PreQualification Document - Jakarta Car Rental and Driver Services - Rev2

INPEX MASELA, LTD.
ABADI GAS FIELD DEVELOPMENT
DOKUMEN PRAKUALIFIKASI
PREQUALIFICATION DOCUMENT
UNTUK
FOR
JAKARTA CAR RENTAL & DRIVER

SERVICES
MAS/2017/0040
This document is the property of INPEX MASELA, LTD. and the copyright therein is vested in INPEX MASELA, LTD.. All rights are reserved.
Neither the whole nor any part of this document may be disclosed to others or reproduced, stored in a retrieval system or transmitted in any form
by any means (electronic, mechanical, reprographic recording or otherwise) without prior written consent of the copyright owner.
Dokumen Prakualifikasi / Prequalification Documents
Daftar Isi / Table of Contents
DAFTAR ISI
TABLE OF CONTENTS
BAGIAN 1 – INSTRUKSI UMUM DAN PART 1 – GENERAL INSTRUCTIONS AND

ADMINISTRASI ADMINISTRATION
1.1. INFORMASI UMUM 1.1. GENERAL INFORMATION
1.2. DEFINISI 1.2. DEFINITION
1.3. KORESPONDENSI DAN KLARIFIKASI 1.3. CORRESPONDENCE AND

CLARIFICATION
1.4. PEMBERITAHUAN KEIKUTSERTAAN 1.4. NOTIFICATION OF PARTICIPATION

ATUA PENGUNDURAN DIRI OR WITHDRAWAL
1.5. PENGAJUAN 1.5. SUBMITTAL
1.6. EVALUASI PENGAJUAN 1.6. EVALUATION OF SUBMITTAL
1.7. MENGHINDARI PERTENTANGAN 1.7. AVOIDANCE OF CONFLICT OF

KEPENTINGAN INTEREST
1.8. PERJANJIAN KERAHASIAAN 1.8. CONFIDENTIALITY AGREEMENT
1.9. 1.9.
Lampiran 1 – Surat Pernyataan Attachment 1 – Letter of Confirmation

Partisipasi / Pengunduran Diri / Withdrawal
Lampiran 2 – Ringkasan Jadwal Attachment 2 – Outline Schedule
Lampiran 3 – Daftar Kelengkapan Attachment 3 – Document Check List

Dokumen
Lampiran 4 – Kriteria Evaluasi Teknis Attachment 4 – Technical Evaluation

Criteria
BAGIAN 2 – PERSYARATAN PENGAJUAN PART 2 – SUBMITTAL REQUIREMENTS
2.1. PERSYARATAN UMUM 2.1. GENERAL REQUIREMENTS
2.2. RINCIAN DAN DATA CALON 2.2. DETAIL AND DATA OF POTENTIAL
PESERTA TENDER BIDDER
Apendiks A - Formulir Isian Appendix A - Prequalification Form

Prakualifikasi
Apendiks B - Perjanjian Kerahasiaan Appendix B - Confidentiality
Agreement
Apendiks C - Surat Pengganti Appendix C - Surat Pengganti
Dokumen Administrasi Dokumen Administrasi
(SPDA) (SPDA)
Apendiks D - Kemampuan Dasar (KD) Appendix D - Basic Capability (KD)
dan Nilai Pengalaman and Value of Highest
Tertinggi (NPt) Experience (NPt)
i
Dokumen Prakualifikasi / Prequalification Documents
Daftar Isi / Table of Contents
Apendiks E - Persyaratan Teknis Appendix E - Technical Requirements

Apendiks F - Surat Dukungan Appendix F - Funding Support Letter
Pendanaan Kerja
Apendiks G - Persyaratan Kesehatan, Appendix G - Health, Safety, Security
Keselamatan Kerja, and Environmental
Keamanan dan (HSSE) Requirements
Lindungan Lingkungan
(K3LL)
Apendiks H - Status Perusahaan Appendix H - Company Status
Apendiks I - Komitmen Penggunaan Appendix I - Commitment of Using
Rekening Bank BUMN/BUMD Bank
BUMN/BUMD untuk Account for Payment
Pembayaran
Apendiks J - Pembentukan Appendix J - CONSORTIUM
KONSORSIUM (Jika Arrangement (If any)
ada)
Apendiks K - Surat Pernyataan Appendix K - Statement Letter of
Kesanggupan Memenuhi Fulfillment Minimum
Batasan Minimal TKDN Threshold for Local
Content
Apendiks L - Kuesioner Kepatuhan Appendix L - Compliance
Questionnaire
BAGIAN 3 – RINGKASAN RUANG PART 3 – OUTLINE OF SCOPE

LINGKUP
3.1. PENDAHULUAN 3.1. INTRODUCTION
3.2. RINGKASAN RUANG LINGKUP 3.2. OUTLINE OF SCOPE
ii
Dokumen Prakualifikasi / Prequalification Document
Bagian 1 – Instruksi Umum dan Administrasi / Part 1 – General Instruction and Administration
DOKUMEN PRAKUALIFIKASI
PREQUALIFICATION DOCUMENT
BAGIAN 1 – INSTRUKSI UMUM DAN PART 1 – GENERAL INSTRUCTION AND

ADMINISTRASI ADMINISTRATION
1.1. INFORMASI UMUM 1.1. GENERAL INFORMATION
1.1.1 INPEX MASELA, LTD. 1.1.1 INPEX MASELA, LTD.

("PERUSAHAAN") menerbitkan (“COMPANY”) is issuing this
DOKUMEN PRAKUALIFIKASI ini PREQUALIFICATION DOCUMENT to
kepada perusahaan-perusahaan the companies (“POTENTIAL
("CALON PESERTA TENDER") yang BIDDER”) that are registered in the
terdaftar di sistem CIVD (Centralized Centralized Integrated Vendor
Integrated Vendor Database) dan Database (CIVD) system and have a
memiliki SPDA (Surat Pengganti valid SPDA (Certificate for
Dokumen Administrasi) yang masih Replacement of Administrative
berlaku, serta mendaftar untuk Document) and registered to
mengikuti proses PRAKUALIFIKASI participate in the
sebagai CALON PESERTA TENDER, PREQUALIFICATION process as
untuk TENDER yang secara spesifik POTENTIAL BIDDER for the specific
disebutkan dalam surat pengantar TENDER mentioned in the cover
DOKUMEN KUALIFIKASI. letter of the PREQUALIFICATION
DOCUMENT.
1.1.2 Tujuan utama dari proses
PRAKUALIFIKASI ini adalah untuk 1.1.2 The primary purpose of the
meyakinkan PERUSAHAAN bahwa PREQUALIFICATION process is to
CALON PESERTA TENDER memiliki ensure COMPANY that the
pengalaman yang sesuai dan POTENTIAL BIDDER has relevant
kemampuan teknis yang mencukupi experience and capability, and meet
serta memenuhi syarat sesuai dengan with requirements in accordance with
peraturan yang berlaku untuk prevailing regulations, to participate
mengikuti TENDER dan in TENDER and performs the work in
melaksanakan pekerjaan sesuai accordance with Scope of Work of
dengan lingkup pekerjaan TENDER. the TENDER.
1.1.3 Proses TENDER termasuk proses 1.1.3 The TENDER process including
PRAKUALIFIKASI dilakukan sesuai PREQUALIFICATION process shall
ketentuan Pedoman Tata Kerja be conducted according to the
Nomor PTK- “Pedoman Tata Kerja” Number PTK-
007/SKKMA0000/2017/S0 007/SKKMA0000/2017/S0
(“PTK007”) dan peraturan (“PTK007”) and the prevailing laws
perundangan-undangan yang berlaku, and regulation, and its amendments
dan perubahan-perubahannya as applicable.
sebagaimana berlaku.
1.1.4 Agar memenuhi syarat sebagai 1.1.4 In order to become a qualified

PESERTA TENDER, CALON BIDDER, POTENTIAL BIDDER that
PESERTA TENDER yang ikut serta di is participating in this
dalam proses PRAKUALIFIKASI ini PREQUALIFICATION process shall
harus memberikan tanggapan submit a complete response to the
terhadap DOKUMEN PREQUALIFICATION DOCUMENT
PRAKUALIFIKASI secara lengkap to satisfy COMPANY that they are
agar dapat meyakinkan reasonably capable of performing the
PERUSAHAAN bahwa mereka dapat SERVICES to a high professional
melaksanakan JASA dengan standar standard and/or provide the GOODS
professional yang tinggi dan/atau in line with the specification, founded
menyediakan BARANG sesuai on extensive previous experience,
spefisikasi, yang didasarkan pada and have resources readily available
pengalaman sebelumnya yang luas, to commence the SERVICES at the
Page 1 of 63
dan memiliki sumber daya yang siap time of CONTRACT award.

untuk memulai JASA pada saat
pemberian KONTRAK.
1.1.5 CALON PESERTA TENDER yang 1.1.5 POTENTIAL BIDDER that pass
lulus dan memenuhi syarat sebagai through and qualified as BIDDER
PESERTA TENDER akan diundang will be invited by COMPANY to
oleh PERUSAHAAN untuk mengambil collect the TENDER DOCUMENT
DOKUMEN TENDER yang akan which will be advised by COMPANY.
diberitahukan oleh PERUSAHAAN. If applicable, POTENTIAL BIDDER
Apabila berlaku, PESERTA TENDER will be requested to pay such amount
akan diminta untuk membayar biaya for TENDER DOCUMENT’s
penggantian DOKUMEN TENDER replacement fee in line with PTK007
sesuai dengan ketentuan dalam stipulation.
PTK007.
1.1.6 DOKUMEN PRAKUALIFIKASI ini 1.1.6 This PREQUALIFICATION

terdiri dari 3 (tiga) bagian, yaitu: DOCUMENT consists of the following
three (3) parts:
Bagian 1 – Instuksi Umum dan Part 1 – General Instruction and

Administrasi Administration
Bagian 2 – Persyaratan Pengajuan Part 2 – Submittal Requirements
Bagian 3 – Ringkasan Ruang Lingkup Part 3 – Outline of Scope
PERUSAHAAN berhak meminta COMPANY has the right to request

penambahan dan atau pengurangan additional or substraction to the
persyaratan dalam DOKUMEN requirements of
PRAKUALIFIKASI selama tahap PREQUALIFICATION DOCUMENT
PRAKUALIFIKASI ini. during the PREQUALIFICATION
phase.
1.2. DEFINISI 1.2. DEFINITION
“BARANG” adalah peralatan, material, “GOODS” means equipment,

suku cadang, barang yang habis materials, spare parts, consumables,
pakai, dan obyek fisik lainnya yang and any other physical object to be
harus disediakan oleh penyedia provided by the GOODS/SERVICES
BARANG/JASA sebagaimana provider as required under Part 3 of
dimaksud pada Bagian 3 dalam this PREQUALIFICATION
DOKUMEN PRAKUALIFIKASI ini. DOCUMENT.
“CALON PESERTA TENDER” adalah “POTENTIAL BIDDER” means a

penyedia BARANG/JASA yang GOODS/SERVICES provider that
mendaftar untuk mengikuti proses register to join a TENDER process
TENDER dan belum lulus and has not passed the
PRAKUALIFIKASI. PREQUALIFICATION.
“DOKUMEN PENAWARAN” adalah “BID PROPOSAL” means all

seluruh dokumen yang disampaikan documents submitted by BIDDER on
oleh PESERTA TENDER pada waktu the BID PROPOSAL submission date
dan tempat pemasukan DOKUMEN and place determined by
PENAWARAN yang ditentukan oleh PROCUREMENT COMMITTEE
PANITA TENDER termasuk which includes technical and
penawaran teknis dan komersial. commercial proposals.
“DOKUMEN PRAKUALIFIKASI” “PREQUALIFICATION DOCUMENT”

adalah suatu paket dokumen lengkap means a complete package of
yang disiapkan dan dikeluarkan oleh documents prepared and issued by
PERUSAHAAN seperti yang diuraikan COMPANY as specified in item 1.5
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pada butir 1.5 dalam dokumen ini above as reference to

sebagai acuan PRAKUALIFIKASI PREQUALIFICATION to POTENTIAL
kepada CALON PESERTA TENDER. BIDDER.
“JASA” adalah pekerjaan “SERVICES” means the work as

sebagaimana yang dirinci dalam specified in the TENDER
DOKUMEN TENDER yang harus DOCUMENT which shall be
dilaksanakan oleh penyedia performed by the
BARANG/JASA sebagaimana GOODS/SERVICES provider as
dimaksud pada Bagian 3 dalam required under Part 3 of this
DOKUMEN PRAKUALIFIKASI ini. PREQUALIFICATION DOCUMENT.
“KONSORSIUM” adalah gabungan “CONSORTIUM” means an

dari 2 (dua) atau lebih orang incorporation of two (2) or more
perorangan, perusahaan, organisasi, individuals, corporate, organizations
atau kombinasi dari elemen-elemen or combination of such elements, to
tersebut, untuk mengadakan suatu conduct joint activities, businesses,
kegiatan, usaha, atau pembiayaan or financing in the efforts of achieving
bersama dalam rangka mencapai specific purposes within a certain
tujuan tertentu dalam batas waktu period by incorporating resources
tertentu dengan menyatukan owned by the incorporated parties,
sumberdaya yang dimiliki para pihak where each of CONSORTIUM
yang bergabung, dimana masing- members remains independent.
masing anggota KONSORSIUM tetap
berdiri sendiri-sendiri.
“KONTRAK” adalah perjanjian “CONTRACT” means an agreement

pelaksanaan penyediaan for providing GOODS/SERVICES
BARANG/JASA antara satu atau lebih between one or more Production
Kontraktor Kontrak Kerja Sama Sharing Contract (PSC) with a
(KKKS) dengan pelaksana KONTRAK contractor contained in a written and
yang dituangkan dalam kesepakatan binding agreement. A CONTRACT
tertulis dan bersifat mengikat. can be in a form of Purchase/Service
KONTRAK dapat berupa antara lain Order, SERVICE CONTRACT.
Surat Pesanan, KONTRAK JASA.
“PANITIA TENDER” adalah panitia “PROCUREMENT COMMITTEE”

yang dibentuk dan disahkan oleh means a committee formed and
pejabat berwenang untuk endorsed by the authorized official to
melaksanakan proses TENDER carry out the process of
BARANG/JASA. GOODS/SERVICES TENDER.
“PENGAJUAN” adalah dokumen yang “SUBMITTAL” means documents

diajukan kepada PERUSAHAAN oleh submitted to COMPANY by
CALON PESERTA TENDER yang POTENTIAL BIDDER(s) which is a
merupakan tanggapan terhadap response to the
DOKUMEN PRAKUALIFIKASI. PREQUALIFICATION DOCUMENT.
“PERUSAHAAN” adalah INPEX “COMPANY” means INPEX

MASELA, LTD. MASELA, LTD.
“PERUSAHAAN ASING” adalah “FOREIGN COMPANY” means a

perusahaan yang didirikan bukan company established not under law
berdasarkan hukum Negara Republik of Republic of Indonesia.
Indonesia.
“PERUSAHAAN DALAM NEGERI” “LOCAL COMPANY” means a

adalah perusahaan yang didirikan company established under law of
berdasarkan hukum negara kesatuan Republic of Indonesia and minimum
Republik Indonesia dan minimal 51% of 51% (fifty one percent) of the
Page 3 of 63
(limapuluh satu persen) dari saham share which has voting right,
yang memiliki hak suara (voting dividend right and Management
right), hak dividen dan hak Kendali Control right is owned by individual of
Manajemen dimiliki oleh Indonesian citizen (WNI), state-
perseorangan Warga Negara owned business entity (BUMN),
Indonesia (WNI), Badan Usaha Milik regional-owned business entity
Negara (BUMN), Badan Usaha Milik (BUMD), local government
Daerah (BUMD), pemerintah daerah (pemerintah daerah) and/or
dan/atau negara kesatuan Republik government of Republic of Indonesia
Indonesia serta minimal 2/3 (dua per and minimum of 2/3 (two third)
tiga) anggota direksi, termasuk member of board of director,
pimpinan tertinggi perusahaan dan including the top management and
anggota direksi yang member of board of director which
bertanggungjawab atas pengelolaan responsible for financial management
keuangan dan strategi bisnis, adalah and business strategy, is Indonesian
WNI. citizen (WNI).
“PERUSAHAAN NASIONAL” adalah “NATIONAL COMPANY” means a

perusahaan yang didirikan company established under law of
berdasarkan hukum Negara Republik Republic of Indonesia which
Indonesia yang melakukan conducted investment within territory
penanaman modal di wilayah negara of Republic of Indonesia but does not
Republik Indonesia namun tidak meet requirements as LOCAL
memenuhi persyaratan sebagai COMPANY.
PERUSAHAAN DALAM NEGERI.
“PERUSAHAAN PERSEROAN “PERUSAHAAN PERSEROAN

BUMN” – adalah BUMN yang BUMN” means BUMN which form
berbentuk perseroan terbatas yang limited partnership which the assets
modalnya terbagi dalam saham yang divided into shares and whole or at
seluruh atau paling sedikit 51% (lima least 51% (fifty one percent) of the
puluh satu persen) sahamnya dimiliki shares are owned by Republic of
oleh negara kesatuan Republik Indonesia where the main objective
Indonesia yang tujuan utamanya is to obtain profit.
mengejar keuntungan.
“PESERTA TENDER” adalah “BIDDER” means

penyedia BARANG/JASA yang telah GOODS/SERVICES provider which
dinyatakan lulus dalam proses has been notified by COMPANY that
PENILAIAN KUALIFIKASI oleh it passed through
PANITIA TENDER dan oleh PREQUALIFICATION by
karenanya akan diundang oleh PROCUREMENT COMMITTEE and
PERUSAHAAN untuk berpartisipasi therefore will be invited by the
dalam proses TENDER selanjutnya. COMPANY to participate in
subsequent TENDER process.
“PRAKUALIFKASI” adalah bagian dari “PREQUALIFICATION” is part of the

proses TENDER yang dilakukan TENDER process that is conducted
untuk mengevaluasi tanggapan atas to evaluate the response for
DOKUMEN PRAKUALIFIKASI yang PREQUALIFICATION DOCUMENT
disampaikan oleh CALON PESERTA submitted by the POTENTIAL
TENDER yang dilakukan sebelum BIDDER that is conducted before the
tahap pemasukan DOKUMEN BID PROPOSAL submission.
PENAWARAN.
“PTK 007” adalah adalah Pedoman “PTK 007” means the Working
Pengelolaan Rantai Suplai Kontraktor Procedures Manual on Guidance of
Kontrak Kerjasama yang dikeluarkan Supply Chain Management of the
oleh SKK Migas untuk Kontraktor- Contractors of Cooperation Contracts
Kontraktor Kontrak Kerja Sama issued by SKK Migas for Contractors
Page 4 of 63
dengan Nomor PTK- of Cooperation Contracts, reference

007/SKKO0000/2015/S0 melalui Number PTK-
Surat Keputasan yang dikeluarkan 007/SKKO0000/2015/S0 issued by
oleh Kepala SKK Migas tanggal 27 the Head of SKK Migas dated 27
Januari 2015 dengan nomor KEP- January 2015, reference number
0018/SKKO0000/2015/S0 dan/atau KEP-0018/SKKO0000/2015/S0,
perubahan-perubahan, revisi-revisi and/or its amendments, revisions,
dan/atau penambahan-penambahan and/or addendum thereof, and
daripadanya, dan untuk itu, berlaku therefore, applies for procurement of
untuk pengadaan BARANG/JASA GOODS/SERVICES in this TENDER
dalam proses TENDER ini. process.
“SKK Migas” adalah Satuan Kerja “SKK Migas” means The Special
Khusus Pelaksana Kegiatan Usaha Upstream Oil and Natural Gas
Hulu Minyak dan Gas Bumi yang Regulatory Unit (Satuan Kerja
didirikan dan berdasarkan Peraturan Khusus Pelaksana Kegiatan Usaha
Presiden No. 9 Tahun 2013 mengenai Hulu Minyak dan Gas Bumi)
Penyelenggaraan Pengelolaan established by and based on
Kegiatan Usaha Hulu Minyak dan Presidential Regulation No.9 of 2013
Gas) yang mengambil alih tugas, regarding the Implementation of the
fungsi dan organisasi dari Badan Management of Upstream Oil and
Pelaksana Usaha Hulu Minyak dan Gas Business Activities which
Gas (BPMIGAS) assumed the previous tasks,
sebelumnya sebagai badan functions and organization of the
pelaksana kegiatan usaha hulu Executive Agency for Upstream Oil
minyak dan gas (dimana sebelumnya and Gas Business Activities
diganti secara sementara) dan yang (BPMIGAS) as the implementing
telah dialihkan kepada SKMIGAS agency for upstream oil and gas
berdasarkan Peraturan Menteri Energi business activities (which had been
dan Sumber Daya Mineral Republik replaced previously on an interim and
Indonesia (No. 3135 K/08/MEM/2012) temporary basis) and which were
mengenai Pengalihan Tugas, Fungsi assigned to SKMIGAS pursuant to
dan Organisasi dalam Pelaksanaan the Regulation of the Minister of
Kegiatan Usaha Hulu Minyak dan Energy and Mineral Resources of the
Gas. Republic Indonesia
(No.3135 K/08/MEM/2012)
regarding the Assignment of the
Tasks, Functions and Organization in
the Implementation of Upstream Oil
and Gas Business Activities.
“TENDER” adalah pengajuan “TENDER” means the submission of

penawaran untuk melaksanakan bid to perform SERVICES or to
JASA atau menyediakan BARANG. provide GOODS. TENDER process
Proses TENDER dapat dilaksanakan may be carried out through open
melalui metode pelelangan umum, tender, limited tender, simple tender,
pelelangan terbatas, pelelangan direct selection or direct appointment.
sederhana, pemilihan langsung atau The TENDER process is one whole
penunjukan langsung. Proses process, conducted after the
TENDER merupakan kesatuan proses PREQUALIFICATION process.
yang utuh, yang dilakukan setelah TENDER PROCESS continues up
proses PRAKUALIFIKASI. Proses until CONTRACT signing. In regards
TENDER berlangsung hingga to this, the process that will be
penandatanganan KONTRAK. Dalam conducted is through open tender
hal ini, proses yang dilaksanakan process as per the terminilogy used
adalah melalui proses pelelangan in PTK007.
umum yang sesuai dengan istilah
yang digunakan dalam PTK007.
“WAKIL CALON PESERTA TENDER” “POTENTIAL BIDDER
Page 5 of 63
adalah pimpinan tertinggi atau REPRESENTATIVE” means the

pejabat/pekerja perusahaan BIDDER’s company highest
PESERTA TENDER yang memiliki authorized official or authorized
kewenangan yang dibuktikan antara official/staff having the authority as
lain dengan akte pendirian proven among others, by a Deed of
perusahaan dan perubahannya, Establishment and its amendments,
Anggaran Dasar/Anggaran Rumah POTENTIAL BIDDER’s company
Tangga (AD/ART) perusahaan Articles of Associations/By-laws
CALON PESERTA TENDER, atau (AD/ART), or a Power of Attorney. In
Surat Kuasa. Dalam hal case of CONSORTIUM, the
KONSORSIUM, WAKIL CALON POTENTIAL BIDDER
PESERTA TENDER adalah pemuka REPRESENTATIVE is the leadfirm
KONSORSIUM atau yang diberikan or the one which is given the
kuasa oleh pemuka KONSORSIUM. authority by the leadfirm.
1.3. KORESPONDENSI DAN 1.3. CORRESPONDENCE AND

KLARIFIKASI CLARIFICATION
1.3.1 CALON PESERTA TENDER diminta 1.3.1 POTENTIAL BIDDER is requested to

untuk mempelajari persyaratan di carefully review the requirements in
dalam DOKUMEN PRAKUALIFIKASI this PREQUALIFICATION
secara cermat dan menyampaikan DOCUMENT and submit a
PENGAJUAN yang menyediakan SUBMITTAL that provides complete
tanggapan lengkap secara terperinci details in response to this
terhadap DOKUMEN PREQUALIFICATION DOCUMENT.
PRAKUALIFIKASI ini. Jika ada Questions and requests for
pertanyaan dan pengajuan clarification concerning the
penjelasan tentang DOKUMEN PREQUALIFICATION DOCUMENT
PRAKUALIFIKASI (sejauh untuk (to the extent necessary to prepare
mempersiapkan PENGAJUAN) dapat the SUBMITTAL) may be submitted
diajukan kepada PERUSAHAAN to COMPANY by fax and e-mail to
melalui fax dan e-mail ke alamat the following address:
berikut:
Ditujukan kepada/Addressed to : INPEX MASELA, LTD.

Untuk Perhatian/Attention to : PROCUREMENT COMMITTEE
Fax No. : +62-21-2970 0100
Nomor Tender/Tender No. : MAS/2017/0040
Judul Tender/Tender Title : Jakarta Car Rental & Driver Services
E-mail address : msl.inpextender@inpex.co.jp
Semua klarifikasi dan korespondensi All clarifications and correspondence

harus diberi nomor urut dan judul oleh must be assigned a serial number
CALON PESERTA TENDER untuk and title by POTENTIAL BIDDER for
tujuan kontrol dokumen. document control purposes.
Kecuali pertanyaan yang diajukan Except for clarifications submitted in

menurut Bagian 1 ini, CALON accordance with this Part 1,
PESERTA TENDER tidak diijinkan POTENTIAL BIDDER must not
mengadakan kontak lain dengan contact any persons in COMPANY’s
siapa pun di dalam organisasi organization regarding the
PERUSAHAAN berkenaan dengan PREQUALIFICATION DOCUMENT
DOKUMEN PRAKUALIFIKASI atau or its SUBMITTAL.
PENGAJUAN.
Jika terjadi pelanggaran atau usaha If any such prohibited contact is

pelanggaran terhadap larangan made or attempted, COMPANY may
kontak tersebut, PERUSAHAAN immediately disqualify the
dapat segera melakukan diskualifikasi POTENTIAL BIDDER.
terhadap CALON PESERTA
Page 6 of 63
TENDER.
1.3.2 Jika CALON PESERTA TENDER 1.3.2 If POTENTIAL BIDDER has any
memiliki pertanyaan, maka CALON requests for clarification, the
PESERTA TENDER harus segera clarification requests shall be
mengajukan pertanyaan tersebut submitted to COMPANY immediately
kepada PERUSAHAAN, agar to enable COMPANY to respond any
PERUSAHAAN dapat menanggapi clarification requests promptly and
pertanyaan tersebut dengan cepat efficiently.
dan efisien.
Seluruh permintaan harus diterima Any clarification requests must be

PERUSAHAAN selambat-lambatnya received by COMPANY no later than:
pada:
Hari : Rabu Day : Wednesday

Tanggal : 27 September 2017 Date : 27 September 2017
Jam : 15:00 Time : 15:00
sehingga PERUSAHAAN dapat in order for COMPANY to give

memberikan jawabannya sebelum response prior to closing date of
tanggal penutupan PENGAJUAN. SUBMITTAL. Delay by POTENTIAL
Keterlambatan CALON PESERTA BIDDER in issuing a request for
TENDER dalam menyampaikan clarification will not to be basis an
pertanyaan tidak akan menjadi dasar extension of the closing date of the
untuk perpanjangan tanggal SUBMITTAL. With exception to any
penutupan PENGAJUAN. Dengan proprietary information, COMPANY
pengecualian terhadap informasi yang will issue responses to all requests
bersifat kepemilikan, PERUSAHAAN for clarification to all POTENTIAL
akan memberikan jawabannya BIDDERs at the same time.
terhadap semua pertanyaan kepada Notwithstanding the foregoing,
semua CALON PESERTA TENDER COMPANY shall not be obliged to
pada waktu yang bersamaan. respond to any request for
PERUSAHAAN tidak berkewajiban clarification if considered
menanggapi seluruh permintaan inappropriate. POTENTIAL BIDDER
penjelasan. CALON PESERTA shall be deemed to have taken into
TENDER dianggap telah account in its SUBMITTAL all
memperhatikan sepenuhnya semua responses that COMPANY has
jawaban/penjelasan dari issued before the closing date.
PERUSAHAAN di dalam
PENGAJUAN sebelum tanggal
penutupan.
1.4. PEMBERITAHUAN 1.4. NOTIFICATION OF

KEIKUTSERTAAN ATAU PARTICIPATION OR
PENGUNDURAN DIRI WITHDRAWAL
CALON PESERTA TENDER diminta POTENTIAL BIDDER is requested to

untuk mengisi dan menyampaikan fill and submit notification of
formulir pemberitahuan keikutsertaan participation or withdrawal form in
atau pengunduran diri dari proses this PREQUALIFICATION process
PRAKUALIFIKASI ini yang terdapat as refer to Part 1 Attachment 1 of this
dalam Bagian 1 Lampiran 1 dari PREQUALIFICATION DOCUMENT
DOKUMEN PRAKUALIFIKASI ini at the latest on the SUBMITTAL
paling lambat pada saat tanggal submission date.
pemasukan PENGAJUAN.
1.5. PENGAJUAN 1.5. SUBMITTAL
1.5.1 CALON PESERTA TENDER harus 1.5.1 POTENTIAL BIDDER shall deliver its
Page 7 of 63
menyampaikan PENGAJUAN (seperti SUBMITTAL (as stipulated in item

yang ditentukan di dalam butir 1.5.2 di 1.5.2 below) to COMPANY at the
bawah) kepada PERUSAHAAN ke below address at the latest by the
alamat berikut ini selambat- stated below:
lambatnya sesuai dengan waktu
yang disebutkan di bawah:
PROCUREMENT COMMITTEE
INPEX MASELA, LTD.
th
37 Floor, TCC Batavia Tower One,
Jl. K.H. Mas Mansyur Kav. 126, Jakarta 10220, Indonesia
Nomor Tender/Tender No. : MAS/2017/0040

Judul Tender/Tender Title : JAKARTA CAR RENTAL & DRIVER
SERVICES
Tanggal Penutupan/Closing Date : 29 September 2017
Waktu Penutupan/Closing Time : 15:00
Setiap PENGAJUAN yang diserahkan Any SUBMITTAL delivered after the

setelah tanggal dan waktu penutupan closing date and time as indicated
sebagaimana disebutkan di atas above will be REJECTED, and the
TIDAK AKAN DITERIMA, dan relevant POTENTIAL BIDDER will
CALON PESERTA TENDER yang automatically be disqualified from the
bersangkutan secara otomatis tidak PREQUALIFICATION process.
akan diikutsertakan di dalam proses
PRAKUALIFIKASI selanjutnya.
1.5.2 PENGAJUAN CALON PESERTA 1.5.2 POTENTIAL BIDDER’s SUBMITTAL

TENDER harus dimasukkan di dalam shall include the following, all in one
satu atau lebih amplop atau paket or more sealed envelope(s) or
tertutup, yang masing-masing amplop package(s), each envelope or package
atau paket tersebut ditandai dengan being clearly marked with the
jelas dengan informasi dibawah ini: following:
TO: PROCUREMENT COMMITTEE

INPEX MASELA, LTD.
37th Floor, TCC Batavia Tower One,
Jl. K.H. Mas Mansyur Kav. 126, Jakarta 10220, Indonesia
Calon Peserta Tender /Potential Bidder : _____
Nomor Tender/Tender No. : _____
Judul Tender/Tender Title : _____
Tanggal Penutupan/Closing Date : _____
Waktu Penutupan/Closing Time : _____
1.5.3 PERUSAHAAN berhak untuk menolak 1.5.3 COMPANY reserves the right to
beberapa PENGAJUAN yang tidak reject any SUBMITTAL that does not
sesuai dengan persyaratan yang comply with the stipulated
ditentukan, atau membatalkan proses requirements, or to cancel the
PRAKUALIFIKASI kapan pun, tanpa PREQUALIFICATION process at any
harus memberikan ganti rugi atau time, without incurring any liability to
berkewajiban untuk mengungkapkan POTENTIAL BIDDER or having any
alasannya kepada CALON PESERTA obligation to inform POTENTIAL
TENDER mengenai tindakan BIDDER of the grounds for any such
PERUSAHAAN tersebut. action on COMPANY's part.
1.5.4 CALON PESERTA TENDER harus 1.5.4 POTENTIAL BIDDER shall bear all
menanggung semua biaya yang its own costs associated with
terkait dengan keikutsertaannya di participating in this
dalam proses PRAKUALIFIKASI dan PREQUALIFICATION process and
Page 8 of 63
proses TENDER selanjutnya. the subsequent TENDER process.
1.5.5 Kecuali CALON PESERTA TENDER 1.5.5 Unless POTENTIAL BIDDER

secara resmi menarik diri dari proses formally withdraws from the
PRAKUALIFIKASI, PENGAJUAN dari PREQUALIFICATION process, its
CALON PESERTA TENDER yang SUBMITTAL shall remain valid until
bersangkutan akan tetap berlaku its SUBMITTAL is replaced by the
sampai dengan PENGAJUAN-nya BID PROPOSAL which are required
diganti dengan DOKUMEN in respect of this TENDER process or
PENAWARAN yang diperlukan terkait if COMPANY notifies POTENTIAL
dengan proses TENDER ini atau jika BIDDER that they are disqualified
PERUSAHAAN memberitahukan from the PREQUALIFICATION
kepada CALON PESERTA TENDER process, whichever is relevant.
bahwa CALON PESERTA TENDER
didiskualifikasi dalam proses
PRAKUALIFIKASI, yang mana lebih
relevan.
1.6. EVALUASI PENGAJUAN 1.6. EVALUATION OF SUBMITTAL
1.6.1 Sebagai tanggapan dari 1.6.1 In response to the SUBMITTAL as

PENGAJUAN sebagaimana diminta per Part 2 – Submittal Requirements,
pada Bagian 2 – Persyaratan COMPANY will carry out a thorough
Pengajuan, PERUSAHAAN akan evaluation of all SUBMITTAL to
melakukan evaluasi terhadap semua identify the POTENTIAL BIDDER
PENGAJUAN untuk mengidentifikasi that, generally, has met the following
CALON PESERTA TENDER yang requirements:
memenuhi persyaratan berikut ini:
1.6.1.1. Kelengkapan dan keabsahan 1.6.1.1 Completeness and validity of

dokumen yang diminta serta requested documents as well as
tanggapan terhadap semua respond to all questionnaires,
kuesioner, surat pernyataan dan statement letters and other forms.
formulir isian lainnya.
1.6.1.2. Bukti yang menegaskan bahwa 1.6.1.2 Substantiated affirmation that

CALON PESERTA TENDER POTENTIAL BIDDER intends to
berkeinginan untuk patuh terhadap comply with the following
persyaratan berikut ini, yang menjadi requirements, that will be specific
persyaratan khusus dari proses conditions of the
PRAKUALIFIKASI ini. PREQUALIFICATION process:
a) CALON PESERTA TENDER a) POTENTIAL BIDDER must be

harus PERUSAHAAN DALAM LOCAL COMPANY and/or
NEGERI dan/atau PERUSAHAAN NATIONAL COMPANY and shall
NASIONAL, mereka harus possess the appropriate current
memiliki tanda daftar perusahaan registrations and licenses in
dan perijinan yang masih berlaku accordance with Indonesian
sesuai dengan ketentuan hukum regulations.
perundang-undangan Indonesia.
b) CALON PESERTA TENDER b) POTENTIAL BIDDER which has

yang memiliki hubungan istimewa special relationship with other
dengan CALON PESERTA POTENTIAL BIDDER is not
TENDER lainnya tidak allowed to concurrently
diperbolehkan mengikuti participate in same subject
TENDER yang sama secara TENDER. If the POTENTIAL
bersamaan. Apabila CALON BIDDER having special
PESERTA TENDER memiliki relationship with other
hubungan istimewa dengan POTENTIAL BIDDER, the
Page 9 of 63
CALON PESERTA TENDER POTENTIAL BIDDERs which

lainnya, maka CALON PESERTA have the special relationship
TENDER yang memiliki shall decide that only one of
hubungan istimewa tersebut them to participate in this
harus menentukan hanya salah TENDER process.
satu dari mereka untuk mengikuti
proses TENDER ini.
Apabila hubungan istimewa If the special relationship is

diketahui pada saat atau setelah known as of or after the
penyampaian DOKUMEN submission of BID PROPOSAL
PENAWARAN dalam proses during the TENDER process, to
TENDER, maka kepada the BIDDERs having special
PESERTA TENDER yang relationship shall be disqualified.
memiliki hubungan istimewa
tersebut didiskualifikasi.
Apabila hubungan istimewa If the special relationship is

diketahui setelah known as of the CONTRACT
penandatanganan KONTRAK, signature, to the particular
maka pelaksana KONTRAK yang contractor shall be imposed with
memiliki hubungan istimewa red sanction, however, the
tersebut dikenakan sanksi merah, CONTRACT execution shall be
namun pelaksanaan KONTRAK continued to completion.
tetap dilakukan sampai dengan
selesai.
c) Jika CALON PESERTA TENDER c) If POTENTIAL BIDDER intends

ingin membentuk KONSORSIUM, to form a CONSORTIUM, a
maka KONSORSIUM harus CONSORTIUM must be firmly
sudah terbentuk pasti pada saat formed at the SUBMITTAL
pemasukan PENGAJUAN dengan submission, also the structure
struktur dan keanggotaan arrangement and membership of
KONSORSIUM harus sudah CONSORTIUM shall be fixed.
pasti. Ketentuan KONSORSIUM Further requirement for
dijelaskan lebih lanjut dalam CONSORTIUM is explained
Apendiks I, Bagian 2 – Formulir under Appendix I of Part 2 –
Isian Prakualifikasi. Form of the Prequalification.
1.6.1.3. Penting bahwa CALON PESERTA 1.6.1.3 It is essential that the POTENTIAL
TENDER pernah mengerjakan dan BIDDER has undertaken and has
memiliki pengalaman yang luas dalam extensive experience in undertaking
melaksanakan dan menangani and managing similar works and/or
pekerjaan sejenis dan/atau provide goods as per mentioned
menyediakan barang yang serupa under Part 2, Appendix E of this
dengan yang disebutkan dalam document. The Evaluation Criteria
Bagian 2, Apendiks E dari dokumen with regard to technical experience
ini. Kriteria Evaluasi terkait and capability is described in the
pengalaman dan kemampuan teknis Attachment 4 of this document.
diuraikan di Lampiran 4 dokumen ini.
1.6.1.4. CALON PESERTA TENDER harus 1.6.1.4 POTENTIAL BIDDER shall prioritize
mengutamakan penggunaan barang, the utilization of domestic goods,
jasa dan sumberdaya dalam negeri services and resources to maximize
guna memaksimalkan Tingkat Indonesian Local Content
Komponen Dalam Negeri mengacu requirements which refer to Appendix
kepada Apendiks K, Bagian 2 – K of Part 2 – Submittal
Persyaratan Pengajuan). Requirements). Commented [RS1]:
1.6.1.5. CALON PESERTA TENDER harus 1.6.1.5 POTENTIAL BIDDER shall
Page 10 of 63
menunjukkan komitmennya terhadap demonstrate its commitment to high

standar tinggi praktek kesehatan, standards in respect of health, safety,
keselamatan kerja, dan lindungan environmental practices, security and
lingkungan serta etika bisnis. Ini business ethics. These are
merupakan nilai inti PERUSAHAAN, COMPANY’s core values, and
dan PERUSAHAAN mengharuskan COMPANY requires all companies
semua perusahaan yang bekerja conducting business with it to respect
sama dengannya mematuhi komitmen these values. Any POTENTIAL
tersebut. Setiap CALON PESERTA BIDDER with an unacceptable track
TENDER yang catatannya tidak dapat record in these areas or who
diterima di bidang ini atau disregards these areas will be
mengesampingkan bidang ini tidak disqualified from the
akan diikutsertakan dalam proses QUALIFICATION ASSESSMENT
PRAKUALIFIKASI. process.
1.6.2 Sebagai bagian dari evaluasi 1.6.2 As part of COMPANY’s evaluation of

PERUSAHAAN terhadap the SUBMITTAL, COMPANY may
PENGAJUAN, PERUSAHAAN dapat ask POTENTIAL BIDDER to submit
meminta CALON PESERTA TENDER additional written information and / or
untuk menyampaikan informasi to take part in interview sessions to
tambahan dan/atau mengikuti sesi clarify the SUBMITTAL. Any
wawancara untuk memberikan clarifications or supplementary
penjelasan atas PENGAJUAN. Setiap information that POTENTIAL
penjelasan/klarifikasi atau informasi BIDDER may provide in due course
tambahan yang diberikan oleh must be fully consistent with and not
CALON PESERTA TENDER harus change the substance of the
sepenuhnya sesuai dengan dan tidak SUBMITTAL.
mengubah substansi PENGAJUAN.
CALON PESERTA TENDER dapat POTENTIAL BIDDER may add

menambahkan dokumen untuk documents to complete the
melengkapi persyaratan SUBMITTAL requirement whether it
PENGAJUAN baik diminta maupun is requested by PROCUREMENT
tidak diminta oleh PANITIA TENDER COMMITTEE or not and it will not be
dan tindakan tersebut tidak categorized as Post Bidding. The
dikategorikan sebagai Post Bidding. additional document shall be
Batas waktu penyampaian dokumen submitted at the latest by two (2)
tambahan harus diajukan selambat- working days after SUBMITTAL
lambatnya dua (2) hari kerja setelah submission date, or at any agreed
tanggal pemasukan PENGAJUAN, time appointed during clarification
atau waktu yang ditentukan pada saat meeting or written request.
rapat klarifikasi atau permintaan
tertulis.
1.6.3 PERUSAHAAN juga dapat melakukan 1.6.3 COMPANY may carry out audits,
pemeriksaan terhadap kantor dan inspections to the POTENTIAL
fasilitas-fasilitas, dan meninjau BIDDER’s office and facilities,
catatan CALON PESERTA TENDER environmental and quality assurance
terkait dengan keselamatan kerja, records, technical capabilities and
lindungan lingkungan dan jaminan other relevant aspects of the
mutu serta informasi lainnya yang SERVICES. POTENTIAL BIDDER
terkait dengan JASA. CALON shall ensure that COMPANY is able
PESERTA TENDER harus to carry out the above mentioned
memastikan bahwa PERUSAHAAN audits without restraint. If
dapat melakukan aktivitas tersebut di POTENTIAL BIDDER does not
atas tanpa menemui kendala apapun. comply with this requirement, it may
Jika CALON PESERTA TENDER be disqualified from the
tidak mematuhi ketentuan ini, maka PREQUALIFICATION process.
CALON PESERTA TENDER dapat
didiskualifikasi dari proses
Page 11 of 63
PRAKUALIFIKASI ini.
1.6.4 Metode PRAKUALIFIKASI akan 1.6.4 The method of PREQUALIFICATION

menggunakan sistem sebagai berikut: shall use the following system:
Tick the box as appropriate Tick the box as appropriate
☐ Gugur ☐ Pass/Fail
CALON PESERTA TENDER POTENTIAL BIDDER is

harus menyediakan semua required to provide all the
kelengkapan dokumen completeness of document as
sebagaimana dipersyaratkan required and applied in the
dan diperlukan pada Bagian 2 Part 2 – Submittal
– Persyaratan Pengajuan. Requirements. If the
Apabila CALON PESERTA POTENTIAL BIDDER could
TENDER tidak dapat not provide documents as
memberikan dokumen- required and applied, then the
dokumen sebagaimana POTENTIAL BIDDER will be
dipersyaratkan dan diperlukan, deemed as fail.
maka CALON PESERTA
TENDER akan dianggap
gugur.
☒ Nilai; Kriteria PENILAIAN ☒ Scoring; the QUALIFICATION

KUALIFIKASI untuk nilai ASSESSMENT criteria for
terlampir. scoring is attached.
1.7. MENGHINDARI PERTENTANGAN 1.7. AVOIDANCE OF CONFLICT OF

KEPENTINGAN INTEREST
Masing-masing CALON PESERTA Each POTENTIAL BIDDER that will

TENDER yang akan menandatangani be a signatory of the CONTRACT for
KONTRAK untuk JASA/BARANG the SERVICES/GOODS cannot
tidak boleh berperan sebagai appear as a proposed signatory in
penandatangan untuk lebih dari satu more than one SUBMITTAL. This
PENGAJUAN. Ketentuan ini juga provision also applies Fto any
berlaku untuk anggota grup member of the signatories' group
penandatangan (termasuk (including holding companies and
perusahaan induk dan anak subsidiaries of the signatory). This
perusahaan pihak yang matter is categorized as Special
menandatangani). Hal tersebut Relationship.
dikategorikan sebagai Hubungan
Istimewa.
1.7.1 Hubungan Istimewa: 1.7.1 Special Relationship:
a) Penyedia BARANG/JASA yang a) GOODS/SERVICES provider

memiliki hubungan istimewa having a special relationship
dengan Penyedia with another
BARANG/JASA lainnya tidak GOODS/SERVICES provider is
diperbolehkan secara bersama- not allowed to concurrently be a
sama menjadi PESERTA BIDDER in one tender package.
TENDER dalam satu paket Special relationship can be
tender. Hubungan istimewa indicated from the relation
dilihat dari hubungan antara dua amongst two or more
atau lebih penyedia GOODS/SERVICES provider
BARANG/JASA yang which controlled by same party
dikendalikan langsung oleh pihak or other POTENTIAL BIDDER,
yang sama atau CALON i.e. more than fifty percent
PESERTA TENDER yang lain, (50%) of the share holders
Page 12 of 63
yaitu lebih dari 50% persen (lima and/or one of the management
puluh persen) pemegang saham is same person.
dan/atau salah satu
pengurusnya sama.
b) Ketentuan hubungan istimewa ini b) Provision of this special

tidak berlaku bagi BUMN/BUMD. relationship is not applicable for
BUMN/BUMD.
1.7.2 Pekerja SKK Migas, dan pekerja 1.7.2 SKK Migas employee, and PSC
KKKS termasuk pekerja alih daya employee including outsource
yang bekerja untuk KKKS sebagai employee for PSC as individual must
individu tidak boleh bertindak sebagai not act as consultation services
penyedia jasa konsultansi dan/atau provider and/or as management
sebagai pengurus dan/atau pelaksana and/or POTENTIAL BIDDER’s
usaha perusahaan CALON PESERTA company business officer and unless
TENDER dan kecuali bertindak if act on behalf of BUMN/BUMD.
sebagai yang mewakili BUMN/BUMD.
1.8. PERJANJIAN KERAHASIAAN 1.8. CONFIDENTIALITY AGREEMENT
Informasi dan rincian yang dimuat di The information and details

dalam DOKUMEN PRAKUALIFIKASI contained in this
ini (yang dapat diperbarui setiap PREQUALIFICATION DOCUMENTs
waktu), sangat rahasia. CALON (as may be updated from time to
PESERTA TENDER dan pihak lain time), are highly confidential.
yang terlibat sepenuhnya terikat pada POTENTIAL BIDDER and any other
Perjanjian Kerahasiaan (Apendiks B party so involved is fully bound to the
dari Bagian 2 – Persyaratan respective Confidentiality Agreement
Pengajuan) tersebut, seluruhnya (Appendix B of Part 2 – Submittal
sebagaimana ditandatangani sebagai Requirements), all as signed as a
syarat kesertaan dalam pelaksanaan condition of participating in this
PRAKUALIFIKASI ini dan semua QUALIFICATION ASSESSMENT
pihak yang terlibat harus exercise and all parties involved shall
melampirkan Perjanjian Kerahasiaan provide signed Confidentiality
yang telah ditandatangani dalam Agreement in the SUBMITTAL.
PENGAJUAN.
CALON PESERTA TENDER YANG TIDAK POTENTIAL BIDDER THAT DOES NOT
MEMENUHI PERSYARATAN TERSEBUT DI MEET THE ABOVE REQUIREMENTS OR
ATAS ATAU YANG TIDAK MENANGGAPI THAT DOES NOT RESPOND TO ALL
SEMUA PERTANYAAN-PERTANYAAN / QUESTIONS / REQUIREMENTS TO THE
PERSYARATAN – PERSYARATAN YANG REASONABLE SATISFACTION OF
DIMINTA PERUSAHAAN SECARA COMPANY WILL NOT BE QUALIFIED AND
MEMUASKAN AKAN DINYATAKAN TIDAK WILL NOT BE INVITED AS A BIDDER FOR
LULUS DAN TIDAK AKAN DIUNDANG THE RESPECTIVE TENDER OF
SEBAGAI PESERTA TENDER PADA GOODS/SERVICES.
PENGADAAN BARANG/JASA INI.
PERUSAHAAN AKAN SECARA RESMI COMPANY WILL FORMALLY ADVISE THE

MEMBERITAHUKAN HASIL EVALUASI RESULTS OF THIS QUALIFICATION
PENILAIAN KUALIFIKASI KE MASING- ASSESSMENT EXERCISE TO THE
MASING CALON PESERTA TENDER YANG RESPECTIVE POTENTIAL BIDDERS
BERPARTISIPASI DALAM PROSES PARTICIPATED IN THE QUALIFICATION
PENILAIAN KUALIFIKASI INI. ASSESSMENT PROCESS.
Page 13 of 63
Lampiran 1 – Notifikasi Keikutsertaan / Pengunduran Diri / Attachment 1 – Notification of Participation or Withdrawal
(Dicetak diatas Kop Surat CALON PESERTA TENDER)

To be printed in the POTENTIAL BIDDER’s Letter Head)
LAMPIRAN 1
ATTACHMENT 1
PERNYATAAN PARTISIPASI / PENGUNDURAN DIRI *)

STATEMENT OF CONFIRMATON / WITHDRAWAL *)
To:
INPEX Masela, Ltd.
37th Floor, TCC – Batavia Tower One
Jl. KH. Mas Mansyur Kav. 126
Jakarta 10220, Indonesia
Attn.: PROCUREMENT COMMITTEE
Tender No. : MAS/2017/0040

Tender Title : JAKARTA CAR RENTAL & DRIVER SERVICES
Dengan Hormat, Dear Sir,
Kami mengakui penerimaan lengkap atas We acknowledge receipt your complete

DOKUMEN KUALIFIKASI tertanggal Insert QUALIFICATION DOCUMENT dated Insert
Date untuk subyek TENDER diatas, dan Date for the subject TENDER, and hereby
dengan ini menegaskan bahwa kami akan confirm that we will participate in the
berpartisipasi dalam proses PENILAIAN QUALIFICATION ASSESSMENT process /
KUALIFIKASI / menarik diri dari proses withdraw from the QUALFICATION
PENILAIAN KUALIFIKASI ini *) dan akan EVALUATION process *) and will submit our
menyerahkan PENGAJUAN kami sesuai SUBMITTAL in accordance with the terms
dengan ketentuan dan persyaratan di and requirements therein.
dalamnya.
Kami selanjutnya menegaskan bahwa kami We further confirm that we shall treat the
akan memperlakukan DOKUMEN QUALIFICATION DOCUMENT as
KUALIFIKASI sebagai materi rahasia dan confidential matter and only disclose to
hanya dapat mengungkapkan informasi others such information as is necessary for
tersebut kepada pihak lain sebagaimana the preparation of the SUBMITTAL
diperlukan untuk persiapan PENGAJUAN.
[Pernyataan berikut harap diisi HANYA [Write the following ONLY IF POTENTIAL
JIKA CALON PESERTA TENDER BIDDER confirm the participation. Please
memberikan konfirmasi keikutsertaannya. delete after being read].
*Harap dihapus setelah membaca].
Orang yang dinominasikan untuk menjadi The person nominated by us to be our

perwakilan kami untuk tujuan proses representative for the purpose of this
PENILAIAN KUALIFIKASI ini, dan kepada QUALIFICATION ASSESSMENT process,
siapa komunikasi lebih lanjut harus ditangani, and to whom any further communication
adalah: should be addressed, is:
Bapak./Ibu. _____ Mr./Ms. _____

Jabatan _____ Job Title _____
Perusahaan _____ Company _____
Alamat _____ Address _____
Telepon/Fax _____ Phone/Fax _____
HP _____ Cellphone _____
Page 14 of 63
Lampiran 1 – Notifikasi Keikutsertaan / Pengunduran Diri / Attachment 1 – Notification of Participation or Withdrawal
Alamat Email _____ Email Address _____
Jakarta, _____
Nama perusahaan CALON PESERTA

TENDER / POTENTIAL BIDDER’s company
name
Harap membubuhkan dan tanda tangan di

atas materai Rp. 6.000 oleh WAKIL CALON
PESERTA TENDER atau kuasa-nya / Please
affix and sign over a Rp. 6.000 duty stamp by
POTENTIAL BIDDER REPRESENTATIVE or
its proxy
Jabatan penandatangan / Position of

signatory
*) Delete where appropriate
Page 15 of 63
Lampiran 2 – Ringkasan Jadwal / Attachment 2 – Outline Schedule
LAMPIRAN 2
ATTACHMENT 2
RINGKASAN JADWAL
OUTLINE SCHEDULE
Ringkasan susunan jadwal TENDER yang The outline schedule for the dates of the key
disediakan dalam tabel dibawah adalah events is provided in the table below. The
jadwal perkiraan. Tanggal untuk periode dates for the QUALIFICATION
PENILAIAN KUALIFIKASI adalah tetap ASSESSMENT period are fixed unless any
kecuali ditentukan lain oleh PERUSAHAAN, information on rescheduling is announced by
untuk tanggal jadwal selanjutnya bisa COMPANY, the dates thereafter are subject
disesuaikan dan ini hanya sebagai estimasi to adjustment and thus are estimationonly.
saja.
Tahapan Stage Tanggal/Date
Pengumuman Pra Kualifikasi PQ announcement 22 September 2017
Periode pendaftaran Registration period 25& 26 September 2017
Waku penutupan penyerahan PENGAJUAN SUBMITTAL submission closing date 29 September 2017
Penyelesaian evaluasi PENGAJUAN
COMPANY to complete the SUBMITTAL of
PENILAIAN KUALIFIKASI oleh 4 October 2017
QUALIFICATION ASSESSMENT
PERUSAHAAN
PERUSAHAAN memberitahukan kepada COMPANY to notify the POTENTIAL
CALON PESERTA TENDER mengenai hasil BIDDER(s) of the result of COMPANY’s 4 October 2017
evaluasi KUALIFIKASI QUALIFICATION
PERUSAHAAN menerbitkan DOKUMEN COMPANY to issue the TENDER DOCUMENT
5 October 2017
TENDER kepada PESERTA TENDER to BIDDER(s)
PESERTA TENDER mengambil DOKUMEN BIDDER(s) to collect the TENDER
6-9 October 2017
TENDER DOCUMENT
Rapat pemberian penjelasan Pre-bid meeting 12 October 2017
PESERTA TENDER menyampaikan

BIDDER to submit BID PROPOSAL 19 October 2017
DOKUMEN PENAWARAN
PERUSAHAAN membuka DOKUMEN COMPANY to open First Envelope BID
19 October 2017
PENAWARAN Sampul Pertama PROPOSAL
PERUSAHAAN selesai mengevaluasi COMPANY to complete evaluation of First
24 October 2017
DOKUMEN PENAWARAN Sampul Pertama Envelope BID PROPOSAL
Pemberitahuan hasil evaluasi DOKUMEN COMPANY to notify of First Envelope BID
24 October 2017
PENAWARAN Sampul Pertama PROPOSAL evaluation result
PERUSAHAAN membuka DOKUMEN COMPANY to open Second Envelope BID
27 October 2017
PENAWARAN Sampul Kedua PROPOSAL
PERUSAHAAN selesai mengevaluasi COMPANY to complete the evaluation of
31 October 2017
DOKUMEN PENAWARAN Sampul Kedua Second Envelope BID PROPOSAL
PERUSAHAAN melakukan negosiasi COMPANY to conducts negotiation and/or
31 October 2017
dan/atau klarifikasi clarification
PERUSAHAAN memberitahukan pemenang COMPANY to notify the TENDER winner to
9 November 2017
TENDER kepada PESERTA TENDER BIDDER(s)
Penunjukan pemenang TENDER Notification of TENDER winner 14 November 2017
Page 16 of 63
Lampiran 3 – Daftar Kelengkapan Dokumen / Attachment 3 – Document Check List
(Dicetak diatas Kop Surat CALON PESERTA TENDER)

(To be printed in the POTENTIAL BIDDER’s Letter Head)
LAMPIRAN 3
ATTACHMENT 3
DAFTAR KELENGKAPAN DOKUMEN

DOCUMENT CHECK-LIST
Keterangan Ada Tdk Ada If N/A

Appendix
Description Yes No (Why?)
Formulir Isian Penilaian Kualifikasi
A.
Qualification Assessment Form
Perjanjian Kerahasiaan
B.
Confidentiality Agreement
Kemampuan Dasar (KD) dan Nilai Pengalaman Tertinggi
(NPt) - (wajib untuk Usaha Besar)
C.
Basic Capability (KD) and Value of Highest Experience
(NPt) - (mandatory fo Large Scale Business)
Data Teknis, Personil dan Data Peralatan atau
D. Perlengkapan – jika ada
Technical, Personnel and Tools or Equipment Data – if any
Persyaratan Kesehatan, Keselamatan, Keamanan dan
Lindungan Lingkungan (K3LL)
E.
Health, Safety, Security and Environmental (HSSE)
Requirements
Status Perusahaan sesuai dengan SKUP
F.
Company Status based on SKUP
Komitmen Penggunaan Rekening Bank BUMN/BUMD
untuk pembayaran
G.
Commitment of Using BUMN/BUMD Bank Account for
Payment
Pembentukan KONSORSIUM dalam bentuk MoU (jika ada)
H.
CONSORTIUM Arrangement (if any)
Commented [RS2]: Check further
Surat Pernyataan Kesanggupan Memenuhi Batasan
Minimal Tingkat Kandungan Dalam Negeri (TKDN)
I.
Statement Letter of Fulfillment Minimum Threshold for
Local Content
Kuesioner Kepatuhan
J. Commented [RS3]: Revised based on PASS / FAIL.
Compliance Questionnaire
Catatan: Seluruh dokumen yang Note: All of the requested documents

diminta didalam Formulir Isian Penilaian under this Qualification Assessment must
Kualifikasi ini wajib dilampirkan, apabila be attached; if one of these documents
salah satu dari dokumen tersebut tidak are not attached then the POTENTIAL
dilampirkan maka perusahaan CALON BIDDER company may not be further
PESERTA TENDER dapat tidak considered to participate in the further
dipertimbangkan lagi untuk diundang TENDER process. Commented [RS4]: Move to Top
dalam proses TENDER nantinya.
Page 17 of 63
LAMPIRAN 4
ATTACHMENT 4
TECHNICAL EVALUATION CRITERIA

KRITERIA EVALUASI TEKNIS
1.0 General
POTENTIAL BIDDER’s shall provide technical information as required in this Appendix E to

demonstrate that it has relevant prior experience in the area of Car Rental and Driver
Services. COMPANY will carry out a thorough and objective technical evaluation based on
POTENTIAL BIDDER’s SUBMITTAL in respond to this Appendix E to develop COMPANY’s
understanding and confidence that POTENTIAL BIDDER has sufficient experience,
knowledge and technical capability to perform the work as described further in the TENDER.
COMPANY may require clarifications, interviews, and site visits as deems necessary.
For the purposes of the technical evaluation, Company has develop the required technical
information as described further in Section 2.0 of this Appendix E.
2.0 Description of Methodology
For the purposes of the technical evaluation, Company has broken down the required
technical information into a number of main Categories, with further sub-division into main
Areas and Attributes as further explained below:
1) Categories:
1. POTENTIAL BIDDER’s Prior Experience
2. Key Personnel
3. Health, Safety, Security and Environmental
2) The Categories have been weighted in accordance with the degree of influence of the
Work and the success drivers thereto and will be evaluated based on a merit point
scoring system.
3) Against each Category, Areas and in some cases Attributes are identified that will be
assessed for that Category during the technical evaluation.
The overall scoring against each Category will be determined by the Evaluation Team based
on the evaluation and result for each Area and likewise each Area will be based on the
evaluation and result for each Attribute thereto, all based on the POTENTIAL BIDDER’s
SUBMITTAL in respond to this Appendix E, and subsequent clarifications addressed by the
Evaluation Team. Some Attributes will not be scored, they refer to information that Company
requires to ensure that the Bidders will comply with the contractual requirements such as
office facilities for company and for general comments around the scope of work etc.
Company has included Forms in the PREQUALIFICATION DOCUMENT to direct

POTENTIAL BIDDER to the minimum information that it should provide for each Category,
Area and Attribute. POTENTIAL BIDDER may provide additional details that it considers will
augment its proposal.
Page 18 of 63
3. Method of Evaluation
The Evaluation Team will individually assess the Technical and Administrative Proposals by
Area/ Attribute under each Category and develop a score for each Area based on the various
Attributes thereto. Thereafter the Evaluation Team will collectively review their conclusions
and substantiate their findings. Eventually, the Evaluation Team will jointly agree on the
scores to be allocated for the respective Bidders. The PROCUREMENT COMMITTEE will be
present during the collective review and adjudicate to ensure a fair and consistent approach
to theoverall scoring against each Category for each POTENTIAL BIDDER. Table 1 below
provides details of the Categories and Areas, refer to Attachment 1 hereto for details of the
Attributes.
4. Evaluation System
The Evaluation Team will utilize a systematic approach in their assessment of the Technical
and Administrative Proposals as follows:
Each Area/ Attribute will be scored based on the following five (5) ratings ranging from 0 to
4, and the respective percentages assigned below will be used in the Technical Evaluation
Scoring Matrix (Attachment 1, see below) for each POTENTIAL BIDDER as follows:
4 is Exceeds Expectations (100%) – excellent response addressing all main aspects and
demonstrate full compliance, exceeds requirements
3 is Meets Expectations (80%) - meets and in many cases exceeds Company requirements;
demonstrates a good understanding of requirements
2 is Borderline (70%) - meets most Company requirements with a few manageable shortfalls;
demonstrates a reasonable level of understanding of requirements
1 is Incomplete (50%) – partial response which lacks significant aspects
0 is Unacceptable (0%) – does not meet Company requirements in any way (or nil response)
5. Final Result
The Category score will be multiplied by the weighting to determine the total score for that
Category as will be captured in the Technical Evaluation Scoring Matrix. The aggregate sum
of the Category scores will represent the actual result for the respective POTENTIAL
BIDDER.
A minimum score of eighty (80) points is required to pass through Technical and
Administrative.
6. Other Considerations
If a POTENTIAL BIDDER has submitted a generally acceptable technical and administration

information, but with a few weak areas, Company may notify the POTENTIAL BIDDER of the
identified areas of weakness, and allow it an opportunity and a limited time to remedy the
deficiencies. Company will not give such an opportunity to any POTENTIAL BIDDER that has
submitted a generally poor proposal.
Area Score Criterion: Regardless of other results from the scoring process, any POTENTIAL
BIDDER that has any Category scoring less than two thirds of the maximum available score
will be eliminated from further consideration. The scores in the brackets are the minimum scores
Page 19 of 63
required for the relevant items. Even if total score exceeds 80 scores, if score of any of the relevant
category as listed in the above table is below the minimum score, the POTENTIAL BIDDER will be
eliminated. In order to be invited for TENDER, total minimum score need to clear 80 as well as clear
minimum scores for each items
Page 20 of 63
Dokumen Kualifikasi / Qualification Document
Bagian 2 – Persyaratan Pengajuan / Part 2 – Submittal Requirements
BAGIAN 2 – PERSYARATAN PENGAJUAN PART 2 – SUBMITTAL REQUIREMENTS
2.1. PERSYARATAN UMUM 2.1. GENERAL REQUIREMENTS
Pertama-tama, CALON PESERTA In the first instance, POTENTIAL

TENDER harus menyediakan BIDDERs shall provide the
informasi dan dokumen yang diminta information and documents as
dalam Bagian 2 dari DOKUMEN requested in this Part 2 of the
PRAKUALIFIKASI ini. CALON PREQUALIFICATION DOCUMENT.
PESERTA TENDER harus POTENTIAL BIDDERs shall provide
menyediakan informasi yang sangat with very basic information is
mendasar yang diminta terkait requested on the experience and
dengan pengalaman dan kemampuan capability of the POTENTIAL
dari CALON PESERTA TENDER BIDDERs to ensure that only
untuk memastikan bahwa hanya companies with the relevant
perusahaan-perusahaan dengan experience and resources (human
pengalaman yang relevan dan and equipment) to safely and
sumber daya (manusia dan efficiently perform the SERVICES
equipment) yang mencukupi dan and/or provide the GOODS are
dianggap mampu menyediakan JASA invited to participate in the
dan/atau menyediakan BARANG subsequent TENDER exercise.
secara aman dan efisien yang akan
diundang berpartisipasi dalam Passing through the
pelaksanaan TENDER berikutnya. PREQUALIFICATION phase does
not mean a POTENTIAL BIDDER
Lolos pada tahap PRAKUALIFIKASI has been qualified as an acceptable
tidak berarti CALON PESERTA GOODS/SERVICES providers as
TENDER telah memenuhi syarat addressed herein.
sebagai penyedia BARANG/JASA
yang diterima sebagaimana
disebutkan disini.
2.2. RINCIAN DAN DATA CALON 2.2. DETAIL AND DATA OF

PESERTA TENDER POTENTIAL BIDDER
CALON PESERTA TENDER harus POTENTIAL BIDDER shall fill and

mengisi data-data dan menyerahkan submit the required data and
dokumen yang dipersyaratkan secara document in detail and complete as
terperinci dan lengkap sesuai dengan per Document Check-List which
Daftar Kelengkapan Dokumen yang consists of:
terdiri dari:

Prakualifikasi
Apendiks B - Perjanjian Kerahasiaan Appendix B - Confidentiality
Agreement
Apendiks C - Kemampuan Dasar Appendix C - Basic Capability (KD)

(KD) dan Nilai and Value of Highest
Pengalaman Tertinggi Experience (NPt)
(NPt)
Apendiks D - Data Teknis, Personil Appendix D - Technical, Personnel
dan Data Peralatan/ and Tools/Equipment
Perlengkapan (Jika Data (If any)
ada)
Apendiks E - Persyaratan Appendix E - Health, Safety,

Kesehatan, Security and
Keselamatan Kerja, Environmental (HSSE)
Keamanan dan Requirements
Page 21 of 63
Lindungan Lingkungan
(K3LL)
Apendiks F - Status Perusahaan Appendix F - Company Status
Apendiks G - Komitmen Penggunaan Appendix G - Commitment of the
Rekening Bank Using the of
BUMN/BUMD untuk BUMN/BUMD Bank
Pembayaran Account for Payment
Apendiks H - Pembentukan Appendix H - CONSORTIUM
KONSORSIUM (Jika Arrangement (If any)
ada)
Apendiks I - Surat Pernyataan Appendix I - Statement Letter of

Kesanggupan Fulfillment Minimum
Memenuhi Batasan Threshold for Local
Minimal TKDN Content
Apendiks J - Kuesioner Kepatuhan Appendix J - Compliance
Questionnaire
Page 22 of 63
Apendiks A / Appendix A
(Dicetak diatas kop surat)

(To be printed on letterhead)
APENDIKS A
APPENDIX A
FORMULIR PRAKUALIFIKASI
PREQUALIFICATION FORM
Nomor Tender / Tender No. : _____

Judul Tender / Tender Title : _____
Saya yang bertanda tangan dibawah ini: / I, the undersigned:
Nama / Name : _____

Jabatan / Title : _____
Bertindak untuk dan atas nama : _____
For on behalf of Company Name
Alamat / Address : _____
Telepon / Telephone : _____

Faksimili / Facsimile No. : _____
Alamat Email / Email Address : _____
Status Perusahaan / Company Status : _____
Menyatakan dengan sesungguhnya bahwa: Stating the fact that:
1. Saya secara hukum mempunyai 1. I, by law, have the capacity to sign any
kapasitas menandatangani KONTRAK contract based on _____, (in accordance
berdasarkan _____; (sesuai akte with the deed of establishment/ its
pendirian/perubahannya/ surat kuasa; amendment/ power of attorney;
sebutkan secara jelas nomor akte mentioned clearly number of the deed of
pendirian/ perubahannya / surat kuasa establishment/ its amendment/ power of
dan tanggalnya). attorney and the date).
2. Saya/perusahaan saya tidak sedang 2. I/my company is not being declared

dinyatakan pailit atau kegiatan usahanya bankrupt, or my/my company business
tidak sedang dihentikan atau tidak activities are not being halted or not
sedang menjalani sangsi pidana atau undergoing criminal sanction or under
sedang dalam pengawasan pengadilan. court surveillance.
3. Saya tidak pernah dihukum berdasarkan 3. I have never been sentenced based on
putusan pengadilan atas tindakan yang court judgment for the act related to my
berkaitan dengan profesionalisme saya. professionalism.
4. Perusahaan saya atau salah satu 4. My Company or one of the management,

pimpinan yang tertulis dalam akte whose name is stated in the deed of
pendirian perusahaan dan/atau company’s establishment and/or valid
perubahannya yang sah, tidak pernah amendment thereof, is declared of having
melakukan tindak pidana di bidang been proven to commit any criminal act in
perdagangan dan/atau perpajakan trading and/or taxation under a final and
berdasarkan putusan pengadilan yang binding court decision.
berkekuatan hukum tetap.
5. Perusahaan saya tidak dalam sengketa 5. My Company is not in dispute with SKK
dengan SKK Migas baik sebagai Migas either as defendant or plaintiff; nor
tergugat maupun sebagai penggugat am I aware of any potential dispute.
dan dengan pengetahuan saya tidak
pula ada potensi perselisihan.
Page 23 of 63
6. Saya menegaskan bahwa perusahaan 6. I hereby confirm that my company and its
saya dan personilnya tidak akan personnel shall not perform any act
melakukan segala tindakan yang categorized as corruption act and we fully
dikategorikan sebagai tindakan korupsi agree to comply with and willing to be
dan setuju untuk patuh kepada dan subject to investigation against Law No
bersedia untuk dilakukan pemeriksaan 20 of 2001 on Anti-Corruption with its
terhadap Undang-Undang No 20 Tahun amendments, if any (“Anti-Corruption
2001 tentang Pemberantasan Tindak Laws“), Law No. 11 of 1980 on Criminal
Pidana Korupsi berikut dengan Acts of Bribery with its amendments,
perubahannya, jika ada (“Undang- Foreign Corrupt Practices Act (FCPA),
Undang Tindak Pidana Korupsi”), and/or Anti-Bribery and Corruption (ABC)
Undang-Undang No. 11 Tahun 1980 by an independent auditor appointed by
tentang Tindak Pidana Suap berikut COMPANY and/or SKK Migas, based on
dengan perubahannya, Foreign Corrupt hard copy and digital data. This
Practice Act (FCPA), dan/atau Anti- commitment and obligation shall apply
Bribery and Corruption (ABC) oleh without limitation regardless of time
auditor independen yang ditunjuk oleh whereas POTENTIAL BIDDER is
PERUSAHAAN dan/atau SKK Migas, involved in the subject TENDER process
berdasarkan data hard copy dan data or otherwise not.
digital. Komitmen dan kewajiban ini
harus berlaku tanpa batasan apapun
terlepas dari waktu CALON PESERTA
TENDER terlibat dalam proses TENDER
yang dimaksud maupun tidak.
7. Data-data saya/perusahaan saya adalah 7. My/my company data as mentioned in

sebagaimana yang disebutkan di dalam the following Appendices which forms an
Appendiks-appendiks berikut yang integral and inseparable part of the
merupakan satu kesatuan dan bagian PREQUALIFICATION DOCUMENT
yang tidak terpisahkan dari DOKUMEN submitted.
PRAKUALIFIKASI yang disampaikan.

Prakualifikasi
Apendiks B - Perjanjian Kerahasiaan Appendix B - Confidentiality Agreement
Apendiks C - Kemampuan Dasar (KD) Appendix C - Basic Capability (KD) and

dan Nilai Pengalaman Value of Highest
Tertinggi (NPt) Experience (NPt)
Apendiks D - Data Teknis, Personil dan Appendix D - Technical, Personnel and
Data Peralatan/ Tools/Equipment Data (If
Perlengkapan (Jika ada) any)
Apendiks E - Persyaratan Kesehatan, Appendix E - Health, Safety, Security

Keselamatan Kerja, and Environmental (HSSE)
Keamanan dan Lindungan Requirements
Lingkungan (K3LL)
Apendiks F - Status Perusahaan Appendix F - Company Status
Apendiks G - Komitmen Penggunaan Appendix G - Commitment of Using
Rekening Bank BUMN/BUMD Bank
BUMN/BUMD untuk Account for Payment
Pembayaran
Apendiks H - Pembentukan Appendix H - CONSORTIUM
KONSORSIUM (Jika ada) Arrangement (If any)
Apendiks I - Surat Pernyataan Appendix I - Statement Letter of
Kesanggupan Memenuhi Fulfillment Minimum
Batasan Minimal TKDN Threshold for Local
Content
Apendiks J - Kuesioner Kepatuhan Appendix J - Compliance Questionnaire
Page 24 of 63
Sebagai dukungan terhadap Formulir As a supporting document to the

Prakualifikasi ini, kami sampaikan Perjanjian Prequalification Form, we submit
Kerahasiaan sebagaimana terdapat dalam Confidentiality Agreement as provided under
Apendix B dokumen ini. Appendix B hereto.
Demikian persyaratan ini kami buat dengan Thus, I the undersigned hereby swear and
sebenarnya dan penuh rasa tanggung jawab. declare that this statement is made truthfully
Apabila dikemudian hari, ditemukan bahwa and full of responsibility. If at a later date it is
data/dokumen yang kami sampaikan tidak found that we conducted violation to this
benar, maka kami bersedia untuk statement, then we are willing to be
didiskualifikasi dari proses TENDER dan disqualified from TENDER process and to be
dikenakan sanksi sesuai dengan PTK007 subject in accordance with PTK007 applied at
yang berlaku pada saat dokumen ini dibuat. the time of this document is made.
Jakarta, _____

name

its proxy

signatory
Page 25 of 63
Apendiks B / Appendix B

APENDIKS B
APPENDIX B
PERJANJIAN KERAHASIAAN
CONFIDENTIALITY AGREEMENT
(Selanjutnya disebut sebagai “Perjanjian”)

(Hereinafter referred to as the “Agreement”)
Diberikan oleh / Given By : Insert Name of POTENTIAL BIDDER’s Company
Kepada / To : PROCUREMENT COMMITTEE

INPEX Masela, Ltd.
37th Floor, TCC – Batavia Tower One
Jl. KH. Mas Mansyur Kav. 126
Jakarta 10220, Indonesia
(Selanjutnya disebut sebagai “PERUSAHAAN” / Hereinafter
referred to as “COMPANY”)
Regarding / Mengenai : JAKARTA CAR RENTAL & DRIVER SERVICES

MAS/2017/0040
Dengan Hormat, Dear Sir,
Dengan mempertimbangkan bahwa CALON In consideration of POTENTIAL BIDDER’s

PESERTA TENDER telah menerima semua receipt of all documents issued by COMPANY
dokumen yang diterbitkan oleh to POTENTIAL BIDDER in respect of the
PERUSAHAAN sehubungan dengan proses PREQUALIFICATION and any associated
PENILAIAN KUALIFIKASI dan semua information subsequently issued by
informasi yang terkait, baik secara tertulis, COMPANY, in written, oral or electronic form
verbal maupun dalam bentuk elektronik (collectively referred to as “Confidential
(secara bersama-sama disebut sebagai Information”), including in the event (should
“Informasi Rahasia”), termasuk dalam hal such arise) of any future CONTRACT where
(apabila timbul) setiap KONTRAK di masa POTENTIAL BIDDER is selected as the
depan dimana CALON PESERTA TENDER contractor to COMPANY, POTENTIAL
terpilih sebagai kontraktor dari BIDDER undertakes and agrees as follows:
PERUSAHAAN, CALON PESERTA TENDER
berjanji dan setuju sebagai berikut:
1. Semua Informasi Rahasia harus 1. All Confidential Information shall be kept

diperlakukan secara rahasia dan tidak strictly confidential and shall not be
boleh diungkapan oleh CALON disclosed by POTENTIAL BIDDER
PESERTA TENDER selain yang except as addressed herein subject to
disebutkan disini tanpa adanya COMPANY’s written consent.
persetujuan PERUSAHAAN terlebih
dahulu.
2. PESERTA TENDER tidak akan 2. POTENTIAL BIDDER shall not use the
menggunakan Informasi Rahasia untuk Confidential Information for any purpose
tujuan apapun selain mata-mata hanya whatsoever other than solely to prepare
untuk mempersiapkan PENGAJUAN its SUBMITTAL for the subject TENDER
untuk subyek TENDER di atas. above.
3. Semua Informasi Rahasia harus setiap 3. All Confidential Information shall at all
saat tetap menjadi milik eksklusif times remain the exclusive property of
PERUSAHAAN, dan CALON COMPANY, and POTENTIAL BIDDER
Page 26 of 63
PESERTA TENDER harus segera shall promptly return all documentation

mengembalikan semua dokumentasi when COMPANY requests POTENTIAL
ketika PERUSAHAAN meminta BIDDER to do so. At the same time
CALON PESERTA TENDER untuk POTENTIAL BIDDER shall destroy any
melakukannya. Pada saat yang sama, further copies or analyses made from the
CALON PESERTA TENDER akan Confidential Information.
memusnahkan setiap salinan atau
analisis yang dibuat dari Informasi
Rahasia.
4. CALON PESERTA TENDER setiap 4. POTENTIAL BIDDER shall not at any

saat tidak akan membuat time make any public or any other
pengumuman publik atau lain apapun announcement whatsoever relating to
yang berkaitan dengan PENILAIAN this QUALIFICATION ASSESSMENT.
KUALIFIKASI ini.
5. CALON PESERTA TENDER harus 5. POTENTIAL BIDDER shall ensure that its
memastikan bahwa karyawan, employees, official advisors and any
penasihat resmi dan setiap mitra formal formal partners (and their employees
(dan karyawan mereka dll) yang etc) that must have access to the
memiliki akses ke Informasi Rahasia, Confidential Information, fully comply
sepenuhnya mematuhi kewajiban yang with the obligations set out in this
diatur dalam Perjanjian ini. Agreement.
6. CALON PESERTA TENDER hanya 6. POTENTIAL BIDDER shall only disclose

boleh mengungkapkan bagian-bagian those parts of the Confidential
Informasi Rahasia untuk setiap entitas Information to any entity other than those
selain yang disebutkan dalam angka 5 mentioned in Item 5 above (including
di atas (termasuk calon subkontraktor candidate subcontractors and suppliers
dan pemasok yang berpartisipasi who are participating in preparing, or
dalam penyusunan, atau memberikan providing information for POTENTIAL
informasi untuk PENGAJUAN CALON BIDDER’s SUBMITTAL) to the extent
PESERTA TENDER) sejauh benar- absolutely necessary for each such
benar diperlukan untuk masing-masing entity to complete its respective portion
entitas tersebut dalam menyelesaikan of its SUBMITTAL.
masing-masing bagian dari
PENGAJUAN.
CALON PESERTA TENDER tidak POTENTIAL BIDDER shall not make

akan membuat pengungkapan sampai such disclosure until it has secured, for
telah diamankan, untuk kepentingan the benefit of COMPANY from the entity
PERUSAHAAN, dari entitas kepada to whom the disclosure is to be made, a
siapa pengungkapan tersebut harus confidentiality undertaking in the same
dibuat, usaha kerahasiaan dalam form and content as this Agreement.
bentuk dan konten yang sama dengan POTENTIAL BIDDER shall ensure that
Perjanjian ini. CALON PESERTA all such entities fully comply with the
TENDER harus memastikan bahwa confidentiality undertakings as set out in
semua entitas tersebut sepenuhnya this Agreement and any subsequent
mematuhi janji-janji kerahasiaan CONTRACT as may be issued in due
sebagaimana diatur dalam Perjanjian course.
ini dan KONTRAK berikutnya yang
mungkin dikeluarkan pada waktunya.
CALON PESERTA TENDER setuju bahwa POTENTIAL BIDDER agrees that a breach of
pelanggaran dari janji-janji di atas akan any of the above undertakings will be grounds
menjadi dasar untuk PERUSAHAAN untuk for COMPANY to eliminate POTENTIAL
menghilangkan CALON PESERTA TENDER BIDDER from further consideration and for
dari pertimbangan lebih lanjut dan untuk COMPANY to take further actions as deemed
PERUSAHAAN untuk mengambil tindakan appropriate in consideration of the actual
lebih lanjut yang dianggap sesuai dengan breach of this Agreement.
Page 27 of 63
mempertimbangkan pelanggaran yang

sebenarnya terhadap Perjanjian ini.
Jakarta, _____

name

its proxy

signatory
Page 28 of 63
Apendiks D / Appendix D

APENDIKS C
APPENDIX C
KEMAMPUAN DASAR (KD) DAN NILAI PENGALAMAN TERTINGGI (NPt)

BASIC CAPABILITY (KD) AND VALUE OF HIGHEST EXPERIENCE (NPt)
Melampirkan bukti pembayaran yang diterima Attach evidence of payment receipt which
dari pemberi kontrak atau dokumen sah received from your client (pemberi
lainnya untuk menunjukkan nilai pekerjaan KONTRAK) or other legal document to show
yang sudah diselesaikan yang menunjukkan the value of work that has been completed as
bahwa perusahaan CALON PESERTA supporting documents that shows the
TENDER memiliki pengalaman POTENTIAL BIDDER’s company has the
menyelesaikan pekerjaan sejenis experience to complete similar work.
CALON PESERTA TENDER diminta untuk POTENTIAL BIDDER shall fill in the Value of
mengisi formulir Nilai Pengalaman Tertinggi Highest Experience (NPt) as stipulated
(NPt) di bawah ini dengan ketentuan sebagai below: *)
berikut: *)
*) Tidak berlaku bagi Pabrikan dan Agen yang *) Not applicable for Manufacturer and Agent
mewakili Pabrikan which represent Manufacturer
Nilai Pengalaman Tertinggi (“NPt”)

Highest Completed Experience Value (“NPt”)
NPt = Nilai pengalaman tertinggi yang diperoleh dalam kurun waktu 7 NPt = The value of highest experience which is
(tujuh) tahun terakhir dan, pada sub bidang pekerjaan yang sesuai achieved within seven (7) years, and similar to
dengan sub bidang pekerjaan pada paket TENDER. the work field which is in line with the TENDER
package work field.
Deskripsi Kontrak / PO Mulai Berakhir Nilai
Value of the Contract /

Contract / PO Description Start Period End Period
PO
USD / IDR **
Dimana, NPt perhitungannya mengacu pada Where, NPt calculation shall refer to
ketentuan PTK007: stipulation of PTK007:
(a) Untuk Pekerjaan Konstruksi NPt = 1/3 KD; (a) For Construction Works NPt =1/3 KD;
(b) Untuk Pengadaan BARANG, Pengadaan (b) For GOODS Procurement, Other
JASA Lainnya, dan Jasa Konsultansi NPt SERVICES Procurement, and
=1/5 KD; dan Consultancy Service Procurement, NPt
=1/5 KD; and
(c) Dalam hal Konsorsium, NPt yang (c) For a Consortium, NPt calculated is the
diperhitungkan adalah jumlah kumulatif cumulative sum of NPt from all members
NPt dari perusahaan anggota of the Consortium.
Konsorsium.
Page 29 of 63
Apendiks D / Appendix D
Page 30 of 63
APENDIKS D
APPENDIX D
INFORMASI TEKNIS, PENGALAMAN YANG SESUAI, PERSONIL DAN PERALATAN

TECHNICAL INFORMATION, RELEVANT EXPERIENCE, PERSONNEL, TOOLS
For each of the questions in this Form T-1, POTENTIAL BIDDER shall provide concise details
of its prior experiences in the past seven (7) years as is relevant to the Work.
1. Domicile
POTENTIAL BIDDER shall be legally domiciled in Greater Jakarta area (Jakarta, Bogor,
Depok, Tangerang, and Bekasi). POTENTIAL BIDDER shall provide Statement of Domicile
legalized by the local Authority.
2. Relevant Prior Experience

POTENTIAL BIDDER is required to provide comprehensive details to demonstrate its
experience for Car Rental and Driver Services in Greater Jakarta area. POTENTIAL BIDDER
shall provide detail experience in the following areas.
2.1. POTENTIAL BIDDER shall describe details of similar services which has been performed
within the last seven (7) years by using the form below.
Deskripsi Kontrak / PO Mulai Berakhir Nilai Kontrak /

Contract / PO Description Start Period End Period Value of the Contract / PO
USD / IDR *
* Hapus yang tidak sesuai / Delete as applicabl
3. Key Personnel
3.1. POTENTIAL BIDDER shall submit a Table similar to the following format of Table 1 below,
which list Key Personnel required to perform the Work.
Employement Status WORK List of Work Experience CV Provided

Job Position Name Experience (Yes/No)
(years)
Staff Associate
(Yes/No) (Yes/No)
Project/Opera
tional
Manager
HSE Manager
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Table 1
2.2 Provide a brief narrative in One Page only, describing the roles and responsibilities for each
person in position and how they would contribute to the overall success of the Work.
2.3 POTENTIAL BIDDER shall explain details of the Key Personnel whether they are full time
employees, agency personnel or permanently deployed from consortium members or
subcontractors
32 of 53
Apendiks F / Appendix F
APENDIKS E
APPENDIX E
PERSYARATAN KESEHATAN, KESELAMATAN KERJA DAN LINDUNGAN LINGKUNGAN

(K3LL)
HEALTH, SAFETY, SECURITY AND ENVIRONMENTAL (HSSE) REQUIREMENTS
CALON PESERTA TENDER harus POTENTIAL BIDDER shall provide response

memberikan tanggapan terhadap persyaratan to HSSE requirements under Appendix F of
K3LL dalam Apendiks F dari Bagian 2 ini Part 2 hereto.
Apabila diperlukan, PERUSAHAAN dapat If required, COMPANY may request

meminta CALON PESERTA TENDER untuk POTENTIAL BIDDER to provide additional
menyediakan data-data dan/atau dokumen data and/or documents and conduct site visit
tambahan dan melakukan kunjungan
to POTENTIAL BIDDER’s facilities and
terhadap fasilitas-fasilitas dan kantor-kantor
CALON PESERTA TENDER offices.
Bagi CALON PESERTA TENDER mendaftar For POTENTIAL BIDDER registered as

sebagai KONSORSIUM, maka persyaratan di CONSORTIUM, the requirement below shall
bawah ini wajib diisi oleh Pemuka be provided by the leadfirm and all other
KONSORSIUM dan seluruh anggotanya.
members of CONSORTIUM.
HEALTH, SAFETY, SECURITY AND ENVIRONMENTAL – HSSE QUESTIONNAIRE
General Information
HSSE Contact :
Name : _____
Title : _____
Phone : _____
E-mail : _____
Section 1 – Leadership and Commitment
1.1. Commitment of HSSE Aspects through Leadership
a) How senior managers are personally involved in HSSE management, for example
objective-setting and monitoring?
b) Provide evidence of commitment at all levels of the organization.
c) How do you promote a positive culture towards HSSE matters?
Section 2 – HSSE Policy and Strategic Objectives
1.1. HSSE Policy Documents
a) Does your company have an HSSE policy document? If the answer is YES please attach
a copy?
b) Who has overall and final responsibility for HSSE in your organization?
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c) Who is the most senior person in the organization responsible for this policy being carried
out at the premises and on site where his/her employees are working? Provide name and
title.
d) Itemize the methods by which you have drawn your policy statements to the attention of all
your employees.
e) What are your arrangements for advising employees of changes in the policy?
1.2. HSSE Contract Strategic Objectives
a) Does your company have strategic HSSE objectives? If the answer is YES please attach a
copy.
b) Itemize the methods by which you have communicated your strategic HSSE objectives to
the attention of all your employees.
Section 3 – Organization, Responsibilities, Resources, Standards and Documentation
3.1. Organizational Structure for HSSE Management
a) How is your organization structured to manage and communicate HSSE effectively?
b) Do HSSE meetings promote HSSE awareness?
c) Do client and contractor meet regularly to discuss and act upon any interface situations?
d) What provision does your company make for HSSE communication meetings? Please
provide an organization chart.
3.2. HsSE training of managers, supervisors and HSSE critical position holders
a) Have the managers and supervisors at all levels who will plan, monitor, oversee, and carry
out the work received formal HSSE training in their responsibilities with respect to
conducting work to HsSE requirements?
b) If YES please give details. Where the training is given in-house, please describe the
content and duration of courses. Please provide an example of training matrix.
c) How have you identified areas of your company’s operations where specialized training is
required, for instance training related to health hazard such as radiation, asbestos and
chemicals?
d) What specialist HSSE resources does your organization have available?
e) How does your company provide HSSE specialized training for HSSE staff?
3.3. General HSSE training
a) What arrangements does your company have to ensure new employees have knowledge
of basic industrial HSSE, and to keep this knowledge up to date?
b) What arrangements does your company have to ensure new employees also have
knowledge of your HSSE policies, practices and company requirements?
c) What arrangements does your company have to ensure new employees have been
instructed and have received information on any specific hazards arising out of the nature
of the activities?
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NB) for (a), (b) & (c): if training is provided in-house, please give details of the content.
3.4. Competence Assurance
a) Does your organization have a competence system in place? If YES, please describe the
scope and content of your competence system.
b) What arrangements does your company have to ensure existing staff’s HSSE knowledge
is up to date?
3.5. Contractor Management Process
a) Does your company have a contractor management process or system? If YES, provide
an outline of the process.
b) How do you assess contractors, HSSE competence or HSSE performance?
c) Where do you define the company standards you require your contractors to meet?
d) How do you ensure these standards are met and verified?
3.6. HSSE Standards
a) How do you identify new industry or regulatory standards that may be applicable to your
activities?
b) Is there an overall structure for producing, updating and disseminating standards?
c) Are your company standards aligned with OGP/industry guidelines or recommended

practices? If YES, state which one.
Section 4 – Risk Management
4.1. Risk Assessment and Control
a) How does your company identify hazards, assess risk, control and mitigate consequences,
to a level as low as reasonably practicable?
4.1. Health Hazards
a) Do you have specific policies and programs on specific health hazards, e.g. substance
abuse, blood borne pathogens, malaria pandemic diseases etc.?
b) What types of health hazards (chemical, vibration, noise, radiation, etc.) are associated
with the scope of your services? Explain how occupational health hazards are identified,
assessed and controlled.
c) What systems are in place to control these hazards and monitor the effectiveness of these
controls? Is worker’s regular exposure monitoring part of these systems?
4.3. Safety Hazards
a) What types of safety hazards (mechanical guarding, work at height, lifting and hoisting,
confined space entry, explosive atmospheres, etc.) are associated with the scope of your
services?
b) What systems are in place to control these hazards and monitor the effectiveness of these
controls?
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4.4. Logistics Hazards
a) What types of logistics hazards (land transport, air transport, marine transport, materials
handling etc.) are associated with the scope of your services?
controls?
4.5. Environmental Hazards
a) What types of environmental hazards (chemical spill, atmospheric emissions, waste

disposal etc.) are associated with the scope of your services?
controls?
4.6. Security Hazards
a) What types of security hazards (terrorism, hostage taking, robbery, hostile local population
etc.) are associated with the scope of your services?
controls?
4.7. Social responsibility hazards
a) What types of social hazards are associated with the scope of your services?
b) What systems are in place to control these hazards and impacts and monitor the
effectiveness of these controls?
Section 5 – Planning and Procedures
5.1. HSSE Operations Manual
a) Do you have a company HSSE-MS manual (or operations manual with integrated HSSE
requirements) which describes in detail your company approved HSSE working practices
relating to your work activities? If the answer is YES, please attach a copy of an index and
relevant supporting documentation.
5.2. Infrasturcture and Equipment Integrity
a) How do you ensure that infrastructure, plant and equipment used within your operations
(own premises, client site, or at other locations) are correctly certified, registered,
controlled and maintained in a safe working condition?
5.3. Management of Change
a) How do you manage changes and assess associated risks, e.g. personnel, equipment,
processes, documentation?
5.4. Emergency Planning and Response
a) What arrangements does your company have for emergency planning and response?
b) Which emergency situations are included?
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Section 6 – Implementation and Preformance Monitoring
6.1. HSSE-MS Implementation and Active Performance Monitoring of Work Activities
a) What arrangements does your organization have for monitoring the implementation of your
HSSE-MS?
b) How does your company assure the implementation of work procedures within your work-
site operations (e.g. compliance with procedures, toolbox meetings, safety meetings,
supervision, job observations)?
c) How do you monitor employee HSSE performance (e.g. hazard identification systems,
HSSE participation)?
d) What active HSSE monitoring is performed (i.e. where no incident has occurred)?
e) How do you report and correct deficiencies identified?
f) How do you communicate the results of active performance monitoring to relevant

personnel?
6.2. Safety Performance Indicators
a) Please provide the following statistics for each year for the last five years:
 Number of Fatalities
 Number of Lost Time Injuries
 Number of Lost Workday Cases
 Number of Restricted Work Day Cases
 Number of Medical Treatment Cases
 Number of First Aid Cases
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 Number of Near-Miss Incidents
 Fatal Accident Rate (per 100 milion hours worked)
 Lost Time Injury Frequency (per million hours worked)
 Total Recordable Incident Rate (per million hours worked)
NOTE: If not using the OGP definitions (refer to the OGP safety performance indicators
report), please include the definitions used at your company.
6.3. HSSE Performance Monitoring
a) How is health performance monitored and recorded?
b) How is environmental performance monitored and recorded?
c) How is security performance monitored and recorded?
d) How and what near-miss incidents are reported?
e) How often is HSSE performance reviewed? By whom?
f) How is logistics performance monitored and reported?
g) Do you record vehicle incidents?
6.4. HSSE Incident Investigation and Follow-Up
a) What types of HSSE incident are investigated?
b) What process is used to investigate HSSE incidents?
c) Who conducts HSSE incident investigations?
d) How are the findings of an incident investigation followed up to ensure effective prevention
of recurrence?
e) How is incident learning communicated to all relevant personnel?
6.5. Statutory Notifiable Incidents or Non-Compliance Notices
a) Has your company suffered any statutory notifiable incidents in the last five years (safety,
occupational health and environmental)?
Answers with details including dates, country and location, summary of incident and follow-
up preventative measures taken.
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Section 7 – HSSE Auditing and Management Review of HSSE-MS
7.1. Audits
a) Do you have a written procedure for HSSE auditing? If yes, please attach a copy.
b) Who is involved in conducting HSSE audits? How are audit team members selected to
have specific expertise and be independent from the activities being audited? What are
the qualifications required for auditors?
c) How does your company schedule HSSE audits and what scope of auditing is covered?
(e.g. internal, regulatory compliance, supplier/contractor, HSSE management system
implementation).
d) How does management follow up on audit findings and ensure effective close out of action
items?
7.2. Management Review and Follow Up
a) Do you have a written procedure for management review of the HSSE-MS? If yes, please
attach a copy.
b) How often are HSSE-MS reviews conducted and who is involved in the process?
c) How are identified actions and improvement efforts recorded and tracked to effective
completion?
Section 8 – HSSE Management – Additional Features
8.1. Certification of Your HSSE-MS
a) Please provide information on any certification which you have received from certification
bodies.
8.2. Memberships of Associations
a) Describe the nature and extent of your company’s participation in relevant industry, trade,
and governmental organizations.
8.3. Additional Features of Your HSSE-MS
a) Does your organization (globally, regionally or locally) have any HSSE features or
arrangements not described elsewhere in your response to the questionnaire?
Section 9 – Company Specific Information
9.1 HSSE Contract Responsible for the Answers of this Questionnaire
Name : _____
Title : _____
Phone : _____
E-mail : _____
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Apendiks G / Appendix G
APENDIKS F
APPENDIX F
STATUS PERUSAHAAN
COMPANY STATUS
CALON PESERTA TENDER harus POTENTIAL BIDDER shall provide SKUP (If
menyediakan Surat Keterangan Usaha any)
Penunjang (SKUP) (Jika Ada).
40 of 53
Apendiks H / Appendix H

APENDIKS G
APPENDIX G
KOMITMEN PENGGUNAAN BANK BUMN/BUMD UNTUK PEMBAYARAN

COMMITMENT OF USING BUMN/BUMD BANK FOR PAYMENT
CALON PESERTA TENDER harus POTENTIAL BIDDER shall provide a

menyediakan surat pernyataan dengan format statement letter with free format on its
bebas di atas kop surat perusahaannya yang company’s letter head, signed by its
ditandatangani oleh pejabat yang authorized official stated in the deed of
berwenangnya sesuai dengan akte pendirian establishment article association and its
perusahaannya dan perubahannya di atas amendment on Rp 6.000,00 duty stamp as its
materai Rp 6.000,00 sebagai bentuk commitment for the usage of BUMN/BUMD
komitmennya untuk penggunaan rekening bank account for payment if POTENTIAL
Bank BUMN/BUMD untuk pembayaran BIDDER is awarded the CONTRACT.
apabila CALON PESERTA TENDER
ditetapkan sebagai pemenang TENDER.
41 of 53
Apendiks I / Appendix I
APENDIKS H
APPENDIX H
PEMBENTUKAN KONSORSIUM (JIKA ADA)

CONSORTIUM ARRANGEMENT (IF ANY)
Tujuan dari Apendiks J ini adalah supaya The purpose of this Appendix J is for
CALON PESERTA TENDER (termasuk POTENTIAL BIDDER (including each member
masing-masing anggota KONSORSIUM untuk of its CONSORTIUM for itself and collectively)
atas namanya sendiri-sendiri dan secara to provide a legally binding and executed
bersama-sama) untuk menyediakan CONSORTIUM agreement that addresses the
perjanjian KONSORSIUM yang mengikat below aspects as a minimum and which is
secara hukum yang paling sedikitnya supported and executed by all members of the
membahas aspek-aspek di bawah yang CONSORTIUM.
didukung dan dilaksanakan oleh semua
anggota KONSORSIUM.
Untuk proses TENDER ini, yang dapat For this TENDER process, the POTENTIAL
menjadi pemuka KONSORSIUM (leadfirm) BIDDER that can become the leadfirm of the
adalah PERUSAHAAN DALAM NEGERI CONSORTIUM is LOCAL COMPANY and
dan yang dapat menjadi anggota that can become the member of the
KONSORSIUM adalah NATIONAL CONSORITUM is NATIONAL COMPANY
COMPANY
Bentuk keikutsertaan CALON PESERTA The form of participation of POTENTIAL

TENDER baik sendiri-sendiri atau dalam BIDDER either individually or in a
bentuk KONSORSIUM masih dapat berubah, CONSORTIUM can still be changed, but must
namun harus pasti pada saat pemasukan be fixed at the time of submitting a
PENGAJUAN dengan ketentuan: SUBMITTAL with the following conditions:
1. KONSORSIUM dapat dibentuk oleh 1. A CONSORTIUM can be formed by a

CALON PESERTA TENDER, baik dengan POTENTIAL BIDDER, either with other
sesama CALON PESERTA TENDER POTENTIAL BIDDER who has registered
yang telah mendaftar maupun dibentuk or can be formed with a
dengan penyedia BARANG/JASA yang GOODS/SERVICES provider that has not
belum mendaftar; been registered.
2. Struktur dan keanggotaan KONSORSIUM 2. The structure and membership of the

harus sudah pasti; dan CONSORTIUM must have been fixed; and
3. Struktur dan keanggotaan KONSORSIUM 3. The structure and membership of the

dibuktikan dengan Nota CONSORTIUM shall be proven with a
Kesepahaman/MOU (Memorandum of Memorandum of Understanding which
Understanding) yang mendukung hal supports the said purpose and is signed
dimaksud dan ditandatangani oleh seluruh by all member of CONSORTIUM.
anggota KONSORSIUM.
Dalam hal mendaftar sebagai KONSORSIUM, In the event of register as a CONSORTIUM,

CALON PESERTA TENDER harus POTENTIAL BIDDER shall submit:
menyerahkan:
1. Perjanjian kerja sama kemitraan yang 1. A Partnership cooperation agreement

memuat antara lain: which contains the following:
a. Tanggung jawab baik secara a. Jointly and severally liability;

bersama dan sendiri-sendiri (jointly
and severally liability);
b. Bagian lingkup pekerjaan para pihak; b. Portion of the scope of services of
each party;
c. Hak dan tanggung jawab para pihak; c. Rights and responsibilities of the
42 of 53
dan parties; and

d. Perusahaan yang menjadi pemuka d. A company as the leadfirm.
KONSORSIUM (leadfirm) tersebut.
2. Program ahli teknologi, jika 2. Program for transfer of technology, if

dimungkinkan; possible;
3. Surat izin usaha bagi pemuka 3. A business permit for the leadfirm which
KONSORSIUM (leadfirm) yang sesuai meets the requirement in the
dengan yang dipersyaratkan di dalam QUALIFICATION DOCUMENT;
DOKUMEN KUALIFIKASI;
4. Surat pernyataan yang ditandatangani 4. A statement letter signed by the highest

oleh pimpinan tertinggi pemuka authorized official of the leadfirm
KONSORSIUM (leadfirm) yang berisi: containing:
a. Nilai Kemampuan Dasar a. Basic Capability Value of

KONSORSIUM yang didukung oleh CONSORTIUM supported with data
data-data NPt anggota of each of CONSORTIUM member
KONSORSIUM; dan Highest Completed Job Value (NPt);
and
b. Bahwa seluruh anggota b. All CONSORTIUM member have
KONSORSIUM mempunyai experience to complete partially or
pengalaman menyelesaikan entirely of similar work with the work
sebagian atau seluruh pekerjaan being tendered.
yang sejenis dengan pekerjaan yang
ditenderkan.
Perjanjian KONSORSIUM (dilaksanakan CONSORTIUM agreement (fully executed by

sepenuhnya oleh anggota KONSORSIUM). all CONSORTIUM members). The
Perjanjian KONSORSIUM harus disediakan CONSORTIUM agreement must be provided
oleh CALON PESERTA TENDER dalam by POTENTIAL BIDDER under this Appendix
Apendiks I ini. Perjanjian KONSORSIUM J. The CONSORTIUM agreement must be
harus ditandatangani oleh wakil-wakil yang signed by authorised representatives of each
berwenang dari masing-masing anggota member of the CONSORTIUM. As a
KONSORSIUM. Paling sedikit, perjanjian minimum, the CONSORTIUM agreement
KONSORSIUM harus: shall:
 Ditandatangani oleh pejabat berwenang  Signed by an authorized official of each

dari masing-masing anggota CONSORTIUM member that is authorized
KONSORSIUM yang berwenang untuk to sign the CONSORTIUM agreement duly
menandatangani perjanjian attested that the authorized official has the
KONSORSIUM dengan memberikan bukti authority to sign the CONSORTIUM
bahwa pejabat tersebut mempunyai agreement;
kewenangan untuk menandatangani
perjanjian KONSORSIUM;
 Mengikat secara hukum diantara semua  Be legally binding among all members of
anggota KONSORSIUM; the CONSORTIUM;
 Secara jelas menerangkan peran,  Clearly set out the roles, responsibilities,
tanggung jawab, kewajiban dan kontribusi liabilities and contribution of each member
setiap anggota KONSORSIUM of the CONSORTIUM as would apply for
sebagaimana akan berlaku untuk the SERVICES and/or provide the
melaksanakan JASA dan/atau GOODS for COMPANY. This shall be
menyediakan BARANG untuk more detailed than generic such that it is
PERUSAHAAN. Hal ini harus lebih totally clear as to the extent of, and actual
terperinci daripada secara umum seperti contribution, of each member;
bahwa itu sepenuhnya jelas sejauh mana,
dan kontribusi nyata dari setiap anggota;
 Menetapkan pemimpin dan peran dan  Stipulate the leader and the roles and
tanggung jawab dari pemimpin; responsibilities of the leader;
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 Bagaimana pengaturan dana untuk  How the funding would be arranged

KONSORSIUM dan bagaimana kontribusi across the CONSORTIUM and the
setiap anggota (pada dasarnya atau contribution of each member (at a principle
berdasarkan persentase); level or percentage basis);
 Menyatakan bahwa semua anggota  State that the members are jointly and
menanggung resiko secara sendiri-sendiri severally liable without limitation
maupun bersama-sama dan tanggung throughout the term of the CONSORTIUM
renteng tanpa batasan sepanjang waktu agreement; and
dari perjanjian KONSORSIUM; dan
 Mempunyai jangka waktu untuk TENDER  Have a term duration for the TENDER and
dan JASA (pemutusan setelah TENDER the SERVICES (termination after TENDER
diperbolehkan apabila PESERTA is acceptable if BIDDER is not the
TENDER tidak menjadi kontraktor JASA). eventual contractor for the SERVICES).
PERUSAHAAN akan mengkaji dan COMPANY shall review and evaluate the
mengevaluasi perjanjian KONSORSIUM CONSORTIUM agreement to ensure that it
untuk memastikan bahwa perjanjian itu sudah adequately addresses the roles and
cukup membahas mengenai peran dan responsibilities of the various members and
tanggung jawab dari berbagai anggota dan demonstrates the efficient operation of the
menunjukkan operasional yang efisien dari CONSORTIUM in an integrated manner in the
KONSORSIUM yang terpadu dalam hal event of the TENDER winner appointment.
ditunjuk sebagai pemenang TENDER.
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Apendiks J / Appendix J
45 of 53
Apendiks K / Appendix K

APENDIKS I
APPENDIX I
SURAT PERNYATAAN KESANGGUPAN MEMENUHI BATASAN MINIMAL TKDN

STATEMENT LETTER OF FULFILLMENT MINIMUM THRESHOLD FOR LOCAL CONTENT
TENDER NO.: MAS/2017/0040

TENDER TITLE: JAKARTA CAR RENTAL & DRIVER SERVICES
Saya yang bertanda tangan dibawah ini: / I, the undersigned:
Nama / Name : _____

Jabatan / Title : _____
Bertindak untuk dan atas nama : _____
For on behalf of Company Name
Alamat / Address : _____
Telepon / Telephone : _____
Faksimili / Facsimile No. : _____
Alamat Email / Email Address : _____
Status Perusahaan / Company Status : _____
Menyatakan dengan sesungguhnya bahwa: Stating the fact that:
Saya akan memenuhi batasan minimal I will commit to the minimum Local Content
persentase Tingkat Komponen Dalam Negeri percentage requirement of:
(TKDN) sebesar
_____ % _____ %
Untuk memenuhi persyaratan TENDER To meet the above TENDER number and title
dengan nomor dan judul diatas. requirements.
Demikian pernyataan ini saya buat dengan We declare that this statement and all
sebenarnya dan penuh rasa tanggung jawab. information provided herein are duly legitimate
and full of accountability.
Jakarta, _____

name

atas materai Rp. 6.000 oleh direktur atau
kuasa-nya / Please affix and sign over a Rp.
6.000 duty stamp by director or its proxy

signatory
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Apendiks L / Appendix L

APENDIKS J
APPENDIX J
KUESIONER KEPATUHAN
COMPLIANCE QUESTIONNAIRE
A. INFORMASI KORPORASI A. CORPORATE INFORMATION
Nama Perusahaan / Company Name
Tipe Badan Usaha / Type of

Business
Setara Perseroan (PT, CV, PLC, LL.C, Persekutuan / Lainnya

dll.) / Corporation (PT, CV, PLC, LL.C, Partnership (jelaskan) / Other
etc.)/ (describe)
Perseorangan / Proprietorship Usaha Sendiri /
Individual
Lingkup Kerja / Scope of Work
Jelaskan pengalaman kerja /

Describe job experience
Alamat 1 (Kantor Pusat) /

Address 1 (Head Office)
Alamat 2 (jika ada) /

Address 2 (if existed)
Telepon / Telephone
Faksimili / Fax
Situs / Website
Nama Petugas Penghubung /

Contact Name
E-mail / E-mail
Tanggal Berdiri / Date of

Establishment
Nomor Pokok Wajib Pajak (NPWP /

Tax Registration Number
Jumlah Pegawai / Number of

Employees
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A1. Daftar semua anggota Dewan A1. List all members of the Board of
Direksi dan Dewan Komisaris atau Directors & Commissioners or
pejabat yang setara atau pejabat equivalent or the other managers or
eksekutif atau manajer lainnya. executives:
Nama / Name Jabatan / Title Warga negara / Citizenship
A2. Sebutkan, jika ada, semua orang A2. List, if any, all the person(s) who
yang bertindak sebagai perwakilan shall act as the representative(s) of the
CALON PESERTA TENDER dalam POTENTIAL BIDDER in the potential
Perjanjian yang mungkin atau individu Agreement or other individuals or
atau badan usaha yang ditugaskan oleh entities engaged by the POTENTIAL
CALON PESERTA TENDER untuk BIDDER to operate and work with
beroperasi dan bekerja dengan COMPANY. (if required, please do so on
PERUSAHAAN. (Jika perlu, daftar a separate sheet of paper attached to
terpisah dapat dilampirkan pada this questionnaire)
kuesioner ini.)
Nama / Name Jabatan / Title Warga negara / Citizenship
A3. Jelaskan pengalaman dan A3. Please describe the experience and
kualifikasi personel CALON PESERTA qualifications of the POTENTIAL
TENDER yang akan bekerja dan BIDDER’s personnel who will work and
beroperasi untuk PERUSAHAAN. (Jika operate with COMPANY. (if required,
perlu, daftar terpisah dapat dilampirkan please do so on a separate sheets of
pada kuesioner ini.) paper attached to this questionnaire)
A4. Mohon diberikan curriculum vitae A4. Please provide the curriculum vitae
dari Pemilik atau Pemegang Saham of the Owner/Major Shareholders,
Mayoritas, Direktur atau pejabat yang Directors or equivalent, Commissioners
setara, Komisaris atau pejabat yang or equivalent related to the contractual
setara, yang berkaitan dengan kegiatan activity.
kontrak.
48 of 53
B. HUBUNGAN PEMERINTAH B. GOVERNMENT RELATIONSHIP
B1. Apakah ada Pegawai Pemerintah B1. Does any current or former
atau Politisi (anggota Partai Politik atau Government Official or politicians
MPR, DPR, DPD/ DPRD) yang masih (member of a party, member of MPR,
menjabat atau sudah tidak menjabat, DPR, DPD or DPRD) have any
memiliki hak atau kepentingan lain pada ownership or other interest in your
CALON PESERTA TENDER? POTENTIAL BIDDER?
Ya / Yes Tidak / No
B1 a) Jika jawaban adalah Ya, mohon B1 a) If the answer is yes, please identify
disebutkan nama Pegawai Pemerintah the Government Official or politicians
atau Politisi tersebut (anggota Partai Politik (member of a party, member of MPR, DPR,
atau MPR, DPR, DPD/ DPRD)? (Jika DPD or DPRD) (if required, please do so
perlu, daftar terpisah dapat dilampirkan on a separate sheets of paper attached to
pada kuesioner ini.) this questionnaire)
B2. Apakah Pemilik/Pemegang Saham B2. Is or was any Owner/Major

Mayoritas perusahaan CALON Shareholders of the POTENTIAL
PESERTA TENDER, Direksi atau pejabat BIDDER company, Directors or
setara, Komisaris atau pejabat setara equivalent, Commissioners or
adalah Pegawai Pemerintah ATAU equivalent a Government Official OR is
apakah Pemilik/Pemegang Saham any Owner/Major Shareholders,
Mayoritas Perusahaan CALON Directors or equivalent, Commissioners
PESERTA TENDER, Direksi atau pejabat or equivalent otherwise in a position to
setara, Komisaris atau pejabat setara influence or provide services for public
berada dalam posisi untuk entity?
mempengaruhi atau memberikan
pelayanan/jasa kepada entitas public?
Ya / Yes Tidak / No
B2 a) Jika jawabannya adalah Ya, mohon B2 a) If the answer is yes, please identify
disebutkan nama Pemilik/Pemegang the Owner/Major Shareholders and the
Saham Mayoritas atau pejabat setara position held as Government Official: (if
tersebut dan jabatannya sebagai Pegawai required, please do so on a separate
Pemerintah? (Jika perlu, daftar terpisah sheets of paper attached to this
dapat dilampirkan pada kuesioner ini.) questionnaire)
B3. Apakah anggota keluarga dari B3. Is or was any family member of any
Pemilik/Pemegang Saham Mayoritas Owner/Major Shareholders of the
dari perusahaan CALON PESERTA POTENTIAL BIDDER’s company a
TENDER adalah/pernah menjadi Government official? (The term “family
Pegawai Pemerintah? (Istilah anggota member of Owner/Major Shareholders”
keluarga dari Pemilik/Pemegang Saham means the Owner/Major Shareholders’
49 of 53
Mayoritas berarti istri, orang tua istri, spouse; the Owner/Major Shareholders
orang tua, saudara, keponakan, bibi, and the spouse’s grandparents, parents,
paman, sepupu inti, pasangan dari siblings, children, nieces, nephews,
orang-orang tersebut, dan pihak lain aunts, uncles, and first cousins; the
yang satu rumah.) spouse of any of these people; and any
other individuals who share the same
household.)
Ya / Yes Tidak / No
B3 a) Jika jawaban adalah Ya, mohon B3 a) If the answer is yes, please identify
disebutkan nama kantor, nama pegawai the office held, the name of the person
pewerintah, dan hubungan orang tersebut holding the office, and that person’s
dengan Pemilik/Pemegang Saham relationship to the Owner/Major
Mayoritas dari perusahaan CALON Shareholders of the POTENTIAL
PESERTA TENDER. (Jika perlu, daftar BIDDER’s company: (if required, please do
terpisah dapat dilampirkan pada kuesioner so on a separate sheets of paper attached
ini.) to this questionnaire)
B4. Jika Pemilik/Pemegang Saham B4. If any Owner/Major Shareholders of

Mayoritas perusahaan CALON the POTENTIAL BIDDER’s company was
PESERTA TENDER pernah menjadi previously a Government Official, what
Pegawai Pemerintah, sebutkan nama is the name of the employer and the
instansi dan jabatannya. Sebutkan pula position or rank held? Please indicate
tanggal pensiun dari pegawai the retirement date from such service.
pemerintah.
Nama Individu Kantor Jabatan Tanggal Pensiun

Name of Individual Agency Position Retirement Date
B5. Apakah CALON PESERTA TENDER B5. Does the POTENTIAL BIDDER have
memiliki hubungan bisnis, selain yang any kind of business relationship,
disebut di atas, dengan Pegawai different from those described above,
Pemerintah atau Kantor Pemerintahan? with Government Official or public
(Jika perlu, daftar terpisah dapat entities? (if required, please do so on a
dilampirkan pada kuesioner ini.) separate sheets of paper attached to
this questionnaire)
B6. Apakah situasi sebagaimana B6. Could any of the situations as above
dijelaskan di atas menciptakan kondisi illustrated create a conflict of interests
atau persepsi konflik kepentingan, or a perception of a conflict of interest,
berkaitan dengan operasi dan/atau with respect to the operations and/or
aktivitas yang akan diberikan CALON activities that the POTENTIAL BIDDER
50 of 53
PESERTA TENDER dalam Perjanjian? will provide under the Agreement?
Ya / Yes Tidak / No
B7. Apakah CALON PESERTA TENDER B7. Would the POTENTIAL BIDDER
akan menggunakan orang atau entitas utilize other people or business entities
usaha lain (termasuk consultant dan (including any consultant or
subcontractor) yang belum disebut di subcontractor) not already mentioned
atas, dalam aktivitas yang akan dijalan above, in the activities to be carried out
dalam Perjanjian? under the Agreement?
Ya / Yes Tidak / No
B7 a. Jika jawaban Ya, mohon disebutkan B7 a. If the answer is yes, please identify
nama atau entitas yang akan dipakai dan the name of the person or entity that you
hubungannya dengan CALON PESERTA would rely upon and their relationship to
TENDER. (Jika perlu, daftar terpisah dapat the POTENTIAL BIDDER. (if required,
dilampirkan pada kuesioner ini.) please do so on a separate sheets of paper
attached to this questionnaire)
C. INFORMASI RELEVAN LAINNYA C. FURTHER RELEVANT INFORMATION
C1. Apakah CALON PESERTA TENDER C1. Does the POTENTIAL BIDDER have
memiliki Kode Perilaku, kebijakan atau written Code of Conduct, procedures or
prosedur berkaitan dengan etika bisnis, policies addressing business ethics,
kepatuhan atas anti suap dan anti anti-bribery and anti-corruption
korupsi, hiburan dan hadiah untuk klien compliance, entertainment or gifts for
atau Pegawai Pemerintah, atau tema- clients or for Government Officials, or
tema yang berkaitan? Jika ya, agar related topics? If yes, please attach.
dilampirkan.
Ya / Yes Tidak / No
C2. Dalam kurun 5 tahun lalu, apakah C2. In the past five (5) years, has the
CALON PESERTA TENDER (termasuk POTENTIAL BIDDER (including any
asosiasi atau sebelumnya pernah associated or previously associated
terasosiasi atau organisasi sebelum organization or any predecessor
mengalami perubahan) atau organization) or any present or former
Pemilik/Pemegang Saham Mayoritas, Owner/Major Shareholders, Directors or
Direksi atau pejabat setara, Komisaris equivalent, Commissioners or
atau pejabat setara, saat ini atau yang equivalent been (1) suspended from
terdahulu, (1) pernah dilarang doing business in any capacity, (2)
melakukan bisnis dalam kapasitas Investigated for or charged with any
apapun, (2) diinvestigasi atau diberi criminal act, (3) subject to any allegation
hukuman berkaitan dengan tindakan of fraud, misrepresentation, bribery,
pidana, (3) menjadi tersangka dalam corruption, money laundering, tax
dalam dugaan fraud, misrepresentasi, evasion or other related activities?
suap, korupsi, pencucian uang,
penggelapan pajak, atau kegiatan lain
yang berkaitan dengan hal-hal
tersebut?.
51 of 53
Ya / Yes Tidak / No
C2 a. Jika jawaban Ya, mohon diberikan C2 a. If the answer is yes, please provide
penjelasan lebih lengkap. (Jika perlu, complete details (if required, please do so
daftar terpisah dapat dilampirkan pada on a separate sheets of paper attached to
kuesioner ini.) this questionnaire)
C3. Dalam kurun lima (5) tahun lalu, C3. In the past five (5) years, has
apakah CALON PESERTA TENDER, POTENTIAL BIDDER, any employee of
atau karyawan, atau Direksi atau POTENTIAL BIDDER’s company,
pejabat setara, atau komisaris atau director or equivalent or commissioner
pejabat setara, pernah melakukan or equivalent violated any government
pelanggaran atas peraturan laws or regulations?
Pemerintah?
Ya / Yes Tidak / No
C3 a. Jika Ya, mohon diberikan penjelasan C3 a. If the answer is yes, please provide
lebih lengkap. (Jika perlu, daftar terpisah complete details (if required, please do so
dapat dilampirkan pada kuesioner ini.) on a separate sheets of paper attached to
this questionnaire)
C4. Mohon gunakan tempat yang C4. Please use this space to provide any
disediakan di bawah, untuk additional information which you feel
memberikan informasi mengenai hal-hal may be relevant to the relationship
yang relevan dengan hubungan antara between the POTENTIAL BIDDER and
CALON PESERTA TENDER dan COMPANY (if required, please do so on
PERUSAHAAN (Jika perlu, daftar a separate sheets of paper attached to
terpisah dapat dilampirkan pada this questionnaire).
kuesioner ini).
Saya telah mereview kuesioner ini, dan I have reviewed this questionnaire, and I
saya menyatakan bahwa informasi yang declare that the information provided is
diberikan adalah benar dan akurat dan true and accurate and complete to the
lengkap sepenjang pengetahuan terbaik best of my knowledge and belief.
dan keyakinan saya.
Nama Perusahaan / Name of the Tanda Tangan / Signature

Company
52 of 53
Tanggal / Date Nama dan Jabatan / Name and Title
Kembalikan kuesioner yang telah diisi Please return the completed

lengkap dan semua lampiran kepada Questionnaire and all attachments to
PERUSAHAAN COMPANY.
Disclaimer. Melengkapi kuesioner ini Disclaimer. Completion of this form is a

adalah bagian dari penerapan Peraturan part of the implementation of SKK Migas
SKK Migas PTK 007 Bab I Pasal 5.15. Jika Regulation of PTK 007 Chapter I Article
diperlukan, PERUSAHAAN dapat 5.15. COMPANY has the right to perform
melakukan due diligence. further due diligence as necessary.
53 of 53
Bagian 3 – Ruang Lingkup Jasa / Barang / Part 3 – Scope of Services / Goods
BAGIAN 3 – RINGKASAN RUANG PART 3 – OUTLINE OF SCOPE

LINGKUP
3.1. PENDAHULUAN 3.1. INTRODUCTION
Jasa-Jasa Penyewaan Alat Rental of Land Transportation

Transportasi darat Services
3.2. RINGKASAN RUANG LINGKUP 3.2. OUTLINE OF SCOPE
Dalam hal ini, Perusahaan Company requires the contractor to

membutuhkan Kontraktor untuk provide Jakarta Office land
menyediakan jasa-jasa penyewaan transportation rental including driver
alat transportasi darat untuk kantor services to support Company’s daily
Jakarta termasuk jasa pengemudi operation for 24 Months.
untuk mendukung operasi sehari-hari
Perusahaan
54 of 53

PreQualification Document - Jakarta Car Rental and Driver Services - Rev2

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PreQualification Document - Jakarta Car Rental and Driver Services - Rev2

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INPEX MASELA, LTD.

ABADI GAS FIELD DEVELOPMENT

JAKARTA CAR RENTAL & DRIVER

BAGIAN 1 – INSTRUKSI UMUM DAN PART 1 – GENERAL INSTRUCTIONS AND

1.1. INFORMASI UMUM 1.1. GENERAL INFORMATION

1.2. DEFINISI 1.2. DEFINITION

1.3. KORESPONDENSI DAN KLARIFIKASI 1.3. CORRESPONDENCE AND

1.4. PEMBERITAHUAN KEIKUTSERTAAN 1.4. NOTIFICATION OF PARTICIPATION

1.5. PENGAJUAN 1.5. SUBMITTAL

1.6. EVALUASI PENGAJUAN 1.6. EVALUATION OF SUBMITTAL

1.7. MENGHINDARI PERTENTANGAN 1.7. AVOIDANCE OF CONFLICT OF

1.8. PERJANJIAN KERAHASIAAN 1.8. CONFIDENTIALITY AGREEMENT

Lampiran 1 – Surat Pernyataan Attachment 1 – Letter of Confirmation

Lampiran 2 – Ringkasan Jadwal Attachment 2 – Outline Schedule

Lampiran 3 – Daftar Kelengkapan Attachment 3 – Document Check List

Lampiran 4 – Kriteria Evaluasi Teknis Attachment 4 – Technical Evaluation

BAGIAN 2 – PERSYARATAN PENGAJUAN PART 2 – SUBMITTAL REQUIREMENTS

2.1. PERSYARATAN UMUM 2.1. GENERAL REQUIREMENTS

Apendiks A - Formulir Isian Appendix A - Prequalification Form

Apendiks E - Persyaratan Teknis Appendix E - Technical Requirements

BAGIAN 3 – RINGKASAN RUANG PART 3 – OUTLINE OF SCOPE

3.1. PENDAHULUAN 3.1. INTRODUCTION

3.2. RINGKASAN RUANG LINGKUP 3.2. OUTLINE OF SCOPE

BAGIAN 1 – INSTRUKSI UMUM DAN PART 1 – GENERAL INSTRUCTION AND

1.1. INFORMASI UMUM 1.1. GENERAL INFORMATION

1.1.1 INPEX MASELA, LTD. 1.1.1 INPEX MASELA, LTD.

1.1.4 Agar memenuhi syarat sebagai 1.1.4 In order to become a qualified

dan memiliki sumber daya yang siap time of CONTRACT award.

1.1.6 DOKUMEN PRAKUALIFIKASI ini 1.1.6 This PREQUALIFICATION

Bagian 1 – Instuksi Umum dan Part 1 – General Instruction and

PERUSAHAAN berhak meminta COMPANY has the right to request

1.2. DEFINISI 1.2. DEFINITION

“BARANG” adalah peralatan, material, “GOODS” means equipment,

“CALON PESERTA TENDER” adalah “POTENTIAL BIDDER” means a

“DOKUMEN PENAWARAN” adalah “BID PROPOSAL” means all

“DOKUMEN PRAKUALIFIKASI” “PREQUALIFICATION DOCUMENT”

pada butir 1.5 dalam dokumen ini above as reference to

“JASA” adalah pekerjaan “SERVICES” means the work as

“KONSORSIUM” adalah gabungan “CONSORTIUM” means an

“KONTRAK” adalah perjanjian “CONTRACT” means an agreement

“PANITIA TENDER” adalah panitia “PROCUREMENT COMMITTEE”

“PENGAJUAN” adalah dokumen yang “SUBMITTAL” means documents

“PERUSAHAAN” adalah INPEX “COMPANY” means INPEX

“PERUSAHAAN ASING” adalah “FOREIGN COMPANY” means a

“PERUSAHAAN DALAM NEGERI” “LOCAL COMPANY” means a

“PERUSAHAAN NASIONAL” adalah “NATIONAL COMPANY” means a

“PERUSAHAAN PERSEROAN “PERUSAHAAN PERSEROAN

“PESERTA TENDER” adalah “BIDDER” means

“PRAKUALIFKASI” adalah bagian dari “PREQUALIFICATION” is part of the

dengan Nomor PTK- of Cooperation Contracts, reference

“TENDER” adalah pengajuan “TENDER” means the submission of

“WAKIL CALON PESERTA TENDER” “POTENTIAL BIDDER

adalah pimpinan tertinggi atau REPRESENTATIVE” means the

1.3. KORESPONDENSI DAN 1.3. CORRESPONDENCE AND

1.3.1 CALON PESERTA TENDER diminta 1.3.1 POTENTIAL BIDDER is requested to

Ditujukan kepada/Addressed to : INPEX MASELA, LTD.

Semua klarifikasi dan korespondensi All clarifications and correspondence

Kecuali pertanyaan yang diajukan Except for clarifications submitted in

Jika terjadi pelanggaran atau usaha If any such prohibited contact is

Seluruh permintaan harus diterima Any clarification requests must be

Hari : Rabu Day : Wednesday

sehingga PERUSAHAAN dapat in order for COMPANY to give

1.4. PEMBERITAHUAN 1.4. NOTIFICATION OF

Bapak./Ibu. _ Mr./Ms. _

Alamat Email _ Email Address _