List of Supporting Document to Interm Payment Statement No.

15
Surface Section CP103 MRT Jakarta Project

Milestone
No. Date of Physical Work Document / Letter No. Subject From Remark
No.
Attachment of Environmental Monitoring for 6 months 02 (July -
1 1.13.03
December) :
August 5, 2014 CNT3/RPT/2014/08-0376 Health, Safety and Environmental Monthly Report No. 08 (As at JMCMC NONO
July 25, 2014 OSJ-103-CMN-MTR-HSS-0007 25 July 2014) OSJ JV
August 28, 2014 CNT3/RPT/2014/08-0443 Health, Safety and Environmental Monthly Report No. 09 (As at JMCMC NONO
September 24, 2014 OSJ-103-CMN-MTR-HSS-0008 25 August 2014) OSJ JV
November 3, 2014 CNT3/RPT/2014/11-0589 Health, Safety and Environmental Monthly Report No. 10 (As at JMCMC NONO C
October 28, 2014 OSJ-103-CMN-MTR-HSS-0009 25 September 2014) OSJ JV
December 11, 2014 CNT3/RPT/2014/12-0693 Laporan Rencana Pengelolaan Lingkungan (RKL) dan Rencana JMCMC NONO C
Pemantauan Lingkungan (RPL) Periode Juli - September 2014
December 1, 2014 OSJ-103-CMN-EVR-ENV-0003 OSJ JV
Rev. B
December 22, 2014 CNT3/RPT/2014/12-0728 Health, Safety and Environmental Monthly Report No. 11 (As at JMCMC NONO
December 18, 2014 OSJ-103-CMN-MTR-HSS-0010 25 October 2014) OSJ JV
January 13, 2015 CNT3/RPT/2015/01-0029 Health, Safety and Environmental Monthly Report No. 12 (As at JMCMC NONO
December 31, 2014 OSJ-103-CMN-MTR-HSS-0011 25 November 2014) OSJ JV
February 27, 2015 CNT3/RPT/2015/02-0170 Health, Safety and Environmental Monthly Report No. 13 (As at JMCMC NONO
February 11, 2015 OSJ-103-CMN-MTR-HSS-0012 25 December 2014) OSJ JV
March 19, 2015 CNT3/RPT/2015/03-0222 Laporan Rencana Pengelolaan Lingkungan (RKL) dan Rencana JMCMC NONO C
Pemantauan Lingkungan (RPL) Periode October - December 2014
February 11, 2015 OSJ-103-CMN-MTR-HSS-0012 OSJ JV

2 1.14.18 March 25, 2015 Monthly Operation 16: OSJ JV

Monthly expenses for Electricity, Internet, Facs,
Telephone, Salary Employee, Transportation
3 2.02.A.26 August 5, 2014 CNT3/DTR/2014/08-0375 Alignment - Track Centre (Rev. C) JMCMC TD Civil Arch No.1
July 25, 2014 103-JMCMC-0369-0714 OSJ JV NONO
August 14, 2014 CNT3/DVA/2014/08-0403 Technical Design - Viaduct Substructure JMCMC TD Civil Arch No.2
August 14, 2014 103-JMCMC-0400-0814 Standard Details OSJ JV NONO
March 24, 2015 CNT3/DVA/2015/03-0236 Technical Design - Viaduct Superstructure JMCMC TD Civil Arch No.3
February 24, 2015 103-JMCMC-0963-0215 Standard Details OSJ JV NONO
October 16, 2014 CNT3/DVA/2014/10-0540 Technical Design - Viaduct Foundations 1 JMCMC TD Civil Arch No.4
October 1, 2014 103-JMCMC-0503-1014 Pier AP 29 OSJ JV NONO
December 16, 2014 CNT3/DVA/2014/11-0594 Technical Design - Viaduct Foundations 2 JMCMC TD Civil Arch No.5
November 20, 2014 103-JMCMC-0636-1114 Pier MP1-MP5 OSJ JV NONO
October 16, 2014 CNT3/DVA/2014/10-0539 Technical Design - Viaduct Foundations 3 : JMCMC TD Civil Arch No.6
September 19, 2014 103-JMCMC-0474-0914 Transition Slabs OSJ JV NONO
December 15, 2014 CNT3/DVA/2014/12-0703 Technical Design - Viaduct Foundations 4 : JMCMC TD Civil Arch No.7
December 10, 2014 103-JMCMC-0704-1214 Piers AP26-28; SP1-11 OSJ JV NONO
October 28, 2014 CNT3/DVA/2014/10-0572 Technical Design - Viaduct Foundations 5 : JMCMC TD Civil Arch No.8
September 30, 2014 OSJ-103-VID-DSR-STR-0027 Piers AP 10 - AP 25 OSJ JV NONO
November 28, 2014 CNT3/DVA/2014/11-0658 Technical Design - Viaduct Foundations 6 : JMCMC TD Civil Arch No.9
October 31, 2014 103-JMCMC-0571-1014 Piers AP 1 - AP 9 OSJ JV NONO
January 15, 2015 CNT3/DVA/2015/01-0007 Technical Design - Viaduct Foundations 7 JMCMC TD Civil Arch No.10
December 10, 2014 103-JMCMC-0701-1214 Piers MP6- MP13 (30507) OSJ JV NONO
February 17, 2015 CNT3/DVA/2015/02-0130A Technical Design - Viaduct Pier / Pier Cap 1 : JMCMC TD Civil Arch No.11
January 20, 2015 103-JMCMC-0820-0115 Pier Column AP 29 & MP 1 OSJ JV NONO
October 29, 2014 CNT3/DVA/2014/10-0575 Technical Design - Viaduct Pier / Pier Cap 2 : JMCMC TD Civil Arch No.12
October 1, 2014 OSJ-103-VID-DSR-STR-0046 Piers AP 20 - AP 24 OSJ JV NONO B
February 20, 2015 CNT3/DVA/2015/02-0144 Technical Design - Viaduct Pier / Pier Cap 3 : JMCMC TD Civil Arch No.13
January 23, 2015 103-JMCMC-0831-0115 Piers Column MP2 & MP3 OSJ JV NONO
February 11, 2015 CNT3/DVA/2015/02-0108 Technical Design - Viaduct Pier / Pier Cap 4 : JMCMC TD Civil Arch No.14
January 15, 2015 103-JMCMC-0804-0115 Piers Column MP2 & MP3 OSJ JV NONO
February 20, 2015 CNT3/DVA/2015/02-0145 Technical Design - Viaduct Pier / Pier Cap 5 : JMCMC TD Civil Arch No.15
January 23, 2015 103-JMCMC-0832-0115 Piers Head AP 29 OSJ JV NONO
February 20, 2015 CNT3/DVA/2015/02-0149 Technical Design - Viaduct Pier / Pier Cap 6 : JMCMC TD Civil Arch No.16
January 23, 2015 103-JMCMC-0836-0115 Piers Head MP 2- MP3 OSJ JV NONO
February 4, 2015 CNT3/DVA/2015/02-0086 Technical Design - Viaduct Pier / Pier Cap 7 : JMCMC TD Civil Arch No.17
January 5, 2015 103-JMCMC-0768-0115 Piers Head MP 2- MP3 OSJ JV NONO
February 25, 2015 CNT3/DVA/2015/02-0162 Technical Design - Viaduct Pier / Pier Cap 8 : JMCMC TD Civil Arch No.18
Piers Head MP 2- MP3 NONO
February 24, 2015 CNT3/DVA/2015/02-0158 Technical Design - Viaduct Pier / Pier Cap 9 : JMCMC TD Civil Arch No.19
January 27, 2015 OSJ-103-VID-DSR-STR-0055 Piers Head MP 2- MP3 OSJ JV NONO
July 8, 2014 CNT3/DVA/2014/07-0314 JMCMC TD Civil Arch No.20
Technical Design : Viaduct Deck- Superstructure Design
July 3, 2014 103-JMCMC-0316-0714 OSJ JV NONO
July 8, 2014 CNT3/DVA/2014/07-0313 Technical Design : Viaduct Setting Out- Setting Out of JMCMC TD Civil Arch No.21
July 3, 2014 103-JMCMC-0315-0714 Superstructure and Bearing OSJ JV NONO
December 8, 2014 CNT3/COT/2014/12-0687 JMCMC TD Civil Arch No.22
Technical Design : Transition Slab
November 10, 2014 OSJ-103-TRA-DSR-STR-0033 OSJ JV NONO B
January 7, 2015 CNT3/DST/2015/01-0018 JMCMC TD Civil Arch No.23
Technical Design - Sisingamangaraja Station Foundations
December 19, 2014 103-JMCMC-0738-1214 OSJ JV NONO
February 4, 2015 CNT3/DST/2015/02-0088 JMCMC TD Civil Arch No.24
Technical Design - Sisingamangaraja Station Superstructure
January 9, 2015 OSJ-103-ST4-DSR-STR-0075 OSJ JV NONO B
October 8, 2014 CNT3/DSA/2014/10-0523 JMCMC TD Civil Arch No.25
Technical Design - Sisingamangaraja Station Architecture
October 1, 2014 OSJ-103-ST4-DSR-ARC-0040 OSJ JV NONO B
October 21, 2014 CNT3/DOT/2014/10-0557 Technical Design - Blok M Station Foundation (31001) JMCMC TD Civil Arch No.26
September 24, 2014 103-JMCMC-0482-0914 OSJ JV NONO
March 23, 2015 CNT3/OTH/2015/03-0229 Technical Design - Blok M Station Superstructure JMCMC TD Civil Arch No.27
March 20, 2015 103-JMCMC-1061-0315 OSJ JV NONO
October 14, 2014 CNT3/DSA/2014/10-0534 Technical Design - Blok M Station Architecture JMCMC TD Civil Arch No.28
October 13, 2014 103-JMCMC-0523-1014 OSJ JV NONO
January 7, 2015 CNT3/DST/2015/01-0019 Technical Design - Blok A Station Foundation (31101) JMCMC TD Civil Arch No.29
December 19, 2014 103-JMCMC-0739-1214 OSJ JV NONO
January 6, 2015 CNT3/DSA/2015/01-0012 Technical Design - Blok A Station Architecture JMCMC TD Civil Arch No.30
December 26, 2014 OSJ-103-ST2-DSR-ARC-0100 OSJ JV NONO B
 Milestone
No. Date of Physical Work Document / Letter No. Subject From Remark
No.
April 2, 2014 CNT3/DUT/2014/04-0127 Ancillary Work - Utility Diversion Between Approach - JMCMC TD Civil Arch No.31
Sisingamangaraja Station NONO
April 2, 2014 CNT3/DUT/2014/04-0128 Ancillary Work - Utility Diversion Around Sisingamangaraja JMCMC TD Civil Arch No.32
Station NONO
April 4, 2014 CNT3/DUT/2014/04-0134 Ancillary Work - Utility Diversion Between Sisingamangaraja JMCMC TD Civil Arch No.33
Station and Blok M Station NONO
April 4, 2014 CNT3/DUT/2014/04-0135 Ancillary Work - Utility Diversion At Blok M Station JMCMC TD Civil Arch No.34
NONO
March 29, 2014 CNT3/DUT/2014/04-0125 Ancillary Work - Utility Diversion Between Blok M Station and JMCMC TD Civil Arch No. 35
Blok A Station NONO
April 10, 2014 CNT3/DUT/2014/04-0149 JMCMC TD Civil Arch No.36
Ancillary Work - Utility Diversion Around Blok A Station
NONO
April 10, 2014 CNT3/DUT/2014/04-0150 Ancillary Work - Utility Diversion Between Blok A Station and H JMCMC TD Civil Arch No.37
Nawi Station NONO
April 16, 2014 CNT3/DUT/2014/04-0160 JMCMC TD Civil Arch No.38
Ancillary Work - Utility Diversion Around H Nawi Station
NONO
March 19, 2015 CNT3/OTH/2015/03-0215 Reinstatement Road and Drainage Blok M JMCMC TD Civil Arch No. 39
March 16, 2015 OSJ-103-CMN-DSR-HWY-0034 OSJ JV NONO B
4 4.02.D.06 Attachment of Finish Concrete Pouring at Piles for 3 Spans of OSJ JV
Pilebent :
- Request for Work Acceptance Inspection (RWAI)
- Request for Inspection (RFI)
- Pile Schedule
- Report from Subcont / QC
- Piling Record
- Photograph
5 5.02.E.01 Attachment of Precast Yard Preparation Work : OSJ JV
- Request for Work Acceptance Inspection (RWAI)
- Request for Inspection
- Map
- Schedule
- Minutes of Meeting (MOM)
- Photograph
- Company Profile of Subcontractor
6 5.02.E.02 Attachment of Procurement and Installation of 1 Mould : OSJ JV
- Request for Work Acceptance Inspection (RWAI)
- Request for Inspection
- Quality Plan
- Map
- Equipment List
- Schedule
- Minutes of Meeting (MOM)
- Photograph

6 4 (four) copies CD (on CD)

Jakarta, April 2nd, 2015