Current Lines: Please Click Here

Page 1 of 9
Note:This PO has additional file attachments. To view them online, please click here.
Kindly acknowledge with company stamp the acceptance of the attached PO and reply by email to
<HMS.POConfirmation@sampoerna.com>. Please note that this PO will be considered acknowledged and
accepted by you if we do not receive the signed PO copy within three (3) working days.
MODIFICATION OF PURCHASE ORDER
Bill to:
Number Released Date
PT. Hanjaya Mandala Sampoerna
Tbk 5700299768 02.08.2022
JI RUNGKUT INDUSTRI RAYA 18 Contract
:
Kec.Gunung Anyar Reference
SURABAYA, 60293, Indonesia PMI requestor : Adi Hidayat
Tel: +62 31 843 1699, Fax: +62 31 E-mail : Adi.Hidayat@sampoerna.com
843 0986
NPWP: 01.108.205.4-631.000
Vendor
: PT SARANA UTAMA ADIMANDIRI
Name Please send original hard copy invoice to:
Vendor No. : 0000156807 Jl. Rungkut Industri Raya No. 18
PLAZA SUA, 5-7TH FLOOR, Rungkut Tengah
Address : JALAN PROF. DR. SOEPOMO, Gunung Anyar - Surabaya
SH., NOMOR 27, RT 002 RW 003 JAWA TIMUR 60293
Indonesia
City : JAKARTA SELATAN
P.C. : 12810 Currency : IDR
Country : Indonesia Terms of
: 120 days from invoice reception date.
Contact : rioa@sua.co.id payment
Telephone :
Delivery address : PT HM Sampoerna Tbk.
KIIC, JL. Permata Lot BB-3, 4B, 7, 8A & CC-1, 2, 3, 4, 5 Sukaluyu, Telukjambe Timur
Karawang, Jawa Barat, 41361, Indonesia
Delivery Contact : Adi Hidayat
Terms of delivery :
Means of Transport :
1. Please return signed PO acknowledgement immediately, advising shipping/ delivery date and price changes to
Accounts Payable or you can return the signed PO to <HMS.POConfirmation@sampoerna.com>.
2. Invoices must be submitted on the day of delivery together with the delivery orders to the Accounts Payable -
Finance Department.
3. Purchase Order number must appear on all invoices and delivery orders.
4. The seller has to remit the applicable VAT amount to the appropriate tax authority. Failure to do so, the seller shall
be responsible of any penalty / claim imposed.
5. Vendor must submit the correct Invoice after goods & services received by HMS within 90 days to avoid Tax
Invoice expiration. If HMS did not received the invoice from vendor up to 240 days for Direct Materials and 360
days for Indirect Materials & Services from date of goods & services received by HMS, the related liability will be
automatically written off and HMS will have the right to reject the billing.
6. The total price is subject to applicable VAT but inclusive any applicable Withholding Tax(WHT)
Note: PIC: Adi Hidayat
Current Lines
GOODS OR SERVICES ORDERED

Expected
PART PRICE PER
ITEM MATERIAL DESCRIPTION QUANTITY UNIT Start Date Delivery AMOUNT
NUMBER UNIT
Date
1 Material Motorized Damper for DH 9.0 EA 30.07.2022 6,361,100 57,249,900
WS 1-5, DH ST 1, DH BB1
• Note: PROJECT : ID RRP

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
PACKAGE : MECHANICAL
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY
BILL NO. RRF - 1700 :

ADDITIONAL
Deskription :Material
Motorized Damper for DH
WS 1-5, DH ST 1, DH BB1
User: Adi Hidayat

adi.hidayat@sampoerna.com
2 Labour Motorized Damper for DH WS 9.0 EA 30.07.2022 292,200 2,629,800
1-5, DH ST 1, DH BB1
file:///C:/Users/Pajak/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Fil... 02/08/2022
Page 2 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY
Reference : BILL NO. RRF

1700
Deskription :
Labour Motorized Damper
for DH WS 1-5, DH ST 1, DH
BB1
User: Adi Hidayat

3 Material Motorized Damper for DH 1.0 EA 30.07.2022 5,967,400 5,967,400
K-1

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY
BILL NO. RRF 1700 - ADD

WORKS (HVAC)
Deskription :
Material Motorized Damper
for DH K-1
User: Adi Hidayat
4 Labour Motorized Damper for DH K-1 1.0 EA 30.07.2022 284,300 284,300

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY
BILL NO. RRF 1700 - ADD

WORKS (HVAC)
Deskription : Labour
Motorized Damper for DH
K-1
User: Adi Hidayat

5 Material Motorized Damper for AHU 1.0 EA 30.07.2022 6,361,100 6,361,100
FGW (Exhaust Air Damper)

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
Deskription : Material
Page 3 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
Motorized Damper for AHU
User: Adi Hidayat

6 Labour Motorized Damper for AHU 1.0 EA 30.07.2022 292,200 292,200

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
User: Adi Hidayat

FGW (Fresh Air Damper)

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
User: Adi Hidayat


FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
User: Adi Hidayat

FGW (Back Damper)

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
Page 4 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
BILL OF QUANTITY

ADDITIONAL
FGW (Back Damper)
User: Adi Hidayat

FGW (Back Damper)

FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
FGW (Back Damper)
User: Adi Hidayat

11 Material Cabling for Motorized 13.0 SET 30.07.2022 1,546,251 20,101,263
Damper
• Note:
PROJECT : ID RRP
FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY

ADDITIONAL
Cabling for Motorized
Damper
User: Adi Hidayat

12 Labour Cabling for Motorized Damper 13.0 SET 30.07.2022 30.07.2022 14,604 189,852
• Note:
PROJECT : ID RRP
FOOTPRINT PT. HM
SAMPOERNA Tbk. -
KARAWANG, INDONESIA
& ELECTRICAL
INSTALLATION WORKS
PROJECT NO. : 21015
BILL OF QUANTITY
BILL NO. RRF - 16201
Deskription : Labour Cabling

for Motorized Damper
User: Adi Hidayat

13 Material ADDITIONAL INSULATION 59.0 M 30.07.2022 1,627,700 96,034,300
CEILING
• Note: PT SARANA UTAMA

ADIMANDIRI
Description :Material
Page 5 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
ADDITIONAL INSULATION
CEILING
Qty : 59
unit price : 1,627,700
total price : 96,034,300
Pic : Adi Hidayat

Email :
Lokasi : Karawang lot 41
RRP Building
14 Labour ADDITIONAL INSULATION 59.0 EA 30.07.2022 538,400 31,765,600
CEILING

ADIMANDIRI
Description :Labour
ADDITIONAL INSULATION
CEILING
Qty : 59
unit price : 538,400
Pic : Adi Hidayat

Email :
RRP Building
15 Material Add display monitoring T& 1.0 LOT 30.07.2022 74,601,092 74,601,092
RH

ADIMANDIRI
Description :Material Add

display monitoring T& RH
Qty : 1 lot
unit price : 74,601,092
Pic : Adi Hidayat

Email :
RRP Building
16 Labour Add display monitoring T& 1.0 LOT 30.07.2022 5,928,368 5,928,368
RH

ADIMANDIRI
Description :Labour Add

display monitoring T& RH
Qty : 1 lot
Pic : Adi Hidayat

Email :
RRP Building
17 Material Add heater for PACU QA 1.0 LOT 30.07.2022 254,654,260 254,654,260
LAB

ADIMANDIRI
Description :Material Add

heater for PACU QA LAB
Qty : 1 lot
unit price : 254,654,260
Pic : Adi Hidayat

Email :
RRP Building
18 Labour Add heater for PACU QA LAB 1.0 LOT 30.07.2022 35,912,995 35,912,995
Page 6 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
ADIMANDIRI
Description :
Labour Add heater for PACU
QA LAB
Qty : 1 lot
unit price : 35,912,995
Pic : Adi Hidayat

Email :
RRP Building
19 Material ADDITIONAL FILTER FOR 1.0 LOT 30.07.2022 147,520,600 147,520,600
COMPRESSED AIR SYSTEM

ADIMANDIRI
Description : Material
ADDITIONAL FILTER FOR
COMPRESSED AIR
SYSTEM
Qty : 1 lot
unit price : 147,520,600
Pic : Adi Hidayat

Email :
RRP Buildin
20 Labour ADDITIONAL FILTER FOR 1.0 LOT 30.07.2022 7,640,400 7,640,400
COMPRESSED AIR SYSTEM

ADIMANDIRI
Description :
Labour ADDITIONAL
FILTER FOR
COMPRESSED AIR
SYSTEM
Qty : 1 lot
Pic : Adi Hidayat

Email :
RRP Buildin
21 Material lighting below mezanine 1.0 LOT 30.07.2022 31,969,560 31,969,560
secondary RRP

ADIMANDIRI
Description :
Material lighting below
mezanine secondary RRP
Qty : 1 lot
unit price : 31,969,560
Pic : Adi Hidayat

Email :
RRP Buildin
22 labour lighting below mezanine 1.0 LOT 30.07.2022 8,437,486 8,437,486
secondary RRP

ADIMANDIRI
Description :
labour lighting below
mezanine secondary RRP
Qty : 1 lot
Pic : Adi Hidayat
Page 7 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
Email :
RRP Building
23 Material Electrical for new lab 1.0 LOT 30.07.2022 462,156,679 462,156,679
instrument

ADIMANDIRI
Description :
Material Electrical for new
lab instrument
Qty : 1 lot
unit price : 462,156,679
Pic : Adi Hidayat

Email :
RRP Building
24 Labour Electrical for new lab 1.0 LOT 30.07.2022 78,087,826 78,087,826
instrument

ADIMANDIRI
Description :
Labour Electrical for new lab
instrument
Qty : 1 lot
unit price : 78,087,826
Pic : Adi Hidayat

Email :
RRP Building
25 Material electrial socket for IT 1.0 LOT 30.07.2022 7,572,000 7,572,000

ADIMANDIRI
Description :
Material electrial socket for

IT
Qty : 1 lot
Pic : Adi Hidayat

Email :
RRP Building
26 Labour electrial socket for IT 1.0 LOT 30.07.2022 1,100,871 1,100,871

ADIMANDIRI
Description :
Material electrial socket for

IT
Qty : 1 lot
Pic : Adi Hidayat

Email :
RRP Building
27 Material male socket for supporting 1.0 EA 30.07.2022 3,840,300 3,840,300
equip LU

ADIMANDIRI
Description :
Material male socket for
supporting equip LU
Qty : 1 lot
unit price: 3,840,300
total price : 875,588
Page 8 of 9
Expected
PART PRICE PER
NUMBER UNIT
Date
Pic : Adi Hidayat

Email :
RRP Building
28 Labour male socket for supporting 1.0 LOT 30.07.2022 875,588 875,588
equip LU

ADIMANDIRI
Description :
Labour male socket for
supporting equip LU
Qty : 1 lot
unit price: 875,588
total price : 875,588
Pic : Adi Hidayat

Email :
RRP Building
106,382,415 IDR
Total value (excluding VAT) in IDR
1,354,480,340
Added Lines
Expected
PART PRICE PER
NUMBER UNIT
Date
13 Material ADDITIONAL 59.0 M 30.07.2022 1,627,700 96,034,300
INSULATION CEILING
14 Labour ADDITIONAL 59.0 EA 30.07.2022 538,400 31,765,600
INSULATION CEILING
15 Material Add display monitoring 1.0 LOT 30.07.2022 74,601,092 74,601,092
T& RH
16 Labour Add display monitoring T& 1.0 LOT 30.07.2022 5,928,368 5,928,368
RH
17 Material Add heater for PACU QA 1.0 LOT 30.07.2022 254,654,260 254,654,260
LAB
18 Labour Add heater for PACU QA 1.0 LOT 30.07.2022 35,912,995 35,912,995
LAB
19 Material ADDITIONAL FILTER 1.0 LOT 30.07.2022 147,520,600 147,520,600
FOR COMPRESSED AIR
SYSTEM
20 Labour ADDITIONAL FILTER 1.0 LOT 30.07.2022 7,640,400 7,640,400
FOR COMPRESSED AIR
SYSTEM
21 Material lighting below mezanine 1.0 LOT 30.07.2022 31,969,560 31,969,560
secondary RRP
22 labour lighting below mezanine 1.0 LOT 30.07.2022 8,437,486 8,437,486
secondary RRP
23 Material Electrical for new lab 1.0 LOT 30.07.2022 462,156,679 462,156,679
instrument
24 Labour Electrical for new lab 1.0 LOT 30.07.2022 78,087,826 78,087,826
instrument
25 Material electrial socket for IT 1.0 LOT 30.07.2022 7,572,000 7,572,000
26 Labour electrial socket for IT 1.0 LOT 30.07.2022 1,100,871 1,100,871
27 Material male socket for 1.0 EA 30.07.2022 3,840,300 3,840,300
supporting equip LU
28 Labour male socket for supporting 1.0 LOT 30.07.2022 875,588 875,588
equip LU
For and on behalf of
Confirmed and Accepted by:
PT HANJAYA MANDALA SAMPOERNA TBK.
____________________________________________ ____________________________________________
Company Stamp / Authorised Signature (the “Buyer”) Company Stamp & Authorised Signature (the “Seller”)
____________________ ____________________
Date Date
If this Purchase Order (the “Order”) identifies the terms that apply to it, or if terms have been agreed between the parties
or their affiliates that are intended to apply to the transaction contemplated by this Order (for example, a specific
agreement), then those terms apply to the exclusion of any other terms. Otherwise, this Order is governed by the Terms
and Conditions of Purchase Order Product and/or Services available at
Page 9 of 9
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Page 1 of 9

Note: PIC: Adi Hidayat

GOODS OR SERVICES ORDERED

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

PROJECT NO. : 21015

Reference : BILL NO. RRF

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF 1700 - ADD

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF 1700 - ADD

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

• Note: PROJECT : ID RRP

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

PROJECT NO. : 21015

BILL NO. RRF - 1700 :

User: Adi Hidayat

PROJECT NO. : 21015

Deskription : Labour Cabling

User: Adi Hidayat

• Note: PT SARANA UTAMA

Pic : Adi Hidayat

• Note: PT SARANA UTAMA

Pic : Adi Hidayat

• Note: PT SARANA UTAMA

Description :Material Add

Pic : Adi Hidayat

• Note: PT SARANA UTAMA

Description :Labour Add

Pic : Adi Hidayat

• Note: PT SARANA UTAMA

Description :Material Add

Pic : Adi Hidayat

Pic : Adi Hidayat

• Note: PT SARANA UTAMA