No : 2030329

MATERIAL PURCHASE REQUISITION (MPR)

Unit Activity Date Date Needed

Transportir HO 12/13/2020 12/14/2020

Suggested Vendor/Supplier/Contractor
Account Number

Cost Center : 683-O-EPN

No. Part Barang/Jasa Keterangan Qty Unit Qyt in Shortage

no. Stock
1 BBM Ownuse MT TBBM Liter
GORONTALO - PT. PERTAMINA 12.000
PATRA NIAGA PII Desember 2020
(15-31 Desember 2020)

Keterangan :

BBM Ownuse MT TBBM GORONTALO - PT. PERTAMINA PATRA NIAGA PII Desember 2020 (15-31 Desember 2020)

RUANG LINGKUP PENGADAAN BARANG

Layanan dari Vendor dibutuhkan setidaknya sampai dengan tanggal :

Hal-hal / kewajiban yang harus dilaksanakan oleh Vendor :

No. Kewajiban Qty Quality / Specs Delivery time Sanksi atau Catatan larangan-
denda apabila Tambahan larangan
kewajiban
vendor tidak
sesuai

Disetujui : Diketahui/Diperiksa : Dibuat :

.............................. .............................. m. Ravi Ashar

Dept. Head Spv / Section Head ..............................
 No : 2030329

MATERIAL PURCHASE REQUISITION (MPR)

DOKUMEN PENGADAAN BARANG

No. Requirement Notes

1 Spesifikasi Barang

2 Jangka Waktu Penyerahan Barang

3 Lokasi Penyerahan Barang

4 Harga Perkiraan Pengguna

/ User Estimate (UE)

5 Syarat Penyerahan Barang

6 Keterangan Lainnya
 No : 2030329

SURAT PERNYATAAN
PENUNJUKAN LANGSUNG VENDOR

Yang bertanda tangan di bawah ini:

Nama : ............................................................................................................................................................
NIK : ............................................................................................................................................................
Jabatan : ............................................................................................................................................................

Memutuskan penunjukan langsung atas Mitra Kerja berikut:

Nama Perusahaan : ............................................................................................................................................................

Alamat Perusahaan : ............................................................................................................................................................
Lingkup Pekerjaan : ............................................................................................................................................................
Nama Proyek : ............................................................................................................................................................
Nilai Barang/Jasa : ............................................................................................................................................................
Waktu Pelaksanaan : ............................................................................................................................................................

Adapun alasan dan penjelasan atas penunjukan langsung ini adalah:

* Checklist pada salah satu kriteria penunjukan langsung dibawah ini dan berikan penjelasannya *

Afiliasi Elnusa atau Pertamina Group

................................................................................................................................................................................................
................................................................................................................................................................................................
Persyaratan kontrak (klausul kontrak terlampir)
................................................................................................................................................................................................
................................................................................................................................................................................................
Sudah ada MOU atau Perjanjian Kerja Sama dengan Mitra Kerja (MOU atau Kontrak terlampir)
................................................................................................................................................................................................
................................................................................................................................................................................................
Meneruskan kerja sama dengan Mitra Kerja Incumbent atas pertimbangan operasional proyek (PO atau Kontrak sebelumnya terlampir)
................................................................................................................................................................................................
................................................................................................................................................................................................
Pertimbangan lain (dokumen pendukung terlampir)
................................................................................................................................................................................................
................................................................................................................................................................................................

Sesuai dengan kebijakan pengadaan Perusahaan yang berlaku maka calon Mitra Kerja yang ditunjuk harus melengkapi persyaratan dokumen
registrasi, memenuhi persyaratan/ kualifikasi mitra kerja dan memberikan penawaran yang terbaik untuk Perusahaan.

Jakarta, [dd-mmm-yyyy]

[nama pejabat minimal setingkat GM atau Dept. Head]

[Jabatan]

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