreement / letter (as applicable)

CORRESPONDENCE

31 Email correspondence

32 Minutes of meeting

33 Letters (and NOC letters)

34 Memorandum of Understanding (any other agreement)

MONITORING & EMERGENCY

35

Monitoring regime – vibration – settlements - movements (base line data and ongoing data collection, thresholds, etc.)

36 Drainage / Dewatering Plan & Reports

37 Noise & Vibration report (as applicable)

38 Emergency Response Plan

LOGISTICS & TEMPORARY TRAFFIC MANAGEMENT (TDP)

39 Traffic Diversion Plan (access agreement/arrangement drawings)

40 Logistics Plan

COMPLIANCE & LIABILITY

41 Compliance certificate

42 Undertaking letter

43 Letter of Authorization

44 Letter of Award

45 Liability Letter

46 Insurance Policy

OTHER SUPPORTING DOCUMENTATION

47 Others

48

49

50

51

This list has to be attached to all Third Party PTWs. INFRASTRUCTURE = related to all infrastructure schemes (DR/RO) PIN = related to all building developments and developments on land parcels (PIN=Parcel Identification Number)

= as required = mandatory

= not required



CURRENT RO #

_ _ _ _ _ _

ASSOCIATED DR #

_ _ _ _ _

03




QATAR RAIL

CURRENT RO INTERFACE DRAWING (s)

04




ASSESSMENT/CONDITIONS

QR-CIVIL QR-PMC QR-CONTRACTOR QR-OPERATOR RKH QITARAT OTHER _____________

• Site specific conditions • Interface Control Form ICF • Access Requirements • Operational Requirements • Any other

05




APPLICANT’S

RELEVANT DRAWING (S)

• LOCATION PLAN • SITE SET-UP PLAN • LOGISTIC PLAN • DESIGN (LAYOUT, SECTIONS, PROFIL) • PROTECTION MEASURES • ANY OTHER

06




TEMPORARY

TRAFFIC DIVERSION PLAN (TDP)

&

PEDESTRIAN MANAGEMENT PLAN

07




MONITORING PLAN

• STRUCTURAL MONITORING • SETTLEMENT / MOVEMENT • NOISE & VIBRATION • DUST / WASTE • EMERGENCY RESPONSE

08




OTHER DOCUMENTS

• EMAIL • MINUTES OF MEETING • LETTER OF AUTHORISATION • LIABILITY LETTER / UNDERTAKING /

INSURANCE • TEMPORARY LAND OCCUPATION • QATAR ID • COMMERCIAL REGISTRATION • PROGRAM OF WORKS • ANY OTHER

09




APPLICANT’S

METHOD STATEMENT

& RISK ASSESSMENT

SITE SPECIFIC &

ADDRESS THE RAILWAY - INTERFACE

10




QATAR RAIL

GENERAL CONDITIONS

11


Qatar Rail General Conditions (Infrastructure)


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Printed copy is uncontrolled and only valid at the time of printing. Document: PMTG-QRC-TIF-00023, Rev 21, 22 July 2019

GENERAL CONDITIONS

1. Expiry This NOC is VALID for 6 months from the issuing date. Design approvals are valid for 6 months and construction to start (including associated RO) within this 6 month otherwise the applicant to apply for re-approval / re-validation. Qatar Rail Permit to Work (PTW) is valid 3 months from the issuing date.

2. Validity This consent is VALID for the interface with Qatar Rail Scheme(s) ONLY, and is not considered as approval / acceptance of the technical design content. Valid as per Qatar Rail general conditions, special conditions and overview drawing.

3. Applicability All activities within the Railway Protection Zone require Qatar Rail’s NOC. The Qatar Rail Safeguarding document and Restricted Activities document, and related documents apply. Also as per local construction regulations the applicant is, in any case, required to coordinate their works with authorities, infrastructure owners and neighboring / adjacent schemes and projects.

Refer to QCS 2014 and in particular section 01 part 17, part 18, and part 19. All standards, codes, regulations, guidance documents and laws apply as applicable in the State of Qatar. The latest document revision applies.

4. Pre-Submission Meeting Before the actual submission of the application the applicant shall conduct initial review- and feedback meetings or workshops with Qatar Rail. Such meetings should be scheduled with sufficient time prior to the formal submission and construction start date. Once the interfaces/conflicts are fully coordinated and agreed the formal submission (package) can be processed. Splitting the submission in multiple parts is advised.

5. Submission Design Consultant: concept / preliminary / detailed design (DC1 & DC2) Contractor: construction (for all activities) Traffic Management: every TDP submission [It is recommended to submit major schemes in smaller parts.]

QDRS (DR): Design Consultant / Design & Build Contractor QPRO2 (RO): Contractor / Design & Build Contractor [every RO requires a valid DR approval]

For bigger schemes submissions shall be packaged and submitted following consultation, coordination, and agreement with Qatar Rail and the QR representatives. Submissions and additional or revised information which is issued in multiple iterations via different channels and are not clearly addressed to Qatar Rail GIP (Governmental Interfaces & Permits) will be rejected. Final submissions to be packaged, complete, technically conclusive, and consistent with signatures and stamps.

6. Responsibility It remains the full responsibility of the applicant to ensure and demonstrate that there is no adverse impact on the

Metro & Long Distance & Lusail LRT (trams) network short, medium and long term. Any concerns have to be raised to Qatar Rail and fully coordinated.

The applicant remains fully liable for any of the proposed work & scope as per the application. Any subletting and subcontracting does not exempt the applicant from this responsibility.

7. Coordination Fully liaise, cooperate, coordinate and interface with Qatar Rail and our D&B contractor(s) and the Rail Operator & Service Provider RKH Qitarat prior and during works commencement. You are requested to share design & construction information; working program/timing & sequence of work; commencement and finish date; preparatory works; access & egress arrangements; temporary traffic management (TDPs). In all cases the applicant (i.e. contractor) is first in the sequence of the construction program.

The applicant shall carry out, in coordination with above mentioned parties, impact & structural analysis/assessment, Finite Element Modeling (FEM) to estimate potential ground movements and assess the stress redistribution from TBM tunneling operations (rail), settlements, etc.

Pipelines: consider pipe settlements caused through TBM drive of the rail tunnel and a minimum 1% volume loss for their settlement calculations, etc.), if not agreed otherwise.

Rail piers are designed to withstand the vehicular collision. For protection of the public traffic Road/Highway Safety barriers as per Ashghal’s design standards) can be used.

Flooding & Drainage & Dewatering: the impact on the railway from the applicant’s scheme shall be fully

assessed and included in the design. Rail assets shall be maintained in a fully functional, safe and secure condition. The third party design has to ensure that the station area cannot be flooded at any time.

For critical interfaces we highly recommend the use of a 2-Party NOC agreement (joint NOC).

8. Agreement with Qatar Rail and/or D&B Contractor and/or Rail Operator Qatar Rail Governmental Interfaces & Permits (GIP) Department requires the applicant for ‘live’ rail schemes where

a consultant designer, contractor or both (D&B) and/or a rail operator is awarded, to fully agree the solution to the interface(s) between the applicants design and / or work.

The applicant has to provide evidence of coordination and agreement in form of signed & stamped Interface Control Form ICF, letter, minutes of meeting with unambiguous clear statements, sketches and drawings or particular rail permits. The submitted information has to be complete, consistent with previous correspondence, clear and easy to follow & understand packaged. Refer also to the compliance template in document Third Party Utility Crossing Spec and similar Qatar Rail guidelines.

9. Method / Risk a) All railway schemes:

The designer is required to show the railway interface, risks and measures associated on the drawings. The contractor is required to provide method statement and site specific risk assessment reflecting and addressing the rail interface.

b) Awarded, on-going and live operated railway schemes: The contractor shall carry out their scope and works at interface locations with caution and assigned approved control measures by Qatar Rail. The applicant’s health & safety and quality process shall have documents, checks and briefings containing the rail interface and requirements. This includes physical on-site marking and segregation / protection of rail assets and regular briefings for all involved staff, workers and operators.

THE WORKS REQUIRE A SEPARATE APPILCATION: Drilling & Boring & Piling & Bolting & Anchoring & Diaphragm & Blasting

(and any related works)



2 | P a g e


c) Future planned railway schemes: Refer to 9a. The contractor shall carry out their scope and works at interface locations with caution. The applicant’s quality process shall have documents, checks and briefings containing the rail interface and requirements. The contractor shall follow the approved drawings as agreed with Qatar Rail and conduct regular briefings for all involved staff, workers and operators.

d) The Tunnel critical zone to be marked on site with pole and flags highlighting Qatar Rail Tunnels beneath – this is to be clearly maintained at all time.

10. Program of Works The Contractor shall coordinate the construction program with Qatar Rail and/or the rail D&B Contractor and/or Rail Operator in order to identify timing interfaces (i.e. at crossings, overlapping work zones and where works are likely to be carried out at the same location at the same time) to avoid conflicts and include the findings in their program of works (schedule) when preparing the Baseline Schedule.

This program of works shall be updated and mitigated jointly with Qatar Rail prior and during to your works commencement. In the event of the schemes taking place at the same time a coordinated/mitigated program of works shall be provided prior commencement.

11. Traffic & Pedestrian Management The contractor is required (must) to provide an approved Traffic Diversion Plan for any temporary traffic diversion scheme (TDP) and temporary traffic management in line with the latest WZTMG. The applicant is required to comply with the QDRS and QPRO2 requirement within the Right-of-Way and the NOC requirement within the Rail Protection Zone.

Meeting at MOTC TDP: Temporary Traffic Management – Keep Doha Moving (to coordinate) For coordination initiation contact: Mr. Markus Leppert, Sr. Interface Manager, Qatar Rail, [email protected]

12. Pedestrian Management & Pedestrian/Cycle Connectivity - all proposed works within 400 meters of any rail asset. All developments / construction works will be required to demonstrate that provisions are provided and implemented, to make sure that all access routes to and from x metro station(s), x emergency exit(s) x metro utility building(s) is safeguarded and protected with an approved ‘design and access’ statement to

make sure the pedestrian traffic is continuous during any 3rd party activity within the RPZ/ Public RoW and from private land developments.

The main requirements for Pedestrian / Cycle Connectivity to the Catchment Area of the Stations are:

All pedestrian routes to and from the station up to 400m is to be maintained and kept clear at all times. No illegal car parking on footpaths and places not designated for car parking. Routes shall be safe, secure and unobstructed for all members of public.

The minimum requirements are as follows:

1. Unobstructed width of Pedestrian Walkways 1.8 meter.

2. Maximum cross slope 2.5%

3. Local obstructions (street lighting, sign posts) up to an absolute minimum width of 0.9 meter.

4. Road signage and markings at road crossings.

5. Lowered curbs for equal access. 6. Prevention against vehicle intrusion / illegal parking. 7. No tripping hazards.

Station Area (SAP) Example Station

Bike Paths

Cycling Assumption: 2km

Pedestrian & Bike Paths Walking Assumption: 400m



3 | P a g e


13. Access & Egress Access and egress to Qatar Rail allocated land has to be maintained at all times and throughout all project stages of the applicant. This includes handing over and operation of the applicant’s project, especially when the rail scheme continuous on. Any changes to established temporary traffic management schemes have to be coordinated and agreed with Qatar Rail. The access strategy and/or arrangement has to be clearly documented (ICF with drawings, start/end date, etc.) between the parties and attached to the QR THIRD PARTY PERMIT TO WORK.

14. Emergency Access& Egress (Fire & Life Safety) Any Qatar Rail access related to health & safety (ambulance, Civil Defense) shall be kept clear / cannot not be blocked at all times and no changes to this access road can be made without Qatar Rail approval. Amendments or changes to such emergency access routes require the prior agreement about alternate routes. This is applicable for temporary and permanent road arrangements.

15. Qatar Rail allocated Land / Station Area No work to be carried out on Qatar Rail allocated land without Qatar Railways Company and their PMC / D&B contractor (construction) and RKH Qitarat (railway operation) approval.

16. Damage to Qatar Rail Assets Any damage to a Qatar Rail assets (i.e. property, resources, plant & equipment, possessions, goods and materials, fencing, buildings, etc.) either (temporary) during design & construction or (permanently) during operation, caused by a third party and associated subcontracts will result into holding the third party accountable and liable. All associated costs are at the originator’s account.

17. Updated Information It is the applicant's responsibility to officially (per letter, RFI) request the latest Metro/Long Distance Network Plans in order to identify any potential interface, clash or any other design or construction relevant issue. Your client is receiving a monthly update on the Qatar Rail scheme alignment.

18. Urban Integration & Station Area Planning & Transit Orientated Developments TODs and Park & Ride Facilities (Bus Stops) Comply with Urban/Utility Integration Plans & Drawings UIPs and Station Area Plans (SAPs). The applicant to

confirm their coordination agreement with the SAP designer containing with a drawing showing the road layout and levels and utilities tying into the station area realm.

On top of specific metro stations and within stations areas (refer to SAP) TOD (building developments) will be designed and constructed. The applicant to confirm their coordination agreement with the TOD designer / contractor with a drawing showing the building- and road layout / levels and utilities tying into the station area realm.

There are Park & Ride Facilities with main bus stops planned at designated locations within the metro network (stations Al Qassar, Qqba Ibn Nafie, Al Sudan, Msheireb, Lusail, Al Wakra; subject to update/change). The applicant to confirm their coordination agreement with the P&R designer (MoTC/AECOM and the contractor containing a drawing showing the building- and road layout / levels and utilities tying into the station area realm.

19. Integration & Connectivity The designer/contractor shall ensure and demonstrate full connectivity with the Qatar Rail stations as per the UIP and/or SAP (higher priority) drawings for either the permanent or any intermediate road scheme required to provide an integrated fully functional transportation system (i.e. access strategy, etc.). This means connectivity of the interfacing station(s), emergency exits and utility pop-ups has to be ensured and maintained under all possible scenarios available now and in the foreseeable future at the time of station completion (interim and/or final solution). Completion of any road scheme / connecting roads to the station has

to be fully operational prior to the opening of the rail scheme(s) (tentative, unless otherwise announced by Qatar Rail);

Metro Phase 1 stations operational 2019 (Phase O / Operational) Metro Phase 1a (Green Line UG/EAG), commencement to be confirmed with Qatar Rail Long Distance, Phase 1 – commencement to be confirmed with Qatar Rail. Lusail LRT phase 1 – operational 2019/2020 For interfacing utility schemes programs and work sequence has to reflect this constraint in order not

to jeopardize key and opening dates of the Metro and Long Distance railway.

The above dates require reconfirmation from Qatar Rail via formal request from the applicant. For cases where clarification or further coordination is required contact Qatar Rail.

20. Third Party Hazards & Analysis (required by MoTC) The applicant shall together with Qatar Rail identify rail hazards, risks (i.e. to the road traffic) and assess and develop joint mitigation measures to be implemented.

21. Alterations & Changes There are to be no alterations from the reviewed application, design (drawings), method of work and coordinated agreements. This consent/approval is invalid if the proposed work or part of it is getting carried out by any other authority / designer / contractor than the authority / designer / contractor as mentioned in the application. If there are any changes, Qatar Rail and its contractor must be notified immediately and a new application must be made for NOC and coordination has to take place, this includes any deviation from the original submissions and agreement as this approval will become invalid/ void. Construction must start within 6 month from the date the QR design NOC was provided; otherwise a new application (DR, design re-validation) has to be done.

22. Temporary Works The applicant has to accommodate (responsible for) all temporary/ permanent measures and associated works which may arise from any interface with Qatar Rail related to their own work.

23. Costs All the associated costs and expenses resulting from the applicants proposed design, intended work activities and compliance with these conditions and incidental to the preparation and completion of the applicant’s works are at the applicants account.

24. As-Build Records Qatar Rail will require ‘As Built’ AutoCAD record drawings for your project including depth, location and coordinates QND (95) in PDF- and AutoCAD format. Any associated records related to HSEQ shall be provided on request. Discrepancies between the Qatar Rail interface drawing(s) and associated documents approved by Qatar Rail and the provided ‘As Build’ records, identified at any time, will result in the applicant’s client to carry any costs which may arise from rectifying such differences in order to allow the railway being constructed and operated.

25. Qatar Rail Works at Interface Location Should permits be required to carry out Qatar Rail work, to divert or work around your works, utilities, associated apparatus, and structures then these require issuance within 2 weeks (10 working days) in line with the QDRS and QPRO requirements.

26. Future required Qatar Rail works Any future railway/metro works which are required to be carried out in relation to the applicants works due to interface and/or conflict with our alignment (including all structures, technical/utility pop-ups, pedestrian access) and associated assets are considered as ‘approved in principle’, since already identified and known at the time



4 | P a g e


of this review process and in such case where the need for the anticipated work/development/requirements was foreseen in time (for example: related correspondence from QR, Qatar Rail’s UIP Stakeholder submissions, coordination with QR PMC / D&B Contractors, etc.). This includes: Construction of the railway, related structures, utility works, utility connections, access, land requirements. Diversion, relocation, protection, shifting of or modifications to or dismantling of the utility service (i.e.

crossing), either temporary or permanent, as required for the proper construction and/or functioning of the Railway/Metro/Trams.

In the event of it being necessary in the opinion of Qatar Rail to support or protect the railway tracks, land, works or assets, currently or in future, during or after the execution of any of the applicants works thereof the work of supporting or protecting the railway by installing, removing or restoring of any works as deemed required and fit by Qatar Rail.

27. 3rd Party Access during Railway Operations – IMPORTANT The Metro and Long Distance Railway Corridor will be non-accessible during operations over the width of the Critical Zone, as a minimum. Other access restrictions may apply. Only authorized personal will be permitted and allowed inside the designated corridor. Refer to RKH Qitarat and QR-SDD.

28. Utility Crossing Guidance Document Comply with the latest approved manuals from Qatar Rail. The “Third Party Utility Crossing Guidance” document and guideline for Third Party Utility Interfaces with Metro, Long Distance and Light Rail shall be adhered to including any associated documents. You are required to install suitable protection for your utility scheme over the entire length of the Critical

Zone + 5 meter. The protection measure shall be continuous across the rail corridor, but at least extend across the Critical Zone of the railway.

Installation of spares shall be considered. This is to highlight that future works and access within the Critical Railway Zone of the Railway will be highly restricted due to operational and safety concerns.

Underground and above ground utility apparatus such as poles, manholes, chambers, pull-boxes, etc. is not permitted within the Critical Zone and any fenced off railway zone.

For light rail (i.e. Lusail Tram) the above is applicable and to be read in conjunction with the relevant QR guidelines.

29. Verification prior Construction Start The designer / contractor is required to familiarize themselves with the Rail Permitting Requirements and verify with Qatar Rail the location and design of the proposed works in relation to the rail/metro alignment and structures (underground & at-grade & elevated) prior commencement of their works. The Qatar Rail –Technical Interface Department (TID) representative shall be invited to site before construction / implementation of the respective protection to assure compliance with Qatar Rail requirements.

30. Law & Directive Comply with Law 10 of 2014. The designer of the scheme has to obtain a NOC from Qatar Rail for all design stages within the Rail Protection Zone. The designer and contractor of the works have to obtain a NOC from Qatar Rail for all activities within the Rail Protection Zone. Refer also to Administrative Circular 8 of 2017 from MME under letter 75178/2017 dated 22 March 2017 and Ministerial Circular-6-2018 Circular no. (6) of 2018.

31. Policy Plan Railway corridor as per approved Rail Protection Zone (RPZ) within the CGIS policy plan. Comply with MMUP Policy Plan.

32. Inclusion of known Interface with Qatar Rail schemes The rail interface including all related information and data shall be included in all of your drawings, programs, tenders and relevant documents (i.e. as-built, etc.). Sufficient allowances shall be included to accommodate for

design & construction coordination monetary and program related. The site specific drawings and document (method statement & risk assessment, permits, etc.) shall reflect the rail interface, constraints and other important information.

33. Control & Monitoring (Protection of Railway Assets) The applicant shall ensure that robust control & monitoring schemes are implemented to control and monitor the third party works and their effect on the railway asset (track, tunnel, station, viaduct, etc.). The monitoring scheme (track, structural, etc.) shall be reviewed and approved by Qatar Rail. Such measures and procedures have to cover operations of instrumentation information, installation of instruments, measurement methods, manual and automated collection of monitoring data, automated data streaming, data management, the use of monitoring database and related system components, as well as the contingency action plan when monitoring trigger values are exceeded.

34. Revoking / Cancellation of NOC A violation of any of the conditions prescribed in the provided NOC will render the Qatar Rail NOC and permit void and withdrawn, with immediate effect.

35. Compliance Certification & Liability Letter & Undertaking Letter/Indemnification The applicant is required to provide compliance certification with the conditions stipulated within the NOC document. The applicant is required to provide a Liability/Undertaking Letter prior to the commencement of the works for interfaces with existing railway assets.

36. Non-Compliance Non-compliance with Qatar Rail conditions will result in the applicant / company being notified of the non-compliance and the revocation / cancellation of the NOC takes immediate effect for this particular case. Continuous non-compliance will result in the NOC applications and/or DRs/ROs by this designer/contractor, ‘approved’ or ‘under review’ for this particular scheme, will be ‘on hold’. Continuous non-compliance will result in the designer/ contractor being blacklisted. Continuous non-compliance will result into all NOC requests from the authority will be ‘on hold’. At the discretion of Qatar Rail a “Stop Notice” will be issued. Until compliance has been demonstrated by the applicant and verified by Qatar Rail above actions will remain in place.

37. Back Charge of Costs Qatar Rail reserves the right to back charge all the associated costs and expenses resulting from non-compliance with Qatar Rail’s conditions and incidental to the preparation and completion of the applicant’s work are at the applicants account.

At a time determined by Qatar Rail, Qatar Rail will design & build all necessary works to protect the Metro/Railway and the utility service following the non-compliance. The non-compliant agency/authority/ 3rd party will carry all future costs related to the protection measures as required and deemed suitable by Qatar Rail. This contains all associated activities/tasks to deliver a fully functional & safe system and includes any charges arising from shut down, maintenance, start-up, penalties, 3rd party claims, loss of profit, etc.

38. Qatar Rail’s Third Party PERMIT TO WORK Prior to starting your work (activity) on site the applicant is required to obtain a permit to work from Qatar Rail.

39. Dilapidation Survey (condition survey) The third party contractor shall carry out a pre-condition survey prior to starting your work (activity) on site in presence of Qatar Rail representative and RKH Qitarat. Same applies for the post-condition survey.



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40. Site visit / inspection Qatar Rail (or appointed inspectors on behalf of Qatar Rail) will conduct site inspections verifying the conditions and requirements stipulated in the provided NOC (DR, RO) and permit to work.

41. Permit Close-Out i. The third party contractor shall carry out ii. Pre-Dilapidation Survey iii. Joint Inspections during works commencement iv. Snagging; Non-compliances must be closed for partial acceptance. v. Post-Dilapidation survey and vi. Closing of the Qatar Rail Permit to Work to start the liability period of 365 days (partial acceptance). Non-

compliances must be closed for partial acceptance. vii. At the end of the liability period final inspection/snagging shall be carried out to obtain final completion &

acceptance from Qatar Rail.

42. Insurance Policy by Third Party The third party shall include Qatar Rail as the named company co-insured in their insurance policy. In particular cases Qatar Rail reserves the right to request a bond insurance; as deemed required. The third party (contractor) shall have adequate insurance coverage.

Relegated QR Documents (latest versions apply): 1. Qatar Rail Safeguarding Document 2. Guidance for Third Party Restricted Activities ( 3. Third Party Utility Crossing Guideline / Spec (TM-208-SR01_Utility_Crossing (manual)) rev 2 4. Typical plan_COMB (typical drawings) 5. OHL-DwgTyp_QRC_11Oct2016 (Overhead power line crossing railway) 6. Guidelines for Utilities Interface with Light Rail Transit 7. Guidance Document for Third Party Grade Separated Structures 8. Guidance Document for Third Party Structural Interventions on Existing Qatar Rail Assets 9. H&S: QR_Metro Safety Awareness Event_Leaflet 10. H&S: QR_AWARENESS (Poster) 11. H&S: QR_METRO_SAFETY_AWARENESS_NOTE

QR Permit to Work: 1. TM-215-F06-Permit_to_Work 2. TM-215-F08-Permit_to_Work_Contents_List_Index 3. TM-215-F11-Dividers_PTW_Infrastructure 4. TM-215-F04-Location_Verification_Validation 5. TM-226-F01-Confirmation_of_Inclusion_of_Station_Area_Plan_Design 6. TM-215-F16_Bridge_Headroom_Check_Sheet 7. TM-215-F17_Certificate_of_Design_and_Checking 8. TM-215-F15_Dilapidation_Condition_Survey 9. TM-215-F14 Closing of Permit to Work (Liability Period)

(QR documents will be constantly added and updated)

INCIDENTS & ACCIDENTS TO BE REPORTED TO QATAR RAIL IMMEDIATELY (AS SOON AS REASONABLY POSSIBLE).

Drilling & Boring & Piling & Bolting & Anchoring & Diaphragm & Blasting Works* (and related works)

ALL WORKS AS NOTED ABOVE (*) REQUIRE A SEPARATE APPILCATION AND APPROVAL FROM QR DRILLING IN THE CRITICAL / EXLCUSION ZONE IS NOT PERMITTED.

1. Method Statement / Risk Assessment Drilling & work method - The contractor to provide Method Statement / Risk Assessment and Program of Works to Qatar Rail prior to the works commencement. In the event of the schemes taking place at the same time with QR works, a coordinated/mitigated program of works shall be provided. Where drilling support fluid is proposed, the fluid shall be selected to avoid potential ingress of fluid into the nearby tunnels, for instance from transmission of the fluid through fissures in the ground.

2. Location Provide location plan, detailed drawings with diameter, depth, inclination and coordinates (and AutoCAD). Your temporary trial pits / bore holes / trenches can be located on top of our metro / long distance alignment. Depth restriction for your works can be applied maximum depth in meter QND(95)

3. Reinstatement All trial pits/bore holes/disturbed surfaces by trench excavations or similar shall be reinstated by the contractor to match existing and adjacent ground. Boreholes shall be grouted, unless otherwise agreed with Qatar Rail. Evidential information to be provided to QRC.

4. Monitoring and Reporting Monitoring of drilling/excavation activities is mandatory. Monitoring scheme to be agreed with Qatar Rail.



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DESIGN - STATION AREA PLANNING SAP Surface Level Works at Stations / Emergency Exits

Compliance with latest approved SAP design is mandatory. Approved SAP Design Metro Phase 0 (Constructed/Existing Metro) - Qatar Rail states that as per the agreement between Qatar Rail and Ashghal, the Station Area Planning (SAP) has been designed by Ashghal’s Consultant Gannett Fleming, and has been approved by Ashghal and issued to Qatar Rail for construction as per the SAP drawings stamped by Ashghal.

METRO Stations & EE (Emergency Exits) Full integration of Station design including access/egress roads to be carried out and complied with. Provide signed (filled out) “SAP Inclusion Form”.

SAP Condition (1) - COMPLIANCE a) Full compliance with and integration of the PWA approved Station Area Planning SAP design. b) Any changes / amendments to the approved design have to be re-approved via the SAP Approval Process. c) Present to the meeting: Qatar Rail Tower, C-Ring, every Tuesday, 8:30am, 12 floor. d) Contact: Shripad Korantak, Qatar Rail ([email protected]) or Slawomir Mieczyslaw Kaszewski, Ashghal

CFO ([email protected]) e) MOTC approval is required. Contact : Mr. Durga Mahesh Kasani ([email protected]); Mr. Vinod

Ayyappa ([email protected])

SAP Condition (2) – TEMPORARY TRAFFIC MANAGEMENT Temporary Traffic Management (diversions, tie-ins, etc.) at Metro Stations, Emergency Exits and metro neuralgic locations (i.e. emergency routes, etc.) must be fully coordinated with Qatar Rail and approved by Qatar Rail.

SAP Condition (3) – OPERATIONAL METRO Metro Operations scenario with the third party proposal shall be coordinated and agreed with the Qatar Rail Service Delivery Team and RKH-Qitarat.

SAP Condition (4) – KEEP PEDESTRIANS MOVING Pedestrian routes around the station to be constructed to the minimum requirements, see QR General Conditions. Obtain information & requirements from Eng. Rami Jandali, Qatar Rail ([email protected]).

TEMPORARY TRAFFIC MANAGEMENT STATION AREA PLANNING Requirements

Construction of SAP Design Qatar Rail’s Metro Civil Contractor and REDCO International constructing/implementing the SAP Design.

Third Party SAP Coordination Qatar Rail as part of their General Condition requires the third party to coordinate their design with Gannett Fleming or the respective person within Ashghal in order to avoid any abortive works related to Ashghal’s SAP design.

Third Party Introduced Changes to SAP Design In order to avoid unnecessary costs and abortive works, we hereby request the third party contractor to inform Ashghal to inform Qatar Rail immediately about any intended changes in the SAP design.

Third Party Minimum Requirements Below is the list of the minimum requirements which the third party authority (i.e. Ashghal, Kahramaa, etc.) and its

consultants & contractors for their Projects shall consider and incorporate in any interface and amendment to the existing SAP approved by Ashghal, in addition to all temporary and permanent works proposals:

a) Qatar Civil Defense (QCD) Requirements Uninterrupted (24/7) access/exit from and through the service road to the Roads/ Emergency Vehicle routes, noting that fulfilling QCD requirements for minimum road width must be maintained. This applies to all remote emergency exits also.

b) Operational Readiness Requirements i. Uninterrupted safe and functional accessibility must be maintained by the third party at all times for

pedestrians, cyclist and drop off facilities (equal access parking, bus and taxi drop offs) during all phases of TTM with proper signage as per temporary works Qatar Highway Standards and traffic regulations WZTMG.

ii. TTM plans for all phases must be submitted to Qatar Rail‘s consent as per usual process prior to its implementation. TTM plans and Traffic Control Plans must demonstrate the safe access to pedestrians/cyclist and drop off facilities.

iii. The third party must maintain and incorporate all the elements of Ashghal designed and approved SAP including feeder & network (commuter/city) bus bays, equal access parking, private car and taxi pick-up and drop-off bays in the new design.

iv. The above facilities must be maintained for each metro entrance shelter. v. The walking distances from drop off facilities to metro entrances must be in line with approved SAP (walking

distances from bus bays in SAP are within 20m -30m). Always shortest possible route. vi. The road design must follow traffic calming measures and pedestrian crossing facilities as per SAP.

CONSTRUCTION – STATION AREA PLANNING The area around Stations like Entrances, Emergency Exits or

Utility pop-ups and related Assets. QATAR RAIL STATION AREA & EMERGENCY EXITS For any of the above mentioned activities, if within Qatar Rail Protection Zone (RPZ), the owner of the utility has to apply for a permit from Qatar Railways Company.

QATAR RAIL PERMIT TO WORK For any of the above mentioned activities, if within Qatar Rail Protection Zone (RPZ) and particularly at Station Areas & Emergency Exits & Railway Assets, the owner of the third party asset (proposed, planned, to be under construction) has to apply for a permit from Qatar Railways Company. Statutory requirements apply.

OPERATIONAL DOHA METRO & LUSAIL LIGHT RAIL TRANSIT (TRAM) The OPERATOR (Qatar Rail) in conjunction with the SERVICE PROVIDER (RKH Qitarat) is maintaining and operating the railway networks within the Rail Protection Zones.

SPECIAL PERMITS & APPROVAL (RKH Qitarat) might be required in order to ensure OPERATIONAL SAFETY of the railway system. Potential Impact on the railway system/operations:

1. Station Area (dust, noise, vibration, damage) 2. QR structure & utilities (vibration, damage) 3. Visual nuisance 4. Wayfinding 5. Segregation 6. Waste management (flying debris) 7. Metro related movements due to plant & machinery movement, deliveries



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8. Pedestrian & cycle connectivity (walking routes) 9. Public traffic flow for public transport (bus, etc.), cars, etc. 10. Emergency & maintenance traffic 11. Qatar Rail’s feeder bus services around the entrance.

THIRD PARTY WORKS It is the road-, asset-, utility owner’s sole responsibility for his utilities to carry out routine maintenance, renewal, changes, adjustment, revitalization, replacement, repairs and emergency actions unless otherwise coordinated and agreed with Qatar Rail.

INPSECTION & MAINTENACE WORKS For the inspection and maintenance of utilities located within the Rail Protection Zone the Utility Owner shall submit an Inspection and Testing Plan to Qatar Railways Company.

Every owner of a utility installed under a railway or within the RPZ shall at all times maintain their assets in good working order and condition, so that:

• the safety of railway operations is not jeopardized, put at risk, interrupted or threatened in any manner; • the safety of the public, including the lives, well-being and health of people is safeguarded; and • the environment is protected

IMPACT TYPES

TYPE DESCRIPTION REQUIREMENT 1 2 3 4

CHANGE TO SAP (including Emergency Exit arrangements / access road) CROSSING THE SAP& LOCALIZED WORK WORKS UNDER RAIL VIADUCT WORKS UNDER RAIL VIADUCT – with access obstruction

1. Railway Operational requirements apply for the metro and LLRT. Once the metro is operational, works might only be possible during engineering hours (i.e. night

time or particular time slots); subject to RKH approval / subject to change. 2. Install your works prior (physical works where an impact on the Station Area

including access roads is expected from your works. 3. You are also kindly requested to coordinate/bundle amongst OTHER

AUTHORITIES and your efforts as much as possible, to minimize the impact. 4. Access to the metro stations cannot be blocked. 5. Emergency related elements, routes and assembly areas must be maintained. 6. The site shall be tidy, clean, controlled & organized. 7. In any case, full reinstatement will be with the originator to Qatar Rail Quality &

Material Standard. 8. The disturbed area shall be handed over / dilapidation survey and handed back.

There will be partial and final completion after liability period. 9. The usual requirement of “making the site safe” applies. Refer to QR General

Conditions & Manuals.

EXAMPLE



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INTENDED WORKS AFFECTING SAP OR QR ASSETS As-Build drawings: Applicant to obtain IFC or ‘as-built’ information from Qatar Rail

a) Metro JV (SAP, structures, related utilities) b) REDCO-SAW (SAP, related utilities)

Superimpose & clash detection & solution a) Applicant to overlay the IFC or ‘as-built’ information from QR with the proposed scheme. b) Conduct clash analysis & Conduct impact analysis c) Propose solution(s)

Design Submission (QDRS Design Review for Approval) a) Design must reflect fully functional SAP. Demonstrating SAP compliance. b) The road curb lines must be in line with the SAP design (and not affecting utilities & SAP furniture). c) The SAP provisions for the lay-bys areas/ parking in addition to the EV access shall be considered in

the design. d) Emergency routes/facilities (Fire & Life Safety) & Assembly Points (access) to be maintained. e) The architectural (materials) design shall be the same as the SAP.

QPRO2 (Road Opening Application before starting construction) a) RO information must contain (DR) design reflecting fully functional SAP. b) Method Statement & Risk Assessment & HAZOP Analysis c) Pedestrian Connectivity d) General Accessibility to the Station (bus, Metro Link, emergency & maintenance, etc.)

QR-Permit to Work (last stage before starting construction) a) Do not request PTW unless points in DR and RO are & satisfied (approved). b) Provide Untertaking Letter. c) Complete PTW for construction and implementation. d) Carry out Handover & Handback and start of liability (365 days).

# CONTROLLING (Traffic) TYPE 1 TYPE 3 TYPE 4 1 Site Set-up: Site office, storage & lay-down areas CANNOT be located on SAP area. 2 Only small machinery and hand tools permitted. 3 Protect existing assets, surfaces and furniture and maintain proper housekeeping, waste

management, and management of fire risks, flooding, noise, dust, smell and vibration. 4 Keep vehicles and people apart. Provide hoarding and barriers. (Separation)

The best way to protect pedestrians is to make sure people and vehicles cannot interact. Where powered mobile plant is used at our workplace, we must ensure it does not collide with pedestrians or other powered mobile plant. This can be achieved by not allowing vehicles on site into pedestrian spaces or not allowing pedestrians in vehicle operating areas (segregation). However this may not be always be reasonably practicable at our workplace. Where people and vehicles cannot be separated we should consider using:

• Hoarding • barriers or guardrails at building entrances and exits to stop pedestrians

walking in front of vehicles • high impact traffic control barriers • temporary physical barriers, or • separate, clearly marked footpaths or walkways

5 Provide clear public vehicular, pedestrian routes & QR emergency / maintenance routes. Provide work access strategy, public access strategy, traffic / pedestrian management, phasing / shift work, working hours.

6 Limit vehicle movements or speed. 7 Avoid the need for vehicles to reverse. 8 Provide dedicated loading, unloading and parking areas for worker. 9 Provide a safe area for the driver and worker. 10 Provide clear signage road/area markings.

Pedestrian routes and intersections shall be clearly marked with wayfinding signage, unobstructed, well maintained and well lit (illumination).

11 Ensure effective workplace communication. 12 Comply with QCS 2014 Section 1 Part 10 Occupational Health and Safety (related pages)

Safety and security procedure, warning signs, lighting, adequate barricades, railing, reduced & control speed

Access to properties shall be maintained. Watchman, banksman to be assigned. Designated pedestrian routes to be provided. Method statement and job hazard analysis for all activities.



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# INTERFACE REQUIREMENTS TYPE 3 - WORKS UNDER VIADUCT 1 Elevated & At-

Grade Access for QR maintenance & inspection:

a) For inspections and regular cleaning (during day and night) by foot (only walking) and with MEWP mobile elevated platforms.

b) Dedicated, suitable access point and route. Special measures to gain access to be avoided.

c) Level, solid and suitably stable ground able to withstand maintenance vehicles and works in general

d) No major obstruction (bollards, planters, lighting column, manholes, hills, barriers, fencing); if possible.

e) If third party buildings are in the vicinity (i.e. substations), working above and around such buildings must be permitted for the purpose of metro maintenance.

f) Maintenance / inspection must be permitted: Structure (sub- and superstructure), waterproofing, drainage system, bearings, cover plates at bearings, corrosion monitoring, expansion joints, earthing & lighting protection, protective coating, handrail, fencing, retaining walls, access gates & stairs, remote entrance, glass facade and associated elements, CCTV cameras, equipment, MEP & HVAC system equipment, Lighting and illumination, signaling and systems equipment, utility supply (electrical, portable water, TSE, Storm, Foul Sewer, Chilled Water, Irrigation, etc.), septic tanks, holding tanks, ponds, rail plantation, etc.

2 QR Emergency Access

Unobstructed & unrestricted, safe access must be maintained at all times. Diverting emergency routes must be agreed with Qatar Rail. Emergency assembly areas and parking areas must be maintained.

3 QR drainage / ponds

Must be maintained or adequate replacement to be agreed with Qatar Rail.

4 QR Utilities QR utilities to be maintained (electrical, portable water, TSE, Storm, Foul Sewer, Chilled Water, Irrigation, etc.), septic tanks, holding tanks QR utilities cannot be altered, changed, removed, and blocked without Qatar Rail approval.

5 Flooding & Drainage & Dewatering

The impact on the railway from the applicant’s scheme shall be fully assessed and included in the applicant’s design. Rail assets shall be maintained in a fully functional,

safe and secure condition. The third party design has to ensure that the station area cannot be flooded at any time.

6 QR substructure Station structure / Footings / Pier / Drainage / Earthing / etc. Assessment required by third party. Adequate measures by third party, as required and agreed with QR. Related pipes, ducts, cables and other railway elements/furniture must be maintained and/or protected as agreed with Qatar Rail.

7 QR Structure Third Party structural works require provision of impact assessment. Adequate measures by third party, as required and agreed with QR.

Soft / hard landscaping

Non-invasive, conduct hazard analysis and risks and assess and develop joint mitigation measures to be implemented in relation to railways.

8 Manual & Requirements

QR Restricted Works Manual and associated guidelines apply. QR assets shall be protected from any impact, damage, etc.

9 Maintanenance Third party maintenance works to be carried out not to affect the railway. Works must be agreed with QR Service Delivery Department (Operator). QR maintenance works cannot be obstructed.

INTERFACE REQUIREMENTS TYPE 3 - WORKS UNDER VIADUCT

OPERATIONAL DOHA METRO & LUSAIL LIGHT RAIL TRANSIT (TRAM)

The OPERATOR (Qatar Rail) in conjunction with the SERVICE PROVIDER (RKH Qitarat) is maintaining and operating the railway networks within the Rail Protection Zones. SPECIAL PERMITS & APPROVAL & AGREEMENTS (RKH Qitarat) are required in order to ensure OPERATIONAL SAFETY of the railway system. Third Party to maintain at all times:

a) the safety of railway operations is not jeopardized (risk assessment) and interrupted or threatened in any manner;

b) the safety of the public, including the lives, well-being and health of people is safeguarded; and

c) protection of the environment in accordance with MME regulations

Third Party to provide prior to starting the intended works: a) Method statement / risk assessment with all necessary drawings b) Traffic Diversion Plan / drawing c) Pedestrian management plan / drawing d) Access strategy e) Monitoring plan (vibration, dust, noise, etc.) f) Structural monitoring, depending on type of works, severity of impact and potential

adverse effects on rail infrastructure



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RAIL PROTECTION ZONE – Emergency Exits & Access Roads

PROTECTION OF RAIL INFRASTRUCTURE All work carried out on or near railway lines shall require special protective measures to be implemented to prevent damage to the rail assets.

These measures shall be considered at an early stage of the work proposals and submitted with method statement/risk assessment at the time of NOC application. Where required by Qatar Rail, protective measures shall be designed, constructed, maintained and removed on completion as directed by Qatar Rail.

Excavation in the vicinity of structure footings are therefore not permitted unless documented engineering advice and approval are obtained from Qatar Rail.

No excavation shall be made below the base of the footings of any structure (for example bridges, retaining walls and station platforms) without prior analysis of structure stability with respect to the effects of the excavation.

CHECK AND COMPLY WITH “QR RESTRICTED WORKS” MANUAL HEALTH & SAFETY AT OPERATIONAL RAIL INTERFACES

1. Prioritize Areas of Risk at our Workplace. 2. Identify appropriate Design & Construction Controls. 3. Site specific coordinated drawings, plans, and sequence/stage schematics 4. Method Statement & Risk Assessment 5. Monitoring Regime 6. Review, Revise, Prepare traffic management procedures and Plans. 7. Provide Emergency Procedures & Contacts (information). 8. Allocate Responsibility and clear line of Communication.

MINIMUM CHECK-POINTS BEFORE APPROVAL Work access strategy, public access strategy, major events, site segregation/fencing, site traffic crossing-points, traffic / pedestrian management, phasing / shift work, working hours, housekeeping, waste management, noise / dust, vibration, etc.

NOISE / DUST / VIBRATION generated on the existing tunnel structure during any of Works must not exceed the local/international value for the peak particle velocity.

PLANT (MACHINERY) & CRANE MOVEMENTS All work carried out on or near railway lines related to machinery and equipment used which can potentially put the railway at risk requires special measures to be implemented to prevent damage to the rail assets.

METHOD STATEMENT / RISK ASSESSMENT - Refer to page 2, point 9

EMGERGENCY RESPONSE PROCEDURES / PLAN Emergency response procedures shall be developed by the applicant for all project phases and submitted to Qatar Rail for approval. Construction / operation: For all risks which could arise in a Health & Safety concern; i.e. to handle a situation in which a

pipeline leak or railroad derailment or any incident may jeopardize the integrity of the pipeline/cable and/or railway line.

all applications shall include a section for ‘Fire Safety’. Any utility and device, apparatus, building,

stations or similar related is required to fully comply with the latest fire safety standards, codes and regulations for the State of Qatar.



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Particular attention shall be given to underground services as follows; substances and surroundings with a high risk and likelihood by its nature highly flammable contents; substances with risk of explosions; areas with explosive substances areas and substances with risk of external sabotage and attacks

OPERATION & MAINTENANCE PLAN The Operation and Maintenance Plan shall be provided and the regime shall be clearly defined in coordination and agreement with Qatar Railways Company.

USE & OCCUPANCE PLAN The applicant shall provide a statement regarding the extent to which facilities they are expecting to occupy, shall be available, if at all, for the use of other stakeholders and include terms and conditions of such use to be agreed by Qatar Rail and other relevant stakeholders. This might be related to general maintenance in this area or emergency access requirements. If facilities will or have be available for others a Use and Occupancy Plan shall be provided to Qatar Railways Company.

PROGRAM OF WORKS The Contractor shall coordinate the construction program with Qatar Rail and/or the rail D&B Contractor in order to identify timing interfaces (i.e. at crossings, overlapping work zones and where works are likely to be carried out at the same location at the same time) to avoid conflicts and include the findings in their program of works (schedule) when preparing the Baseline Schedule. This program of works shall be updated and mitigated jointly with Qatar Rail prior and during to your works commencement. In the event of the schemes taking place at the same time a coordinated/mitigated program of works shall be provided prior commencement.

TRAFFIC & PEDESTRIAN MANAGEMENT The contractor is required to provide an approved Traffic Diversion Plan for any temporary traffic diversion scheme (TDP) and temporary traffic management in line with the latest WZTMG and MME requirements. The applicant is required to comply with the QDRS and QPRO2 requirement within the Right-of-Way and the NOC requirement within the Rail Protection Zone.

GENERAL PROCESS for ROW / PIN / QR-SAP Area

(A) Public Right-of-Way (ROW)

The station area planning is public realm and utility corridors are (or will be) located within the ROW without exception. As such, a process already exists (QDRS/QPRO2) to manage and control access and installations. Qatar Rail is reviewing authority in the PWA online approval system and will respond to all applications.

i. Follow and comply with statutory requirements and the QDRS / QPRO process. This includes emergency works.

ii. Inform bus-, taxi- and related companies at least 2 weeks before commencement of the intended works. iii. Once the Metro becomes operational specific conditions for access may apply, see point (C). Inform

Qatar Rail Operator and Service Provider at least 2 weeks before commencement of the intended works.

iv. Coordinate all works within Rail Protection Zone with Qatar Rail.

(B) Public & Private Land – refer to MME Building Permit Complex BPC process and as above ii, iii, iv. Qatar Rail is reviewing authority in the MME BPC online approval system.

(C) Qatar Rail Land (Station Area) – including areas around stations, station entrances, emergency- &

maintenance access, utility buildings, service routes, fenced-off rail related areas. As the Metro relies on pedestrian accessibility for daily operations and requires uninterrupted access for emergency services / maintenance to ensure safe operations it is likely the requirements for undertaking works adjacent to the Metro will be more specific, better regulated, inspected to ensure compliance and punitive in the event of specific non-compliances.

i. Follow and comply with Qatar Rail requirements. Refer also to QR document TM-208-SR01 Rev 2, chapter 4.16 Maintenance of Utilities, 7.2 Emergency Response Procedures / Plans, 7.3 Operation and Maintenance Plan, 7.4 Use and Occupancy Plan

ii. Follow and comply with QR Service Delivery / Operator RKH Qitarat requirements, i.e.: a) Particular access & operational requirements will be communicated via the Service Delivery Team to

all Stakeholders that have potential works within the ROW at the appropriate time. b) Emergency vehicle access (ambulance, fire engine, maintenance) as well as safe exiting for people

from the area to be maintained at all times. c) Provision of Method Statement & Risk Assessment, drawings, program of works. d) Work areas, access routes for workers, members of the public and rail staff have to be clear, safe and

secure (access strategy). e) Work program to be clear and mitigated to ensure minimum impact on rail operations. f) Reinstated to be done to the existing conditions. g) RKH will provide access control to the Qatar Rail Network under their Permit to Work. h) RKH will provide an operational and maintenance impact advice on the 3rd party proposal in order to

put protection and monitoring in place for the operational railway, as and if required (to ensure safe rail operations).

i) Utility maintenance & Emergency - It is advised to establish a standard process with the Operator/Service Provider RKH Qitarat.



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0 1

Three (3) Typical Cases

Third parties to follow the statutory approval process via Ashghal’s

QDRS /QPRO2 (in ROW) and MME Building Permit applications

(plots/PIN). PTW process and comply with the requirements under

Law 10 of 2014. Qatar Rail Dept.’s (design/construction /structural

impact); Service Delivery / RKH to review and identify / operational

impact; necessary measures

New Construction including replacement,

revitalization; use of MME corridors Standard

Maintenance Works within specified area

(reoccurring, regular) Standard

Emergency Works within specified area Standard (Emergency Notification to RKH Qitarat/QR-SDD)

0 2


Rail Operated Area:

• Work zone handover to applicant with access permission;

operational requirements

• Excavation, pipe/cable installation, testing & commissioning,

backfilling, reinstatement

• Inspections by QR or appointed person

• Work zone hand-back to Operator / RKH (closing of permit)


revitalization; use of MME corridors Standard


(reoccurring, regular) Standard

Emergency Works within specified area Standard

0 3 (maintenance)


Standard Maintenance:

• Third party to provide Maintenance Plan and requirements in line

with QR requirements

• Method Statement + Health & Safety + risk assessments

• Access for public traffic, pedestrians, and Rail maintenance &

emergency to be maintained at all times. (safe & secure)


revitalization; use of MME corridors

Beneficial;

A standard process can be agreed


(reoccurring, regular)

Beneficial;


Emergency Works within specified area Beneficial;


PROCEEDING WITHOUT QATAR RAIL APPROVAL.

1. The Applicant’s proceeding with the proposed / intended work activities (disciplines) without complying with the:

i. Statutory requirement to obtain DR approval… ii. Statutory requirement to obtain RO approval... iii. Obtaining approvals for works within parcel boundaries via MME Building Permit Complex BPC online

approval process… iv. Qatar Rail requirement to obtain Permit to Work approval AND obtain signatures from concerned

parties… v. Obtaining / complying with the requirements of the operational / live railway (Doha Metro, Lusail LRT,

etc.)… …is on the Applicant’s OWN RISK & full LIABILITY.

2. The Qatar Rail Approval is valid only for activities (disciplines) provided and attached to the applications (AutoCAD / PDF format) and can be (electronically) superimposed on the Qatar Rail Network Scheme for detailed review & assessment. Mismatching information and descriptions may be rejected.

3. Work description in “writing” only is deemed as not acceptable for a detailed review.

ELECTRICTRICITY (POWER) SUBSTATIONS KAHRAMAA ELECTRICITY APPROVAL Qatar Rail requires sight of the KM-E approval for the substation design and construction.

On Parcels (PIN) Locations 1. All substations which are within parcel (land) boundaries are required to go via MME Building Permit Complex

BPC online approval process. 2. All substations require Parcel Identification Number (PIN) allocation by MME.

WITHIN Public Right-of-Way ROW Qatar Rail’s conditional approval is only related to works within the Rail Protection Zone & ROW for substation(s) within the ROW, subject to (on the basis of):

1. Obtaining valid approved DR/RO. 2. Obtaining QR PTW 3. Final IFADA, DC1 / DC2 approval by PIN allocation from MME 4. Qatar Rail’s final approval via MME BPC online process (QR is part of the system) OUTSIDE Public Right-of-Way ROW (within land parcels) Substations which are allocated outside the Public Right-of-Way ROW are excluded from any QDRS/QPRO2 approval since the MME BPC online process is applicable.



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OPERATIONAL RAILWAY – METRO – LIGHT RAIL

HEIGHT CLEARANCE (MIN. 6.50 METER)

Road, Directional Signage & Totem Marker

1. Supply The full responsibility of the applicant to procure, ship, store and deliver to the location of installation. This includes all approvals, permits and other regulatory or state requirements (customs, etc.).

2. Installation The full responsibility of the applicant to procure, ship, store and deliver to the location of installation. This includes all approvals, permits in accordance with state and authorities’ requirements. Position signage not to obstruct safe walking routes.

3. Relocation of Signage Signage and associated shall be protected and stored safely. Inventory list to be provided to Qatar Rail with location and photographs.

ENERGIZED RAILWAY HIGH VOLTAGE

Sign Face / Board Sign Post

Footing



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Compaction & Vibration 1. Duty of Care

The applicant is fully responsibility (duty of care) during backfilling over Qatar Rail structures, but also for demolition activities to provide fulltime supervision during the entire backfilling operation. The contractors supervisor shall at all times be in contact with the relevant Metro/LRT Operator in order to notify each other in case of irregular occurrences related to either structural behavior, vibrations, noise or any other adverse situation arising from the 3rd party work and affecting the metro/LRT.

2. Impact assessment (vibration, etc.) The applicant shall conduct an impact and risk assessment based on the method of construction and the interfacing Qatar Rail asset. Adjustments to methods and/or monitoring systems must be installed based on the risk assessment and Qatar Rail’s review, regulations and risk categorization.

3. Installation The full responsibility to comply with accordance with state-, authorities’ requirements and Qatar Rails conditions is with the applicant This includes all approvals, permits.

NOTES:

Load Impact Vibration

Noise

Railway Underground

Structure

LOAD



QATAR RAIL

CONTACT LIST

12


Qatar Rail Contact List


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Printed copy is uncontrolled and only valid at the time of printing, QR Contact List ‐ Rev 26, 15 January 2020

# QIRP Line PH Contact Company Email 0

1

Technical Interface ‐

Permitting ‐ NOC ‐ DR/RO

– Traffic Management

All phases

Mr. Markus Leppert, Senior Interface Manager Qatar Rail [email protected]

Mr. Mohammad Abdelaaty, Sr. Infrastructure Engineer Qatar Rail [email protected]

Mr. Selvaraj Andiyappan, Infrastructure Engineer Qatar Rail [email protected]

Mr. Abdelrahman Mohamed, Infrastructure Engineer Qatar Rail [email protected]

Mr. Ahmed Abdulrazaq A A Al Muslih, Civil Engineer Qatar Rail [email protected] (77471375)

Mr. Praveen Krishna Dev, Infrastructure Engineer Qatar Rail [email protected] (3044 8795)

0

2

Technical Interface ‐

Permitting ‐ NOC ‐ PIN –

Building Development

All phases

Mr. Ashwin Rabadia, Technical Interface Manager Qatar Rail [email protected]

Mr. Mohamed Ali Eissa, Technical Interface Engineer Qatar Rail [email protected]

Mrs. Fadia Amro, Technical Interface Engineer Qatar Rail [email protected]

Mrs. Dana Nabil Enaya, Technical Interface Engineer Qatar Rail [email protected]

Mr. Fahad Al‐Muftah, Interface Manager Qatar Rail falmuftah @qr.com.qa

Email for land parcels (developments) Qatar Rail [email protected]

Email for DR & RO & PTW Qatar Rail [email protected]

Third Party Permit to Work (PINs) Qatar Rail [email protected]

0

3

QR‐Rail Inspector ALL Mr. Trinadha Rao Bodetti, Surveying Eng. (7022 6846) Qatar Rail [email protected]

Mr. Qaisar Imtiaz, Surveying Eng. (7727 1342) Qatar Rail [email protected]

Mr. Darcelon Aquino Reyes, Inspector (3316 6437) Qatar Rail [email protected]

Mr. Frederick D. Fernandez, Inspector (50452539) Qatar Rail [email protected]

OPERATIONAL (O&M) DOHA METRO & LUSAIL LRT (TRAMS) Building 14 in Ras Bu Fontas Depot

O

&

M

Service Provider

(Operation &

Maintenance O&M)

Metro & LLR

T Phase 1

Mr. Amit CHAKRABORTY, Civil Interface Mgr (30018117) RKH‐Qitarat [email protected]

Mr. Ashutosh BARANWAL, Civils & Tracks Mgr (31568073) RKH‐Qitarat [email protected]

Mrs. Susan JEOJU, Civil Engineer (33403384) RKH‐Qitarat [email protected]

Mr. Mohammad ZAMAN, Systems Eng (3041 6817) RKH‐Qitarat [email protected]

Mr. Samir Husein, Project Manager (5001 2189) EGIS Red Line Samer.HUSEIN‐[email protected]

Mr.Chadi Saliba, Project Manager (33100924) APAVE

Green & Gold

[email protected]

Protection Zone Application ‐ This share mailbox is dedicated to any mail exchange related to RKH PTW application request

RKH‐Qitarat [email protected]

This share mailbox is dedicated to any mail exchange related to RPZ information.

RKH‐Qitarat [email protected]

Qatar Rail Operator

(Service Delivery

Department SDD)

Mr. Nitish Singh, Operational Readiness Manager Qatar Rail [email protected] (4433 1426)

Mr. James Bromley, Senior Metro Manager (44331917) Metro [email protected]

Mr. Miguel Martins, O&M Manager (44331762) LLRT‐O&M [email protected]

Mr. Michiel Smuts Lombard, Senior Emergency, Security & Crisis Management Manager

Qatar Rail [email protected]

STATION – CONNECTIVITY & ACCESS

SAW

STATION AREA WORKS &

Pedestrian Connectivity

Works (managed by Qatar

Rail site teams/ PMC)

MET

RO PHASE 1

Mr. JAZIB MINHAS, Interface & Technical Manager REDCO [email protected] (74787819)

Mr. Tasleem Abbas, Interface Coordinator REDCO [email protected] (66690716)

Mr. Wasim Abbas, Interface Engineer REDCO [email protected] (50381943)

Mr. Derek Clucas, Senior Project Manager Qatar Rail [email protected]

Mr. Lee Robert Graves, Senior Project Manger Qatar Rail [email protected]

S

A

P

STATION AREA

PLANNING (Design)

(SAP)

Mr. Shripad Korantak, SAP Coordination Manager Qatar Rail [email protected] (44331707)

Mr. Phil Hadley, Sr. Third Party Coordination Manager Qatar Rail [email protected] (44331196)

Mr. Amr Fangary, Architect Station Manager (44331705) Qatar Rail [email protected] Mr. Meerza Baig, Transport Integration Manager Qatar Rail [email protected]

Mr. Benjamin Vardon, Transport Planning Mgr (Cycling) Qatar Rail [email protected]

SP

Station Pedestrian/Cycle Connectivity

Mr. Rami Jandali, Interface Manager (44331857) Qatar Rail [email protected]

Qatar Rail Contact List


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Printed copy is uncontrolled and only valid at the time of printing, QR Contact List ‐ Rev 26, 15 January 2020

QR CIVIL DEPARTMENT

C QR Civil Department Mr. Marin Griguta, Director Qatar Rail [email protected]

1 Red Line North UG & Lusail LRT

Mr. Mohammed Mbaye, Civil Work Interface Manager Mr. Sotirios Tsournakis, Structural Engineer

Qatar Rail [email protected] [email protected]

2 Red Line South UG & HIA1 Red Line North EAG

Mr. Christian Frank, Technical Manager Mr. Georgios Nikolis, Tunnel Expert

Qatar Rail [email protected] [email protected]

3 Red Line South EAG Green Line EAG

Mr. Stefan Bender, Senior Project Manager (4032 7604)


4 Green Line UG Mr. Arvid Boehnke, Technical Manager (4457 0598) Qatar Rail [email protected]

5 Gold Line UG Mr. Spyridon Konstantis, Technical Manager

Mr. Petros Chronopoulos, Structural Engineer


[email protected]

6 Major Stations Mr. George Alexiadis, Structural Expert (Msheireb /Edu City) Qatar Rail [email protected]

LAND & LOGISTICS LL Logistics / Land All Mr. Chamakh Mohamed Chamakh, Techn. Interf Eng. Qatar Rail cchamakh @qr.com.qa

Mr. Ashwin Rabadia, Technical Interface Manager Qatar Rail [email protected]

METRO – LIGHT RAIL – TRANSIT ORIENTED DEVELOPMENTS 1 Major Stations

(Msheireb/Education City)

1 Mr. Jerry Garland; Utility Lead (3341 4026) Qatar Rail [email protected]

Mr. Phil Slaven, Sr. Project Manager Qatar Rail [email protected]

2 Red Line North UG 1 Mr. Derek Clucas, Sr. Project Manager Qatar Rail [email protected] 3 Red Line North Extension

Elevated / At Grade

1

Ext

Mr. Christian Frank, Technical Manager Qatar Rail [email protected]

Mr. Mohamed Ghadi, Depot & Trackwork Director Qatar Rail [email protected]

4 Red Line South

Underground

1 Mr. Christian Frank, Technical Manager (6604 6005) Qatar Rail [email protected]

Mr. Firas Ezudin, Stakeholder Manager (5555 8375) D&B Contr. firas.ezudin@rls‐jv.com 5 Red Line South

Elevated/At Grade

1 Mr. Jaco Botha, Construction & Engineering Manager PMC [email protected]

Mr. Stefan Bender, Senior Project Manager (4032 7604) Qatar Rail [email protected] 6 Green Line Underground 1 Mr. Arvid Boehnke, Technical Manager (4457 0598) Qatar Rail [email protected]

Mr. Thomas Warncke, Sr. Project Manager (4457 0593) Qatar Rail [email protected] 7 Green Line Elevated/At

Grade

1 Mr. Jaco Botha, Construction & Engineering Manager PMC [email protected]

Mr. Stefan Bender, Senior Project Manager (4032 7604) Qatar Rail [email protected] 8 Gold Line Underground 1 Mr. Spyridon Konstantis, Technical Manager Qatar Rail [email protected]

9 MSI (Systems / Depot) 1 Mr. Ender Nabghali, Stakeholder Manager (5540 2236) MMHKT [email protected]

10 Lusail Light Rail Transit

(LLRT; Trams)

1 Mr. Ahmad Al Daradkeh, Permitting Specialist (4459 3205) PMC [email protected]

Mr. Carlos Cesar Galli, Sr. Construction Specialist PMC [email protected]

Mr. Saif Al‐Hilal, Interface Manager (5581 8472) Qatar Rail [email protected]

Mr. Robin LABAUNE, Coordination Engineer (7048 5094) QDVC robin.labaune@lrt‐i.com

11 Green Line (Extension)

Phase 2 Metro

Long Distance

1A Mr. Daniel Metzger, Concept Design & Approvals Manager Qatar Rail [email protected] (4433 1810)

Mr. Bruno Gilbert, Alignment Manager Qatar Rail [email protected]

Mr. Bashir Ahmed Siddiqi, Utility Manager Qatar Rail [email protected] 12 Transit Orientated

Developments TODs

All

Mr. Roch Wery, Sr. Project Mgr Real Estate (4433 1814) Qatar Rail [email protected] (7059 9176)

Dr. Saleh Ragab, Sr. Real Estate Development Manager Qatar Rail [email protected]

DO NOT DRILL WITHOUT QR – PERMIT

ENERGIZED RAILWAY HIGH VOLTAGE

OPERATIONAL METRO



PREVIOUS PTW #

_ _ _ _ _ _

DATE APPROVED

______________

Expired on: _______

13
