WORKSHOP WILAYAH I

FORMULIR PERMINTAAN BARANG / JASA

No. Permintaan : 00006.FPPBJ/OM-WS/PGAS/VII/2016.WIL1
Tanggal : 18 Juli 2016
Tenggat Waktu : 120 Hari Kalender
PIC : A.Samsudin
Uraian : Pengelolaan Workshop Wilayah I
Keperluan : Pengadaan Sparepart Meter RMG

No. Deskripsi Spesifikasi Jumlah Satuan Keterangan

1 Cartridge Meter Turbin Terlampir

- G.65 (2') 16 unit
- G.160 (4'') 1 unit
- G.250 (4'') 1 unit
- G.400 (4'') 1 unit
- G.400 (6'') 1 unit
- G.1600 1 unit
- G.2500 1 unit
2 Magnetic Coupling Terlampir 10 set
3 Reed Switch Terlampir 10 bh
4 LF Pulsa transmiter Terlampir 10 set
5 Oil pump Terlampir 10 set
6 Binder plug (male) Terlampir 5 pcs
7 Binder plug (female) Terlampir 5 pcs
8 Straightener Terlampir
- 3'' 6 bh
- 4'' 2 bh
- 6'' 2 bh
82

Lampiran :
1.Harga Perhitungan Sendiri
2.KAK / Spesifikasi atau Kualifikasi Teknis / Gambar
3.Bill of Quantity (BoQ)

Pengguna Barang / Jasa, Menyetujui,

R. Victor Tetrano P Sulistyo Elly Haryanto

Manager Workshop Wil I Direktur Utama
 WORKSHOP WILAYAH I

HARGA PERKIRAAN SENDIRI

INTERNAL* / EKSTERNAL
Lampiran : 00006.FPPBJ/OM-WS/PGAS/VII/2016.WIL1

No. Deskripsi Qty Satuan Harga Satuan (Rp) Total Harga (Rp)

1 Cartridge Meter Turbin

- G.65 (2') 16 unit Rp 23,100,000 Rp 369,600,000
- G.160 (4'') 1 unit Rp 27,999,146 Rp 27,999,146
- G.250 (4'') 1 unit Rp 27,999,146 Rp 27,999,146
- G.400 (4'') 1 unit Rp 30,450,000 Rp 30,450,000
- G.400 (6'') 1 unit Rp 39,900,000 Rp 39,900,000
- G.1600 1 unit Rp 59,430,000 Rp 59,430,000
- G.2500 1 unit Rp 73,500,000 Rp 73,500,000
2 Magnetic Coupling 10 set Rp 16,196,775 Rp 161,967,750
3 Reed Switch 10 bh Rp 6,405,000 Rp 64,050,000
4 LF Pulsa transmiter 10 set Rp 12,768,000 Rp 127,680,000
5 Oil pump 10 set Rp 1,207,500 Rp 12,075,000
6 Binder plug (male) 5 pcs Rp 1,732,500 Rp 8,662,500
7 Binder plug (female) 5 pcs Rp 1,732,500 Rp 8,662,500
8 Straightener
- 3'' 6 bh Rp 2,562,651 Rp 15,375,906
- 4'' 2 bh Rp 3,567,060 Rp 7,134,120
- 6'' 2 bh Rp 5,123,738 Rp 10,247,475
JUMLAH Rp 1,044,733,542
PPN 10% 104,473,354
TOTAL Rp 1,149,206,897

Mengusulkan, Menyetujui,

R. Victor Tetrano P Sulistyo Elly Haryanto

Manager Workshop Wil I Direktur Utama
 Lampiran 2

BILL OF QUANTITY (BQ)

Uraian : Pengelolaan Workshop Wilayah I
Keperluan : Pengadaan Sparepart Meter RMG

No. Deskripsi Qty Satuan Harga Satuan (Rp) Total Harga (Rp)

1 Cartridge Meter Turbin

- G.65 (2') 16 unit
- G.160 (4'') 1 unit
- G.250 (4'') 1 unit
- G.400 (4'') 1 unit
- G.400 (6'') 1 unit
- G.1600 1 unit
- G.2500 1 unit
2 Magnetic Coupling 10 set
3 Reed Switch 10 bh
4 LF Pulsa transmiter 10 set
5 Oil pump 10 set
6 Binder plug (male) 5 pcs
7 Binder plug (female) 5 pcs
8 Straightener
- 3'' 6 bh
- 4'' 2 bh
- 6'' 2 bh
JUMLAH
PPN 10%
TOTAL