Nomor Dokumen FORM-01/SAS/OM/PROC/2016

FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-023/SAS/XII/2017 5-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 JASA SEWA SCAFOLDING BIASA 4 SET

- Tinggi scaffolding 20 meter

-Panjang scaffolding 2 meter

- lebar scaffolding 2 meter

MATERIAL YANG DI SEWA DARI VENDOR
- Pipa galvanize 6 meter (Rp. 5000/meter) 20 BATANG Rp 600,000.00

- Pipa galvanize 2 meter (Rp. 5000/meter) 100 BATANG Rp 1,000,000.00

- Clamp swivel (Rp. 4000/meter) 260 PCS Rp 1,040,000.00

Jasa mobilisasi material dari samarinda ke PLTU 1 LOT Rp 5,500,000.00

SUB TOTAL Rp 8,140,000.00

TOTAL PRICE Rp 8,140,000.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-024/SAS/XII/2017 5-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 JASA SEWA SCAFOLDING UNTUK PEKERJAAN OVERHAUL TURBINE 2 SET

- Pipa 2 m 10 Batang

- Pipa 6 m 8 Batang

- Catwalk 8 PCS

2 JASA SEWA SCAFOLDING UNTUK PEKERJAAN BLASTING

- Pipa 3M 20 batang

Clamp swiviel 135 PCS

SUB TOTAL Rp -

TOTAL PRICE Rp -

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-025/SAS/XII/2017 5-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 JASA KALIBRASI INSTRUMEN 3 HARI

-Transmitter Pressure 50 PCS Rp 21,250,000.00

- Transmitter Suhu 50 PCS Rp 21,250,000.00

SUBTOTAL Rp 42,500,000.00

DISCOUNT 15% Rp 6,375,000.00

SUBTOTAL Rp 36,125,000.00

PPN10% Rp 3,612,500.00

SUBTOTAL+PPN Rp 39,737,500.00

BIAYA TEKNISI Rp 4,500,000.00

SUB TOTAL

TOTAL PRICE Rp 44,237,500.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-026/SAS/XII/2017 5-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 JASA PERBAIKAN KONSTRUKSI CONTROL WEIGHT 1 UNIT Rp 14,000,000.00

2 JASA PERBAIKAN SNUB PULLEY (PABRIKASI) 1 UNIT Rp 8,000,000.00

3 PENGGANTIAN SKRIT RUBBER RDPBK-M PLOW BLADE KIT M BW 1 PCS Rp 1,827,000.00

800
4 PRIMARY CLEANER EZP1-800-50 BW 800,90911 1 PCS Rp 19,314,000.00

5 RELAGGING BW 800, DIAMETER 400mm x 100mm 1 UNIT Rp 13,000,000.00

6 BELT TRACKING TOP SIDE BW800 1 PCS Rp 38,000,000.00

7 BELT TRACKING RETURN BW800 1 PCS Rp 53,480,000.00

TRUBLESHOOTING SERVICE INVERTER ACS800

8 MOTOR 200KW BRAND ABB 1 EA Rp 87,500,000.00
MOTOR 185 BRAND ABB
Rp 15,000,000.00
9 MOB DE MOB (BIAYA KENDARAAN, MAN POWER, DAN AKOMODASI LS

SUB TOTAL Rp 250,121,000.00

VAT% Rp 25,012,100.00

SUB TOTAL Rp 275,133,100.00

DISCOUNT 10% Rp 27,513,310.00

TOTAL PRICE Rp 247,619,790.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-027/SAS/XII/2017 5-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 DGA TEST 4 UNIT Rp 16,000,000.00

- Hydrogen (Hz)
- Methane (CH4)
- Acetylene (C2H2)
- Ethylene (C2H4)
- Ethane (C2H6)
- Carbon Monoxide (CO)
- Carbon Dioside (CO2)
- Oxygen (O2)
- Nitrogen (N2)
- Transportasi

2 ANALYSIS TEST 4 UNIT Rp 12,000,000.00

- BDV (Kv/2,5mm)
- Kadar air (ppm)
- Simen (w t%)
- Warna
- Kadar asam (mg KOH/g)
- Tegangan antar muka (mN/m)
- Titik nyala (*C)

3 Transportasi 1 LOT Rp 8,000,000.00

SUB TOTAL Rp 36,000,000.00

PPN 10% Rp 3,600,000.00

TOTAL PRICE Rp 39,600,000.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-028/SAS/XII/2017 21-Dec-17

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 Kalibrasi transmiter suhu
- Transmiter suhu feed water 1 ea
- Transmiter suhu super heater 1 ea
- Transmiter suhu Economizer 1 ea
1 ea
- Transmiter suhu Air preheater
1 ea
- Transmiter suhu Condensat 1 ea
- Transmiter suhu Main steam

2 Kalibrasi transmiter Preassure

- Transmiter pressure feed water 1 ea
- Transmiter pressure super heater 1 ea
- Transmiter pressure Economizer 1 ea
1 ea
- Transmiter pressure Air preheater
1 ea
- Transmiter pressure Condensat 1 ea
- Transmiter pressure Main steam

SUB TOTAL Rp 5,100,000.00

TOTAL PRICE Rp 5,100,000.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

DANI ABDULLAH M HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
 Nomor Dokumen FORM-01/SAS/OM/PROC/2016
FORMULIR
Tanggal Berlaku 1-Dec-16
Revisi 00
JOB REQUEST
Jumlah Halaman 1

JR NO. JR DATE USER Job Request

JR
SECTION DEPARTMENT
JR-020/SAS/IX/2017 5-Sep-17
OPERATION

JOB SITE PRIORITY DIC (DEPT. IN CHARGE) JR CATEGORIES

SECTION DEPARTMENT
SMO
Purchasing Procurement

NO DESCRIPTION QTY UOM COST/RIT DUE DATE

1 JASA SEWA KENDARAAN DT 1 RIT Rp 400,000.00 15-Sep-17

- Unit yang digunakan DT Kapasitas 4 Ton

- Biaya sewa dihitung berdasarkan Ritase

- BBM Solar Ditanggung oleh pihak Penyewa

- Makan siang driver tidak ditanggung oleh pihak penyewa
- Konsumsi Solar per ritase (+- 40 km ) rata-rata 15 ltr
- Jam Istirahat unit tidak dihitung sebagai jam kerja

- Maintenance DT ditanggung pemilik unit

- Jika jam istirahat unit diminta untuk tetap bekerja, maka dihitung
sebagai jam kerja.
Unit digunakan untuk pekerjaan angkut material Repair PLTU

- Material yang dimuat :

1. Pasir halus 3 M3

2. Batu bata 150 pcs

3. Semen Tiga Roda @40 kg/zak

SUB TOTAL Rp 400,000.00

TOTAL PRICE Rp 400,000.00

SPECIAL INSTRUCTION : SERVICE BY PROCUREMENT

SPV/SPT PURCHASING PROCUREMENT MANAGER

TAJUDIN MUHAMMAD ASYIKIN

FILL BY USER CHECK & APPROVED

INITIATOR USER MANAGER PLTU MANAGER FINANCE MANAGER DIRECTOR

PERKASA ARI WIBOWO HADITYA ENDRAKUSUMA HADITYA ENDRAKUSUMA ERWIN SAPTADI TRIA SUPRAJENI
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