The World Bank SCN Quadra 2 Lo4 A Tel 55 (61) 3329-1000
INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVEL( P,eEN Financial Center, 70 Andar Fax 55 (61) 3329-1010
Op" M rasili- DF, BRASIL
DOCUMENTS
f
2012
His E: cellency
Jos6 Sergio Gabrielli de Azevedo Secretary of Planning
Secretariat of Planning Avenida Luiz Viana Filho Segunda Avenida, 250
Centro Administrativo da Bahia Salvador, BA, 41.745-003 Brazil
Re: IBRD Loan 7951-BR (Integrated Health and Water Management Project) Additional Instructions: Disbursement Letter
Excellencies,
I refer to the Loan Agreement between the International Bank for Reconstruction and
Development (the "Bank") and the State of Bahia (the "Borrower") for the above-referenced project, dated n ; jg
l
The Loan Agreement provides that the Bank may issue additicnal instrfdctioit regarding the withdrawal of the proceeds of Loan 7951-BR ("Loan"). This letter ("Disbursement Letter"), as revised from time to time, constitutes the additional instructions.The attached World Bank Disbursement Guidelines for Projects, dated May 1, 2006, ("Disbursement Guidelines") (Attachment 1), are an integral part of the Disbursement Letter. The manner in which the provisions in the Disbursement Guidelines apply to the Loan is specified below. Sections and subsections in parentheses below refer to the relevant sections and subsections in the Disbursement Guidelines and, unless otherwise defined in this letter, the capitalized terms used have the meanings ascribed to them in the Disbursement Guidelines.
I. Disbursement Arrangements
(i) Disbursement Methods (section 2). The following Disbursement Methods may be used
under Ihe Loan:
* Reimbursement (available for Part 2 of the Project only) * Advance (available for all Par:s of the Project)
(ii) Disbursement Deadline Date (subsection 3.7). The Disbursement Deadline Date is four
months after the Closing Date specified in the Loan Agreement. Any changes to this date will be
Public Disclosure Authorized
Public Disclosure Authorized
Public Disclosure Authorized
notified by the Bank.
(iii) Disbursement Conditions (subsection 3.8). None.
II. Withdrawal of Loan Proceeds
(i) Authorized Signatures (subsection 3.1). A letter in the Form attached (Attachment 2) should be furnished to the Bank at the address indicated below providing the name(s) and specimen signature(s) of the official(s) authorized to sign Applications for withdrawal:
Banco Mundial
Setor Comercial Norte, Quadra 02, Lote A
Edificio Corporate Finance Center
70 Andar
70712-900 Brasilia, D.F. Brazil
Attention: Mrs. Deborah L. Wetzel, Country Director-Brazil Country Management Unit
(ii) Applications (subsections 3.2 -3.3). Please provide completed and signed Applications for withdrawal, together with supporting documents, to the address indicated below:
Banco Mundial
Setor Comercial Norte, Quadra 02, Lote A
Edificio Corporate Finance Center 70 Andar
70712-900 Brasilia, D.F. Brazil
Attention: Loan Department
(iii) Electronic Delivery (subsection 3.4) The Bank may permit the Borrower to electronically deliver to the Bank Applications (with supporting documents) through the Bank's Client Connection, web-based portal. The option to deliver Applications to the Bank by electronic means may be effected if: (a) the Borrower has designated in writing, pursuant to the terms of subparagraph (i) of this Section, its officials who are authorized to sign and deliver Applications and to receive secure identification devices ("Tokens") from the Bank for the purpose of delivering such Applications by electronic means; and (b) all such officials designated by the Borrower have registered as users of Client Connection. If the Bank agrees, the Bank will provide the Borrower with Tokens for the designated officials. Following which, the designated officials may deliver Applications electronically by completing Form 2380, which is accessible
through Client Connection (https://clientconnection.worldbank.org). The Borrower may
continue to exercise the option of preparing and delivering Applications in paper form. The Bank reserves the right and may, in its sole discretion, temporarily or permanently disallow the electronic delivery of Applications by the Borrower.
(iv) Tirms and Conditions of Use of Tokens to Process Applications. By designating officials
to acce)t Tokens and by choosing to deliver the Applications electronically, the Borrower confins through the authorized signatory letter its agreement to: (a) abide by the Terms and
Condij ions of Use of Secure Identificaion Devices in connection with Use of Electronic Means to Process Applications and Support,ng Documentation ("Terms and Conditions of Use of
Tokens") provided in Attachment 3; and (b) to deliver the Terms and Conditions of Use of Tokens to each such official and to cause such official to abide by those terms and conditions.
(v) Minimum Value ofApplications (subsection 3.5). The Minimum Value of Applications for
Reimbursements is United States Dollars (US$) 2,000,000 equivalent.
(vi) Advances (sections 5 and 6)
* Type of Designated Account (subsection 5.3). Segregated
* Currency of Designated Account (subsection 5.4): United States Dollars
* Financial Institution at which the Designated Account Will Be Opened (subsection 5.5): Banco do Brasil S/A
Ceiling (subsection 6.1). US$ 11,000,000
III. Reportin! on Use of Loan Proceeds
(i) Supporting Documentation (section 4). Supporting documentation should be provided with
each Application for withdrawal as set out below:
* For requests for Reimbursement:
o Summary Sheet in the form attached (Attachment 4) and Records evidencing eligible expenditures (e.g., copies of receipts, supplier invoices) for payments made under:
>
Goods contractls costing US$ 1,000,000 equivalent per contract or more;>
Consultant firm and Non-Consultant Services contracts costing US$ 200,000 equivalent per contract or more; and>
Individual consultant contracts costing US$ 50,000 equivalent per contract or mo-e;o Statement of Expenditure in the form attached (Attachment 5) for payments against contracts that do not exceed the thresholds established above.
o Summary Sheet in the form attached (Attachment 4) and Records evidencing eligible expenditures (e.g., copies of receipts, supplier invoices) for payments made under:
>
Goods contracts costing US$ 1,000,000 equivalent per contract or more;>
Consultant firm and Non-Consultant Services contracts costing US$ 200,000 equivalent per contract or more; and>
Individual consultant contracts costing US$ 50,000 equivalent per contract or more;" Statement of Expenditure in the form attached (Attachment 5) for payments against contracts that do not exceed the thresholds established above;
o Customized Statements of Expenditure in the form attached (Attachment 6 & 7) for payments under Categories 2 & 3;
" Customized Statement of Expenditure in the form attached (Attachment 8) for payments under Category 4; and
o Designated Account Bank Statement(s) and Reconciliation.
(ii) Frequency of Reporting Eligible Expenditures Paid from the Designated Account (subsection 6.3): Every 6 months.
IV. Other Disbursement Instructions
(i) Health Sector Output Payments (Category 2): SESAB will prepare and submit to SEPLAN semi-annual draft Withdrawal Applications to request advances from the Bank. For the second and subsequent disbursements, SESAB will submit draft Withdrawal Applications to document the use of advances (supported by Customized SOEs) to the SUS Auditors which should give the "Clearance" to the Customized SOE before submitting it to SEPLAN.
(ii) Water Sector Output Payments (Category 3): INGA/CERB will prepare and submit to
SEPLAN semi-annual draft Withdrawal Applications to request advances from the Bank. For the second and subsequent disbursements, INGA/CERB will submit draft Withdrawal Applications to document the use of advances (supported by Customized SOEs) to SEPLAN (for outputs 1, 2, 3, 5 and 6) and to TCE (for output 4),which should give the "Clearance" to the Customized SOE before submitting it to SEPLAN.
(iii) Per-Capta Premia Payments (Category 4): SESAB will prepare and submit to SEPLAN semi-annual draft Withdrawal Applications to request advances from the Bank. For the second and subsequent disbursements SESAB will consolidate the list of beneficiaries (cadastro), prepare and submit draft Withdrawal Applications to document the use of advances (supported by Customized SOEs) to the SUS Auditors which should give the "Clearance" to the Customized SOE before submitting it to SEPLAN.
V. Other Important Information
For additional information on disbursement arrangements, please refer to the Disbursement Handbook available on the Bank's public website at https://www.worldbank.org
and its secure website "Client Connection" at https://clientconnection.worldbank.org. Print copies 3re available upon request.
If you have not already done so, the Bank recommends that you register as a user of the Client Connection website (https://clie:itconnection.worldbank.org). From this website you will be abl. to prepare and deliver Applications, monitor the near real-time status of the Loan, and
retrieve related policy, financial, and procurement information. All Borrower officials
authorized to sign and deliver Applications by electronic means are required to register with Client Connection before electronic delivery can be effected. For more information about the
websile and registration arrangements, please contact the Bank by email at
<clientconnection@worldbank.org>.
If you have any queries in relation to the above, please contact us at loalcr@(worldbank.org using the above Project name and Loan number as a reference in the subject line.
Yours sincerely,
Deborah L. Wetzel Director
Brazil -Country Management Unit
Latin America and the Caribbean Region
Attachments
1. World Bank Disbursement Guidelines for Projects, dated May 1, 2006.
A.
Form for Authorized Signatures./3. Terms and Conditions of Use of Secure Identification Devices in connection with Use of El2ctronic Means to Process Applications and Supporting Documentation, dated January 20, 2010.
Ferm of Summary Sheet.
5.
Fcrm of Statements of Expenditures6. Customized Statement of Expenditire - Output Payments Health
,/. Customized Statement of Expenditire - Output Payments Water
8. Customized Statement of Expendit ire - Capitation Payments
Prepared by: Miguel-Santiago Oliveira, CTRFC
Cleared with and cc: Catarina Portelo, LEGLA Fernando Lavadenz, LCSHH
Attachment 2 [Letterhead]
Secretaria de Estado de Planejamento -BA
2a Av., 250 -Centro Administrativo da Bahia
Salvador -BA
[D'TE] Banco Mundial
SeLor Comercial Norte, Quadra 02, Lote A
Edificio Corporate Financial Center
70 Andar
70712-900 Brasilia, DF Brazil
Attention: Mrs. Deborah L. Wetzel. Director Brazil-Country Management Unit
Re: IBRD Loan 7951- BR (Integrated Health and Water Mana2ement Project) Dear Mrs. Wetzel:
I refer to the Loan Agreement between the International Bank for Reconstruction
and Development (the "Bank") and the State of Bahia (the "Borrower"), dated _,
providing the above Loan. For the purposes of Section 2.03 of the General Conditions as defined in the Loan Agreement, any 1 [one] of the persons whose authenticated specimen
signatures appear below is authorized on behalf of the Borrower to sign Applications for withdrawal under this Loan.
For the purpose of delivering Applications to the Bank, 2[each] of the persons whose authenticated specimen signatures appears below is authorized on behalf of the Borrower, acting 3[individually] 4[jointly], to deliver Applications, and evidence in support thereof on the terms and conditions specified by the Bank.
1 Instruction to the Borrower: Stipulate if more than one person needs to sign Applications, and how many
or which positions, and if any thresholds apply. Please delete this footnote in final letter that is sent to the
Bank.
2 Instruction to the Borrower: Stipulate if more than one person needs to jointly sign Applications, if so,
please indicate the actual number. Please ielete this footnote in final letter that is sent to the Bank.
3nstruction to the Borrower: Use this bracket if any one of the authorized persons may sign; if this is not
applicable, please delete. Please delete this footnote in final letter that is sent to the Bank.
4 Instruction to the Borrower: Use this bracket only if several individuals must jointly sign each
Application; if this is not applicable, please delete. Please delete this footnote in final letter that is sent to
5 [This confirms that the Borrower is authorizing such persons to accept Tokens and to deliver the Applications and supporting documents to the Bank by electronic mcaqs. In full recognition that the Bank shall rely upon such representations and
watianties, including without limitation, the representations and warranties contained in the Terms and Conditions of Use of Secure Identification Devices in connection with Use of Electronic Means to Process Applications and Supporting Documentation ("Terms and Conditions of Use of Tokens"), the Borrower represents and warrants to the Bank thzi it will deliver to each such person a copy of the Terms and Conditions of Use of Tokens and will cause such persons to abide by those terms and conditions.]
This Authorization replaces and supersedes any Authorization currently in the Bank records with respect to this Agreement.
[Name], [position] Specimen Signature: [Name], [position] Specimen Signature: [Name], [position] Sp:ecimen Signature:
Yours truly,
/ signed /
Secretary of Planning
5 Instruction to the Borrower: Add this piragraph if the Borrower wishes to authorize the listed persons to
accept Tokens and to deliver Applications by electronic means; if this is not applicable, please delete the paragraph. Please delete this footnote in final letter that is sent to the Bank.
Attachment 3 Terms and Conditions of Use of Secure Identification Devices
in connection with Use of Electronic Means to Process Applications
and Supporting Documentation
January 20, 2010
The World Bank (Bank)' will provide secure identification devices (Tokens) to permit the Borrower2
to deliver applications for withdrawal and applications for special commitments under the Agreement(s) and supporting documentation (such applications and supporting
documentation together referred to in t ese Terms and Conditions of Use as Applications) to the Bank electronically, on the terms and conditions of use specified herein.
A. Identification of Users.
1. The Borrower will be required to identify in a completed Authorized Signatory Letter
(ASL) duly delivered to and received by the Bank each person who will be authorized to
deliver Applications. The Bank will provide Tokens to each person identified in the ASL (Signatory), as provided below. The Borrower shall also immediately notify the Bank if a Signatory is no longer authorized by the Borrower to act as a Signatory.
2. Each Signatory must register as a user on the Bank's Client Connection (CC) website (https://clientconnection.worldbaink.org ) prior to delivery of Tokens. Registration on CC will require that the Signatory establish a CC password (CC Password). The Signatory shall not reveal his/her CC Password to anyone or store or record the CC Password in written or other form. Upon registration as a CC user, the Signatory will be assigned a unique identifying account name.
B. Distribution, Initialization and Return of Tokens.
1. The Bank will physically delive:- a Token to each Signatory in a manner to be determined
by and satisfactory to the Bank.
2. At the time of delivery of a Token to a Signatory, the Signatory will receive a copy of these Terms and Conditions of Use for purposes of initializing the Token.
'"Bank' includes IBRD and IDA.
2 "Borrcwer" includes the borrower of an IBRD loan, IDA credit, or Project Preparation Facility advance and the recipient of a grant.
3. The Bank will verify that the Tcken, Temporary Password and Terms and Conditions of Use have been duly delivered to and received by the CC User.
4. Promptly upon receipt of the Token and Terms and Conditions of Use, the Signatory will
access CC using his/her account name and CC Password and register his/her Token and set a personal identification number (PIN) to be used in connection with the use of his/her Token, after which the Token will be initialized for use by the Signatory exclusively for purposes of delivering Applications. Upon initialization of the Token, the Signatory will be a "Token User". The Bank will maintain in its database a user account (Account) for each Token User for purposes of managing the Token of the Token User. Neither the Borrower nor the Token User will have any access to the Account.
5. Prior to first use of the Token by the Token User for delivering Applications, the
Borrower shall ensure that the Token User has received training materials provided by the Bank in use of the Token.
6. Tokens shall be promptly return.d to the Bank upon request of the Bank.
C. Management of Tokens.
1. Tokens will remain the property of the Bank.
2. Use of the Token is strictly limited to use in the delivery of Applications by the Token
User in the manner prescribed by the Bank in the Agreement(s) and these Terms and Conditions. Any other use of the Token is prohibited.
3. The Bank assumes no responsibility or liability whatsoever for any misuse of the Token
by the Token User, other representatives of the Borrower, or third parties.
4. The Borrower undertakes to ensure, and represents and warrants to the Bank (such
representation and warranty being expressly relied upon by the Bank in delivery of a Token to each Token User) that each Token User is provided, understands and will abide by, these Terms and Conditions of Use, including without limitation the following:
Security
4.1. The Token User shall not reveal his/her PIN to anyone or store or record the PIN
in written or other form.
4.2. The Token User shall not allow anyone else to utilize a Token to deliver an
Application to the Bank.
4.3. The Token User shall always logout from CC when not using the system. Failure to logout properly can create a route into the system that is unprotected.
4.4. If the Token User believes a third party has learned his/her PIN or has lost his/her Token he/she shall immediately notify clientconnectiongworldbank.org.
4.5. The Borrower shall immediately notify the Bank at
clientconnection@aworldbank.org of any lost, stolen or compromised Tokens, and take other reasonable steps to ensure such Tokens are disabled immediately.
Care of Tokens
4.6. Tokens contain delicate and sophisticated instrumentation and therefore should be
handled with due care, and should not be immersed in liquids, exposed to extreme temperatures, crushed or bent. Also, Tokens should be kept more than five (5) cm from devices that generate electromagnetic radiation (EMR), such as mobile phones, phone-enabled PDAs, smart phones and other similar devices. Tokens should be carried and
stored separate from any EMR device. At close range (less than 5 cm), these devices can output high levels of EMR that can interfere with the proper operation of electronic equipment, including the Token.
4.7 Without derogating from these Terms and Conditions of Use, other
technical instructions on the proper use and care Tokens are available at http://www.rsa.com.
5. Replacement
5.1. Lost, damaged, compromised (in terms of 4.5, above) or destroyed Tokens will be replaced at the expense of the Borrower.
5.2. The Bank reserves the right, in its sole discretion, not to replace any Token in the case of misuse, or not to reactivate a Token User's Account
6. Reservation of Right to disable Token
6.1. The Borrower shall reserve the right to revoke the authorization of a Token User
to use a Token for any reason.
6.2. The Bank reserves the right, in its sole discretion, to temporarily or permanently disable a Token, de-activate a Token User's Account or both.
Folha Resumo - SS Attachment 4
-BR
Data:
Pagamentos realizados durante o período de: a Pedido N.:
Empréstimo N: 79S1-BR
Para despesas realizadas com: igual ou maior que USD:
• Bens com contratos de valor igual ou maior que 1 000.000 . .
• Firmas de Consultona e servicos nao de consultoria com contratos de valor igual ou maior que 200,000
• Consultores Individuais com contratos de valor igual ou maior que 50,000
PARA CONTRATOS QUE NÃO REQUEREM REVISÂO PRÉVIA
Categoria N° <Inserir No. Categoria>
Conta signada
1 2 3 4 5 6 7 8 9 10 11 12
Item Nome do fomecedor/firma/consultor ou Número do Contrato Valor Total do Contrato Número da fatura Valor Total % Financ. ValorFancMda Data do Débito da Quantidade Debitada
No. No. beneficiãrio benefciano dsFtrs plBRO pelo Banco Mundial Data do Pagamento Observaçoes
das Faturas pelo BIR (6x7) Conta Designada da Conta Designada
Total Total
PARA CONTRATOS QUE REQUEREM REVISÃO PRÉVIA
Categoria N° <Inserir No. Categoria>
Conta Designada
1 2 3 4a 4b 5 6 7 8 9 10 11 12
Itm Nm ofreeo/imloslo uData de BIRD's Valor Financiado
Nte Número do Contrato Valor Total do Contrato No Objection" Número da fatura Valor Total % Finac ancoData do Débito da Quantidade Debitada
No benecino paradas Faturas pelo BIR(6x7) Conta Designada da Conta Designada
Total Total
Obs.: Comprovantes de despesas em anexo. Indicar as despesas Retroactivas se for o caso Preparar uma Folha de Resumo por Categoria
Declaracao de Gastos-SOE Attachment 5
-BR
Data:
Pagamentos realizados durante o período de: a Pedido N°.:
Para despesas realizadas com: inferior a USD:
• Bens com contratos de valor inferior a: 1,000,000
+-• Firmas de Consultoria e servicos nao de consultoria com contratos de valor inferior a 200,000
• Consultores Individuais com contratos de valor inferior a 50,000 :i. lé • Formacao, Custos Operacionais Todos
PARA CONTRATOS QUE NÃO REQUEREM REVISÃO PRÉVIA
<Inserir No.
Categoria NO Categoria>
Conta Designada
1 2 3 4 5 6 7 8 9 10 11 12
Valor dos % Financ Valor Financiado Data do Débito da Quantidade Debitada Item Nome do fomecedorfirmaiconsultor ou Número do Contrato Valor Total do Número da fatura p aaenoto pelo Banco Mundial Data do Pagamento Observações Conta DesignaDda a Conta Designada
No beneficiardo Contratoagmno peBIDCnaDsgda aCntDsiaa
para este SOE plBIO (6x7)
Total Total
PARA CONTRATOS QUE REQUEREM REVISÃO PRÉVIA
<Inserir No.
Categoria NO Categoria>
Conta Designada
1 2 3 4a 4b 5 6 7 8 9 10 11 12
tem Nome do omecedorrmalconsultor ou Valor Total do Data de BIRDs Valor dos % Financ Valor Financiado Data do Débito da Quantidade Debitada
oeciário n Número do Contrato ontrao No Objectio Número da tatura Pagamentos pelo pelo Banco Mundial Data do Pagamento Observações Conta Designada da Conta Designada para o Contrato para este SOE BIRD (6x7)
Total Total
Obs.: Documentos de Suporte para este SOE recebidos em Preparar uma Declaração de Gasto por categoria Indicar as despesas Retroactivas se for o caso
Attachment 6
Detalhamento do out[ut based disbursements-Current Period EMPRESTIMO No:
DATA: No DO PEDIDO DE SAQUE:
No. CATEGORIA:
Inclui os sequintes gastos: PERCENTUAL FINANCIADO:
Cqde 1 2 3 4 5 6 7 8= (5) x (7) 9
Unidade de Data da prestação Data da Verificado Custo Médio Quantidade
Outpt Noe meida e seviço transferência do OBDs Atingidos (Sim/Nao) unitárioVaoDeidaaCnt
medida de serviço OBD Designada
Sub Componente 1.A.(i)
(output based disbursements)
CATEGORY2
Doses aplicadas da
/ vacma oral contra rotavirus Dose aplicada
humano (primeira dose) 400,000 Sim 1.75 700,000.00 700,000.00
Doses aplicadas da
8 vacina oral contra rotavírus Dose aplicada
humano (2 a dose) 400,000 Sim 2.50 1,000,000.00 1,000,000.00
Número de novas
9 equipes de saúde da familia ESF
instituidos no estado 100 Sim 20,000.00 2,000,000.00 2,000,000.00
Relatório consolidado
10 das auditorias realizadas Relatório auditado
nos 25 hospitais com o 100 Sim 3,000.00 300,000.00 300,000.00
Totais 4,000,000.00 4,000,000.00
OBS : Declaramos que as quantias acima detalhadas foram pagas por conta da execução das atividades do projeto de acordo com os termos e condições do Convênio. Toda a documentação de suporte destes gastos será mantida na Unidade de Implementação do Projeto e mediante
Attachment 7
Detalhamento do out[ut based disbursements-Current Period EMPRESTIMO No:DATA:
No DO PEDIDO DE SAQUE:
FOLHA No:
No. CATEGOR;A.
Inclui os sequintes gastos: PERCENTUAL FINANCIADO:
Code 1 2 3 4 5 6 7 8= (5) x (7) 9
Data da Quantidade
utuNme Unidade de Data da prestação DaadVeiido CsoM ioQ ntae Output Nome medida de seriço transferência do OBDs Atingidos SimNao C unitrio Valor Debtsignadaonta
serviçosignaD
Sub Componente I.A.(ii) (outpul based
disbursements)
CA1 T EGOR Y 3 Planos para a construção de sistemas simplificados
de abastecimento de água 200 Sim 1,240.00 248,000.00 248,000.00
Número de sistemas 2 simplificados de
abastecimento de água
construidos e instalados 200 Sim 70,000.00 14,000,000.00 14,000,000.00
Supervisão dos sistemas
3 simplificados de abastecimento de água construído 200 Sim 4,540.00 908,000.00 908,000.00 Número de módulos 4 sanitários rurais nstruidos 1,000 Sim 2,430.00 2,430,000.00 2,430,000.00 Número de planos de bacia hidrográfica elaborado e aprovado pelas
comissões 8 Sim 1,225,000.00 9,800,000.00 9,800,000.00
Agentes voluntários
treinados nas comunidades 772 Sim 1,295.00 999,740.00 999,740.00
Totais 28,385,740.00 28,385,740.00
OBS : Declaramos que as quantias acima detalhadas foram pagas por conta da execução das atividades do projeto de acordo com os termos e condições do Convênio. Toda a documentação de suporte destes gastos será mantida na Unidade de Implementação do Projeto e mediante
Attachment 8-SI EMPRrSTIMO No: DATA: No DO PEDIDO DE SAOUE: FOLHA No: No. CATEGORIA:
n lnte to PERCENTUAL FINANCIADO:
Detalhamento das Cåpitas
1 3 4 5 68
Data de1Registro Data d f iuantidad ]
"; ' ";'
J
do istro t;;;;to Dato atafda i lo E g!!it Veiao Csto Médio Petrcetatm det Paoamento Valor Dbctda da ContalSISPRENATAL da Capra Bnf Desiq «
a b c d e f g h
Alt 6 eses depow Ace 12 -eses Alt 16 otses Att: ¿»tese Att 30 .esee Att 36 mese: Ate 42 me%eo Ate 4 riess
da data do depots da dat de depo~s da oata de tepo.% da ata de depoi da aala de ~e0s da data m opo. da data te ep..1 na ata de
ELetivtdad Efecdvoladk Elect.-..aado Etct.aade Elet.. n Eetof~.dade Efedndade Elec-.aade
tf Oerlorndance f Forr-nance tt Per-oaric Il Pefrman if Bart rf Ba rrna
l6<.euiitld '' In.talors met .nd.caltrs met ind.cato-s mot Ird.ato-s mot Ind.alor, mo' "rd.c ator mret
:- 1)% 0% D' " - - t. ,''- 0.00 000
.,.'12 .': 0' 0- t'- :5 t-' 'ut' 'ou 000 000
0% 0- ' 60 000 0.00
-..:.. 0% 0%. -. tù 'tU- :4.. W-, 000 000
O.. 0'-: - -t-- i0ù tEOt. CO' 0.00 0.00
0 0% t. - ,0) -3 - r:," 000 0.00
0. <' ·.r- '. 0 Ct- F* 0.00 000
s0 0-- ,'. :. :.'ù· '0 - 0.00 0.00
8'.50-,'':* u- .' tu'0.00 000
Totais
os : Declatamos quo as quantas acima detattadas tota» pagas pot cooda da exe.uao das atividades do projeto de acordo com os termos e condições do Cotténio. Toda a documenrtação de suporte destes gastos será mantida na Unddade de Implementaqo do Projet
- Memor de Crlculo
(4)X(6)x(7a) -refee-se aoo adiantamento, a sr realizado no 1 semestre ap6s a efetvidade (4)X(6)x(7b) -refer-se ao 2' adlntameto, a ser realizado to 2 semestre apés a efetividade (4)X(6)x(7c) -refee- ao 3' adiantamento, a set tolzado no 3 semestre ap5s a eftdvidade (4)X(6)x(7d) -refere-se ao 4 adlantameto, a ser realizado no 4' semestrm apos a efetividade (4)X(6)x(7e) -refere-s ao adlantamento, a sr realizado no semestre após a efetividade
(4)X(B)x(71) -refer-se a 0- adlantametto, a ser realizado no B- emestre após a efettvidade
(4)X(6)x(7g) - rfere-se o 7° adlantamento, a ser realizado o 7' semestre apos a efettvidade (4)X(6)x(7h) -refere-s ao adLantamento, a ser realizado to 8' semestre após a efetvidade
Attachm,ent 8-FI EMPRt.STIMO No: ________
DATA: ________
fl,k.,~.. Io 0O TLMTål RPIT No DO pEDIDO DE SAQUE:_______
FOLHA No: ________
LI aNo. CATrGORWA:________
PERCENTUAL FINANCIADO:________
0050 ansen! das Cåpiua.
Dat d.R - tr da - v-ri-do Md Percentagenm de Paga,rontoVlo DbidadCnt
...l . l- 4S~mNaol I etfO1
istta SSRNAL da Cap,ta
bnemficiarmes-a b c d e h
Ale 6 --s.. dop.M Al le 2 A le lan'se At. 24 ~e~e Ate 30 msn Até 36 ~es Até 42 e. Até 48 ne.
da.dm d. do~sdada^d. eo,. ~ adade de.S-ilatade -ep.o.da data de depois dadateade depois da data de depois da data de,
E~,o.edad. Ef..t.ldad. Efec-.dade 4 Eci.h E.-l,ridad. Ef~Mtviade ElPeotividade Efectividade
ib .e..rolh 1 . Pa.~ tNl P ,qe..eN P.9.-MuntN 3 Paga-e.nNi
P~~aiN-.do PagarnentoNW6 Pagam~** N-7 Pagarrent,
-t 00,*.':. 50% 50% 40% 40% 120.000,00 120,000.001 l GC^ i0. >00-il 1..5 50% 50% 40% 40% 000 0.00 i00% 100%.: : 50% 50% 40% 40% 000 0.001 i l 00% 5.-:. 0% 60% 40% 40% 0.00 0001 15,Y lC>, . 0% 50% 4%0%0.0000 rX.i"s~* 0 0 40% 40% 00 0 I GV. M, ~ ~ o.. 50% 50% 40% 40% 000 000 id0- lOo.*' 5 - 50% 501. 40% 40% 0.00 00 I0 50% 5o% 40% 40% 000 00 120000 Totais100001 1?n000
..S : De~~~anoq.-csluanrts.a-ladelallliadstoa-paa-I-r-on--daexeugåo das atividddoprojeto
de acordo com o terMos e condlQöcs do C~m~o Toda a dournofl0 de uporte desi~ gastnosenå mandida ma
Unådade de Implerrertagåo do Projet
* - Mn6,.a d. CMI.uc
(4)X<6)X7a) - refee- -ai- adlantamlenmo, a ser realizado nol- sernestre apds a efeUvildade (4)X(6)x(7b) .refere- a- Z- adlarvtarnento, a Ser reallrado mn2- sernestre ap6s a efeividade
fflX(S)x(7c) - refere-se -03- adlanUmenMo, a. mremalizadO o m3- mmestre ap65 a etetMvdade (4)X(G)x(Ird) - refere- - o adlantamefflo, ae reaftado mC se mestre ap6s a efetividade
(4)X(6)x(7e) - rellee-me -0S-adlantaeMno, aser renlh~d S-? Soetre ap6s al etetivdade
(4)XS0(7). referese -0B- adianrtanento. a er realizado mo 6-emmestre ap6s aeletividde 14>)XO)(Irq - refefe-me -7- adlantmrento, al 5r realizado md 7- sennestre ap6s a eletividade
(4)X(6)x(7h) - refere-Sw -B- adlantamento, a ser relizado mO Semestre apds al efetividade
EMPRESTIMOIDOAÇAO No:
RESUMO OBD DATA:
No DO PEDIDO DE SAQUE: FOLHA No:
Accumulated Prior Periods Current Period_ Total
OBD OBD Executado OBD OBD Executado Cost OBD OBD Executado Cost
Indicador previstos atingidos % previstos atingidos
% previstos atingidos /
Sub Componente 1.A.
(output based disbursements)
Planos para a construção de sistemas simplificados de abastecimento de
_ gua #DIV/0!__ _ 200 _#DIV/0
1
248,000 00 0 200 #DIV/0! 248,000.00 2 Número de sistemas simplificados de abastecimento de ág¯a construidos e #DIV/0!__ 200 #DIV/0! ########## 0 200 #DIV/0! 14,000,000.00
Supervisão dos sistemas simplificados de abastecimento de água
S construdo #DIV/0! 200 #DIV/0! 908,000.00 o 200 #DIV/0! 908,000.00
4 Núm móduos_samtário¯srurais construídos #DIV/! 2,430,00000 1,000 #DIV/0! 2,430,000.00
Número de planos de bacia hidrográfica elaborado e aprovado pelas
comisões______ ____ ___ #DIV/0! 8 #DIV/0 9,800,000.00 0 8 #DIV/0! 9,800,000.00J
omgeies comunidades #DIV/0! 772 DIV/01 999,74000 0 772 #DIV/0! 999,740.00
TOTAL-CA TEGORY 3 0.00 _g__ #42__
28,385,740.00
S 7 Doses aplicadas da vacina oral contra rotavirus humano (primeira dose) _¯#DIV/! 400,000 - DIV/Ot 700,000.00 o 400,000 #DIV/0!
700,000.00 8 Doses aplicadas da vacina oral contra rotavirus humano (2 a dose) #DIV/0! 400,#DIV /DIV/0! 1,000,000 o 400,000 #DIV/0!
1,000,000.00 9 Número de novas equipes de saúde da família instituidos no estado #DIV/0! 100 #DIV/0! 2,000,000.00 0 100 #DIV/0! 2,000,000.00 ¯ Relatório consolidado das auditorias realizadas nos 25 hospitais com o
1 maior número de casos de IID. Base Ano: 2008 #DIV/0! 100 #DIV/0! 300,000.00 o 100 #DIV/0! 300,000.00
TOTAP-CATEGORY 2 0 0 4r,000,000 00 000,000 00
EMPRESTIMO/DOACAO No:
RESUMO per HOSPITAL DATA:
No DO PEDIDO DE SAQUE:
FOLHA No:
Hosoita # 1-Norte favment
Payment No Payments made every semester # of Eligible Beneficiaries Verified Unit Cost Percentage Total Paid date
'YR 1 1 6 montis 1 000 Yes 120 100% 120,000,00 120,000.00
YR 1 2 12 months 1,250 Yes 120 100% 150,000.00 150,000.00
YR2 3 18 months-First Instalment 1,100 Yes 120 50% 66,000.00 66,000.00
YR 2 Second Instalment if PI achiev 1,100 Yes 120 50% 66,000.00 66,000.00 YR 2 4 24 months-First Instalment 1,400 Yes 120 50% 84,000.00 84,000.00 YR 2 Second Instalment if Pi achiev 1,400 Yes 120 50% 84,000.00 84,000.00
YR 3 5 30 months-First Instalment 1,500 Yes 120 50% 90,000.00 90,000.00 YR 3 Second Instalment if Pl achiev 1,500 Yes 120 50% 90,000.00 90,000.00 YR 3 6 36 montns.First Instalmeni 1 600 Yes 120 50% 96,000,00 96,000.00
YR 3 Second Instalment if P sacrev 1 600 Yes 120 506 9600000 96 000 00
fR 4 . 42 mo,nlns-F.r.t Insialmeni 1 700 YE- 120 40%
81 600 00 81 60000
YR 4 Second instalment I Blacn,e 1.700 Yes 120 60 122 400 00 122 400 00
Y< 4 48 urthe-Fi,li m . v - 120 40- 86 400 00 8 400 00
YR 4 . Second Instalment if BI achiev 1,800 Yes 120 60% 129,600.00 129,600.001 1,362,000.00 1,362,000.00
Repeat above Summary for each Hospital
