The Aanwidzing Result of ITB No: 16584

Day / Date : Wednesday, July 28, 2021 Time : 14.00 Venue : Zoom Meeting

A. Unpriced Required Documents Envelope and Original Price Quotation Envelope No. Syarat Administrasi (Administration Requirement) A.

1 Asli Surat Penawaran (Original Unprice quotation) yang:

1. Description sesuai permintaan

2. Bertanggal (dated) 3. Bertanda tangan dan Cap Perusahaan (Company stamped) 4. Menyebutkan waktu pengiriman sampai gudang sesuai permintaan (Time Delivery)

2

Pengalaman Pekerjaan dengan total harga kontrak senilai minimal IDR 210.000.000 – menyerahkan copy kontrak atau PO (Work Experience for contract amount minimum IDR 210.000.000 – submitting the copy of the contract or PO)

3 Copy pembayaran pajak SSP (PPN) periode: Feb, Maret, April 2021 (Copy of payment tax period of: Feb, March, April 2021)

4 Salinan laporan keuangan teraudit oleh Kantor Akuntan Publik minimum tahun 2019 (Copy of financial report audited by public accountant minimum year of 2019)

5 Copy of SPT Tahunan year of 2019 6 Original Pakta Integritas

7

1. Untuk Authorized Distributor : Wajib melampirkan salinan dokumen sebagai distributor resmi dari manufaktur yang dilegalisir oleh negara asal dan sertifikat yang dikeluarkan oleh Direktorat Jenderal Perdagangan Dalam Negeri (The vendor must be attach an authorized distributor of the manufacturer which is legalized by country of origin and copy certificate issued by ministry of trade of the republic indonesia certificate)

2. Untuk Suplier yang bukan Authorized Distributor : Melampirkan Surat Dukungan dari solar panel manufaktur. Bagi perusahaan jasa konstruksi yang bukan merupakan distributor atau pabrikan, wajib melampirkan sertifikat terdaftar dari Direktorat Jenderal Perdagangan Dalam Negeri sehubungan dengan barang impor khusus panel surya. (The vendor/supplier must have a letter of support from the solar panel manufacturer. For a construction service company that is not a distributor or manufacturer, must attach a registered certificate from the Ministry of Trade of the Republic of Indonesia in connection with imported goods specifically for solar panels)

8 Copy (Sertifikat Badan Usaha) dari ESDM atau LPJK sebagai badan usaha untuk pembangunan dan pemasangan PLTS. (copy (Sertifikat Badan Usaha) from ESDM or LPJK as a business entity for the development and

installation of PLTS)

9 Copy certificate for the inverter: IEC 60068, IEC 61683, IEC 61727, IEC 62116, IEC 62109, IEC 61000

10

Original Bid bond minimum 3% from price quotation (including VAT) with the validity until November 12, 2021. - Bid bond should be issued by Bank based on DPJT list and format issued by PLN - Beneficiary of Bid bond to: PT. Perusahaan Listrik Negara (Persero) UIK Tanjung Jati B Desa Tubanan, Kecamatan Kembang, Jepara Jaminan Penawaran asli minimum 3% dari Penawaran Harga (termasuk PPn) dengan validitas sampai dengan November 12, 2021.

B. 1 Copy Surat Ijin Usaha Perusahaan – SIUP / BKPM (PMA)

(copy of Business License ) 2 Copy Surat Ijin Tempat Usaha – SITU / DOMISILI / HO

(Copy of Domicile Certrificate) 3 Copy Nomor Pokok Wajib Pajak - NPWP

(Copy Tax ID number of company) 4 Copy Surat Pengukuhan Perusahaan Kena Pajak - SPPKP

(Copy of Taxable Company Certificate) 5 Copy Tanda Daftar Perusahaan – TDP / NIB

(Copy of Certificate Company Regristration) 6 Copy Akte pendirian perusahaan/perubahan *jika ada

(Deed of Incorporation)

B. Detail Of Specification And Certificate Required At The Delivery Time.

No Description

A Materials

1 Solar Panel Module 1,1 Solar Panel Monocrystalline 400WP - Certificate for solar panels: IEC 16215, IEC 61730, IEC 61701 - Warranty letter of solar panels for 25 years. - Attach Test Certification of solar panel module - Complete with Original Certificate Of Manufacture issued by Manufacturer 1,2 Solar Panel Connector (PV Connector) - Attach Certificate of PV connector from TUV Rheinland - Socket/connector MC4 using 4 ports per solar panels - Rated Voltage 1000 V/ 1500 V - Rated Current 30 A (4/6 mm2) - Wire Size 4 mm2 - Contact Resistance < 0.3 mOhm - IP Protection IP 68

2 Bracket/frame of solar cell panel 2,1 Dak Construction - Concrete base or ground screw - Tilt angle 60deg ( - Materials AL6005-T5 (Anodized) SUS304 & Zinc-Nickel Alloy Electroplated Steel - Painting Grey, Anti-Corrosion - Warranty of bracket 10 years

3 System PV Inverter 3,1 Solar inverter grid tie - 400 VAC, 50 Hz, 3 phase, Pure sinus - Grid Frequency 50 - 60Hz +/- 5% - Efficiency Maximum: 98.2%, MPPT: 99.9% - Warranty 5 Years (minimal) - Certificate for the inverter: IEC 60068, IEC 61683, IEC 61727, IEC62116, IEC 62109, IEC

61000 - Complete with Original Certificate Of Manufacture issued by Manufacturer

4 Cable for solar cell panel and installation 4,1 Standard / Material properties (completed with certificate): - Fire performance : IEC 60332-1

- Smoke emission : IEC 61034;EN 61034-2 - Low fire load : DIN 51900 - Approvals : EN50168; H1Z2Z2-K 4,2 Rated Voltage Value : 1500VDC 4,3 Wire Size : diameter 4 mm

5 PV Combiner DC Box 5,1 Fuse DC PV Holder type Min 15A 5,2 DC MCB 2 Pole Max 1000VDC 5,3 DC PV SPD Surge Arrester 1Pole 20/40kA Max.1000Vdc

6 PV AC Panel 6,1 MCCB 3 phase, 63A 6,2 Arrester 6,3 Inverter to load cable NYYHY cable 4 x 25 mm

7 Installation Grounding and Arrester set 7,1 NYAF 16 mm grounding

8 HMI PC monitoring system 8,1 PC computer for HMI monitoring system with specification compatible for software used 8,2 HMI monitoring for grid inverter - Power graphic - Total energy - Frequency - PV String Voltage - PV string Current - Total Power of PV - Event and Warning - Connected with android Smartphone online monitoring 8,3 HMI monitoring for PV voltage - PV voltage per solar panel - Range 0 - 50VDC

9 Power house building 9,1 The power house is a special room where the main equipment of the solar power plant

is installed (inverter, main control panel, PC computer, etc.). 9,2 Use a container with arrester grounding 9,3 Equipped with air conditioning and facilities for operator (table, chair and cabinet) 9,4 Equipped with a fire extinguisher

10 Service water system installation 10,1 Service water pipe size is 3/4" with material SS304 with a length of + - 50 meters.

10,2 Complete with isolation valve 11 Installation KWH meter export-import (exim)

11,1 Vendor applies for a Permit application letter /surat permohonan pemasangan KWH exim ke PLN

11,2 Vendor applies for a Certificate of Good Operation (SLO) after the installation of PLTS 11,3 Attach a calibration certificate for KWH meter Export-Import

B Work Scope 12 Provide materials,

installation, Commissioning and Testing

❏ Provide and install all the materials (PV, Inverter, Cable, Arrester, etc) ❏ Make a concrete foundation and installation solar cell bracket ❏ Provide and install a service water system. ❏ Build the power house and installation of the arrester of the power

house. ❏ Installation cable from inverter to VAC distribution panel in the AC room ❏ Replacement and installation KWH meter export-import (EXIM) for PLN. ❏ Carry out a site acceptance test (SAT) for each solar panel and Inverter ❏ Commissioning HMI Monitoring System and online monitoring android ❏ Provide manual book (specification, procedure, maintenance,

recommended spare part). ❏ Provide wiring schematic diagram / single line diagram and P&ID

diagram. ❏ Training for operation and maintenance procedure. ❏ Reporting for SAT and Commissioning.

Note:

1. Delivery time should be completed to the warehouse of PT. KPJB not later than 135 calendar days after Purchase Order (PO) effective date.

2. Quotation shall be submitted in two sealed envelopes not later than 11.00 WIB date 12 August 2021.

3. Please see and pay attention to point B in detail the specifications and certificates are required at the delivery time. (if the specifications not match and the requested certificate document is incomplete, PT. KPJB cannot accept the goods)

4. Technical Data Sheet is required at the delivery time. 5. In accordance with the agreement on aanwijzing, please follow the attached Price and Unprice

Format

Attendance List:

NO. NAME COMPANY / POSITION Signature

1 Ikhsan Toga PT. KPJB By Zoom 2 Ali Murtadlo PT. KPJB By Zoom 3 Fardi PT. KPJB By Zoom 4 Ika P PT. KPJB By Zoom 5 Christine PT. Soltek By Zoom 6 David PT. Soltek By Zoom 7 Gunawan PT. Soltek By Zoom 8 Adi PT. Soltek By Zoom 9 Bagas PT. Kencana Alam Putra By Zoom 10 Ade PT. Kencana Alam Putra By Zoom 11 Dwi PT. Energi Putra Nusantara By Zoom 12 Agung PT. Pusindo Murniraya By Zoom 13 Ahmad PT. Guna Elektro By Zoom 14 M. Yahya PT. Ahza Jaya Mulia By Zoom 15 Ridwan PT. Ahza Jaya Mulia By Zoom 16 Indrawan By Zoom

Attachment: 1. Price and Unprice Format 2. Bidbond Format 3. Pakta Integritas Format

No QTY Unit Unit Price Total Price

A1 80 SET

1,1 Solar Panel Monocrystalline 400WP- Certificate for solar panels: IEC 16215, IEC 61730, IEC 61701- Warranty of solar panels for 25 years.- Attach test certification of solar panel module- Complete with COM of manufacture

1,2 Solar Panel Connector (PV Connector)- Attach Certificate of PV connector from TUV Rheinland - Socket/connector MC4 using 4 ports per solar panels- Rated Voltage 1000 V/ 1500 V- Rated Current 30 A (4/6 mm2)- Wire Size 4 mm2- Contact Resistance < 0.3 mOhm- IP Protection IP 68

2 1 LOT2,1 Dak Construction

- Concrete base or ground screw- Tilt angle 60deg (- Materials AL6005-T5 (Anodized) SUS304 & Zinc-Nickel Alloy Electroplated Steel- Painting Grey, Anti-Corrosion- Warranty of bracket 10 years

3 1 SET3,1 Solar inverter grid tie

- 400 VAC, 50 Hz, 3 phase, Pure sinus- Grid Frequency 50 - 60Hz +/- 5%- Efficiency Maximum: 98.2%, MPPT: 99.9%- Warranty 5 Years (minimal)- Certificate for the inverter: IEC 60068, IEC 61683, IEC 61727, IEC62116, IEC 62109, IEC 61000- Complete with COM from manufacture

4 1 LOT4,1 Standard / Material properties (completed with certificate):

- Fire performance : IEC 60332-1- Smoke emission : IEC 61034;EN 61034-2- Low fire load : DIN 51900- Approvals : EN50168; H1Z2Z2-K

4,2 Rated Voltage Value : 1500VDC4,3 Wire Size : diameter 4 mm

5 1 SET5,1 Fuse DC PV Holder type Min 15A5,2 DC MCB 2 Pole Max 1000VDC5,3 DC PV SPD Surge Arrester 1Pole 20/40kA Max.1000Vdc

6 1 SET6,1 MCCB 3 phase, 63A6,2 Arrester 6,3 Inverter to load cable NYYHY cable 4 x 25 mm

7 1 LOT7,1 NYAF 16 mm grounding

8 1 LOT8,1 PC computer for HMI monitoring system with specification compatible for software used8,2 HMI monitoring for grid inverter

- Power graphic- Total energy- Frequency- PV String Voltage- PV string Current- Total Power of PV- Event and Warning- Connected with android smatphone online monitoring

8,3 HMI monitoring for PV voltage- PV voltage per solar panel - Range 0 - 50VDC

9 1 LOT

9,1 The power house is a special room where the main equipment of the solar power plant is installed (inverter, main control panel, PC computer, etc.).

9,2 Use a container with arrester grounding9,3 Equipped with air conditioning and facilities for operator (table, chair and cabinet)9,4 Equipped with a fire extinguisher

10 1 LOT10,1 Service water pipe size is 3/4 " with material SS304 with a length of + - 50 meters.10,2 Complete with isolation valve

11 1 LOT11,1 Vendor applies for a Permit aplication letter /surat permohonan pemasangan KWH exim ke PLN11,2 Vendor applies for a Certificate of Good Operation (SLO) after the installation of PLTS11,3 Attach a calibration certificate for KWH meter Export-Import

B12 Provide materials, installation, Commissioning and Testing 1 LOT

❏ Provide and install all the materials (PV, Inverter, Cable, Arrester, etc)❏ Make a concrete foundation and installation solar cell bracket❏ Provide and install a service water system.❏ Build the power house and installation of the arrester of the power house.❏ Installation cable from inverter to VAC distribution panel in the AC room❏ Replacement and installation KWH meter export-import (EXIM) for PLN.❏ Carry out a site acceptance test (SAT) for each solar panel and Inverter❏ Commissioning HMI Monitoring System and online monitoring android❏ Provide manual book (specification, procedure, maintenance, recommended spare part).❏ Provide wiring schematic diagram / single line diagram and P&ID diagram.❏ Training for operation and maintenance procedure .❏ Reporting for SAT and Commissioning.

TOTALVAT

GRAND TOTAL

Service water system installation

Installation KWH meter export-import (exim)

Work Scope

HMI PC monitoring system

Power house building

PRICE

Solar Panel Module

Bracket/frame of solar cell panel

MaterialsDescription

Sistem PV Inverter

Cable for solar cell panel and installation

PV Combiner DC Box

PV AC Panel

Installation Grounding and Arrester set

No QTY Unit

A1 80 SET

1,1 Solar Panel Monocrystalline 400WP- Certificate for solar panels: IEC 16215, IEC 61730, IEC 61701- Warranty of solar panels for 25 years.- Attach test certification of solar panel module- Complete with Original COM of manufacture

1,2 Solar Panel Connector (PV Connector)- Attach Certificate of PV connector from TUV Rheinland - Socket/connector MC4 using 4 ports per solar panels- Rated Voltage 1000 V/ 1500 V- Rated Current 30 A (4/6 mm2)- Wire Size 4 mm2- Contact Resistance < 0.3 mOhm- IP Protection IP 68

2 1 LOT2,1 Dak Construction

- Concrete base or ground screw- Tilt angle 60deg (- Materials AL6005-T5 (Anodized) SUS304 & Zinc-Nickel Alloy Electroplated Steel- Painting Grey, Anti-Corrosion- Warranty of bracket 10 years

3 1 SET3,1 Solar inverter grid tie

- 400 VAC, 50 Hz, 3 phase, Pure sinus- Grid Frequency 50 - 60Hz +/- 5%- Efficiency Maximum: 98.2%, MPPT: 99.9%- Warranty 5 Years (minimal)- Certificate for the inverter: IEC 60068, IEC 61683, IEC 61727, IEC62116, IEC 62109, IEC 61000- Complete with Original COM from manufacture

4 1 LOT4,1 Standard / Material properties (completed with certificate):

- Fire performance : IEC 60332-1- Smoke emission : IEC 61034;EN 61034-2- Low fire load : DIN 51900- Approvals : EN50168; H1Z2Z2-K

4,2 Rated Voltage Value : 1500VDC4,3 Wire Size : diameter 4 mm

5 1 SET5,1 Fuse DC PV Holder type Min 15A5,2 DC MCB 2 Pole Max 1000VDC5,3 DC PV SPD Surge Arrester 1Pole 20/40kA Max.1000Vdc

6 1 SET6,1 MCCB 3 phase, 63A6,2 Arrester 6,3 Inverter to load cable NYYHY cable 4 x 25 mm

7 1 LOT7,1 NYAF 16 mm grounding

8 1 LOT8,1 PC computer for HMI monitoring system with specification compatible for software used8,2 HMI monitoring for grid inverter

- Power graphic- Total energy- Frequency- PV String Voltage- PV string Current- Total Power of PV- Event and Warning- Connected with android smatphone online monitoring

8,3 HMI monitoring for PV voltage- PV voltage per solar panel - Range 0 - 50VDC

9 1 LOT

9,1 The power house is a special room where the main equipment of the solar power plant is installed (inverter, main control panel, PC computer, etc.).

9,2 Use a container with arrester grounding9,3 Equipped with air conditioning and facilities for operator (table, chair and cabinet)9,4 Equipped with a fire extinguisher

10 1 LOT10,1 Service water pipe size is 3/4 " with material SS304 with a length of + - 50 meters.10,2 Complete with isolation valve

11 1 LOT11,1 Vendor applies for a Permit aplication letter /surat permohonan pemasangan KWH exim ke PLN11,2 Vendor applies for a Certificate of Good Operation (SLO) after the installation of PLTS11,3 Attach a calibration certificate for KWH meter Export-Import

B12 Provide materials, installation, Commissioning and Testing 1 LOT

❏ Provide and install all the materials (PV, Inverter, Cable, Arrester, etc)❏ Make a concrete foundation and installation solar cell bracket❏ Provide and install a service water system.❏ Build the power house and installation of the arrester of the power house.❏ Installation cable from inverter to VAC distribution panel in the AC room❏ Replacement and installation KWH meter export-import (EXIM) for PLN.❏ Carry out a site acceptance test (SAT) for each solar panel and Inverter❏ Commissioning HMI Monitoring System and online monitoring android❏ Provide manual book (specification, procedure, maintenance, recommended spare part).❏ Provide wiring schematic diagram / single line diagram and P&ID diagram.❏ Training for operation and maintenance procedure .❏ Reporting for SAT and Commissioning.

Power house building

Service water system installation

Installation KWH meter export-import (exim)

Work Scope

Delivery Time

Not Later than 135 Calendar Days After PO Effective

Sistem PV Inverter

Cable for solar cell panel and installation

PV Combiner DC Box

PV AC Panel

Installation Grounding and Arrester set

HMI PC monitoring system

Bracket/frame of solar cell panel

UNPRICE

Description

MaterialsSolar Panel Module

BANK GUARANTEE BID BOND UNDER SE BI ______________ [number]

______________ [places & dated]

To : PT. Perusahaan Listrik Negara (Persero) UIK Tanjung Jati B Desa Tubanan, Kecamatan Kembang, Kabupaten Jepara Jawa Tengah, 59453 Whereas PT Bank ________________ [name of bank] domiciled in and having its address at_____________ [address] (hereinafter referred to as the “Bank”), hereby irrevocably guarantee _____________ [name of applicant] having a registered address at _______________ [address] (hereinafter refer as the “Principal”) for the favour of PT. Perusahaan Listrik Negara (Persero) UIK Tanjung Jati B having a registered office at ______________ (hereinafter refer as the “Beneficiary” to make a payment of amount up to____________ (say:____________) if the Principal has failed and/or neglected to perform its obligation, including if Principal does not follow the procurement process and/or does not sign/enter into contracts/agreements or fulfill other provisions as specified in the Bid Document ___________ no ____________ date ___________ [Bid Document] (“Bid Document”) for the Project of ___________ [name of Project], including but not limited to the Principal failure to maintain the validity period of this Bank Guarantee in accordance with the Bid Document and/or request of the Beneficiary. This Bank Guarantee is issued with the following provisions:

1. This Bank Guarantee shall be effective on and as of the date of ____________ until ____________ [maturity date].

2. The payment of Bank Guarantee shall be made without require Principal approval upon our receipt of Beneficiary’s first written demand

BANK GARANSI JAMINAN PENAWARAN BERDASARKAN

SE BI _________________ (Nomor)

__________________ (Tempat & Tanggal) Kepada : PT. Perusahaan Listrik Negara (Persero) UIK Tanjung Jati B Desa Tubanan, Kecamatan Kembang, Kabupaten Jepara Jawa Tengah, 59453 PT Bank ___________ [nama bank] berkedudukan di ___________ [alamat], (untuk selanjutnya disebut “Bank”), dengan ini menjamin tanpa dapat ditarik kembali ____________ [nama badan usaha penyedia barang/jasa] beralamat di ___________ (untuk selanjutnya disebut “Terjamin”) terhadap PT. Perusahaan Listrik Negara (Persero) UIK Tanjung Jati B beralamat di ____________ (untuk selanjutnya disebut sebagai “Penerima Jaminan”), untuk membayar sejumlah uang sebesar ____________ (terbilang: ______________________) apabila Terjamin melakukan tindakan dan/atau gagal untuk melakukan tindakan termasuk apabila Terjamin tidak mengikuti proses pengadaan dan/atau tidak menandatangani/memasuki kontrak/perjanjian atau memenuhi ketentuan lainnya sebagaimana ditentukan dalam Dokumen Pengadaan ___________ no ___________ tanggal _________ [Dokumen Pengadaan] (“Dokumen Pengadaan”) untuk ______________ [nama proyek], termasuk namun tidak terbatas pada kegagalan Terjamin untuk memelihara masa berlaku Bank Garansi ini sesuai Dokumen Pengadaan dan/atau permintaan Penerima Jaminan. Bank Garansi ini dikeluarkan dengan ketentuan-ketentuan sebagai berikut:

1. Bank Garansi ini berlaku efektif sejak tanggal _________ dan akan berakhir pada tanggal ____________ [tanggal jatuh tempo].

2. Pembayaran atas Bank Garansi ini dilakukan tanpa perlu mendapat persetujuan Terjamin setelah adanya

stating that the Principal has failed to fulfill its obligation under the Contract and the amount to be paid to Beneficiary by attaching of the original of this Bank Guarantee.

3. The deadline for submission and receipt of any claim on this Bank Guarantee by Beneficiary to the Bank shall be made in writing, not later than 30 (thirty) calendar days from the date of maturity of this Bank Guarantee, provided that if the date falls on holiday or a day on which banking institutions are permitted to be closed, then the submission shall be made no later than one working day thereafter.

4. The Bank shall be firmly bound unto the Beneficiary for the Payment in the amount as mention above not later than 15 (fifteen) calendar days after receipt of Beneficiary’s first written demand and the original of Bank Guarantee to the Bank.

5. With reference to Article 1832 of Indonesian Civil Code (Kitab Undang-Undang Hukum Perdata), the Bank hereby relinquish/waives its privileges/rights granted by law to claim/demand on asset belonging to the Principal and/or bound as collateral be confiscated, seized or sold in advance for the discharge of Principal debts as stipulated under Article 1831 of Indonesian Civil Code.

6. The payment of Bank Guarantee claims/demands is absolute and unconditional even though there is a demand, request or objection from the principal or any other party whatsoever.

7. The payment of bank Guarantee claims/demand will be made to the account designated by the Beneficiary, free and clear of, without any reduction for any reason, either present or future, of all taxes, levies, fees or withholding whatsoever, imposed or collected with respect thereto.

surat permintaan pencairan Bank Garansi dari Penerima Jaminan kepada Bank yang menyatakan bahwa Terjamin wanprestasi/gagal memenuhi kewajibannya berdasarkan Kontrak dan jumlah yang harus dibayarkan kepada Penerima Jaminan beserta asli Bank Garansi ini.

3. Batas waktu pengajuan dan penerimaan tuntutan penagihan/klaim atas Bank Garansi ini adalah selambat-lambatnya 30 (tiga puluh) hari kalender sejak tanggal jatuh tempo Bank Garansi ini, dengan ketentuan apabila tanggal tersebut jatuh pada hari libur atau diluar hari kerja Bank, maka pengajuan akan dilakukan selambat-lambatnya pada satu hari kerja Bank setelahnya.

4. Bank akan membayar kepada Penerima Jaminan untuk jumlah tersebut di atas seketika selambat-lambatnya 15 (lima belas) hari kalender setelah diterimanya surat permintaan pencairan Bank Garansi dan Asli Bank Garansi dari Penerima Jaminan kepada Bank.

5. Dengan mengacu pada Pasal 1832 Kitab Undang-Undang Hukum Perdata, Bank dengan ini melepaskan hak-hak istimewanya yang diberikan oleh undang-undang sebagaimana dimaksud dalam Pasal 1831 Kitab Undang-Undang Hukum Perdata untuk menuntut supaya benda-benda milik Terjamin dan/atau yang diikat sebagai jaminan lebih dahulu disita dan dijual untuk melunasi hutang Terjamin.

6. Pembayaran atas klaim/tuntutan pencairan adalah mutlak dan tanpa syarat (unconditional) meskipun ada tuntutan, permintaan atau keberatan dari Terjamin atau pihak manapun.

7. Pembayaran atas klaim/tuntutan pencairan Bank Garansi akan dilakukan ke rekening

_______________ [places/tempat], _______________ [dated/tanggal]

PT_______________ [name of bank/nama bank]

[Bank Stamp/Cap Bank]

_______________ [authorized signatory/tandatangan pejabat yang berwenang]

8. This Bank Guarantee is non-transferable and/or cannot be pledged to another party

9. This Bank guarantee can’t be amended, modified or supplement unless such amendment, modification or supplemented has been approved by Beneficiary in written or as expressly required by Beneficiary to Applicant.

10. This Bank Guarantee shall be governed by and construed in accordance with laws and regulations applicable in Indonesia.

11. For the purpose of this Bank Guarantee issuance and any consequence thereof, Bank chooses the Court of _____________ [domicile of court] as general and permanent domicile.

12. This Bank Guarantee has been executed in both Bahasa Indonesia and English. The two versions of this Bank Guarantee shall not be construed as separate documents and, when taken together, shall constitute one and the same instrument. In the event of any conflict or inconsistency between the English language version and the Bahasa Indonesia language version of Bank Guarantee.

This Bank Guarantee is issued by duly authorized officers on the date _______________ and to be used by properly interested party

bank yang ditunjuk oleh Penerima Jaminan, bebas dan bersih serta tanpa pengurangan dengan alasan apapun, baik yang berlaku pada saat ini atau kemudian, dari semua pajak, pungutan, biaya atau pemotongan apapun, yang dibebankan atau dipotong sehubungan dengan hal-hal tersebut.

8. Bank Garansi ini tidak dapat dipindahtangankan dan/atau dijaminkan kepada pihak lain (non-transferable).

9. Bank Garansi ini tidak dapat diubah kecuali perubahan tersebut disetujui oleh Penerima Jaminan melalui surat tertulis atau secara tegas dimintakan oleh Penerima Jaminan kepada Terjamin.

10. Bank Garansi ini diatur oleh dan ditafsirkan berdasarkan peraturan perundang-undangan yang berlaku di Indonesia.

11. Untuk tujuan Bank Garansi ini dengan segala akibat hukumnya, Bank memilih domisili yang tetap di Kantor Panitera Pengadilan Negeri di ___________ [domisili pengadilan].

12. Bank Garansi ini dibuat dalam Bahasa Indonesia dan Bahasa Inggris. Dua versi dari Bank Garansi ini tidak dapat ditafsirkan sebagai dokumen terpisah, dan ketika ditandatangani bersama, harus dianggap satu dan merupakan instrumen yang sama. Dalam hal terdapat konflik atau ketidaksesuaian antara versi Bahasa Inggris dan versi Bahasa Indonesia atas Bank Garansi ini, maka versi Bahasa Indonesia akan berlaku.

Demikian Bank Garansi ini di terbitkan oleh yang berwenang pada tanggal ____________ untuk dapat dipergunakan sebagaimana mestinya dan oleh yang berkepentingan.

(KOP PERUSAHAAN/BADAN/LEMBAGA)

PAKTA INTEGRITAS

Saya yang bertanda tangan di bawah ini, dalam rangka Pengadaan ……. (diisi Nama Pengadaan) dengan nomor …… (diisi nomor RFQ/PR), pada satuan kerja PT KPJB yang dalam hal ini mewakili PT PLN (Persero) Unit Induk Pembangkitan Tanjung Jati B Jepara dengan ini menyatakan bahwa saya:

1. Akan mentaati peraturan tentang Pedoman Pengadaaan Barang/Jasa di Lingkungan PT KPJB dan PT PLN (Persero), dan peraturan perundang-undangan yang terkait dengan pengadaan;

2. Tidak akan melakukan persengkokolan/pengaturan/kerjasama diantara para Peserta Pengadaan/Jasa lain dan/atau Pengguna Barang/Jasa dan/atau Pelaksana Pengadaan yang dapat mengakibatkan terjadinya persaingan usaha tidak sehat;

3. Mendukung prinsip 4 NO’s yang dijunjung tinggi oleh PT KPJB dan PT PLN (Persero) yaitu: a. No Bribery (tidak boleh ada suap menyuap dan pemerasan) b. No Kickback (tidak boleh ada komisi, tanda terimakasih baik dalam bentuk uang

dan dalam bentuk lainnya); c. No Gift (tidak boleh ada hadiah atau gratifikasi yang bertentangan dengan

peraturan d. No Luxirious Hospitality (tidak boleh ada penyambutan dan jamuan yang

berlebihan). 4. Tidak akan melakukan komunikasi yang mengarah dan/atau melakukan praktek

Korupsi, Kolusi dan Nepotisme (KKN) 5. Akan melakukan proses pengadaan secara bersih dan transparan agar

menghasilkan pekerjaan sesuai ketentuan peraturan perundang-undangan yang berlaku.

Apabila saya melanggar hal-hal yangtelah saya nyatakan dalam Pakta Integritas ini, saya bersedia dikenakan sanksi sesuai dengan ketentuan peraturan perundang-undangan yang berlaku.

_______[Tempat], _______ [Tanggal]

[Tanda Tangan & Cap Perusahaan & Materai 10.000]

_______________ [Nama Jelas]

__________________ [Jabatan]