Surat Penawaran

Kepada Yth : Direktur

Alamat : RSUD BALUNG
Jl. Raya Rambipuji, Indonesia

No Penawaran : 005/AMC-QUO/EKAT/V/2022/SE088
Perihal : Penawaran Harga Penawaran Bronchoscopy Flexible
Tanggal : 17 Mei 2022

Dengan hormat,

Bersama surat ini kami sampaikan penawaran harga untuk alat kesehatan Penawaran Harga Penawaran
Bronchoscopy Flexible merk Karl Storz kepada Bapak/Ibu dengan uraian dan kondisi sebagai berikut :

No Kode Name Description Qty Unit Price Total

1 H1419 Flexible Intubation Video Brand Karl Storz 1 377,811,405 377,811,405
Endoscope 4.0 mm with Monitor
Total : 377,811,405
Ongkir 2.5% : 9,445,285
Grand Total : 387,256,690

Terbilang : Tiga Ratus Delapan Puluh Tujuh Juta Dua Ratus Lima Puluh Enam Ribu Enam Ratus Sembilan Puluh Rupiah

Catatan:

Harga sudah termasuk ongkos kirim sesuai dengan wilayah RS Bapak/Ibu

Harga sudah termasuk PPN 11% dan biaya instalasi.
Barang akan dikirim dalam waktu maksimal 120 hari setelah kami menerima Surat Pesanan Barang / Purchase
ORDER (PO)
Pembayaran maksimal 30 (tiga puluh) hari kalender setelah invoice dikirim.
Garansi 1 (satu) tahun untuk kerusakan yang disebabkan oleh kesalahan pabrik dan tidak berlaku untuk
kerusakan yang disebabkan oleh bencana alam, kebakaran atau kelalaian user.
Garansi hanya berlaku untuk unit & telescope, tidak berlaku untuk hand instruments & barang disposible.
Masa berlaku penawaran adalah 45 (empat puluh lima) hari sejak tanggal penawaran.

Keterangan :

1. Daftar kategori & item terlampir merupakan penawaran awal.

2. Jika ada kategori & item yang tidak dikehendaki dapat menginformasikannya kepada kami melalui Product
Specialist terkait atau melalui telpon yang tertera pada Kop surat ini.
3. Barang yang sudah dibeli tidak dapat ditukar/dikembalikan.
4. Mohon mencantumkan NO Penawaran pada Surat Pesanan Barang / Purchase ORDER (PO) yang akan
diterbitkan.
5. Penawaran dengan tanda tangan digital atau elektronik, bukan merupakan penawaran final.
6. Penawaran dengan tanda tangan basah merupakan penawaran final.

page 1 / 4
Demikianlah surat penawaran ini kami sampaikan dan kami menunggu kabar lebih lanjut. Atas perhatian dan
kerjasamanya kami ucapkan terima kasih.

Hormat kami
PT Advance Medicare Corpora

( Yeffri Wirasubrata )
National Sales Manager

page 2 / 4
LAMPIRAN
SET RECOMMENDATION
No Kode Name Description Qty
1 H1419 Flexible Intubation Video Brand Karl Storz 1
Endoscope 4.0 mm with
Monitor

Set Recommendation - Item :

No Code Name Description Qty Unit Price Total
1 11302BDXK Flex.Intubat.Videoend Flexible Intubation Video 1 219,242,119 219,242,119
oscope 4.0x65, Set Endoscope 4 x 65, Set, CMOS
AKL: 20703713078 technology, with suction valve,
AKN: 4816002015-AK Deflection up/down: 140°/140°
1-002153210 Direction of view: 0° Angle of view:
Nama LKPP:Flexible 100° Working length: 65 cm Total
Intubation Video length: 93 cm Working channel
Endoscope 4 x 65 inner diameter: 1.5 mm Distal tip
11302BDXK outer diameter: 4 mm, consisting of:
11302 BDX Flexible Intubation
Video Endoscope 4 x 65 13242 XL
Leakage Tester 11301 CFX Tube
Holder 11301 CD1 Irrigation
Adaptor (2x) 11301 CE1 Suction
Valve 10309 Bronchoscope
Insertion Tube, size 4, sterile 10310
Bronchoscope Insertion Tube, size
2, sterile 29100 Plug, black,
package of 10 8403 YZ Protection
Cap, for use with C-MAC® Monitor
8403 ZX and C-HUB® II 20290301
2 11003MB Grasping Forceps, Grasping Forceps, flexible, double 2 8,349,911 16,699,822
flexible, 1 mm action jaws, diameter 1 mm, length
AKL: 20703710008,10 110 cm, for flexible bronchoscopes
804311069
AKN: 4812199038-AK
1-002087158
Nama LKPP:LOTTA
Neuro-Endoscope
11003MB
3 11003MA Biopsy Forceps, Biopsy Forceps, oval, flexible, 2 7,470,946 14,941,892
flexible, 1 mm double action jaws, diameter 1 mm,
AKL: 10804311069,20 length 110 cm, for flexible
703710008 bronchoscopes
AKN: 4815000183-AK
1-002086449
Nama LKPP:Video
Bronchoscope
11003MA

page 3 / 4
 4 8403ZXK C-MAC® Monitor for C-MAC® Monitor for CMOS 1 114,789,357 114,789,357
CMOS Endoscopes, Endoscopes, Kit, screen size 7" with
Kit 1280 x 800 pixel resolution, two
AKL: 20801615252,20 camera inputs, a USB and a HDMI
703125161 port, optimized user interface, video
AKN: 4815000089-AK and image capturing in real time on
1-002181328 SD card, playback of recorded
Nama LKPP:C-MAC video clips and still images, data
Monitor 8403ZXK transfer from SD card to USB flash
drive possible, splash-proof
according to IP54, suitable for wipe
disinfection, shock-resistant ABS
plastic housing, intelligent power
management with rechargeable Li-
Ion batteries, VESA 75 mounting
option, power adaptor for EU, UK,
USA and Australia, power supply
110 - 240 VAC, 50/60 Hz,
consisting of: 8403 ZX C-MAC®
Monitor 8403 YSD SD Card, 16 GB
8403 YZ Protection Cap 8401 YCA
VESA 75 Quick Clip
ET27-30-0004695 Power Supply
ET27-30-0004697 Plug Adaptor EU
ET27-30-0004698 Plug Adaptor UK
ET27-30-0004699 Plug Adaptor
USA/JP ET27-30-0004700 Plug
Adaptor AUS ET27-30-0004701
IEC (ROW) Plug ET27-30-0004370
Adapter Cable USA/JP
5 8401YA IV-Stand for C-MAC® IV-Stand for C-MAC monitor, height 1 12,138,215 12,138,215
monitor 120 cm, rollable with five legs and
AKL: 20703024603,20 antistatic castors, crossbar 25 cm x
801310353 diameter 25 mm for positioning the
AKN: 4815000089-AK monitor, with tray, dimensions (w x
1-002157070 d x h): 30 x 20 x 10 cm use with:
Nama LKPP:CMOS 8401YAA Crossbar 8401YB
Video Rhino- Crossbar
Laryngoscope 8401YA

page 4 / 4

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 Flexible Intubation Video Endoscope 4.0 mm with Monitor

Specialist : Anasthesiology and Emergency Medicine Code : H1419

Category : Airway Management
Sub Category : Flexible Scope

LIST ITEM
NO PRODUCT DESCRIPTION QTY IMAGE
1 11302BDXK Flex.Intubat.Videoendoscope 4.0x65, Set 1
Flexible Intubation Video Endoscope 4 x 65, Set,
CMOS technology, with suction valve, Deflection
up/down: 140°/140° Direction of view: 0° Angle of
view: 100° Working length: 65 cm Total length: 93
cm Working channel inner diameter: 1.5 mm Distal
tip outer diameter: 4 mm, consisting of: 11302 BDX
Flexible Intubation Video Endoscope 4 x 65 13242
XL Leakage Tester 11301 CFX Tube Holder 11301
CD1 Irrigation Adaptor (2x) 11301 CE1 Suction
Valve 10309 Bronchoscope Insertion Tube, size 4,
sterile 10310 Bronchoscope Insertion Tube, size 2,
sterile 29100 Plug, black, package of 10 8403 YZ
Protection Cap, for use with C-MAC® Monitor 8403
ZX and C-HUB® II 20290301
AKL 20703713078
KARL STORZ Flexible Intubation Video
Endoscope 4 x 65
2 11003MB Grasping Forceps, flexible, 1 mm 2
Grasping Forceps, flexible, double action jaws,
diameter 1 mm, length 110 cm, for flexible
bronchoscopes
AKL 20703710008
KARL STORZ VIDEO BRONCHOSCOPE

3 11003MA Biopsy Forceps, flexible, 1 mm 2

Biopsy Forceps, oval, flexible, double action jaws,
diameter 1 mm, length 110 cm, for flexible
bronchoscopes
AKL 10804311069
KARL STORZ BRONCHOSCOPE FOR ADULT &
PEDIATRIC INSTRUMENT SET

17 May 2022 Page 1 of 2

PT Advance Medicare Corpora, Kompleks Perkantoran Duta Merlin Blok B-26, Jl. Gajah Mada 3-5, Jakarta 10130, Indonesia
Phone : +62-21-6386-1505, Fax : +62-21-6386-1506, Email : amc@advancemedicorp.com, Website : www.advancemedicorp.com
 4 8403ZXK C-MAC® Monitor for CMOS Endoscopes, Kit 1
C-MAC® Monitor for CMOS Endoscopes, Kit,
screen size 7" with 1280 x 800 pixel resolution, two
camera inputs, a USB and a HDMI port, optimized
user interface, video and image capturing in real
time on SD card, playback of recorded video clips
and still images, data transfer from SD card to USB
flash drive possible, splash-proof according to
IP54, suitable for wipe disinfection, shock-resistant
ABS plastic housing, intelligent power
management with rechargeable Li-Ion batteries,
VESA 75 mounting option, power adaptor for EU,
UK, USA and Australia, power supply 110 - 240
VAC, 50/60 Hz, consisting of: 8403 ZX C-MAC®
Monitor 8403 YSD SD Card, 16 GB 8403 YZ
Protection Cap 8401 YCA VESA 75 Quick Clip
ET27-30-0004695 Power Supply
ET27-30-0004697 Plug Adaptor EU
ET27-30-0004698 Plug Adaptor UK
ET27-30-0004699 Plug Adaptor USA/JP
ET27-30-0004700 Plug Adaptor AUS
ET27-30-0004701 IEC (ROW) Plug
ET27-30-0004370 Adapter Cable USA/JP
AKL 20801615252
KARL STORZ C-MAC MONITOR
5 8401YA IV-Stand for C-MAC® monitor 1
IV-Stand for C-MAC monitor, height 120 cm,
rollable with five legs and antistatic castors,
crossbar 25 cm x diameter 25 mm for positioning
the monitor, with tray, dimensions (w x d x h): 30 x
20 x 10 cm use with: 8401YAA Crossbar 8401YB
Crossbar
AKL 20703024603
KARL STORZ CMOS Video Rhino-Laryngoscope

17 May 2022 Page 2 of 2

PT Advance Medicare Corpora, Kompleks Perkantoran Duta Merlin Blok B-26, Jl. Gajah Mada 3-5, Jakarta 10130, Indonesia
Powered by TCPDF (www.tcpdf.org)
Phone : +62-21-6386-1505, Fax : +62-21-6386-1506, Email : amc@advancemedicorp.com, Website : www.advancemedicorp.com