LAMPIRAN PSP

KEPOLISIAN NEGARA REPUBLIK INDONESIA LAMPIRAN SURAT KAPOLDA JATIM
DAERAH JAWA TIMUR NOMOR :B/ /XI/LOG.8.1./2021

TANGGAL : NOVEMBER 2021
DAFTAR BMN RANMOR RODA 2 RUMAH SAKIT BHAYANGKARA H.S. SAMSOERI MERTOJOSO
YANG DIAJUKAN PENETAPAN STATUS PENGGUNAAN TAHUN 2021
KODE JML TAHUN HARGA KONDISI

N0 JENIS MEREK / TIPE NOKA NOSIN NUP
BARANG UNIT PEROLEHAN PEROLEHAN BARANG
1 2 3 4 5 6 7 8 9 10 11
1 3.02.01.05.086 Mobil Patroli Double Cabin Triton 2.5 MMBJNKKL30KH056754 4D56UAZ4610 1 1 26-10-2020 390,200,000 Baik
2 3.02.01.05.094 Mobil Unit Identifikasi Isuzu NMR MHCNMR71LLJ115246 B115246 1 1 16-09-2020 4,569,256,368 Baik
KODE JML TAHUN HARGA KONDISI

N0 JENIS MEREK / TIPE SATUAN NUP
BARANG UNIT PEROLEHAN PEROLEHAN BARANG
1 2 3 4 5 6 7 8 9 10
1 3.07.01.10.073 Hi-flow Antibiotic Nebulizer Solution Unit BYOND HiFres-High Flow Heated Respiratore Humidifi Unit 2 1 01-09-2021 130,000,000 Baik
2 3.07.01.13.005 Patient Monitor GE MS B850V3 + CS1 6P WITH ACCESSORRIES Unit 67 1 01-09-2021 278,060,532 Baik
6 3.07.01.24.004 Icu Bed Electric Electric Delivery Bed Type PD-200 Unit 263 1 01-09-2021 113,067,955 Baik
7 3.07.01.24.004 Icu Bed Electric Electric Delivery Bed Type PD-200 Unit 264 1 01-09-2021 113,067,954 Baik
8 3.01.03.03.001 Transportable Compressor MMC/HMC 100 A Unit 3 1 10/15/2000 111,045,000 Baik
9 3.01.03.03.001 Transportable Compressor MMC/HMC 100 A Unit 4 1 10/15/2000 111,045,000 Baik
10 3.05.01.05.007 CCTV - Camera Control Television System PASANG CCTV DLL SET 3 1 4/11/2018 169,238,993 Baik
11 3.05.01.05.056 Panic Button System, Alarm Indicator FIRE ALRM DAN KELENGKAPANNYA + GAS MEDIS SET 11 1 4/11/2018 173,176,000 Baik
12 3.05.02.01.008 Meja Rapat MEJA + MEBELAIR SET MANAGEMENT SET 6 1 12/30/2019 171,374,500 Baik
13 3.05.02.04.001 Lemari Es MEDICAL VACCINE REFRIGENERATOR TCW 3000 AC/KULKAS Unit 65 1 3/31/2020 108,026,048 Baik
14 3.05.02.06.058 Gordyin/Kray GORDEN MANAGENET LT.3 Unit 93 1 12/30/2019 120,876,910 Baik
15 3.05.02.06.058 Gordyin/Kray GORDEN MANAGEMENT LT.3 Unit 94 1 12/30/2019 115,304,640 Baik
16 3.05.02.06.071 Kabel KABEL NYY 300 METER Unit 1 1 12/30/2017 182,999,999 Baik
17 3.05.02.06.071 Kabel KABEL NYY + PIPA Unit 2 1 11/30/2018 121,968,750 Baik
18 3.05.02.06.071 Kabel KABEL NYY 4X95 MM Unit 3 1 11/30/2018 198,941,600 Baik
19 3.06.01.02.086 Alat Pemanas Prosesing ( Water Heater ) AIR PURIFIER Unit 3 1 12/28/2018 116,600,000 Baik
20 3.06.03.47.002 Genset KUBIKAL + TEMBAH DAYA LISTRIK Unit 1 1 12/30/2017 1,522,829,148 Baik
21 3.06.03.47.002 Genset PERKINS Unit 2 1 12/30/2017 673,001,574 Baik
22 3.06.03.47.002 Genset INSTALASI GENSET 800KVA Unit 4 1 12/28/2018 2,199,464,780 Baik
23 3.07.01.01.119 Pulse Oximeter OXFORD/NOVAMETRIK CO2 SINO Unit 23 1 10/15/2000 150,538,000 Baik
26. 3.07.01.01.119. ….
2 LAMPIRAN SURAT KAPOLDA JATIM
NOMOR :B/ /XI/LOG.8.1./2021
1 2 3 4 5 6 7 8 9 10
27 3.07.01.02.001 Dental Chair FEDESA/TEREZ9C05 BUAH 3 1 10/15/2000 178,886,000 Baik
28 3.07.01.02.001 Dental Chair FEDESA/TEREZ9C05 BUAH 4 1 10/15/2000 178,886,000 Baik
29 3.07.01.02.001 Dental Unit FEDESA BUAH 2 1 10/15/2000 178,886,000 RB
30 3.07.01.04.005 Orthopedy Set ACF, TURKEY BUAH 1 1 9/10/2018 925,971,862 Baik
31 3.07.01.04.012 Operating Table Bedah BenQ, Taiwan BUAH 3 1 9/10/2018 1,368,657,950 Baik
32 3.07.01.04.013 Electro Surgery Unit Electro surgery Unit BUAH 3 1 10/30/2017 490,724,076 Baik
33 3.07.01.04.013 Electro Surgery Unit System 5000 / Conmed, USA BUAH 6 1 9/11/2019 577,512,000 Baik
34 3.07.01.04.014 Endoscopy Unit Endoscopy set Unit 3 1 10/30/2017 7,802,164,267 Baik
35 3.07.01.04.020 Operating Microscope (Alat Kedokteran Bedah) TOPCON, JAPAN Unit 1 1 9/10/2018 2,334,769,445 Baik
36 3.07.01.04.016 Instalasi Gas Medik INSTALASI O2 R. OK Unit 1 1 12/30/2016 199,830,569 Baik
37 3.07.01.04.024 Mobile X-Ray C-Arm TOSHIBA Unit 1 1 10/30/2017 1,870,750,437 Baik
38 3.07.01.04.073 Electric Cauter BOWA, GERMANY Unit 2 1 9/10/2018 563,565,038 Baik
39 3.07.01.04.126 Meja Operasi Minor MEJA OP WITH SLIDDING Unit 2 1 12/30/2016 325,000,000 Baik
40 3.07.01.04.141 Orthopedi Instrument Set SCHREIBER, GERMANY Unit 9 1 9/10/2018 248,774,521 Baik
41 3.07.01.04.141 Orthopedi Instrument Set Various / Dewimed, Germany Unit 10 1 9/11/2019 227,114,000 Baik
42 3.07.01.04.141 Orthopedi Instrument Set Various / Dewimed, Germany Unit 11 1 9/11/2019 259,599,000 Baik
43 3.07.01.04.155 Retractor cranial&retractor Unit 1 1 10/30/2017 1,334,325,297 Baik
44 3.07.01.04.161 Set Laparoscope Laparoscopy Unit 1 1 10/30/2017 3,572,050,810 Baik
45 3.07.01.04.177 Surgical Slym VALLEY LAB Unit 2 1 10/9/2014 198,446,700 Baik
46 3.07.01.05.003 Caesarean Section Set Various / Dewimed, Germany Unit 5 1 9/11/2019 227,695,000 Baik
47 3.07.01.05.060 Baby Incubator (Alat Kesehatan Kebidanan Dan GUIDO RX/NESORET 5050 Unit 6 1 10/15/2000 210,261,000 Baik
50 3.07.01.05.062 Adult Volume Ventilator MMC/HMC 1500 A Unit 8 1 10/15/2000 600,956,000 Baik
51 3.07.01.05.062 Adult Volume Ventilator MMC/HMC 1500 A Unit 9 1 10/15/2000 600,956,000 Baik
52 3.07.01.05.062 Adult Volume Ventilator SIEMENS Unit 10 1 10/15/2000 440,508,000 Baik
53 3.07.01.05.079 Colposcope (alat Kesehatan Kebidanan MEDGYN NST DAN DIGITAL COLPOSCOPE Unit 1 1 9/28/2018 117,775,500 Baik
54 3.07.01.05.079 Colposcope (alat Kesehatan Kebidanan MEDGYN NST DAN DIGITAL COLPOSCOPE Unit 2 1 9/28/2018 117,775,500 Baik
55 3.07.01.06.005 Tonsilectomy Set TENSILIECTOMY MICROLINE Unit 3 1 4/13/2017 198,000,000 Baik
56 3.07.01.06.006 Audiometer (Alat Kedokteran Tht) EYMASA/AUDI ++FF Unit 4 1 10/15/2000 143,619,000 Baik
57 3.07.01.06.006 Audiometer (Alat Kedokteran Tht) SIBELSOUND Unit 5 1 6/15/2016 191,100,000 Baik
58 3.07.01.06.011 ENT Treatment EYMASA/SEVERAL Unit 3 1 10/15/2000 260,459,000 Baik
59 3.07.01.06.011 ENT Treatment EYMASA/SEVERAL Unit 4 1 10/15/2000 260,459,000 Baik
60 3.07.01.07.055 Cataract Instrument Set INSTRUMENT MATA GEUDER Unit 1 1 9/27/2019 119,903,818 Baik
61. 3.07.01.07.061. ….

1 2 3 4 5 6 7 8 9 10 11
61 3.07.01.07.061 Echoscan, Usg Mata NIDEK JAPAN USG Biometry + Pachymatry/US 4000 Unit 1 1 11/30/2018 392,700,000 Baik
62 3.07.01.08.023 Bronchoscope (Alat Kedokteran Bagian Various / Fujinon Fujifilm, Japan Unit 1 1 9/11/2019 2,213,206,000 Baik
63 3.07.01.08.030 Ultra Sono Graphy (USG) Internal Medic SA-8000, MEDISON Unit 4 1 5/7/2007 1,311,310,000 Baik
64 3.07.01.08.030 Ultra Sono Graphy (USG) Internal Medic TOSHIBA Unit 5 1 6/25/2015 969,000,000 Baik
65 3.07.01.08.030 Ultra Sono Graphy (USG) Internal Medic USG 4D Unit 7 1 10/30/2017 1,684,633,070 Baik
66 3.07.01.08.033 Ventilator Internal Medicine MURACO, JAPAN Unit 3 1 5/25/2010 211,750,000 Baik
67 3.07.01.08.033 Ventilator Internal Medicine TECME Unit 4 1 10/25/2012 841,638,828 Baik
68 3.07.01.08.068 Defibrilator REANIDEX5 Unit 4 1 10/15/2000 107,021,000 Baik
69 3.07.01.08.068 Defibrilator REANIDEX5 Unit 5 1 10/15/2000 107,021,000 Baik
70 3.07.01.08.068 Defibrilator INNOMED MEDICAL Unit 6 1 10/25/2012 240,378,828 Baik
71 3.07.01.08.068 Defibrilator NIHON Unit 7 1 6/15/2016 180,015,000 Baik
72 3.07.01.08.068 Defibrilator BRIPSHIC Unit 8 1 12/30/2016 129,800,000 Baik
73 3.07.01.08.068 Defibrilator DEFIB DEFIMAX Unit 9 1 12/30/2017 129,800,000 Baik
74 3.07.01.10.067 Pediatric/Infant Ventilator (Alat Kedokte NEUMOVENT/GRAPH Unit 6 1 1/25/2011 493,350,000 Baik
75 3.07.01.10.067 Pediatric/Infant Ventilator (Alat Kedokte NEUMOVENT Unit 7 1 10/30/2017 1,193,687,698 Baik
76 3.07.01.10.074 Incubator Transport Transport Incubator TI 500 Unit 1 1 11/30/2018 225,832,000 Baik
77 3.07.01.12.013 Electro Stimulation & Analgesia PHYSIOSON EXPERT (US) Unit 1 1 12/28/2015 171,600,000 Baik
78 3.07.01.12.037 Short Wave Diathermy ENRAF NONIUS Unit 2 1 10/15/2000 153,516,000 Baik
79 3.07.01.12.037 Short Wave Diathermy PHYSIOTHERM / SWD Unit 3 1 3/4/2016 175,500,000 Baik
80 3.07.01.12.037 Short Wave Diathermy PHYSIOTHERM S (SWD) Unit 5 1 3/31/2020 143,316,000 Baik
81 3.07.01.12.042 Tread Mill Treatment MARQUETTE/CABE 8000 Unit 2 1 10/15/2000 374,811,000 Baik
82 3.07.01.12.043 Ultra Saound Theraphy EU-941 (CHANNEL ELECTROYHERAPY+1 CHANNEL ULTRASOUN Unit 1 1 3/31/2020 202,025,000 Baik
83 3.07.01.13.005 Patient Monitor INNOMED, HUNGARY Unit 19 1 10/2/2011 219,009,026 Baik
84 3.07.01.13.005 Patient Monitor INNOMED MEDICAL Unit 22 1 10/25/2012 219,038,828 Baik
85 3.07.01.13.005 Patient Monitor GE B850 w/4IBP & CO (Critical Care) Unit 40 1 11/30/2018 284,570,000 Baik
86 3.07.01.13.005 Patient Monitor BSM 3562 / Nihon Kohden, Japan Unit 42 1 9/11/2019 278,285,000 Baik
87 3.07.01.13.005 Patient Monitor BSM 3562 / Nihon Kohden, Japan Unit 43 1 9/11/2019 278,285,000 Baik
88 3.07.01.14.004 Central Gas CENTRAL O2 RUANG ANGGREK Unit 1 1 12/30/2017 443,612,537 Baik
89 3.07.01.14.005 Central Suction (Alat Kedokteran Jantun LOKAL Unit 1 1 12/30/2016 198,500,000 Baik
90 3.07.01.14.026 Ekg Elektro Photo Cardiograph For Reco EKG SYSTEM WITH ACC Unit 1 1 5/9/2017 411,584,118 Baik
91 3.07.01.14.035 Mobile X-Ray & Image Int. MOBILE X-RAY, TOSHIBA Unit 1 1 12/1/2015 933,000,000 Baik
92 3.07.01.15.007 CT-Scan GEC PICKER Unit 2 1 10/15/2000 1,140,982,000 RB
93 3.07.01.15.014 MRI (Magnitic Resonanse/Imaging) Vantage Elan / Canon, JAPAN Unit 1 1 8/17/2018 28,711,753,282 Baik
94 3.07.01.15.017 X-Ray Mobile Unit PICKER METEORE I Unit 2 1 10/15/2000 314,733,000 RB
95 3.07.01.15.018 Radiology Unit (rongent) COMPUTING RADIOGRAPHY SYSTEM Unit 2 1 12/28/2015 974,055,500 Baik
96 3.07.01.16.003 Autopsi Set (Post Mortem Dissectiong S MATHACHANA Unit 2 1 10/15/2000 142,391,000 Baik
97. 3.07.01.16.018. ….

1 2 3 4 5 6 7 8 9 10 11
97 3.07.01.16.018 CT Scanner CT SCAN Unit 1 1 11/4/2016 14,827,025,323 Baik
98 3.07.01.19.064 Air Flow Incubator Norm-O-Temp / CSZ, USA Unit 1 1 9/11/2019 508,298,000 Baik
99 3.07.01.19.067 Blood Conting Instrument INSTRUMEN BANK DARAH Unit 1 1 11/14/2017 187,943,250 Baik
100 3.07.01.19.109 Urology Set Urology Set / Richard Wolf / Germany Unit 1 1 9/11/2019 6,859,809,000 Baik
101 3.07.01.21.008 Blanket Roll Cincinnati Sub zero (CSZ), USA Unit 1 1 9/10/2018 483,051,606 Baik
102 3.07.01.21.024 ENT Treatment Unit EUROCLINIC, ITALY Unit 1 1 9/10/2018 1,339,904,632 Baik
103 3.07.01.21.028 Infant Ventilator GUIDO RX Unit 3 1 10/15/2000 230,408,000 Baik
104 3.07.01.21.028 Infant Ventilator GUIDO RX Unit 4 1 10/15/2000 230,408,000 Baik
105 3.07.01.23.004 Boor Reamer BOOR ORTHO SET COLIBRI II Unit 1 1 12/1/2015 582,541,000 Baik
106 3.07.01.23.010 Hand Driil Feet Contrak High speed drill Unit 1 1 10/30/2017 691,627,467 Baik
107 3.07.01.23.013 Reduction Forceps REDUCTION FORCEPS Unit 4 1 10/15/2000 21,873,798,000 Baik
108 3.07.01.25.002 Central Oxygen CENTRAL O2 R. VVIP Unit 3 1 10/31/2018 160,611,224 Baik
109 3.07.01.28.001 Anesthesi Apparatus Prima 400/ Penlon, UK Unit 3 1 9/10/2018 1,326,103,039 Baik
110 3.07.01.28.001 Anesthesi Apparatus AONMED ANASTHESIA MACHINE Unit 4 1 6/15/2016 315,000,000 Baik
111 3.07.02.01.014 O 2, N 2 Blood Analyzer AVL / OPTI-1 Unit 2 1 10/15/2000 198,248,000 Baik
112 3.08.01.11.115 Autoclave Unit (Alat Laboratorium Umu AUTOCLAVE TUTTNAUER NEDHERLAND Unit 5 1 12/28/2015 250,330,003 Baik
113 3.08.01.11.118 Microscope Dengan Camera Full spec Microscop Unit 1 1 10/30/2017 11,689,201,599 Baik
114 3.08.01.12.062 Loop Sterilizer GENANO, FINLAND Unit 1 1 9/10/2018 327,787,829 Baik
115 3.08.01.12.069 Hematology Analyzer ( Blood Cell Count AVL / AUTOLYZER AL-808 Unit 2 1 10/15/2000 363,055,000 Baik
116 3.08.01.41.183 Operating Table+Overhead Light MATACHANA Unit 3 1 10/15/2000 159,090,000 Baik
117 3.08.01.41.183 Operating Table+Overhead Light MATACHANA Unit 4 1 10/15/2000 159,090,000 Baik
118 3.08.01.56.017 Alat Pengolah Air Limbah IPAL Unit 2 1 7/1/2012 404,250,000 Baik
119 3.08.02.05.001 Generator Set (Lab Scale) SUAREZ Unit 4 1 10/15/2000 179,039,000 Baik
122 3.08.02.05.002 X-Ray Machine & Control GEC PICKER Unit 2 1 10/15/2000 1,427,642,000 RB
123 3.10.01.01.007 PC Workstation PROGRAM SIM RS Unit 1 1 12/25/2017 130,482,000 Baik
JUMLAH 151,439,851,823
Surabaya, November 2021
a.n. KEPALA KEPOLISIAN DAERAH JAWA TIMUR

KAROLOG

KAROLOG

PRANYOTO, S.I.K., S.H., M.H.
KOMISARIS BESAR POLISI NRP 68040527
LAMPIRAN SURAT KAPOLDA JATIM
4,959,456,368
8,015,884,978
26,896,441,790

46,201,710,715

65,366,357,972

KAROLOG

KAROLOG

PRANYOTO, S.I.K., S.H., M.H.
KOMISARIS BESAR POLISI NRP 68040527

LAMPIRAN PSP

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KEPOLISIAN NEGARA REPUBLIK INDONESIA LAMPIRAN SURAT KAPOLDA JATIM

DAERAH JAWA TIMUR NOMOR :B/ /XI/LOG.8.1./2021

KODE JML TAHUN HARGA KONDISI

KODE JML TAHUN HARGA KONDISI

3 LAMPIRAN SURAT KAPOLDA JATIM

4 LAMPIRAN SURAT KAPOLDA JATIM

Surabaya, November 2021

a.n. KEPALA KEPOLISIAN DAERAH JAWA TIMUR

a.n. KEPALA KEPOLISIAN DAERAH JAWA TIMUR

LAMPIRAN SURAT KAPOLDA JATIM

LAMPIRAN SURAT KAPOLDA JATIM

Surabaya, November 2021

a.n. KEPALA KEPOLISIAN DAERAH JAWA TIMUR

a.n. KEPALA KEPOLISIAN DAERAH JAWA TIMUR

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