CONTRACT CHANGE ORDER ( CCO ) ( PERTAMA )

PEKERJAAN : PEMBANGUNAN GEDUNG NEONATAL (NICU)

VOLUME : 1 (SATU) PAKET
LOKASI : RUMAH SAKIT UMUM DAERAH
THN. ANGGARAN : 2022

KONTRAK AWAL KONTRAK PERUBAHAN SELISIH

NO. URAIAN DAN JENIS PEKERJAAN KETERANGAN
VOLUME SAT. HARGA SATUAN JUMLAH HARGA VOLUME SAT. HARGA SATUAN JUMLAH HARGA BERKURANG BERTAMBAH

1 2 3 4 5 6 7 8 9 10 11 12 13
I. PEKERJAAN PENDAHULUAN
1. Pembersihan Lokasi 1,00 Ls 3.000.000,00 3.000.000,00 1,00 Ls 3.000.000,00 3.000.000,00 - - Tetap
2. Pembuatan Barak Kerja & Gudang 1,00 Ls 7.000.000,00 7.000.000,00 1,00 Ls 7.000.000,00 7.000.000,00 - - Tetap
3. Adminstrasi & Dokumentasi 1,00 Ls 5.000.000,00 5.000.000,00 1,00 Ls 5.000.000,00 5.000.000,00 - - Tetap
4. Papan Nama Proyek 1,00 Ls 250.000,00 250.000,00 1,00 Ls 250.000,00 250.000,00 - - Tetap
5. Penyediaan Air Bersih & Listrik Kerja 1,00 Ls 4.500.000,00 4.500.000,00 1,00 Ls 4.500.000,00 4.500.000,00 - - Tetap
6. Kesehatan & Keselamatan Kerja (K3) 1,00 Ls 6.400.000,00 6.400.000,00 1,00 Ls 6.400.000,00 6.400.000,00 - - Tetap
7. Pembuatan Lab JMD 1,00 Ls 8.000.000,00 8.000.000,00 8.000.000,00 Tetap

Jumlah 26.150.000,00 Jumlah 34.150.000,00 - 8.000.000,00 -

II. PEKERJAAN PONDASI
1 Pek. Pondasi Garis
- Pek. Galian Tanah 68,12 M³ 80.843,75 5.506.874,14 69,76 M³ 80.843,75 5.639.660,00 132.785,86 Bertambah
- Pek. Urugan Pasir 9,76 M³ 270.537,50 2.639.499,12 10,09 M³ 270.537,50 2.728.370,69 88.871,57 Bertambah
- Pek. Batu Kosong (Aanstamping) 29,27 M³ 565.679,25 16.557.148,81 30,26 M³ 565.679,25 17.114.625,71 557.476,90 Bertambah
- Pek. Pasangan Batu 1 : 3 158,97 M³ 1.020.347,02 162.201.504,73 164,92 M³ 1.020.347,02 168.276.140,71 6.074.635,98 Bertambah
- Pek. Urugan Kembali 17,04 M³ 64.687,50 1.101.951,56 17,45 M³ 64.687,50 1.128.513,87 26.562,30 Bertambah
2 Pek. Urugan Tanah di Datangkan 196,59 M³ 95.343,75 18.743.842,34 196,59 M³ 95.343,75 18.743.842,34 - - Tetap
3 Pek. Ramp
- Pek. Pasangan Batu 1 : 3 6,08 M³ 1.120.347,02 6.806.152,96 6,08 M³ 1.120.347,02 - (6.806.152,96) - Berkurang
- Pek. Plasteran 27,46 M² 75.759,21 2.080.499,49 27,46 M² 75.759,21 - (2.080.499,49) - Berkurang
4 Pek. Rabat Keliling Bangunan
- Pek. Urugan Pasir 3,36 M³ 270.537,50 907.906,27 4,21 M³ 270.537,50 1.137.914,54 - 230.008,28 Bertambah
- Pek. Rabat Beton 3,36 M³ 1.060.792,57 3.559.950,92 5,89 M³ 1.060.792,57 6.246.556,61 - 2.686.605,70 Bertambah
5 Pek. Saluran Keliling Bangunan
- Pek. Galian Tanah 7,94 M³ 80.843,75 641.697,27 27,48 M³ 80.843,75 2.221.513,49 1.579.816,23 Bertambah
- Pek. Urugan Pasir 1,03 M³ 270.537,50 277.300,94 2,50 M³ 270.537,50 675.829,73 398.528,79 Bertambah
- Pek. Batu Kosong (Aanstamping) 3,08 M³ 565.679,25 1.739.463,69 - M³ 565.679,25 - (1.739.463,69) - Berkurang
- Pek. Pasangan Batu 1 : 3 8,20 M³ 1.020.347,02 8.366.845,56 17,03 M³ 1.020.347,02 17.379.060,62 9.012.215,05 Bertambah
- Pek. Tanah Urug 13,44 M³ 250.537,50 3.366.347,12 - M³ 250.537,50 - (3.366.347,12) Berkurang
- Pek. Pasangan Batu 1 : 3 17,27 M³ 1.120.347,02 19.351.193,90 - M³ 1.120.347,02 - (19.351.193,90) - Berkurang
- Pek. Plasteran 115,15 M² 75.759,21 8.723.673,31 95,38 M² 75.759,21 7.226.065,20 (1.497.608,11) Berkurang
- Pek. Acian 115,15 M² 44.278,94 5.098.719,80 95,38 M² 44.278,94 4.223.413,74 (875.306,06) Berkurang

Jumlah 267.670.571,92 Jumlah 252.741.507,24 (35.716.571,34) 20.787.506,66 -

III. PEKERJAAN BETON
1 Pek. Sloof 15/20
- Pek. Beton f’c = 21,7 MPa 5,99 M³ 1.364.669,94 8.174.863,70 5,99 M³ 1.364.669,94 8.174.863,70 - - Tetap
- Pek. Pembesian (Besi polos) 900,57 Kg 19.698,35 17.739.779,70 900,57 Kg 19.698,35 17.739.779,70 - Tetap
- Pek. Bekisting 81,40 M² 160.878,39 13.095.500,74 81,40 M² 160.878,39 13.095.500,74 - - Tetap
2 Pek. Kolom
Pek. Kolom 11/11 42,79 M' 112.232,07 4.802.410,06 42,79 M' 112.232,07 4.802.410,06 - Tetap
Pek. Kolom 15/30
- Pek. Beton Kolom 6,01 M³ 1.364.669,94 8.208.087,89 6,01 M³ 1.364.669,94 8.208.087,89 - Tetap
- Pek. Pembesian (Besi polos) 1.043,26 Kg 19.698,35 20.550.537,39 1.043,26 Kg 19.698,35 20.550.537,39 - Tetap
- Pek. Bekisting 124,74 M² 250.638,53 31.264.650,23 124,74 M² 250.638,53 31.264.650,23 - Tetap
Pek. Kolom 20/20
- Pek. Beton Kolom 0,76 M³ 1.364.669,94 1.035.586,21 - 1.035.586,21 Bertambah
- Pek. Pembesian (Besi polos) 159,98 Kg 19.698,35 3.151.383,01 3.151.383,01 Bertambah
- Pek. Bekisting 17,28 M² 250.638,53 4.331.033,80 4.331.033,80 Bertambah
3 Pek. Balok Latei 11/11 93,50 M' 112.232,07 10.493.698,08 93,50 M' 112.232,07 10.493.698,08 Tetap
4 Pek. Balok Talang 15/20
- Pek. Beton Balok Talang 3,86 M³ 1.364.669,94 5.262.432,69 3,59 M³ 1.364.669,94 4.900.890,47 (361.542,22) Berkurang
- Pek. Pembesian (Besi polos) 579,79 Kg 19.698,35 11.420.877,19 539,96 Kg 19.698,35 10.636.354,95 (784.522,25) Berkurang
- Pek. Bekisting 40,61 M² 270.158,53 10.971.137,90 37,82 M² 270.158,53 10.217.395,60 (753.742,30) Berkurang
5 Pekerjaan Balok Talang + Ring Balk 15/48
- Pek. Beton Balok Talang 3,97 M³ 1.364.669,94 5.416.941,10 3,97 M³ 1.364.669,94 5.416.941,10 - Tetap
- Pek. Pembesian (Besi polos) 491,65 Kg 19.698,35 9.684.607,89 491,65 Kg 19.698,35 9.684.607,89 - Tetap
- Pek. Bekisting 42,56 M² 270.158,53 11.497.947,04 42,56 M² 270.158,53 11.497.947,04 - Tetap
6 Pek. Ringbalk 11/11 58,50 M' 112.232,07 6.565.575,80 58,50 M' 112.232,07 6.565.575,80 - Tetap
7 Pek. Poor Plat 80/80
- Pek. Galian Tanah 4,48 M³ 80.843,75 362.180,00 5,38 M³ 80.843,75 434.616,00 72.436,00 Bertambah
- Pek. Urugan Pasir 0,32 M³ 270.537,50 86.572,00 0,38 M³ 270.537,50 103.886,40 17.314,40 Bertambah
- Pek. Batu Kosong (Aanstamping) 0,64 M³ 565.679,25 362.034,72 0,77 M³ 565.679,25 434.441,66 72.406,94 Bertambah
- Pek. Beton Poor Plat 4,19 M³ 1.364.669,94 5.720.706,91 5,03 M³ 1.364.669,94 6.867.853,46 1.147.146,55 Bertambah
- Pek. Pembesian (Besi polos) 200,26 Kg 19.698,35 3.944.748,50 223,01 Kg 19.698,35 4.392.935,86 448.187,36 Bertambah

Jumlah 185.625.289,54 Jumlah 194.000.977,05 (1.899.806,76) 10.275.494,28 -

IV. PEKERJAAN DINDING
1 Pek. Pemasangan Dinding Bata Merah 1 PC : 4 PP 273,20 M² 135.937,30 37.137.867,14 273,20 M² 135.937,30 37.137.867,14 - Tetap
2 Pek. Plasteran dinding 1 PC : 4 PP 622,21 M² 75.759,21 47.137.760,75 622,21 M² 75.759,21 47.137.760,75 - Tetap
3 Pek. Pas. Transram 1 PC : 3 PP 7,96 M² 140.206,75 1.116.396,25 7,96 M² 140.206,75 1.116.396,25 - Tetap
4 Pek. Plasteran dinding Transram 1 PC : 3 PP 15,93 M² 78.218,29 1.245.626,23 15,93 M² 78.218,29 1.245.626,23 - Tetap
5 Pek. Second Skin conwood 287,93 M² 523.326,17 150.680.606,32 287,93 M² 523.326,17 150.680.606,32 - - Tetap

Jumlah 237.318.256,69 Jumlah 237.318.256,69 - - -

V. PEKERJAAN LANTAI DAN DINDING GRANIT
1 Pek. Rabat Lantai
- Pek. Pasir Urug 12,12 M³ 270.537,50 3.279.929,02 12,57 M³ 270.537,50 3.401.670,89 - 121.741,88 Bertambah
- Pek. Rabat Lantai 12,12 M³ 1.060.792,57 12.860.783,93 17,60 M³ 1.060.792,57 18.673.396,83 - 5.812.612,89 Bertambah
2 Pemasangan Lantai Vinyl 124,24 M² 1.845.518,25 229.282.573,58 124,24 M² 1.845.518,25 229.282.573,58 - Tetap
3 Pemasangan Lantai Granit 60x60 untuk Interior 77,94 M² 311.137,72 24.250.073,97 62,34 M² 311.137,72 19.396.325,53 (4.853.748,45) - Berkurang
4 Pemasangan Dinding Granit 60x60 untuk WC/KM 7,96 M² 443.253,78 3.529.408,23 7,96 M² 443.253,78 3.529.408,23 - Tetap
5 Pemasangan Plint Lantai Interior 69,97 M' 119.393,10 8.353.935,13 69,97 M' 119.393,10 8.353.935,13 - Tetap

Jumlah 281.556.703,87 Jumlah 282.637.310,19 (4.853.748,45) 5.934.354,77 -

VI. PEKERJAAN KUSEN ALUMUNIUM
1 Pek. Pemasangan Kusen Pintu Alumunium
- Pekerjaan P1 2,00 Bh 13.929.764,35 27.859.528,70 2,00 Bh 13.929.764,35 27.859.528,70 Tetap
- Pekerjaan P2 1,00 Bh 8.948.200,96 8.948.200,96 1,00 Bh 8.948.200,96 8.948.200,96 Tetap
- Pekerjaan P3 5,00 Bh 4.326.602,66 21.633.013,31 5,00 Bh 4.326.602,66 21.633.013,31 - Tetap
- Pekerjaan P4 1,00 Bh 4.179.104,84 4.179.104,84 1,00 Bh 4.179.104,84 4.179.104,84 Tetap
- Pekerjaan P5 2,00 Bh 6.391.572,12 12.783.144,23 2,00 Bh 6.391.572,12 12.783.144,23 Tetap
- Pekerjaan PJ1 2,00 Bh 13.900.194,37 27.800.388,75 2,00 Bh 13.900.194,37 27.800.388,75 - Tetap
2 Pek. Pemasangan Kusen Jendela Alumunium
- Pekerjaan J1 2,00 Bh 10.926.142,72 21.852.285,45 2,00 Bh 10.926.142,72 21.852.285,45 Tetap
- Pekerjaan J2 9,00 Bh 5.202.925,11 46.826.325,96 9,00 Bh 5.202.925,11 46.826.325,96 Tetap

Jumlah 171.881.992,20 Jumlah 171.881.992,20 - - -

VII. PEKERJAAN PENGECATAN
1 Pek. Pengecatan Tembok Baru 630,17 M² 50.222,65 31.648.681,79 695,61 M² 50.222,65 34.935.377,57 - 3.286.695,77 Tetap
2 Pek. Pengecatan Plafon 249,11 M² 52.222,65 13.009.184,34 240,15 M² 52.222,65 12.541.269,40 (467.914,94) - Tetap

Jumlah 44.657.866,14 Jumlah 47.476.646,96 (467.914,94) 3.286.695,77 -

VIII. PEKERJAAN PLAFON
1 Pek. Rangka Plafond Hollow Galvalume 249,11 M² 120.743,15 30.078.326,10 240,15 M² 120.743,15 28.996.467,47 (1.081.858,62) - Tetap
2 Pek. Plafon Gypsum board 249,11 M² 59.426,14 14.803.644,49 240,15 M² 59.426,14 14.271.186,32 (532.458,17) - Tetap
3 Pek. List Plafond 206,05 M' 47.127,00 9.710.518,35 206,05 M' 47.127,00 9.710.518,35 - - Tetap

Jumlah 54.592.488,94 Jumlah 52.978.172,14 (1.614.316,79) - -

IX. PEKERJAAN TALANG DAK BETON
1 Pek. Beton f’c = 21,7 MPa 11,30 M³ 1.364.669,94 15.419.043,98 10,70 M³ 1.364.669,94 14.607.205,24 (811.838,73) - Bertambah
2 Pek. Pembesian (Besi polos) 795,50 Kg 19.698,35 15.670.037,43 755,42 Kg 19.698,35 14.880.461,90 (789.575,53) - Bertambah
3 Pek. Bekisting 95,00 M² 433.708,53 41.202.310,35 90,00 M² 433.708,53 39.033.767,70 (2.168.542,65) - Bertambah

Jumlah 72.291.391,75 Jumlah 68.521.434,84 (3.769.956,91) - -

X. PEKERJAAN KUDA-KUDA DAN PENUTUP ATAP
1 Pek. Atap Spandeks 0,4mm 207,04 M² 107.874,60 22.334.285,71 207,04 M² 107.874,60 22.334.285,71 - - Tetap
2 Pek. Struktur Kuda-Kuda Baja 207,04 M² 300.873,75 62.292.701,86 207,04 M² 300.873,75 62.292.701,86 - - Tetap
3 Pek. Nok atap Spandeks 38,25 M' 106.236,43 4.063.543,26 38,25 M' 106.236,43 4.063.543,26 - - Tetap
4 Pek. Pemasangan Kalsiplank 60,00 M' 80.586,25 4.835.175,00 60,00 M' 80.586,25 4.835.175,00 - - Tetap

Jumlah 93.525.705,83 Jumlah 93.525.705,83 - - -

XI. PEKERJAAN AKHIR
1 Pembersihan Akhir 1,00 Ls 4.801.000,00 4.801.000,00 1,00 Ls 4.801.000,00 4.801.000,00 - - Tetap

Jumlah 4.801.000,00 Jumlah 4.801.000,00 - - -

REAL COST 1.440.071.266,87 1.440.033.003,14 (48.322.315,20) 48.284.051,48
 CONTRACT CHANGE ORDER ( CCO ) ( PERTAMA )

PEKERJAAN : PEMBANGUNAN GEDUNG NEONATAL (NICU)

VOLUME : 1 (SATU) PAKET
LOKASI : RUMAH SAKIT UMUM DAERAH
THN. ANGGARAN : 2022

KONTRAK AWAL KONTRAK PERUBAHAN SELISIH

NO. URAIAN DAN JENIS PEKERJAAN KETERANGAN
VOLUME SAT. HARGA SATUAN JUMLAH HARGA VOLUME SAT. HARGA SATUAN JUMLAH HARGA BERKURANG BERTAMBAH

1 2 3 4 5 6 7 8 9 10 11 12 13
1 CLEAN WATER SUPPLY INSTALATION SYSTEM
SANITARY
1. Pek. Pemasangan Pipa PVC 1'' 57 m 32.200,08 1.835.404,56 57 m 32.200,08 1.835.404,56 - - Tetap
2. Pek. Pemasangan Pipa PVC 1/2'' 1 m 12.000,00 6.000,00 1 m 12.000,00 6.000,00 - - Tetap
3. Pek. Pemasangan Pipa PVC 3/4'' 1 m 24.998,70 31.248,38 1 m 24.998,70 31.248,38 - - Tetap
4. Gate Valve dia. 65 mm2 2 m 370.000,00 740.000,00 2 m 370.000,00 740.000,00 - - Tetap
Supporting Material
1. Fitting for Pipe - CW 1 lot 3.680,00 3.680,00 1 lot 3.680,00 3.680,00 - - Tetap
2. Hanger Support - CW 1 lot 14.411,40 14.411,40 1 lot 14.411,40 14.411,40 - - Tetap
TESTING & COMMISSIONING
Pressure Test & Function Test - CW 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL SEWAGE WATER INSTALLATION 3.565.744,34 3.565.744,34 - - -
2. SEWAGE WATER INSTALATION
SEWAGE TREATMENT PLANT (STP)
1. Sewage Treatment Plant (STP) BioTank 2000L include Acc 1 unit 10.000.000,00 10.000.000,00 1 unit 10.000.000,00 10.000.000,00 - - Tetap
SANITARY
1. Clean Out type Floor dia.4 inch - c/w Avur 1 pcs 250.520,00 250.520,00 1 pcs 250.520,00 250.520,00 - - Tetap
PVC Pipe - AW Class
1. PVC Pipe dia. 100 mm 1 m 120.508,00 66.279,40 1 m 120.508,00 66.279,40
2. PVC Pipe dia. 150 mm 29 m 223.045,00 6.390.239,25 29 m 223.045,00 6.390.239,25 - - Tetap
Supporting Material
1. Fitting for Pipe - SW 1 lot 584.119,38 584.119,38 1 lot 584.119,38 584.119,38
2. Hanger Support - SW 1 lot 129.130,37 129.130,37 1 lot 129.130,37 129.130,37 - - Tetap
TESTING & COMMISSIONING
StagnantTest & Function Test - SW 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00
TOTAL SEWAGE WATER INSTALLATION 18.355.288,40 18.355.288,40
 1 2 3 4 5 6 7 8 9 10 11 12 13
3. WASTE WATER INSTALLATION
SANITARY
1 Clean Out type Floor dia.4 inch - c/w Avur 1 pcs 250.500,00 250.500,00 1 pcs 250.500,00 250.500,00 - Tetap
2 Floor Drain dia. 3 inch 13 pcs 83.430,00 1.084.590,00 1 pcs 83.430,00 83.430,00 (1.001.160,00) Bertambah
PVC Pipe - AW Class
1 PVC Pipe dia. 75mm 7 m 76.400,00 559.248,00 7 m 76.400,00 559.248,00 Tetap
2 PVC Pipe dia. 50 mm 63 m 36.655,00 2.298.268,50 63 m 36.655,00 2.298.268,50 - - Bertambah
Vent
1 PVC Pipe dia. 40mm 1 m 35.721,00 28.576,80 1 m 35.721,00 28.576,80 Tetap
2 PVC Pipe dia. 32mm 3 m 32.913,00 93.472,92 3 m 32.913,00 93.472,92 Tetap
Supporting Material
1 Fitting for Pipe - WW 1 lot 120.350,80 120.350,80 1 lot 120.350,80 120.350,80 Tetap
2 Hanger Support - WW 1 lot 22.533,07 22.533,07 1 lot 22.533,07 22.533,07 Tetap
1 Wastafel 2 Unit 1.351.655,00 2.703.310,00 2 Unit 1.351.655,00 2.703.310,00 Tetap
2 Closet Duduk Ex Toto 1 Unit 3.352.636,04 3.352.636,04 1 Unit 3.352.636,04 3.352.636,04 Tetap
3 Jetwasher 1 Unit 400.660,20 400.660,20 1 Unit 400.660,20 400.660,20 Tetap
TESTING & COMMISSIONING
StagnantTest & Function Test - SW 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 Tetap
TOTAL WASTE WATER INSTALLATION 11.849.146,33 10.847.986,33
4. FIRE FIGHTING INSTALATION
HYDRANT SITE
1 Outdoor Hydrant Box
Box Hydrant Type. C 1 unit 5.000.000,00 5.000.000,00 1 unit 5.000.000,00 5.000.000,00 Tetap
2 Pillar Hydrant 1 unit 6.654.015,00 6.654.015,00 1 unit 6.654.015,00 6.654.015,00 Tetap
3 Siamese Connection 1 unit 4.518.333,00 4.518.333,00 1 unit 4.518.333,00 4.518.333,00 Tetap
4 Gate Valve dia. 100 mm 1 unit 520.000,00 520.000,00 1 unit 520.000,00 520.000,00 Tetap
FIRE EXTINGUISER
1 Indoor Hydrant Box 1200x800x200mm c/w: 2 unit 4.800.000,00 9.600.000,00 2 unit 4.800.000,00 9.600.000,00 Tetap
2 Fire Extinguisher Dry chemical type ABC 3 unit 1.750.000,00 5.250.000,00 3 unit 1.750.000,00 5.250.000,00 Tetap
Class ABC 6 Kg c/w include Bracket
3 Head Sprinkler 13 pcs 85.500,00 1.111.500,00 13 pcs 85.500,00 1.111.500,00 Tetap
HYDRANT PIPE - Black Steel Pipe Sch 40
1 Black steel pipe sch 40 dia. 75mm 17 m 295.400,00 4.874.100,00 17 m 295.400,00 4.874.100,00 Tetap
2 Black steel pipe sch 40 dia. 65mm 18 m 282.180,00 5.132.854,20 18 m 282.180,00 5.132.854,20 Tetap
3 Black steel pipe sch 40 dia. 40mm 2 m 211.600,00 330.096,00 2 m 211.600,00 330.096,00 Tetap
SPRINKLER PIPE - Black Steel Pipe Sch 40
1 Black steel pipe sch 40 dia. 75mm 28 m 295.400,00 8.241.660,00 28 m 295.400,00 8.241.660,00 Tetap
2 Black steel pipe sch 40 dia. 25mm 16 m 158.700,00 2.488.416,00 16 m 158.700,00 2.488.416,00 Tetap
3 Black steel pipe sch 40 dia. 25 mm (for drain) 28 m 158.700,00 4.365.837,00 28 m 158.700,00 4.365.837,00 Tetap
VALVE
1 Gate Valve diameter 4" 16k 1 pcs 7.827.682,52 7.827.682,52 1 pcs 7.827.682,52 7.827.682,52 Tetap
2 Gate Valve diameter 2" 16k 2 pcs 3.171.780,00 6.343.560,00 2 pcs 3.171.780,00 6.343.560,00 Tetap
3 Flow switch Dia. 4" 1 pcs 6.963.777,00 6.963.777,00 1 pcs 6.963.777,00 6.963.777,00 Tetap
Supporting Material
1 Fitting for Pipe - FF 1 lot 1.271.648,16 1.271.648,16 1 lot 1.271.648,16 1.271.648,16 Tetap
2 Hanger Support - FF 1 lot 127.164,82 127.164,82 1 lot 127.164,82 127.164,82 Tetap
TESTING & COMMISSIONING
Pressure Test & Function Test - FF 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 Tetap
TOTAL FIRE FIGHTING INSTALATION 81.555.643,70 81.555.643,70
 1 2 3 4 5 6 7 8 9 10 11 12 13
5. AIR CONDITIONING & FAN
1 RUANG ADMIN 1 Unit 9.445.410,00 9.445.410,00 1 Unit 9.445.410,00 9.445.410,00 Tetap
Type FXAQ20PVE (VRV IV)
Model WALL MOUNTED (VRV)
Kapasitas 7.500 Btuh

2 HALL/LOBBY 2 Unit 27.000.000,00 54.000.000,00 2 Unit 27.000.000,00 54.000.000,00 Tetap

Type FXFQ40LV (VRV IV)
Model CEILLING MOUNTED CASSETTE (VRV)
Kapasitas 15.400 Btuh

3 RUANG KONTROL 1 Unit 9.445.410,00 9.445.410,00 1 Unit 9.445.410,00 9.445.410,00 Tetap

Type FXAQ20PVE (VRV IV)
Model WALL MOUNTED (VRV)
Kapasitas 7.500 Btuh

4 RUANG PERINATAL 2 Unit 27.000.000,00 54.000.000,00 2 Unit 27.000.000,00 54.000.000,00 Tetap

Type FXFQ40LV (VRV IV)
Model CEILLING MOUNTED CASSETTE (VRV)
Kapasitas 15.400 Btuh

5 RUANG NICU 2 Unit 27.000.000,00 54.000.000,00 2 Unit 27.000.000,00 54.000.000,00 Tetap

Type FXFQ40LV (VRV IV)
Model CEILLING MOUNTED CASSETTE (VRV)
Kapasitas 15.400 Btuh

Pekerjaan Instalasi
1 Pipa drain lengkap dengan isolasi tebal 3/8" 1 Ls 8.500.000,00 8.500.000,00 1 Ls 8.500.000,00 8.500.000,00 Tetap
untuk yang melintang di atas plafon
2 Kabel Kontrol Outdoor Indoor + Power Indoor + Remote Lokal 1 Ls 14.445.000,00 14.445.000,00 1 Ls 14.445.000,00 14.445.000,00 Tetap
3 Material Bantu, Dudukan Outdoor Dan Gantungan Indoor 1 Ls 12.000.000,00 12.000.000,00 1 Ls 12.000.000,00 12.000.000,00 Tetap
4 Penambahan Freon 1 Ls 14.445.000,00 14.445.000,00 1 Ls 14.445.000,00 14.445.000,00 Tetap
5 Testing Commisioning 1 Ls 166.713,88 166.713,88 1 Ls 166.713,88 166.713,88 Tetap
TOTAL AIR CONDITIONING & FAN 230.447.533,88 230.447.533,88
 1 2 3 4 5 6 7 8 9 10 11 12 13
6. MEDICAL GAS
Sub distribusi
1 Shut off valve :
• Zona valve type 3 Gas (O, A, S) 1 set 8.220.400,00 8.220.400,00 1 set 8.220.400,00 8.220.400,00 Tetap
2 Medical gas outlet :
• Wall outlet Oksigen (O) 6 set 3.072.400,00 18.434.400,00 6 set 3.072.400,00 18.434.400,00 Tetap
• Wall outlet Compress Air (A) 6 set 3.072.400,00 18.434.400,00 6 set 3.072.400,00 18.434.400,00 Tetap
• Wall outlet Vacum (S) 6 set 3.072.400,00 18.434.400,00 6 set 3.072.400,00 18.434.400,00 Tetap
3 Multi gas alarm system :
• Multi gas alarm system (3 gases O,A, S) 1 set 6.460.060,00 6.460.060,00 1 set 6.460.060,00 6.460.060,00 Tetap
Piping System :
1 Pipa copper ASTM B819/B88 Type L
• dia. 3/4'' 78 m 354.200,00 27.627.600,00 78 m 354.200,00 27.627.600,00 Tetap
• dia. 1/2'' 66 m 210.300,00 13.879.800,00 66 m 210.300,00 13.879.800,00 Tetap
• dia. 3/8'' 36 m 122.400,00 4.406.400,00 36 m 122.400,00 4.406.400,00 Tetap
2 Fitting, accessories & material support 1 Ls 2.874.506,20 2.874.506,20 1 Ls 2.874.506,20 2.874.506,20 Tetap
3 Testing & commissioning 1 Ls 1.132.500,00 1.132.500,00 1 Ls 1.132.500,00 1.132.500,00 Tetap
Medical Gas Architecture
1 Bed head unit in R. Kelas 6 set 2.590.200,00 15.541.200,00 6 set 2.590.200,00 15.541.200,00 Tetap
~ Panjang 1200 mm
~ Aluminium Alloy material tebal 2 mm
~ Stop kontak 2 bh
~ Saklar 1 bh
TOTAL MEDICAL GAS SYSTEM 135.445.666,20 135.445.666,20

TOTAL MECHANICAL 481.219.022,84 480.217.862,84 (1.001.160,00) - -

1 2 3 4 5 6 7 8 9 10 11 12 13

1. ELECTRICAL ARMATURE & LIGHTNING PROTECTION INSTALATION

Lighting Fixtures & Installation
1. Down Light RD 125 PLC 1x18 W 28 pcs 346.400,00 9.699.200,00 31 pcs 346.400,00 10.738.400,00 - 1.039.200,00 Tetap
2. Down Light RD 100 PLC 1x10 W 1 pcs 232.348,00 232.348,00 1 pcs 232.348,00 232.348,00 - - Tetap
3. Installation Cable NYM 3 x 2.5 mm² for Lamp 29 point 217.295,40 6.301.566,60 29 point 217.295,40 6.301.566,60 - - Tetap
Switch Fixtures & Installation
4. Double Switch 6 pcs 75.920,00 455.520,00 6 pcs 75.920,00 455.520,00 - - Tetap
5. Single Switch 7 pcs 63.370,00 443.590,00 7 pcs 63.370,00 443.590,00 - - Tetap
6. Installation Cable NYM 3 x 2.5 mm² for Switch 13 point 226.290,50 2.941.776,50 13 point 226.290,50 2.941.776,50 - - Tetap
Socket Outlet Fixtures & Installation
7. Socket Outlet 200 VA (10A) 1 Phasa (on wall, Bed head, TV) 42 pcs 109.600,00 4.603.200,00 42 pcs 109.600,00 4.603.200,00 - - Tetap
8. Installation Cable NYM 3 x 2.5 mm² for Socket Outlet 200 VA 42 point 225.280,40 9.461.776,80 42 point 225.280,40 9.461.776,80 - - Tetap
9. Papan Nama Acrylic Warna + Lampu LED include Instalasi 1 Ls 6.572.575,10 6.572.575,10 1 Ls 6.572.575,10 6.572.575,10 - - Tetap
TESTING & COMMISSIONING
Continue, Megger, Grounding & Function Test - EL 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL ELECTRICAL ARMATURE & LIGHTNING PROTECTION INSTALATON 41.646.553,00 42.685.753,00 - 1.039.200,00

2. TELEPHONE INSTALATION
CABLE
1. Junction Box Telephone 1st ( JB-T.1) 20 pair
Jelly Cable Non Armoured 50 x 4 x 0.6 mm2 40 m 74.500,00 2.980.000,00 40 m 74.500,00 2.980.000,00 - - Tetap
FIXTURES & INSTALATION
1. Telephone Outlet 1 point 223.700,00 223.700,00 1 point 223.700,00 223.700,00 - - Tetap
2. Telephone Installation 1 point 954.528,00 954.528,00 1 point 954.528,00 954.528,00 - - Tetap
3. Hand set analog (standard) 1 pcs 929.160,00 929.160,00 1 pcs 929.160,00 929.160,00 - - Tetap
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test - TLP 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL INSTALATION TELEPHONE 6.022.388,00 6.022.388,00
1 2 3 4 5 6 7 8 9 10 11 12 13

3. FIRE ALARM INSTALATION

1. Interkoneksi Pressure Fan 1 lot 3.140.000,00 3.140.000,00 1 lot 3.140.000,00 3.140.000,00 - - Tetap
2. Interkoneksi AC 1 lot 3.140.000,00 3.140.000,00 1 lot 3.140.000,00 3.140.000,00 - - Tetap
3. Interkoneksi Pemadam 1 lot 3.140.000,00 3.140.000,00 1 lot 3.140.000,00 3.140.000,00 - - Tetap
4. Interkoneksi sound system 1 lot 3.140.000,00 3.140.000,00 1 lot 3.140.000,00 3.140.000,00 - - Tetap
5. Pekerjaan Grounding 1 lot 4.000.000,00 4.000.000,00 1 lot 4.000.000,00 4.000.000,00 - - Tetap
Junction Box FA
1. Junction Box Fire Alarm 1st ( JB-FA) 1 unit 735.000,00 735.000,00 1 unit 735.000,00 735.000,00 - - Tetap
CABLE
1. Junction Box Fire Alarm 1st ( JB-FA.1) 58 m 60.700,00 3.535.775,00 58 m 60.700,00 3.535.775,00 - - Tetap
- Cable NYBY 8 x 1.5 mm2
Fixtures & Armatures
1. - ROR Heat Detector 13 pcs 200.140,00 2.601.820,00 13 pcs 200.140,00 2.601.820,00 - - Tetap
2. - Alarm Bell 1 pcs 358.400,00 358.400,00 1 pcs 358.400,00 358.400,00 - - Tetap
3. - Manual Break Glass Push Button 1 pcs 368.800,00 368.800,00 1 pcs 368.800,00 368.800,00 - - Tetap
4. - Indicating Lamp 1 pcs 389.182,10 389.182,10 1 pcs 389.182,10 389.182,10 - - Tetap
Instalation fixtures c/w conduit,cable & acc
1. - ROR Heat Detector Instalation 13 point 391.300,00 5.086.900,00 13 point 391.300,00 5.086.900,00 - - Tetap
3. - Smoke Detector Instalation point 391.300,00 - - point 391.300,00 - - - Tetap
2. - Alarm Bell instalation 1 point 391.300,00 391.300,00 1 point 391.300,00 391.300,00 - - Tetap
3. - Manual Break Glass Push Button instalation 1 point 391.300,00 391.300,00 1 point 391.300,00 391.300,00 - - Tetap
4. - Indicating Lamp instalation 1 point 391.300,00 391.300,00 1 point 391.300,00 391.300,00 - - Tetap
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test - FA 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL FIRE ALARM INSTALATION 31.744.777,10 31.744.777,10

4. SOUND SYSTEM INSTALATION

1. Junction Box Sound System 1 unit 934.858,87 934.858,87 1 unit 934.858,87 934.858,87 - - Tetap
CABLE
1. Junction Box Sound System
NYMHY 4 x 2,5 mm2 42 m 40.800,00 1.720.944,00 42 m 40.800,00 1.720.944,00 - - Tetap
FIXTURES & INSTALATION
Fixtures & Armatures
1. - Ceiling speaker 6 watt TOA Type ZS-646R or equal 8 pcs 210.000,00 1.680.000,00 8 pcs 210.000,00 1.680.000,00 - - Tetap
2. - Volume Control 6 Watt 8 pcs 388.700,00 3.109.600,00 8 pcs 388.700,00 3.109.600,00 - - Tetap
Installation fixtures c/w conduit,cable & acc
1. - installation Ceiling speaker 8 point 447.190,00 3.577.520,00 8 point 447.190,00 3.577.520,00 - - Tetap
2. - installation Volume Control 8 point 447.190,00 3.577.520,00 8 point 447.190,00 3.577.520,00 - - Tetap
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL SOUND SYSTEM INSTALATION 15.535.442,87 15.535.442,87

5. DATA SYSTEM INSTALATION (IT)

FIXTURES & INSTALATION
1. Outlet Data Cat.6 1 pcs 226.400,00 226.400,00 1 pcs 226.400,00 226.400,00 - - Tetap
2. Router Wireless (Linksys 500 MBps) 1 pcs 1.910.000,00 1.910.000,00 1 pcs 1.910.000,00 1.910.000,00 - - Tetap
3. Pemasangan Kabel Data dari Switch ke Outlet , 1 Point 1.106.225,08 1.106.225,08 1 Point 1.106.225,08 1.106.225,08 - - Tetap
Conduit dan Aksesories pendukung lainnya.
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test - DATA 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL DATA SYSTEM INSTALATION 4.177.625,08 4.177.625,08
1 2 3 4 5 6 7 8 9 10 11 12 13

6. CCTV INSTALATION
FIXTURES & INSTALATION
1. High Resolution Dome Camera, include Accessories 6 pcs 5.026.500,00 30.159.000,00 6 pcs 5.026.500,00 30.159.000,00 - - Tetap
2. Installation CCTV 6 point 907.140,20 5.442.841,20 6 point 907.140,20 5.442.841,20 - - Tetap
3. Socket outlet 200VA for camera 6 point 66.499,73 398.998,38 6 point 66.499,73 398.998,38 - - Tetap
4. Installation Cable NYMHY 3 x 1.5 mm² for Socket Outlet 200 VA 6 point 424.160,20 2.544.961,20 6 point 424.160,20 2.544.961,20 - - Tetap
TOTAL CCTV INSTALATION 38.545.800,78 38.545.800,78
7. MATV
SUB DISTRIBUTOR
1. Kabel RG-11/7C dari ruang kontrol ke Splitter 1st floor 27 m 26.200,00 719.452,00 27 m 26.200,00 719.452,00 - - Tetap
2. Coupler 2 way 1 nos 153.068,10 153.068,10 1 nos 153.068,10 153.068,10 - - Tetap
3. Splitter 4 way 1 nos 250.480,20 250.480,20 1 nos 250.480,20 250.480,20 - - Tetap
4. Televisi 40'' 2 Buah 4.000.000,00 8.000.000,00 2 Buah 4.000.000,00 8.000.000,00 - - Tetap
5. TV Outlet 2 nos 230.600,00 461.200,00 2 nos 230.600,00 461.200,00 - - Tetap
6. Instalasi TV Outlet dengan Kabel RG-6/C dalam Conduit 2 point 740.600,00 1.481.200,00 2 point 740.600,00 1.481.200,00 - - Tetap
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test - EL 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL MATV INSTALATION 12.000.400,30 12.000.400,30
8. ELECTRONIC CABLE TRAY
Electronic Tray Cable on Ceiling
1. Cable Tray 200x50x2 mm 41 m 160.680,00 6.578.239,20 41 m 160.680,00 6.578.239,20 - - Tetap
2. Tee Cable Tray 200x50x2 mm 1 pcs 192.361,10 192.361,10 1 pcs 192.361,10 192.361,10 - - Tetap
4. Accessories Cable Tray 1 lot 340.000,40 340.000,40 1 lot 340.000,40 340.000,40 - - Tetap
TESTING & COMMISSIONING
Continiue, Megger, Grounding & Function Test - EL 1 Ls 935.000,00 935.000,00 1 Ls 935.000,00 935.000,00 - - Tetap
TOTAL ELECTRONIC TRAY CABLE INSTALATION 8.045.600,70 8.045.600,70

9. DIGIPEATER (PENGUAT SIGNAL GSM & 3G)

1. Eksternal Antenna 1 set 4.085.000,00 4.085.000,00 1 set 4.085.000,00 4.085.000,00 - - Tetap
2. Indoor ceilling Antenna 2 pcs 1.810.500,00 3.621.000,00 2 pcs 1.810.500,00 3.621.000,00 - - Tetap
3. Splitter 1 pcs 513.556,10 513.556,10 1 pcs 513.556,10 513.556,10 - - Tetap
4. Booster include adaptor 1 pcs 2.600.500,00 2.600.500,00 1 pcs 2.600.500,00 2.600.500,00 - - Tetap
5. Installation cabel RG 11 in conduit 2 point 790.300,30 1.580.600,60 2 point 790.300,30 1.580.600,60 - - Tetap
TOTAL DIGIPEATER INSTALATION 12.400.656,70 12.400.656,70
TOTAL SEWAGE WATER INSTALLATION 170.119.244,53 171.158.444,53 - 1.039.200,00 -

A STRUKTUR DAN ARSITEKTUR 1.440.071.266,87 1.440.033.003,14 (48.322.315,20) 48.284.051,48

B MEKANIKAL 481.219.022,84 480.217.862,84 (1.001.160,00) -
C ELEKTRIKAL 170.119.244,53 171.158.444,53 1.039.200,00
TOTAL 2.091.409.534,24 2.091.409.310,51 (49.323.475,20) 49.323.251,48
PPn 11% 230.055.048,77 230.055.024,16 (5.425.582,27) 5.425.557,66
JUMLAH TOTAL 2.321.464.583,00 2.321.464.334,67 (54.749.057,47) 54.748.809,14
DIBULATKAN 2.321.464.000,00 2.321.464.000,00 (54.750.000,00) 54.748.000,00

- Andoolo, 18 Agustus 2019Welala ,

Mengetahui / Menyetujui :
Pejabat Pembuat Komitmen (PPK) Pejabat Pelaksana Teknis Kegiatan (PPTK) Diperiksa Oleh Dibuat Oleh
Rumah Sakit Umum Daerah (RSUD) Rumah Sakit Umum Daerah (RSUD) Konsultan Pengawas Kontraktor Pelaksana
Kab. Kalaka Timur Kab. Kalaka Timur CV. MEGA KONSULTAN CV. SOLATA PERKASA

DR. ABDUL MUNIR ABUBAKAR ASRIAWAN DARANGA, S.Km SYAMSUL ALAM, ST ADRIANUS ERWIN RAMANG
Nip. 19830324 201001 1 001 NIP. 19830518 201001 1 017 Direktur Direktur