MDP E-Lelang Barang Pascakualifikasi

7/26/2019 MDP E-Lelang Barang Pascakualifikasi

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Republik Indonesia

Model Dokumen Pengadaan SecaraElektronik

PengadaanBarang

Metode Lelang[Umum/Sederhana]

dengan Pascakualifkasi


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Lembaga Kebijakan Pengadaan Barang/asaPemerinta!


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D " K # M E $ P E $ % & D & & $

$omor' ((((((((((

)anggal' ((((((((((

untuk

Pengadaan__________


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Kelompok Kerja #nit La*anan Pengadaan'__________

Kementerian/Lembaga/Pemerinta! Daera!/Institusi'(((((((

)a!un &nggaran ((((


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D&+)&R ISI

B&B I, #M#M,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-

B&B II, PE$%#M#M&$ PELEL&$%&$ DE$%&$ P&S.&K#&LI+IK&SI,,,, ,,

B&B III I$S)R#KSI KEP&D& PESER)&0IKP1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2

&, #M#M,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2

1. LINGKUPPEKERJAAN......................................................................................42. SUMBERDANA.............................................................................................43. PESERTAPELELANGAN...................................................................................44. LARANGANKORUPSI, KOLUSI, DANNEPOTISME(KKN) SERTAPENIPUAN..................45. LARANGANPERTENTANGANKEPENTINGAN..........................................................56. PENDAYAGUNAANPRODUKSIDALAMNEGERI......................................................67. SATUPENAARANTIAPPESERTA.....................................................................7

B, D"K#ME$ PE$%&D&&$,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3

!. ISIDOKUMENPENGADAAN..............................................................................7". BA#ASADOKUMENPENGADAAN......................................................................!1$. PEMBERIANPENJELASAN.................................................................................!11. PERUBA#ANDOKUMENPENGADAAN................................................................."12. TAMBA#ANAKTUPEMASUKANDOKUMENPENAARAN......................................."

., PE$4I&P&$ D"K#ME$ PE$&5&R&$,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-6

13. BIAYADALAMPENYIAPANPENAARAN.............................................................1$14. BA#ASAPENAARAN...................................................................................1$15. DOKUMENPENAARAN................................................................................1$

16. #ARGAPENAARAN....................................................................................1217. MATAUANGPENAARANDAN%ARAPEMBAYARAN.............................................131!. MASABERLAKUPENAARANDANJANGKAAKTUPELAKSANAAN.........................131". PENGISIANDATAKUALI&IKASI........................................................................142$. PAKTAINTEGRITAS.......................................................................................1421. [SURATJAMINANPENAWARAN(APABILADIPERSYARATKAN)].................................14

D, PEM&S#K&$ D"K#ME$ PE$&5&R&$,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-7

22. PERSIAPAN DOKUMENPENAARAN................................................................1623. PEMASUKAN' PENYAMPAIANDOKUMENPENAARAN..........................................1724. BATASAK#IRAKTUPEMASUKANPENAARAN................................................1!25. PENAARANTERLAMBAT..............................................................................1!

E, PEMB#K&&$ D&$ E8&L#&SI PE$&5&R&$,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-926. PEMBUKAANPENAARAN.............................................................................1!27. EALUASI DOKUMENPENAARAN..................................................................1"2!. EALUASIKUALI&IKASI..................................................................................332". PEMBUKTIANKUALI&IKASI..............................................................................333$. BERITAA%ARA#ASILPELELANGAN.................................................................35

+, PE$E)&P&$ PEME$&$% PELEL&$%&$,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,:

31. PENETAPANPEMENANG................................................................................3532. PENGUMUMANPEMENANG............................................................................3533. SANGGA#AN..............................................................................................3534. SANGGA#ANBANDING.................................................................................36

%, PE$#$#K&$ PEME$&$%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3


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35. PENUNJUKANPENYEDIABARANG'JASA.............................................................3736. BA#P, BERITAA%ARALAINNYA, DANKERA#ASIAANPROSES...............................3"

;, PELEL&$%&$ %&%&L,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,II, SPESI+IK&SI )EK$IS D&$ %&MB&R,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-=3

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A. BENTUK SURAT PENUNJUKAN PENYEDIA BARANG'JASA (SPPBJ)................IB. BENTUK SURAT PESANAN.........................................................................I%. BENTUK JAMINAN SANGGA#AN BANDING DARI BANK.............................IIID. BENTUK JAMINAN PELAKSANAAN DARI BANK..........................................E. BENTUK JAMINAN PELAKSANAAN DARI ASURANSI'PERUSA#AAN

PENJAMINAN............................................................................................ II&. BENTUK JAMINAN UANG MUKA DARI BANK...............................................IG. BENTUK JAMINAN UANG MUKA DARI ASURANSI'PERUSA#AAN

PENJAMINAN............................................................................................. III


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1

B&B I, #M#M

A. D+-/0 P/00 0 --0 /0 P/8-0P//0 N+. 54 T9-0 2$1$ 8/080 P/00 B0'JP//089 :0 8/9 -9 /00 P/8-0 P//0N+. 7$ T9-0 2$12 //8 ;/8-0


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2

@

LDK

L/ D8 K-=

@

P+


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3

@

LPSE

L:00 P/00 S/> E=/8+0 =9-08 / /=/8+0.

@

A;= SPSE

A;= ;/08 =-0 S8/ P/00S/> E=/8+0 (SPSE) / $%& :08/;0 /C/ LPSE :0 ;8 //==- $%&'%LPSE

@

P/0-0SPSE

P/+00'0 -9 :0 /= 9/ /; A;= SPSE, /;//080+=/9 -/ ID 0 ;+ :0 /0 +=/9LPSE, 08 =0 P/


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4

;/00 -0 = =/ .9 :0 =0.&=/ ;/00 9 90: -09 +=/9;//8 :0 0:80 =-=- /C=- 89; I(/C=- 08 0 8/0).

@

U/ ID

N 8- ;/0/0= -0 / /088 ;/0-0 :0 -00 -08- /+;/ = A;= SPSE

@

P+

K-;-=0 8/ 8- 80 :0 -00

+=/9 ;/0-0 -08- /C/ U/ ID/; A;= SPSE

@

APENDO

A;= P/00 D+-/0 :0 /00+=/9 L/ S0 N/

@ &+ I0E=/8+0

T;=0'08- ;/ //08- / +;+0/0 0 :0 ;8 0;-8 +=/9;/0-0 ;=

@ &+ I0E=/8+0D8 K-=

&+ 0 /=/8+0 ; ;= SPSE :0-00 ;/0:/ 0'


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5

B&B II, PE$%#M#M&$ PELEL&$%&$ DE$%&$P&S.&K#&LI+IK&SI

P/0--0 ;/=/=00 8/>08- ; ;= SPSE


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6


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7

B&B III I$S)R#KSI KEP&D& PESER)&0IKP1

&, #M#M

-, LingkupPekerjaan

1.1 P+08-= LDP.

1.2 N ;/8 0 =0-; ;//08- = LDP.

1.3 P/0:/ :0 8-0


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8

>08-0 ;= /+=/90/80)

3.3 P//8 K/80'KSO =0-08- /0-9 ;/='/00 ;/00 :0/98 0'8- /-0 ;9=0

>. /-8 0'8-/0:;0 +-/00'8- /8/00 =0 :08 /0 -08- //0-9;/:80 = D+-/0

P/00 0.


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9

4.2 P//8 :0 8/-8 /=-0

800 /0 -; 0 4.1 /00 0/ /-8?. 0 088, /;/8

--0 ;+/;/=/=00 8- ;/8=0;/0/8;0 ;//00

. 0 ;/0>08-0 =D8 #8

>. [J++ P%+$++ (+4+&*+04%'++6+) 07+6+ 0+0'%86+ 6% 6+' N%-++#D+%+'%&+-+++ %7+/ 0+*+LDP]

. -80 /> ;/8 0'8-/. ;/=;+0 /> ;0 /;

;9 //00.

:, LaranganPertentanganKepentingan

5.1P ;9 = /=008-, -0, 0 ;/00:,/090 0 /0>/9

;/8/0800 /;/0800 ;;9 8/8, /> =0-0-;-0 8 =0-0.

5.2P/8/0800 /;/0800/0 - ; 05.1. 08 =0 /=;-8?

. = -8- 0 -9,0+8 D/ 8- D/0K+ -8- B0 U9=0 /0; /0+8 D/ 8- D/0K+ ; B0 U9=00: :0 /0


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10

:0 //00 /0/8;0;//00 P/=/=00.

>. PPK 0'8- 0+8 P+-8 =-80-00 K'L'D'I.

7, Penda*agunaan ProduksiDalam $egeri

6.1 P//8 //


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11

=/0; /00 ;/8/0, . C+=-/ ;+- = 0//8 ;- //0-9/-8-90.

".9 [A+' 4%--/++ 480/6' 0+*+%-%, 4%+$++ 4%'%+ 0&%6+

4%:%%' +-+ //6 4%6%;++'%&+-+++ %7+/ 0+*+ LDP

+- 0$+;&6+ %--/+6+480/6' 0+*+ %-% 0+#++/4%-+0++ +- &%*+ 0 ++' R4.5.


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12

B, D"K#ME$ PE$%&D&&$

9, Isi DokumenPengadaan

!.1D+-/0 P/00 8/ 8D+-/0 P/=90 0 D+-/0K-=

!.2 D+-/0 P/=90 8/ ?. U-. P/0--0>. I08- K/; P//8. L/ D8 P/=90/. S:8@S:8 U- K+08. S:8@S:8 K9-- K+08

. B/08- S-8 P/


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13

. P8 I08/8 (;=/80 +-/0

=/0; /00 ;808/8. A;= 90: 0-9, ;8 08/8-9 = SPSE 0=8 0 9;-)

>. I0 D8 K-= (;=/80 +-/0=/0; /00 +-= 0-= -08- 0+8 8.A;= 90: 0 -9, 0 -= -9 = SPSE 0 =8 09;-)

. P/8-0


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14

1$.3 A;= ;/=-0 P+


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15

;/-90 ;/080 8//-8 88-00 = A/0-

D+-/0 P/00, /8/08-0 - 8- ;/-908//-8 0; 8 0/8/08-0 :0 /=- =9D+-/0 P/00 :0 =.

11.4 S/8/=9 P//0 P/0


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16

DokumenPenaAaran

P+


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17

. ['/+ 4%;+;+ K%++#K%;+S++ O4%+' (+4+&*+ 4%'%+

&%&%/6 K%++#KSO)]=/. +-/0 ;/00 8/0 :0

8/ ?1) [3*%#'7+ ;+-6+ $+6/4%*+6'+++ 4%6%;++0+#++/ ;+0$+* '%+ %+

4%6%;++] (= 9= /98/ ;//+08+9, +- 0 @ -08- 0 :080 (/-0/00 /-8-90. A;=90: +-, >+08+9 0 9;-0. P LDP008 9- -0 0; +08+9, +-, 0'8-)

?);+0$+* $+6/

4%%++#4%-+ &++-(;= ;/=-0 -08-;//


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18

04%'++6+)] (;==:00 ;-0/8= =:00 ; :0-8-90, =0: =:00;/0080 //08 0:0 /C = 08-0?

1) 80=02) /=- ;/00

&. [S8:784 +'* 4%0++

('7+) J++ P%+$++ +'*


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19

(+4+&*+ 04%'++6+)]=7. S/+ 4%;+;+ K%++#

K%;+ S++ O4%+'(+4+&*+4%'%+ &%&%/6K%++#KSO)=

. +-/0 ;/00 8/0:0 8/ ?1) [;+-6+ $+6/ 4%*+6'+++

4%6%;++ 0+#++/ ;+0$+*'%+ %+ 4%6%;++](= 9= /9 8/;//+08+9, +-0 @(/-0 /00/-8-90. A;= 90:+-, >+08+9 0 9;-0)

3) /088 (08- /00 =/0;0


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20

8- 8/8/08-, 8-=:00 ;/=890'

;/0;00;/0+;/0 ;/=80,==)=

5) -0 (;=;/:80 0 9- /8=

. [:8/* %6+4/*+'4%/-+ TKDN +4+&*+04%'++6+ //6

%0+4+6+ 4%:%%'+-+]

-7, ;argaPenaAaran

16.1 # ;/00 8-=/00


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21

4%&+++#4%6%;++ 0+*+ D+:+K/++' 0+ H+-+. J6+ +-+

'+/+ 0/*' 8* ++/ 0+607+/6+ +6+ 4%6%;++ 0+*+++ 4%&+++ %'%&/0+--+4 %*+ %+'/6 0+*++-+ '+/+ 4%6%;++ +- *+0+ 4%6%;++ %'%&/ %+4 +/'0*+6'++6+.]

[//6 68+6 */4 '/ (+4+&*+04%'++6+), 4%'%+%7+/6+ +-+ '+/+ //6

+4 ++ 4%&+++#4%6%;++0+*+ D+:+ K/++' 0+ H+-+.].] P%7+/+ 7+ +-+ '+/+

4+0+ 4'4+ //6 %+'6+6%'+--/4+ 4%%0+ %-%;+6+'%+4 % 4%6%;++ +-0'++6+.

16.3 B: +C/9/ 0/-08-00 /8 /- ;


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22

17.2 P/:0 8 ;/=00;/00 0 0 =-0

/- /00 :0 8/>08-= LDP 0 -0 =S:8@S:8 U-'K9--K+08.

-9, MasaBerlakuPenaAarandan angka5aktuPelaksanaan

1!.1 M /=- ;/00/- /00 /8/08-0/0 8/>08- = LDP.

1!.2 A;= /C=- /=- /=/=00, //=- 9 /=-0: ;/00, P+ 8/8-= -08-/;/;0


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8/>08- = LDP.

-


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24

;/00 8 ;8 >0 -0 SPSE ;/0:/ 0'08- = LDP.

21.5 S-8 J00 P/00 //0-9/8/08-0 / /-8?

. 8/80 +=/9 B0 U-,;/-90 ;/0. 0 ;//8 /000 :0 8/>08- =

J00 P/00. /0 0= J00 P/00

8 -0 0= 0+0=/0 8/>08- =LDP

/. /0 0= J00 P/00>08-0 = 0 0

9--. 0 P+


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25

=8 14 (/;8 /=) 9/=+0 ;//00, >=+0;//00 >00 1 8- 2; 8 ;/-80-= 8/-8 /=-0;/=-0 8 8-

/. >=+0 ;//00, >=+0;//00 >00 1 8- 2

/0-0-0 /00=0 :0 8 ;88/ 8- = 80800 +08.

D, PEM&S#K&$ D"K#ME$ PE$&5&R&$

==, PersiapanDokumenPenaAara

n

22.1 [U/6 %80% '+/ 3*%]22.1.A) F*% ;/00 :0

;0 +=/9 ;//8 8/ 8- 3*% ;/00 :0

8/=9 00' /0; :0


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8/ ?. P/00 08

. P/00 8/0 0>. P/00 9.

22.1.B) F*% ;/0000'/0; /00A;= P/00 D+-/0(APENDO).

22.1.%) P//8 /00 3*%;/00 :0 8/=900'/0; /==-;= SPSE.

22.1.D) D8 -= 0;-8 00 /==- + 0/=/8+0 8 -= ;SPSE.

22.2 [U/6 %80% 0/+ 3*%]22.2.A) P/00 :0

;0 +=/9 ;//8 8/ - F*% :0 /-8P/00 A08 0

T/0 (F*% I) 0 P/00# (F*%II).

22.2.B) F*% I 0 3*% II 0@0 00 /00A;= P/00 D+-/0(APENDO).

22.2.C) Peserta mengirimkan file satu danfiledua yang telah disandikan/dienkrisi)

melalui alikasi !P!"

22.2.#) D8 -= 0;-8 00 /==- + 0/=/8+0 8 -= ;SPSE

=, Pem

asukan/

23.1 P//8 /0:;0 D+-/0

P/00 /; P+


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Pen*ampaian

DokumenPenaAaran

/8/08-0?. P/8@8, /00 D8

K-= /==- + 0/=/8+0 8 -= ;;= SPSE.

. D=0 /-=0 //=-8 9 8- ;/-0D+-/0 P/00. D8 -=:0 0 8/9 0/0080 8 -= :08/=9 8/ //=-0:.

2?.1.A) [U/6 %80% '+/ 3*%]>1) P//8 /0-09 (/4*8+0)

3*% ;/00 08,8/0 0 9 :0 8/=98//0; (.9) /==-;= SPSE /- /-=0//=- 8 9 8-;/-0 D+-/0P/00. F*% ;/008/9 0 /0080

3*% ;/00 :0 8/=98/ //=-0:

23.1.B) [U/6 %80% 0/+ 3*%]1) F*% ;/00 08

0 8/0 (3*% I) /0;/0-00 A;/0+,/=0


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2) P//8 ;/8@8/0-09 (/4*8+0) 3*% I

/-; =/ ;/0008 0 8/0 :08/=9 8//0; (.9)/==- ;= SPSE,/-0 /8/=9 3*% I/9= 8/ ;//8/=0


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8- ;/00, 0

/;';/ 0'


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31

0&% +-+ '+/+ 0+--+4'/0+ %+'/6 0+*+ +-+

'+/+ 4%6%;++ +- *+ 0++-+ '+/+ 4+0+ 0+:+6/++' 0+ +-+ %+40&+6+ 68'8-=

9) J%' 4%6%;++ +- 0+6%7+/ 0+*+ 0+:+6/++' 0+ +-+ (+4+&*++0+) 0'%'/+6+ 0%-+ ;%'

4%6%;++ +- %7+/0+*+ D86/% P%-+0++0+ +-+ '+/+ 4%6%;++0+--+4 8*= 0+

5) H+'* 68%6' ++6 4+0+&+-+ +-+ '+/+ 0+4+%-/&+ *+ 8+* +-+

4%+$++ '%--+ //+4%-6+ 0+4+ %;+0 *%&-- ++/ *%& %0+ 0+//+ 4%-6+ '%/*+]=

&. [//6 68+6 G+&/-+ L/4S/ 0+ H+-+ S+/+ 4+0+&+-+ L/4 S/ >

1) C8*/% 0+#++/ ;%'4%6%;++ +- %7+/0+*+ 0+:+ 6/++' 0++-+ (+4+&*+ +0+) 0'%'/+6+0%-+ +- %7+/ 0+*+D86/% P%-+0++=

2) J%' 4%6%;++ +- 0+6%7+/ 0+*+ 0+:+

6/++' 0+ +-+ (+4+&*++0+) 0'%'/+6+ 0%-+ ;%'

4%6%;++ +- %7+/0+*+ D86/% P%-+0++=0+

?) H+'* 68%6' ++6 4+0+&+-+ */4'/4 0+6 &8*%%-/&+ *+ 8+* +-+

4%+$++ 4+0+ &+-+ */4S/.]

27.1.B) T+8= 9 ;/00


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/8/=9 +/ 88 :0/=/9 0= 8+8= #PS, 0:80

-- ; /C=- 9.

27.1.%) [A4+&*+ '%/+ +-+4%+$++ '%%*+ 68%6'++6 //6 68+6 +-+'+/+ ++/ 68+6 -+&/-+L/4 '/ 0+ +-+ '+/+%*%& *+ 8+* HPS, 4%*%*+-+0++6+ -+-+*]

[+4+&*+ '%/+ 8+* +-+

4%+$++ +- +'/6 //6K8+6 L/4 S/ 0++' *+ 8+*HPS, 4%*%*+-+ 0++6+ -+-+*].

27.1.D) B/0 9= +/88 P+


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27.2.A) P+


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34

:0 8/=9 8/8;0 = D+-/0P/00 0

. P+. ;/00 :0 //0-9 :8=9 ;/00 :0 /-/00 /8/08-0, :8@:8, 0;/ 8/0 :0 8/8;0= D+-/0 P/00 0, 80; ;/0:;00 :0 /8;/080';++ 8- ;/00/:8

. ;/0:;00 :0 /8;/080';++ 8- ;/00/:8 =9?1) ;/0:;00 D+-/0

P/00 0 :0/;/0-9 =0-;, -=80 9='0/


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(+=-';//+0+=0) 08;//8, ULP 0'8- PPK, /00

8-


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. /C=- 8/9; 8 0890: =-0 8/9; 9=@9=

:0 8 0= ; 8 ;/0=0-=

. ;/00 0:80 //0-9;/:80 08, ;=?1) :8@:8 -80= :0

08 /0 D+-/0P/00 0 ;/0-9'=/0;,:8- /00 =;00:?

) S>0'&=/ S-8 P/00) S>0 J00 P/00 A=

(A;= ;/:80)>) D8 K-088 0 #

(A;= ;/:80)) D+-/0 P/00 T/0/) &+-= TKDN (A;=

;/:80 0 9---08- ;//8 :0 8/0:;0 +-= TKDN, ;/000: 8--0 0 0= TKDN 0:0; $ (0+=))

2) -8 ;/00 //0-9/8/08-0 / /-8?) 08-= LDP 0

) /80=.3) [A4+&*+ 04%'++6+, S-8

J00 P/00 //0-9/8/08-0 / /-8?

) 8/80 +=/9 B0 U-,

;/-90 ;/0


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8/>08- = LDP>) 0 ;//8 /00

0 :0 8/>08- =J00 P/00

) /0 0= J00P/00 8 -0 0= 08- = LDP

/) /0 0= J00P/00 >08-0 =0 0 9--

) 0 P+


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38

8//09 :0 8 //0-9;/:80 08 ;+. /C=- 8/0 =-0/00 8/ -- /00/8/08-0?1) P+08-= LDP

2) P/00 0:80//0-9 ;/:808/0 ;=?) ;/ 8/0 0

:0 80/0 >+08+9,+- 0 @ (/-0

/00 :0 -8-90.


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A;= 90: +-, >+08+9 0

9;-0)/0 8/>08-= BAB II S;/

T/0 D0 G)


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>08-0 /00=/0; 0 08- =LDP

. ;= = /C=- 8/08/;8 9=@9= :0 -0


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41

/=-0 /C=- 8/9;;/00 8//09 /-80:

(;= ) -= /C=- 08

. /C=- 8/0 =-0/00?

[S'% *+ +/ %C+*/+'4%*++ 0%-+ 7++%&%6+ *+ +-6+%%/ 4+0+ '%+4 /'/ +-0*+ &%0+'+6+ 6%+ 0+&8&8 '%&+-+++ %7+/0+*+ LDP, '%+%&+0-6+ ;/*+

4%8*%+ *+ 0+ 4++4%'%+.

S'% *+ 0*+6/6+ 0%-+


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42

7++ %--+&/-6+ &8&8%6' 0+ +-+. B8&8 %6',

&8&8 +-+ 0+ *+ +&+-&++' +/' 07+/6+ 0+*+LDP.]

[S'% 4%*++ &++ '%*++// %688' +/ %C+*/+'

4%*++ +- 0-/+6+6/'/' //6 %-%C+*/+'

4%-+0++ 0%-+%4%/-6+ 4%6++&++ 84%+' 0+ 4%%*+++,'%+ *+ ''+ '%*++ //%688' &++- %'%&/].

. P+08- = LDP.

/. P/00 0:80//0-9 ;/:80 8/0;=?1) ;/ 8/0 0

:0 80/0 >+08+9, +-0 @(/-0 /00 :0-8-90. A;= 90:+-, >+08+9 0 9;-0)/0 8/>08-= BAB II S;/

T/0 D0 G2)


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0 :0 -8-9/80:, 8- 90: -

-0-) :0 808/>08- /00 =/0;0


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0+6 %--/+6+ +&+-&++', 6+*+ 0+4/'6+)

9. P+2.".A) [U/6 3*% II 4+0+ '++

%C+*/+' 4%+$++ 3*% II>]2.".A).1) //=- /C=-

9 =-0 +/88 /00 /8/08-0 ?

+. [//6 68+6 H+-+ S+/+++/ 68+6 G+&/-+

L/4 S/ 0+ H+-+S+/+ 4+0+ &+-+ H+-+S+/+ >1) C8*/% 0+#++/ ;%'

4%6%;++ +-%7+/ 0+*+ 0+:+6/++' 0+ +-+(+4+&*+ +0+) 0'%'/+6+0%-+ +- %7+/0+*+ D86/%

P%-+0++=


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2) +4+&*+ %;+0 6%'+*+++'* 4%6+*+ +++

C8*/% 0%-+ +-+'+/+ 4%6%;++, +6+0*+6/6+ 4%&%/*+,0%-+ 6%%/+ +-+'+/+ 4%6%;++ +-0+$+6+ 0+6 &8*%0/&+=

?) ;%' 4%6%;++ +- 0+60&% +-+ '+/+0+--+4 '/0+ %+'/60+*+ +-+ '+/+

4%6%;++ +- *+ 0++-+ '+/+ 4+0+ 0+:+6/++' 0+ +-+ %+40&+6+ 68'8-=

9) J%' 4%6%;++ +- 0+6%7+/ 0+*+ 0+:+6/++' 0+ +-+(+4+&*+ +0+) 0'%'/+6+0%-+ ;%' 4%6%;++

+- %7+/ 0+*+

D86/% P%-+0++ 0++-+ '+/+ 4%6%;++0+--+4 8*= 0+

5) H+'* 68%6' ++64+0+ &+-+ +-+ '+/+0+4+ %-/&+ *+8+* +-+ 4%+$++'%--+ //+

4%-6+ 0+4+ %;+0*%& -- ++/ *%&%0+ 0+ //+

4%-6+ '%/*+=]&. [//6 K8+6 G+&/-+

L/4 S/0+ H+-+ S+/+4+0+ &+-+ L/4 S/ >1) C8*/% 0+#++/ ;%'

4%6%;++ +-%7+/ 0+*+ 0+:+6/++' 0+ +-+(+4+&*+ +0+) 0'%'/+6+0%-+ +- %7+/

0+*+ D86/%


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46

P%-+0++=2) J%' 4%6%;++ +- 0+6

%7+/ 0+*+ 0+:+6/++' 0+ +-+(+4+&*+ +0+) 0'%'/+6+0%-+ ;%' 4%6%;++

+- %7+/ 0+*+D86/% P%-+0++= 0+

?) H+'* 68%6' ++64+0+ &+-+ */4'/40+6 &8*% %-/&+*+ 8+* +-+

4%+$++ 4+0+ &+-+*/4 S/.]

27.6.A).2) T+8= 9 ;/00/8/=9 +/ 88 :0/=/9 0= 8+8= #PS,0:80 -- />-=;= :0 /-0;/00 9 -0 3(8) ;//8.

27.6.A).3) [+4+&*+ '%/+ 8+*+-+ 4%+$++ '%%*+68%6' ++6 //6 68+6+-+ '+/+ ++/ 68+6-+&/-+ */4 '/ 0+ +-+'+/+ 0 ++' *+ 8+* HPS,

4%*%*+-+ 0++6+ -+-+*.]

27.6.A).4) [+4+&*+ '%/+ 8+*+-+ 4%+$++ +- +'/6//6 K8+6 L/4 S/ 0

++' *+ 8+* HPS, 4%*%*+-+0++6+ -+-+*.]

27.6.A).5) U/6 %C+*/+'0%-+ ''% *+ ++/''% &++ '%*++ //%688', 4%*+6'+++%C+*/+' 4%+$++ +-+0*+6/6+ 8*% P86;+ ULP%+0+4 '%/+ 4%+$++

'%%*+ 68%6' ++6.


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27.6.A).6) A;= /8/=9

+/ 88 8/;8-0 3 (8) ;/0:0 /0 9 -0 0= 8+8= #PS ;+/=/=0 8/8; =0


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48

%'%&/ +/' %+40*+6'++6+. H+-++

0+--+4 %+'/6 0+*++-+ '+/+ 4%6%;++*++=

&. [//6 68+6 */4 '/>]1) +4+&*+ +0+ 4%&%0++

+++ 4%/*'+ *+ +-+4%+$++ +++ +-6+0+ //: +6+ *+ +-0+6/ +0+*+ *+ 0+*+/*'+ //:=

2) +4+&*+ 4%+$++ 0+*++-6+ %/*' 0%-+ ;%*+''%0+-6+ 0+*+ //:0+6 ;%*+', +6+ *+ +-0+6/ +0+*+ *+ 0+*+/*'+ +-6+= ++/

?) +4+&*+ 4%+$++ 0+*++-6+ 0+ //: 0+6 ;%*+',+6+ 4%+$++0++6+ -/-/]

27.6.B.2) D=-0 /C=-/


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50

-08- /;/=-0 ;/98-00#EA -0 /0/8;0

;/08 ;//00;/=/=00. (90:>08-0 ;=/;/:80 TKDN)

27.6.B.4) U/6 4%*++''% *+, 0/- *+68&+' +++ *+ 4%+$++%6' 0%-+ *+ +-+

4%+$++ %68%6' 0*+6/6+0%-+ 7++?

+. %&%6+ N*+ T%&+-(NT) %-- 1NT +-+ 4%+$++ %%0+

+-+ 4%+$++ NE NT &8&8 +-+ 4%'%+]

[U/6 4%*++ &++ '%*++ //%688', 0*+6/6+ 0%-+ 7++ >

+) %-/- &++ 84%+'8+*,4%%*+++, *+ ''+ '%*++// %688' '%&+-+++0%+46+ 0+*+ D86/%P%-+0++=


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&) %;/*+6+ +-+ 4%+$++0%-+ &++ 84%+'8+* 0+

&++ 4%%*+++=7) +'* 4%;/*++ 4+0+ //: &)

06/+- 0%-+ *+ ''+ 4+0++6 // %688'= 0+

0) 4%%+4+ 4%%+-&%0+'+6+ 8+* +-+ %%0+

4+0+ +'* //: 7.]

27.6.B.5) U08- 1 (8-) =/8/ --,;= 3 (8);/00 8//09 /8/=9+/ 88 :0 8//0-9 /C=- 9 P+


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52

27.6.D D= 9= 8/;8 2 (-)>=+0 ;//00 /= 9

;/00 :0 , P+88 =B/8 A> #= P/=/=00.

27.6.E P+=+0;//00 0 >=+0 ;//00>00 1 0 2 (;= ),/00 /8/08-0?+. [U/6 ''% -/-/ 0/*+ 0+

4%+$++ +-+ ++/4%+$++ +-+ %68%6'+- %%0+].

. [//6 ''% *+ 0/*+ 0++- %4/+ *+ 68&+'%--].

>. [//6 ''% 4%*++ &++'%*++ // %688' 0/*+0+ 8+* +-+ +- %%0+.]

=9, EaluasiKualifkasi

2!.1 [D+*+ +* '+/ 3*%> EC+*/+'6/+*36+' 0*+6/6+ %+0+4 7+*8

4%%+- *%*+- '%+ 7+*8 4%%+-7+0+-+ 1 0+ 2 (+4+&*+ +0+)]

[D+*+ +* 0/+ 3*% > EC+*/+' 6/+*36+'0*+6/6+ %+0+4 4%'%+ +-%%/ 4%'+++ %6']

2!.2 EC=- D8 K-= =-0/00 /0-00 /8+/ 8/--.

2!.? [P+6+ %-+' %*+ 0' 0+0+0++-+ 8*% 4%'%+ '%&%*/

4%+'/6+ 4%+$++ (//6 4%'%++- %*+6/6+ 6%++#KSO)]

2!.4 T8 % EC=- K-==-0 /- /00 B IIID+-/0 P/00 0.


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53

2!.5 A;= 8/-0 9=@9= 0'8-

8 :0 -0 8/8-= 0-0 8+=/9 /0-9-80 +-= 0-=.

2!.6 EC=- -= = ;+/;>-= -9 /-;0 8/8-= /=/8+0 8- 0+0 /=/8+0

2".3 P/-80 -= =-0 =-;= SPSE (+0/) /00/;/98-00 8- :0-8-90 -08- /90 ;/0:/0 ;/0:;0 +-/0 :0 0-80

2".4 A;= ;//8 8 ;8 /09;/-80 -= /00 =0

:0 ;8 8/, P+


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54

> /=98 +-/0 = 8-+-/0 :0 -9 =/= +=/9

;9 :0 //00, 0 /08/00:.

2".7 P/-80 -= 8/9; =8;/0:/, ;/=80, 0'8- -/: 0- /8 ;/:80-= =00: ;8 =-0/00 C8, -0


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55

2".12A;= 8 ;/00 :0 =-=-;/-80 -=, ;/=/=00

0:80 =.

6, Berita &cara;asilPelelangan

P+ #=P/=/=00 :0 ;=0 /8 /-8? 0 /=--9 ;//8 9 ;/00 8- 9

;/00 8/+/, 0@0 ;//8

> /8+/ /C=- :0 -00 -0-@-0- :0 /C=-/ -- :0 ;/-00 /8/00@/8/00 =0 :0

0; ;/=- /0/0 9= 9=;/=00 ;/=/=00

. P/0:80 9 ;/=/=00 =

;= 8 ;/00 :0//0-9 :8

+, PE$E)&P&$ PEME$&$% PELEL&$%&$

-, PenetapanPemenang

31.1. P+


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/;/;008- = LDP 0;;0 ;/0--0 / -08-:8

, Sangga!an

33.1 P//8 :0 /-0;/00 ;8 /0:;0090 /> /=/8+0 /==-;= SPSE 8 ;/0/8;0 ;//00/; P+


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-9 :0 /98 0'8->. ;/0:=9-00 //00 +=/9

P+


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34.2 [M%%#P4+ L%&+-+#K%4+*+ D+%+# P4+

I'/'#P%;+&+ +- %%+4%/-+'+ %;+$+& '+--++&+0-] /0 8/>08- =LDP


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59

/0 8/>08- = LDP 8-;0 =- 09

00, 0; / ;/0-00 8/8; 9- 80=0 8/-0 /; APIP.

%, PE$#$#K&$ PEME$&$%

:, Penunjukan Pen*ediaBarang/asa

35.1 P+ #= P/=/=00 (BA#P) /;PPK /00 8/-0 /; K/;=ULP / -08- /0/80S-8 P/0-0. 09 0'8-

09 00 /9.

35.3 PPK /00;-80 8 SPPBJ 0/0-09 9= ;/00 SPPBJ:0 8/=9 8/80 ; ;=SPSE 0 /00 SPPBJ 8//-8/==- ;= SPSE /; P/0:/:0 8-0


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;/000: 9 /=-/00 =0 :0 8 ;8

8/ /> +:/8 +=/9 P+08- = LDP/8 -0 = D8#8, 8-

>. ;= :0 /0-80 8// 8-000 9 /=- 8--9 ;/;0


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35." D= 9= DIPA'DPA 9=+, SPPBJ ;8 8-0 8/80

; 8 8- ;/-0 =++=/9 +8+8 :0 //00.

35.1$ D= SPPBJ /-80 9;/0:/ 9- /0:;0 J00P/=00 //=- ;/008000+08.

35.11 D= 9= PPK 8 ///0/80 SPPBJ /0 8/;/0;8 8 ;/0/8;0 ;//00, /89-0 /; PA'KPA-08- ;-8-0 /00 /8/08-0?

. ;= PA'KPA /;/0;8 /00PPK, =-0 /C=- -=0 8-;/=/=00 0:80 = 8-

b, ;= PA'KPA /;/0;8 /00ULP, PA'KPA /-8-0;/0/8;0 ;//00 +=/9 ULP/8 0= 0 PA'KPA//0890 PPK -08-

/0/80SPPBJ.

35.12 K+08 80800 ;=0=8 14 (/;8 /=) 9 / /=/8+0 :0 8;8 ++ 8- =8 ;=SPSE

36.2 B/8 A> T90 =00:/0 - ; 0 36.1-09 (/4*8+0) +=/9 P+


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=00: ; ;= SPSE.

36.3EC=- ;/00 :0 ;-=0= B/8 A> #= P/=/=00(BA#P) +=/9 P+=+0

;//00 >00 1 0 2,


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64

P//0 N+. 7$ T9-0 2$12 //8;/8-0+. S+--++ &+0- 0+ 4%'%+

%++ &%+= ++/&. P%-+0/+ +'++6+ ++'

%;+0+ KKN +- %*&+6+ KPA,%++ &%+.]

[K%4+*+ D+%+ %++6+ 4%*%*+-+-+-+*, +4+&*+>

+. S+--++ &+0- 0+ 4%'%+%++ &%+= ++/

&. P%-+0/+ +'++6+ ++'%;+0+ KKN +- %*&+6+ PA0+#++/ KPA, %++ &%+.

37.4 S/8/=9 ;/=/=00 0:80=, P+


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!$H (/=;0 ;-=-9 ;//8-); /00 1$$H (/8-

;//8-) 0= 8+8= #PS =9// 5H (= ;//8-) 0= K+08 8-

. 0= J00 P/=00 -08-9 ;/00 8/+/ 8-9 !$H (/=;0 ;-=-9;//8-) 0= #PS =9 //5H (= ;//8-) 0= 8+8=#PS.

3".3 PPK 0 ;/0:/ 8

;//000 /0-9 -80D+-/0 P/00 ; /00;/008000 K+08, />-=/;/08 8- ;/=00;//


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/. :8@:8 -- K+08. ;/ 9--

. ;/ --9. @(;= ). 8 -088 0 9 (;=

) 0


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;9 :0 9 /0 A8P/00'A00 D -08-

/00800 K+08.


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B&B I8, LEMB&R D&)& PEMILI;&$ 0LDP1

&, IDE$)I)&S P"K& 1. P+


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____________[0' ;%' 68+6 +- '%'/+>

K8+6 +/ /--+* ++/K8+6 T+/ J++6]

3. K+08 /0 -/;/000? ____________[0' ;%' 68+6 +- '%'/+>K8+6 P%-+0++ T/--+*=K8+6 P%-+0++ B%'++=++/ K8+6 P+/-(F+%$86 8+7)].

D, S#MBER D&$& P//08- =;= SPSE

*. PENINJAUANLAPAN+AN [a#a$%ad#er%u(an]

[P%;+/+ L+4+-+ +6+0*+6'++6+ 4+0+>H+ > T+--+*> P/6/* > '.0. T%4+> ]

%, M&)& #&$%PE$&5&R&$ D&$.&R& PEMB&4&R&$

1. M8 -0 :0 -00_____________[0' R/4+ ++/ ++ /+-

*++ +4+&*+ 0*+6'++6+ 0*/+ %-%]

2. P/:0 =-0 /00> ________[0' 4%&++++ 00+'+6+

4+0+ +'* 4%-/6/+ &%'++++' C8*/% 4%6%;++ +-&%+&%+ %*+ 0*+6'++6+'%7++ &/*++ (8* 7%37+%), 7++ +-'/+(%;)++/ '%6+*-/']


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;, M&S&BERL&K#$4&PE$&5&R&$

M /=- ;/00 /=______ (__________) 9 =/0//


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______[K+' N%-++#K+' D+%+]

, &D5&LPEM&S#K&$D"K#ME$PE$&5&R&$

L98


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7. G ;/=-0 -08-0?

1) ......2) ......?) ......

(P=9 '%'/+ +- 0+ 0+/+6+ ++ &++- +-%&//6+ 788, &8'/,++/ -+&+)

5. D+:+ 6/++' 0+ +-+(+4+&*+ 04%'++6+), +-0*%-6+4 0%-+ 0%+'(;%', 4%, 0+ %%6) (4*'%'/+ 6%&//+)

". 3*%#'7+ *+++ 4/+;/+*(+4+&*+ 04%'++6+)=

. =/'>0 ;+= -0'-8;/0:80 0 //0=:00 -0 (;=

;/:80)

!. [D+:+ 4%'8* #T%+-+A*#T%6'#T%+4* +-04%*/6+ //6 4%*+6'+++

4%6%;++>] [+4+&*+ 04%*/6+] ________________________________

_[0', ;+&++ 0+*+ 8-+'+'

4+6% 4%6%;++ &', *++4%-+*++ 6%;+,

48:%'#6%+*+ +- 04%*/6+//6 4%%*%'++ 4%6%;++](M88 0&%0+6+ +++%+-+ +- 04%*/6+ //6%*+6'++6+ 4%6%;++0%-+ %+-+ +- $+;&0*6 8*% 4%/'+++. K8*8 //6 %;%*+'6+ %+-++4+ '+;+ +- $+;& 0+$+6+8*% 4%%0+ '%+ 0+6

&%6++ 0%-+ 6/+*36+')


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". D8 P/=80 U8 0=

:0 ;/=-0 -08-;/=00 ;//](+4+&*+ %--/+6+ +&+-&++')

A&+- &++' 4%% &++->(+4+&*+ +0+ +&+- &++' 4%

%)


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N8 N++ B++- A&+-

B++'12

",[SISTE, NILAI] N*+ T%6' (B8&8 .... (1. APIP_______________

[K%%%+#L%&+-+#P%%+ D+%+#I'/'][0' '%7++ *%-6+4 0+

;%*+']

3. S090 B00;0 =- ;=SPSE (8%) 8-


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9. T/-0 090

00 ;0 =-;= SPSE (8%) 8-


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/*+ 0+ +--+*4%+0++-++ 68+6

'+4+ 0%-+ '%+ %+B++-.]

2. J00 P/=00 8-0, >0 0/8+0 ; _________ [K+'N%-++#K+' D+%+] (+4+&*++0+).


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B&B 8, LEMB&R D&)& K#&LI+IK&SI0LDK1

&, LingkupKualifkasi

N P+


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3 (8) -=0 8/9 :8- -=0

...... (8-=0 -=0 :0 08).

P//8 ;8 /008

;/:80 0 /00

/0:;0 S-8 K/8/00

&= (SK&) :0

/=-0'=/= +=/9 K08+

P/=:00 P


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6) 8 = ;/00 ;/0=0,

8 ;=8, /80 -90: 8

/0 9/080 0'8- /

:0 /80 -08- 0 8 0

;/-90 8 /0 =

/0


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;/=-0) /00 -= /9=0

________ /- /00 ; +-;-8 ;//


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11) M/=

=8';/=80';/=/0;0 (;=

;/=-0), :8-?

_____________ /-80 =8'

;/=80' ;/=/0;0 0- :0

;/=-0, 8/- :0 /8

9--';/'/8/0+=+ 80 :0

/00 -='-=8

;/-90. ;/:80 0 90:

;8 ; ;= ;/=-0 =

0 /0>; +-;-8 ;//


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B&B 8I BE$)#K D"K#ME$ PE$&5&R&$

&, BE$)#K S#R&) PE$&5&R&$ PESER)& B&D&$#S&;&/KEMI)R&&$ 0KS"10#$)#K S&)# +ILE1

[K-P SURAT BADAN USAA]

N++ ? _______, _____________ 2$___

L;0?

K/; Y89.?

P+-= 0 D+-/0

P/00 N++? _________________ 80= ______________ 0

/8/=9 ;/=08- = D+-/0 P/00 -08-

/=00 ;//


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S/- /00 ;/:80, / S-8 P/00 0

=;0?1. [S8:784 J++ P%+$++, +4+&*+ 04%'++6+]2. [D+:+ K/++' 0+ H+-+, +4+&*+ 04%'++6+]3. [S/+ K/+'+, +4+&*+ +0+]=4. [S/+ 4%;+;+ K%++#K%;+ S++ O4%+', (;=

;//8 //08- K/80'KSO)5. D+-/0 ;/00 8/0, 8/ ?

. ;/ 8/0 0 :0 80 =/0;/0 >+08+9, +- 0 @

.


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B, BE$)#K S#R&) PE$&5&R&$ PESER)& PER"R&$%&$

0#$)#K S&)# +ILE1

N++ ? _______, _____________ 2$___

L;0?

K/; Y89.?

P+-= 0 D+-/0

P/00 N++? _________________ 80= ______________0

/8/=9 ;/=08- = D+-/0 P/00 -08-

/=00 ;//


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1. [J++ P%+$++ (+4+&*+ 04%'++6+)]=2. [D+:+ K/++' 0+ H+-+, +4+&*+ 04%'++6+]

3. D+-/0 ;/00 8/0, 8/ ?. ;/ 8/0 0 :0 80 =/0;

/0 >+08+9, +- 0 @. 08- = D+-/0 P/00.

., BE$)#K S#R&) PE$&5&R&$ &DMI$IS)R&SI D&$)EK$IS 0#$)#K +ILE I@ ME)"DE D#& +ILE1

[K-P SURAT BADAN USAA]

N++ ? _______, _____________ 2$___

L;0?

K/; Y89.?

P+


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S/9--00 /00 ;/0--0 P/=/=00 U-

/00 P>-= 0 D+-/0 P/00 N++?

_________________ 80= ______________0 /8/=9 ;/=08-

= D+-/0 P/00 -08- /=00 ;//


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D, BE$)#K S#R&) PE$&5&R&$ ;&R%& 0#$)#K +ILE II@ME)"DE D#& +ILE1

[K# Surat Badan U&aha]

N++ ? _______, _____________ 2$___

L;0?

K/; Y89.?

P+


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D/00 ;00: S-8 P/00 0,

/0:80 0-; 0 0 8-0- ; /- /8/08-0

:0 8/>08- = D+-/0 P/00.


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E, BE$)#K S#R&) PE$&5&R&$ &DMI$IS)R&SI D&$

)EK$IS PESERTA PER-RAN+AN 0#$)#K +ILE I@ME)"DE D#& +ILE1

N++ ? _______, _____________ 2$___

L;0?

K/; Y89.?

P+-= 0 D+-/0

P/00 N++? _________________ 80= ______________0

/8/=9 ;/= P//0 P/0


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P/00 0 /=- /+08+9, +- 0 @

2


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S/9--00 /00 -000 ;/-0 D+-/0 P/00S;-= II 0++? _________________ 80= ______________ /8/=9

/;/=08- = D+-/0 P/00.


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%, BE$)#K PER&$I&$ KEMI)R&&$/KER& S&M&

"PER&SI 0KS"1 0!an*a dicantumkan apabilamembole!kan KS"1

S#R&) PER&$I&$ KEMI)R&&$/KER&S&M& "PER&SI 0KS"1

S/9--00 /00 ;/=/=00 ;//


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3. M0@0 ;//8 0+8 K/80'KSO, 0

/0= 0 /- '+-8//-8 ; -8 2 =9= ;/0/=-0, /-08-00, 0 /-0 K/80'KSO.

4. P/0 '+- = K/80'KSO 0 8 0-9 /= ;/00 -;-0 /;0-= /00 ;//8-


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(_______________) (________________) (________________)

[0'

(_________________)

Catatan:

Surat Perjanjian Kemitraan/Kerjasama Operasi ini harus dibuat diatas kertas segel/bermaterai.


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;, BE$)#K D"K#ME$ PE$&5&R&$ )EK$IS

Dokumen PenaAaran )eknis

[+/6+ 0+ ;%*+'6+ '%7++ 7 +*+* &%6/. J6+04%*/6+, 6%%+-+ 0+4+ 07+/6+ 0+*+ *%&+%'%0#+&++]

1. ;/ 8/0 0 (=/0; /00 >+08+9, +-,0 @ /- :0 8/8;0 = B IIS;/ T/0 0 )

2.


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I. [BENTUK *-R,ULIR REKAPITULASI PERITUN+ANTIN+KAT K-,P-NEN DALA, NE+ERI "TKDN)0 a#a$%a

memenuh &'arat untu( d$er(an #reeren& hara]

+"RM#LIR REK&PI)#L&SI PER;I)#$%&$ )I$%K&)K"MP"$E$ D&L&M $E%ERI 0)KD$1

U0 P//


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101

, BE$)#K &MI$&$ PE$&5&R&$ D&RI B&$K

.onto!

[K# Ban( Pener$t Jamnan]

%&R&$SI B&$Ksebagai

&MI$&$ PE$&5&R&$N+. ____________________

Y0 /80 800 9 0? @

__________________________________ =


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. Y0 D


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P 80= ?___________

[B+6]M8/ R;. 6.$$$,@

____________[N++ 0+ J+&++]

U08- /:00,;//0 G0 B000 -08-/0+0 G0


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K, BE$)#K &MI$&$ PE$&5&R&$ D&RI&S#R&$SI/PER#S&;&&$ PE$&MI$&$

.onto!

[K# Pener$t Jamnan]

&MI$&$ PE$&5&R&$

N++ J00? ____________________ N=?_____________

1. D/00 0 0:80, 9 ?_____________________[++], [+*++] /P/0:/, /=0


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4. S-8 J00 0 /=- //8 -= 80= ____..____ 0' '%'/+ +- %7+/ 0+*+ LDP.

5. PENJAMIN 0 /: /; PENERIMA JAMINAN/


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L, BE$)#K P&K)& I$)E%RI)&S

Denan mendatar &e$aa #e&erta #em%han #adaa#%(a& SPSE ma(a #e&erta te%ah men'etu3u dan

menandatanan #a(ta nterta&


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[88 P+6+ I%-+' B+0+ U'++ D%-+ K%++#KSO](++ 07+/6+ +4+&*+ %&8*%6+ K%++#KSO)

P&K)& I$)E%RI)&SK :0 /80 800 9 0?

1. N ? __________ [++ $+6* '+ &+0+ /'++]

N+.I/088 ? ___________ [0' 88 KTP#SIM#P+'48]

J80 ? __________

B/80 -08-

0 80

? PT'%'&'K+;/____________________[4

* +- '%'/+ 0+ 7+/6+ ++]

2. N ? __________ [++ $+6* '+ &+0+ /'++]

N+.I/088 ? ___________ [0' 88 KTP#SIM#P+'48]

J80 ? __________

B/80 -08-0 8

0

? PT'%'&'K+;/____________________[4* +- '%'/+ 0+ 7+/6+ ++]

3. ......[0+ '%%/'+, 0' '%'/+ 0%-+ ;/*+ +--8+6%++#KSO]

= 0 ;/00 _________ [' ++ 4+6%] ;________ [' '%'/+ 0%-+ K#L#D#I] /00 0 /0:809?

1. 8 0 /=-0 ;8/ K+-;, K+=-, 0

N/;+8/ (KKN)

2. 0 /0-8 ;+/ ;/00 /> /9,80;0, 0 ;+/+0= -08- //0 9= /08-0 = D8 #8, -8/> ;/8 0'8- =;+0 /> ;0.

__________[%4+], __[+--+*]__________[&/*+]2$_____[+/]

[N++ P%%0+][N++ P%%0+][N++ P%%0+]


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[ +0+ +-+],[ +0+ +-+],[ +0+ +-+],[++ *%-6+4][++ *%-6+4][++ *%-6+4]

[7+/6+ +0+ +-+ 0+ ++ '%+4 +--8+ K%++]


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M, D&)& ISI&$ K#&LI+IK&SI

Isian Data Kualifkasi bagi Peserta selain anggotaKemitraan/KS" berbentuk +orm Isian Elektronik Data

Kualifkasi *ang tersedia pada aplikasi SPSE


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[*-R,ULIR ISIAN KUALI*IKASI UNTUK KE,ITRAAN/KS-]"han'a d4antum(an a#a$%a mem$%eh(an

Kemtraan/KS-)

S: :0 /80 800 9 0?

N ? __________ [++ $+6* '+ ;6+ &+0+ /'++]

N+.I/088

? __________[0' 0%-+ 8. KTP#SIM#P+'48]

J80 ? __________[0' '%'/+ ;+&++ 0+*+ +6%8+']

B/80-08-0 80

? ____________________[0' ++ &+0+ /'++]

A=8 ? __________

T/=/;+0'&Q ? __________

E= ? __________

/0:80 /00 /-0-90: 9?1. : /> 9-- /80 -08- 0 8 0

;/-90'+;/'/80'KSO /0__________+6+ 4%0+#+--++ 0+'+#'/+6/+'+#P%;+;+ K%++#K%;+ S++ O4%+', 0'%&/6+'%7++ ;%*+' 88 0+ +--+* +6+ 4%0+#+--++0+'+#'/+ 6/+'+#4%;+;+ 6%++#K%;+ S++O4%+'

2. : -0 / ;/ K'L'D'I [&+- 4%-+$+ K#L#D#I+- '%0+- 7/ 0*/+ +--/-+ K#L#D#I 0/*' '%&+-+&%6/ > @S++ %/4+6+ 4%-+$+ K#L#D#I +- '%0+-7/ 0*/+ +--/-+ K#L#D#I]

3. : 8 /0 /0


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5. 0 -9 :0 : = 8 - = D8#8, 8 = ;/00 ;/0=0, 8 ;=8

8- /80 -90: 8 /0 9/080

6. =9 8- 0'8- /- ;/0-- 0 -9 :0: = 8 - = D8 #8

7. 8@8 0 -9 :0 : = =9 //-8?

&, Data &dministrasi

1.

N B0 U9 ? __________

2. S88- ?

3.

A=8 K08+ P-8 ? __________

N+. T/=/;+0 ? __________

N+. &Q ? __________

E@M= ? __________

4.

A=8 K08+ %0 ? __________

______________________________

N+. T/=/;+0 ?N+. &Q ?E@M= ?

B, Landasan ;ukum Pendirian Perusa!aan

1. A8 P/00 P/-90'A00 D K+;/

. N++ ? __________

. T0= ? __________

>. N N+8 ? __________ .N++ P/0/90

K//08/0 #-- 0#AM. (-08- :0 //08-PT)

2. P/-90 T/9 A8P/00 P/-90'A00 D K+;/

. N++ ? __________

. T0= ? __________

Ca(angPusat


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>. N N+8 ? __________

., Pengurus Badan #sa!a

N+. N N+. I/088 J80 =B0 U9

D, Iin #sa!a

1. N+. S-8 I0 U9________

? _______T0= ______

2. M /=- 0 -9 ? __________

3. I080 ;// 0-9

? __________

4. K-= U9 ? ___________

5. K= U9 ? ___________

E, Iin Lainn*a[a#a$%a d#er&'arat(an]

1. N+. S-8 I0____________

? _______T0= ______

2. M /=- 0 ? __________

3. I080 ;// 0 ? __________

+, Data Keuangan

-, Susunan Kepemilikan Sa!am 0untuk P)1/Susunan

Pesero 0untuk .8/+irma1

N+. N N+. I/088A=8 P//08

/

=, Pajak

. N++ P++


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. B-8 =;+0 P. B-8 L;+0 -=00(8 -=0 8/9)?1) PP9 P= 212) PP9 P= 233) PP9 P= 25'P=

2"4) PPN

?????

N+. ________80= ______N+. ________80= ______N+. ________80= ______N+. ________80= ______

0. [S/+ K%%+-+F'6+* ('%&+-+

4%--+ //: & 0+7)]

? N+. ________80= ______

+. Data Personalia0)enaga a!li/teknis/terampil badanusa!a1[a#a$%a d#er%u(an]

N

+N

T='=0'8

90 =9

T08P/0

0

J80

=;// ;/8, 0'8- ;/=;+0 /> ;0 /; ;9//00 /- /00 /8/08-0 ;/8-0 ;/-00@-000.

[%4+], [+--+*] [&/*+]2$ [+/]

PT'%'&'K+;/

____________________[4* +- '%'/+ 0+ 7+/6+ ++]

[%6+6+ %%+ R4 ".


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B&B 8II, PE)#$#K PE$%ISI&$ D&)& K#&LI+IK&SI

I, P/8-00 :0 ;8 9--0, ;=;//8 /88- 08+ >0.

B, Landasan ;ukum Pendirian Badan #sa!a


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1. D /00 0++, 80= 0 0 0+8 ;/0/88 ;/00 ;/-90'00 +;/,

/8 -08- 0 -9 :0 //08- P//+0T/8 0++ ;/0/90 K//08/0#-- 0 #AM.

2. D /00 0++, 80= 0 0 N+8 ;/0/8A8P/-90 T/9 0 -9, ;= .K9-- -08- P//+0 T/8,


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3. D /00 0 080 ;/0/8 -8 0.

+, Data Keuangan

1. D /00 0, 0++ KTP'SIM'P;+, =8;/= 9';//+, 0 ;//08/ /;/=09';//+.

2. P


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;/-80, +0 (= ;//08/), =+ //08 0 0 88- /;/=0 (= /0'/ /='

--00 /) 0@0=8';/=80';/=/0;0 :0 ;/=-0. B-888- /;/=0 9- ;8 8-0


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B&B 8III, )&)& .&R& E8&L#&SI K#&LI+IK&SI

A. D+-/0 K-= :0 0 /C=- 9- //0-9;/:80 /- :0 8/>08- = L/ D8K-= (LDK)

B. P+08- ; ;= SPSE = 9=?

1. /=/0;0 D8 K-= 02. ;//0-90 ;/:80 -=.

%. &+-= I0 K-= -08- KSO :0 8 --98/ 8 --0, ;//8 08 -08- /:/0 8/ /- /8/08-0 ;/8-0 ;/-00 *-000.

D. A;= 8/-0 9=@9= 0'8- 8 :0 -0


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BAB I. BENTUK DOKUMEN KONTRAK

&, BE$)#K S#R&) PER&$I&$

S#R&) PER&$I&$

-08- /=00P/8 P//[ [++ $+6* P%%0+], [;+&++ $+6*P%%0+], +- &%0+6 //6 0+ ++' ++

[++ P%%0+], +- &%6%0/0/6+ 0[+*++ P%%0+], &%0+'+6+ A6+P%0+#A--++ D+'+ N8. [N8. A6+P%0+#A--++ D+'+] +--+* [+--+*

4%%&+ A6+ P%0+#A--++ D+'+], '%*+;/+0'%&/ Pen'eda]

?. U/6 P%%0+ K%++#KSO, +6+ >[K%++#KSO +- &%+--8+6+ '%&+-+ &%6/>1. [++ P%%0+ 1]=

2. [++ P%%0+ 2]=

a( *+. entuk #,kumen -,ntrak 125


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................................................ 0'+- +'-+'- +--8++ &%+--/- ;+$+& '%7++

4&+0 0+ +--/- %%- ++' '%/+ 6%$+;&+ %+0+4PPK &%0+'+6+ K8+6 0+ %*+ %/;/6

[++ +--8+ K%++#KSO +- 0/;/6'%&+-+ $+6* K%++#KSO] //6 &%0+6 ++' ++K%++#KSO +- &%6%0/0/6+ 0 [+*++P%%0+ $+6* K%++#KSO], &%0+'+6+ '/+ P%;+;+K%++#KSO N8. +--+* ,'%*+;/+ 0'%&/ @Pen'eda]

MENGINGAT BA#A?

() PPK 8/=9 /08 P/0:/ -08- /0:/0 B0/0 8/00 = S:8@S:8 U-K+08 :0 8/=; = K+08 0 (/=0;8-8

3) 8/=9 /> 0 /9 /> ;/0-9 /8/08-0K+08 0

4) 8/=9 /0;80 //;80 :0 / -08-// 0 /0+00 /- /8/08-0= K+08 0 //8 /- 8 0 +0 :08/8.


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MAKA OLE# KARENA ITU, PPK 0 P/0:/ /00 0//;8 0 /0:/8-@8+* +-+ K8+6 ++/ N*+ K8+6 %+'/6 P+;+6P%+&++ N*+ (PPN) +- 04%8*% &%0+'+6+6/++' 0+ +-+ '+/+ 4%6%;++ '%&+-+++%7+/ 0+*+ D+:+ K/++' 0+ H+-+ +0+*+'%&%'+ R4 ( /4+)=]

[//6 68+6 L/4 S/ 0/*' '%&+-+ &%6/>@8+* +-+ K8+6 ++/ N*+ K8+6 %+'/6 P+;+6P%+&++ N*+ (PPN) +0+*+ '%&%'+ R4( /4+)=]

2. ;/8=90 0 -0;0 = S-8 P/


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1) /0 0 // ;//


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/=00 K+08 /- /00 /8/08-0 ;/8-0;/-00@-000 R/;-= I0+0/.

U08- 0 8 0 PPK__________

[+0+ +-+ 0+ 7+4 (;6+'+*+ +'* //6 P%%0+

+6+ %6+6+ +%+ R4".


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BE$)#K S#R&) PERI$)&; KER& 0SPK10&pabila nilaipengadaan dibaAa! =66 uta1

[684 '/+ K#L#D#I]

S#R&) PERI$)&;KER& 0SPK1

SATUAN KERJA PPK?________________

NOMOR DAN TANGGAL SPK _____________

PAKET PEKERJAAN ?________

NOMOR DAN TANGGAL SURAT PERMINTAANPENAARAN?

________

NOMOR DAN TANGGAL DOKUMEN

PENGADAAN?______

NOMOR DAN TANGGAL BERITA A%ARA #ASILPELELANGAN?

SUMBER DANA? ['%&+-+ 788, 7+/6+ 0&%&+6+ ++'DIPA T+/ A--++ //6 ++ +--++6%-++AKTU PELAKSANAAN PEKERJAAN? ___ (__________) 9

=/0/'-=0'89-0

NILAI PEKERJAAN

N+.U0

P//


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6%%*+&++]. S/=0 8-0- /; /8/08-0 = SPK 0,P/0:/ //


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S4&R&) #M#MS#R&) PERI$)&; KER& 0SPK1

-, ITIKAD BAIK. P ;9 /80 /0 =0 ;/>: :0 /-0

/00 9@9 :0 8/;8 = SPK.. P ;9 /8-

+. 2


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8/8; ; PPK, 0 /- ;/=80 8//-8 9- /=0 /;PPK ; 8 SPK /9 8- -=0 /-0 8;/0 :0 8 -8- :0 8/-0. PPK ;8//0890 ;/0:/ -08- /0/-0 0 /0-0;0 >>8 -8-,/8 /0-8 -8-.P/0:/ /80-0 >8 -8- /= 6 (/0) -=0 /8/=9 /98/ 9= ;//


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8//-8 /0 /=90 8- /==0 /8 PPK) /9--00 /00= :0 8-= 9=@9= /-8 8/98-0 // 8--9, 8 8- /80P/+0=

3) /9=00 8- /-0 98/0, 0 >/ 8--9, 88- /80 ;9 /8

. T/98-0 /. P/80-00 -0 :0 = +=/9 ;/0:/ 8 /8/


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:0 ;/=- 8+0


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134

890 :0 /8/=9 =00 ;/0-/


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!) PPK 8 /0/80 SPP -08- ;/:0 890 0-0 /-/00 :0 /;8 /0 8/>08- = SPK

") ;/0:/ 8/-8 /=-0 KKN, />-00 0'8- ;/=-0

= ;+/ P/00 :0 ;-8-0 +=/9 080 :0//00 0'8-

1$) ;/0-0 8/080 ;/0:;00 ;+/-, -0 KKN 0'8-;/=00 ;/00 /98 = ;/=00 ;/000:80 /0 +=/9 080 :0 //00.

/. D= 9= ;/-8-0 SPK =-0 /0 /=90 ;/0:/?1) ;/0:/ /: /0 0'8-2) ;/0:/ -0 = D8 #8.

.D= 9= ;/-8-0 SPK =-0 /0 PPK 8/=8 ;/0:;00;+/-, /=-0 KKN 0'8- ;/=00 ;/00 /98 =;/=00 ;/00, PPK /00 0 /0 ;/8-0;/-00@-000.

=7, #AK ATAS KEKAYAAN INTELEKTUALP/0:/ //


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/8/0. ;/:0 8/9 90: =-0 /8/=9 ;// ;/0:/90 ;//. PPK = --0 8- 7 (8-


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B&B >, S4&R&)?S4&R&) #M#M K"$)R&K 0SS#K1

&, KE)E$)#&$ #M#M

-, Defnisi I8=9@8=9 :0 -00 = S:8@S:8 U- K+08 0 9- /;-0:8 8- 80 /;/8 :0 -0/ /-8?

-,- Barang =9 /8; /0 /-


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139

:0 8/>08- = K+08,

-,- ;ari=9 9 =/0/1.14 DaFtar kuantitas dan !arga

0rincian !arga penaAaran1 =98 -088 :0 8/=9 98-0 0


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0:80 ; S-8 P/00 (SP):0 8/80 +=/9 P/


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/6/ +- &%*+6/ 0 I08%'+ ++/ /6/+- &%*+6/ 0 %-++ 4%&%

4;++#&+ (%-+/- 6%'%4+6++4%%+ 0+ %-++ 4%&%4;++#&+)].

2, LaranganKorupsi@Kolusi@ dan$epotisme0KK$1 sertaPenipuan

4.1 B/0 /8 ;/000'


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D/9'P;00 I088-.

4.5 PPK :0 8/=8 = KKN 0;/0;-0 /00 0 /0/8/08-0 ;/8-0 ;/-00@-000.

:, &salBarang

5.1 P/0:/ 9- /0:;0 =8/='90 :0 8/ 0>0+;+0/0 = 0// 0 +;+0/0;+.

5.2 A= 0 /-;0 8/;8 0;/+=/9, 08 =0 8/;8 080, 8--9, 8- ;+-.

5.3 B0 0 9- -800 :0 0-8-, ;,;/80, 0 ;/0:/=/0 9;//


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/@= 0'8- = :0 8-08- = SSKK.

3, 5akil sa!para pi!ak

S/8; 800 :0 ;/:80 8-;/+=/90 -08- =-0, 0 /8;+-/0 :0 ;/:80 8-;/+=/90 -08- -8 /0K+08 0 +=/9 PPK 8- P/0:/ 90:;8 =-0 8- -8 +=/9 ;/880 /-00 :0 -8 08/8 /9--00 /00 ;/=00;//


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= K+08 00 -08--+080.

1$.5 S-+08 /0 ;//


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Pekerjaan 80= :0 8/8;0 = SSKK

14.2 8- ;/=00 +08=9


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. 0+ ;/00 0. +0 /.


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147

:0 0 0 //=-0;.

-9, Lingkuppekerjaan

B0 :0 0 0 9- /-/00 8 -088 0 9

-


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08 +=/9 PPK ;8 /=00;//0 /.

22.4 #= ;//0 /8-00 = B/8 A>. A;== ;//0 //080 ;/-90 K+08, 9- 8-00 = /0-K+08.

=, InspeksiPabrikasi

23.1 PPK 8- T I0;/ :08-0


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8- = SSKK.

25.3 U08- 0@0 :0-9 - 8- /+ 80,;/0:/ 9- //0 0+/> 0> 8/080 >;/00000:.

=7, &suransi 26.1 P/0:/ 9- /0-000@0 :0 0 /90/- /00 /8/08-0 ;/8-0;/-00@-000 :0 /=- 0/8/08-0 :0 8/>08- = SSKK

26.2 P/0:/ 9- /0-00;/00 0@0 /-/00 /8/08-0 ;/8-0 ;/-00@-000 :0 /=- 0 /8/08-0:0 8/>08- = SSKK

26.3 B0 :0 0 />%I& (8', I'/+7% +0 F%-) 9--00 -08- ;/80-00

:0 8/>08- = SSKK 8/9;/-0 8- /9=00 :0-00 8/


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; /00 T/;8 T-


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151

/90 PPK 0'8- P/


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152

80-0 ;/0:/.

-, 5aktuPen*elesaianPekerjaan

31.1 K/>-= K+08 ;-8-0 =/9 =,;/0:/ //


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-08- /0>/9 /8/=80 /8/=80 /;/8 0 8 ;8

08- = SSKK0 /0 8/80 +=/9 %I%+8+* +&% 8: 8%7%.

B,= Pen*elesaian Kontrak

2, Sera!)erimaBarang

34.1 S/8/=9 ;//


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P//0 ;/00P/


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8/ +=/9 P08'P/8 -8- 0/=- ; /00 12 (- /=)-=0 /8/=9 /9 8/ B0 8-

>8 -8- /;P/0:/ // /8/=9 8/-0>>8 -8- 8//-8 /= M

L:00 P-0>8-8- +=/9 PPK, P/0:/ //8-8- =


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157

;9 = +08 /90/0-9 =0-; ;//


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K+08 = :0 ;/=-0-08- /0:/=/0 /=--9

;//08- =K+08 =

d. #= 0/+ 8//-8 8-00= B/8 A> / ;/0:--00 /0- K+08.

?.2 [U/6 4%6%;++ +-%--/+6+ K8+6 L/4 S/ ++/K8+6 G+&/-+ L/4 S/ 0+ H+-+S+/+ 4+0+ &+-+ L/4 S/, 0+6

0+4+ 0*+6/6+ 4%/&++ K8+6.]

26, Peruba!an adAalPelaksanaanPekerjaan

9

+. 4%6%;++ +&+=&. 4%/&++ 0'+=7. 6%%*+&++ +- 0'%&+&6+ 8*%

PPK=0. +'+*+ +- &/* 0*/+ 6%0+*

4%%0+= 0+#++/%. K%+0++ K++.]

[U/6 4%6%;++ +- %--/+6+K8+6 G+&/-+ L/4 S/ 0+ H+-+S+/+ 4+0+ &+-+ L/4 S/,

4%/&++ ;+0$+* 0+*+ +* %;+0


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4%4+;+-+ $+6/ 4%*+6'+++ 0+4+0&%6+ 8*% PPK ++' 4%&+-+

+- *++6 0+ $+;+ //6 +*+*'%&+-+ &%6/>

+. 6%%*+&++ +- 0'%&+&6+ 8*%PPK=

&. +'+*+ +- &/* 0*/+ 6%0+*4%%0+= 0+#++/

7. 6%+0++ 6++.]

4$.2 8- ;/0:/=/0 ;//


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160

/=;-8?. B/0>0 =

. B/0>0 0+0 =>. B/0>0 +=. P/++0/. K/0 0'8-. G0-0 0-8 =00:

/0 0:80 /==-/;-8-0 / M/08/ K/-000 /08/ 8/0 8/8

42.3 A;= 8/


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= K+08 0 /0;8;/0080 : :0


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162

P/0:/ -08- /0/-0 ;/00/;8 -00 P/0:/ /9

-08- /0/ ;/:0 /08/08-0 = K+08 0 /0;8;/0080 : :0


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;8 /0:/=/0 ;//


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164

/4+)]=. U0 M- 9- =-0 +=/9

;/0:/ 8- J00 U0 M->0 (;= )

>. ;/0:/ /: /0/8/=80 (;= 8/;8;/-8-0 +08 8/9; 0+08 :0 /=- /=/0)

. ;/0:/ -0 = D8#8. 0'8-

/. PPK /: /; ;/0://- /00 ;/0>;0 ;/8;//0P/-8-0 K+08 /> 8/8-=/; PPK.

4".3K/


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;//


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-;-0 //08 :0 ;/=-0 -08-;/=00, ;/0:/=/0 0 ;/0

;// = +08. //0 /8/00@/8/00 :0

;/=-0 -08- ;//0 ;/=00:0 =-0 PPK

. /0:/90 9= ;//


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168

6%'%*+++ 6%;+. P+0+ $+6/4%*+6'+++ 4%6%;++, 4%%0+

&%'%+ P%'8*+ 0+--+4 %*+%&+7+ 0+ %++ 4%+/+6%'%*+++ 6%;+ %'%&/.

5".? P%%0+ &%6%$+;&+ ++' &++'%0 //6 %%0+6+ 6%4+0+'%+4 P%'8*+ (%+'/6 P%'8*S/&4%%0+, ;6+ +0+) 4%*%-6+4+6%'%*+++ 6%;+ +- '%'/+ 0+%+0+.

5".9 T+4+ %-/+- 6%$+;&+4%%0+ //6 %*+486+ 6%7%*+6++&%0+'+6+ /6/ +- &%*+6/,

4%%0+ +6+ %*+486+ 6%4+0+ PPK%-%+ '%+4 6%7%*+6++ +- &/*'%/&/-+ 0%-+ 4%*+6'+++K8+6 0+*+ $+6/ 29 (0/+ 4/*/%4+) ;+ '%%*+ 6%;+0+.]

56. [Pe

me%haraanLn(unan"a#a$%ad#er%u(an)

P%%0+ &%6%$+;&+ //6 %-+&*

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7, Kerjasama &ntara

Pen*ediadan SubPen*edia

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+, PEMB&4&R&$ KEP&D& PE$4EDI&

3=, ;argaKontrak

72.1 PPK /: /; ;/0:/ 8;/=00 ;//


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3:, Penanggu!an

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K8+6 P+/- (F+%$868+7)].

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P/0:/ 9- /0:/=/0 ;//


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/- /00/8/08-0 I78%'.

J 8 /- /00 /8/08-0I78%' ;/80-00-0 9- /=;-8 ?

________________________

2. J 0 /> %I& ;/80-00-0 8/9;B0 9-/0 ;/00 T/;8 T- &OB 8- E ;/80-00-0 8/9;B0 9-/0 ;/00 T/;8 T-


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-. In4term& E0' I78%' +- 0-/+6+ +0+*+

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2. M =:00 ;-0


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8, KepemilikanDokumen

P/0:/ ;/+=/90 /0-00=00 +-/0 0 ;08 =-0 :0

9=0 ;//, SumberPembia*aan

K+08 P/00 B0 0 :__________[APBN#APBD]

4, Pemba*aran#ang Muka

P//


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S%6+*-/').

2. P/:0/0 >8//-8 8=-0 /00/8/08-0/ /-8?

__________

3. D+-/0;/0-0


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800: //R;. ______________

(_________________)

&&, Pemba*arandenda

1. D/0 :0 +=/9 ;/0:/;= ? __________________

2. D/0 :0 +=/9 ;/0://00 > ? ________________

3. D/0 :0 +=/9 ;/0:/= 0, J00>0 0 /8+0 /

__________ [N%-++#D+%+]

&., Kompensasi P/0:/ ;8 /;/+=/9 +;/0


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9. K8%3'% 6848% 68+6 +0+*+'%&%'+ ]

&E, Pen*elesaianPerselisi!an

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[P%-+0*+ R%4/&*6 I08%'+ +-&%684%%#B+0+ A&+'% N+'8+*I08%'+ (BANI)]

[J6+ BANI +- 04* '%&+-+ L%&+-+P%//' S%-6%+ +6+ 7+/6+6*+/'/* +&+'% &%6/ %4+ 0 &+$+

4*+ +- 0&/+ 0 ++'>

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Lampiran & S*arat?S*arat K!usus KontrakPer&n%0 Su$#en'eda dan Pera%atan "a#a$%a d#er%u(an)

@ P/+0= :0 8-0? [7+/6+ ++, /++ 0%*+--/- ;+$+& 6%;+, / 6/+*36+', 0+ ;/*+ 8+-&/*+]

@ S-;/0:/ :0 8-0


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Bab >II, SPESI+IK&SI )EK$IS D&$ %&MB&R

Keterangan

P+


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Bab >III, D&+)&R K#&$)I)&S D&$ ;&R%&

Keterangan 0#ntuk Kontrak ;arga Satuan atau Kontrak%abungan Lum# Sumdan ;arga Satuan1

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2. P/:0 8/9; ;/8 ;//


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0 0 9-- ; S-8 P/00 :0>88 0= = 9-- 0

.


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D8 1? M8 P/:0 U-1

N8.

U++ P%6%;++ S+/+

U6/+

K/++'

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T8+*H+-

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1

ata Pem(ayaran mum memuat rinian k,m,nen ekeraan yang (ersiat umum misalnyakeerluan engiriman (iaya muat dan lainlain.2

!emua enis harga yang terantum dalam #atar -uantitas dan 'arga adalah harga se(elum PP%Paak Pertam(ahan %ilai).


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D8 2? M8 P/:0 P//


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D8 R/;8-=

M++ P%&+++ H+-+D8 N+. 1? M8 P/:0 U-D8 N+. 2? M8 P/:0 P//


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B&B >I8, BE$)#K D"K#ME$ L&I$

&, BE$)#K S#R&) PE$#$#K&$ PE$4EDI&B&R&$%/&S& 0SPPB1

Surat Penunjukan Pen*edia Barang/asa 0SPPB1

[684 '/+ K#L#D#I]

N++? __________ __________, ____________2$__L;0? __________

K/; Y89.__________ __________

P/9=? P/0-0


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S8-0 K/


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B, BE$)#K S#R&) PES&$&$

[684 '/+ '+/+ 6%;+ K#L#D#I]

S#R&) PES&$&$ 0SP1N++? __________

P/8 P//


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2. T-08-80 ;/0>0 8- = ;8 8/8-=/00 /=;0 S-8 J0 S090 B00 :0

/0:80 9 S090 B00 8 /0 ______________ [M%%#P4+ L%&+-+#K%4+*+D+%+#P4+ I'/'#4%;+&+ +- %%+ 4%/-+'+%;+$+& '+--++ &+0-];=0 =8 14 (/;8 /=)9 =/0/ /8/=9 80= 08- = -8 1.

3. P/0


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D, BE$)#K &MI$&$ PEL&KS&$&&$ D&RIB&$K

[K# Ban( Pener$t Jamnan]

%&R&$SI B&$Ksebagai

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Y0 /80 800 9 0? @__________________________________ =


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/0 8/08-0 = D+-/0 P/00 :0 -8+=/9 Y0 D0 8- = ;8 8/8-=

/00 /=;0 S-8 P/0:80 0;/8 P/0/ J00 ;=0 =8 14 (/;8 /=) 9=/0/ /8/=9 80= 08- = -8 1.

3. P/0


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E, BE$)#K &MI$&$ PEL&KS&$&&$ D&RI&S#R&$SI/PER#S&;&&$ PE$&MI$&$

[K# Pener$t Jamnan]

&MI$&$ PEL&KS&$&&$

N++ J00? __________________ N=?______________

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%, BE$)#K &MI$&$ #&$% M#K& D&RI&S#R&$SI/PER#S&;&&$ PE$&MI$&$

&MI$&$ #&$% M#K&

N++ J00? ____________________ N=? ___________________

1. D/00 0 0:80, 9 ?_____________________[++], [+*++] /P/0:/, /=0


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