15. dok. pq pengawasan teknis jembatan di pulau buru 2

8/19/2019 15. Dok. PQ Pengawasan Teknis Jembatan Di Pulau Buru 2

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REPUBLIK INDONESIA

KEMENTERIAN PEKERJAAN UMUM DAN

PERUMAHAN RAKYATDIREKTORAT JENDERAL BINA MARGA

DOKUMEN KUALIFIKASI

JASA KONSULTANSI

Paket Pekerjaan :

Nomo

rPaket

Nama Paket

! PENGA"ASAN TEKNIS JEMBATAN DI PULAU BURU #

Ta$%n #&'

BALAI PELAKSANAAN JALAN NASIONAL IX (Maluku & Maluku Utara)


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UNIT LAYANAN PENGADAAN

KELOMPOK KERJA PENGADAAN JASA KONSULTANSI

PROVINSI MALUKU

2

Dku!"# Kual$%ka$ Jaa K#ulta#$


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DAFTAR ISI

BAB I UMUM ...................................................................................................................................1

BAB II PENGUMUMAN PRAKUALIFIKASI .................................................................................4

BAB III INSTRUKSI KEPADA PESERTA (IKP) ...............................................................................6

A. UMUM ......................................................................................................................6

B. DOKUMEN KUALIFIKASI .....................................................................................7

C. PENYIAPAN DOKUMEN ISIAN KUALIFIKASI ..................................................8

D. PEMASUKAN DOKUMEN ISIAN KUALIFIKASI'''''''''''''''''''''''''''''''''''''''''10

E. EVALUASI KUALIFIKASI ......................................................................................10

F. HASIL KUALIFIKASI .............................................................................................1

BAB IV LEMBAR DATA KUALIFIKASI (LDK) ..............................................................................1!

BAB V BENTUK PAKTA INTEGRITAS ..........................................................................................1"

BAB VI BENTUK FORMULIR ISIAN KUALIFIKASI ....................................................................17

BAB VII PETUN#UK PENGISIAN FORMULIR KUALIFIKASI .....................................................

BAB VIII

BAB I$

BENTUK SURAT PER#AN#IAN KEMITRAAN%KER#A SAMA

OPERASI (KSO) ...................................................................................................................

TATA CARA EVALUASI KLASIFIKASI ............................................................................

4

6



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BAB I

UMUM

A. D&'*+ K,-/', + + +2' *3,+2 **52, ,-, *+,',+ ,2, ',-/', ,+ ,

B. D,-, &'*+ + +,',+ *+*52,+ 2-,9 ,+ +',2,+ *3,, 3*5'2:

- Jasa Konsultansi

- Jasa Konsultansi Konstruksi

,,-,9 ;,, -,,+,+ 5&/*&+,- ,+ *329',+ '*,9-,+ 2

*+2,,',+ ,,+, &-,9 '5 (brain ware).<

,,-,9 -,,+,+ ;,, '&+-2,+ *5*+=,+,,+ *'*5;,,+ '&+25' ,+ -

'&+25' ,+ *-2 '**-59,+ ,2, *3,,+ 5,+',,+ '*

*+=,' ;,, '&+-2,+ *'*5;,,+ ,52*'25,- - *',+',- *

3**52, '*-*+',,++, +2' *>;',+ ,2 3,++,+ ,2, 3*+2

- HPS ,,-,9 *592+,+ *5'5,,+ 3,, *-59 *'*5;,,+ ,+ +

'*,9-,+ 3*5,,5',+ ,2, ,+ ,,2 *52,++;,>,3',+ ,9 2

,+ 3*3,+ ,;,'<

- Kemitraan/ Kerja Sama

Operasi(KSO

- Hari

- PA

-

KPA

- ULP

- Pokja ULP

,,-,9 '*5;, ,, ,9, ,+2,5 *+*, 3,' *+*, +,&+,- ,

*+, 9,' '*>,;3,+ ,+ 2,++ ;,>,3 ,+ ;*-, 3*5,,5',+

,,-,9 9,5 ',-*+*5 +2' 5&* *-*' *=,5, *-*'25&+' ,+ 3,2, ,'

,,-,9 P*++, A+,5,+ ,+ *5,',+ *;,3,2 **,+ '*>*

L*3,, % S,2,+ K*5;, P*5,+',2 D,*5,9 ,2, P*;,3,2 ,+ ,,',

,,-,9 K,, P*++, A+,5,+ ,+ *5,',+ *;,3,2 ,+ 2*2,

,2, 2*2,',+ &-*9 K*,-, D,*5,9 +2' *++,',+ APBD<

,,-,9 U+2 L,,+,+ P*+,,,+ ,+ 3*+2' &-*9 M*+2*5 % P

I+22 ,+ 3*5/+ *-,',+,',+ *+,,,+ 3,5,+%;,, ,+ 3*5

*-*',2 ,, +2 ,+ ,9 ,,<

,,-,9 K*-&&' K*5;, ULP *5,+',2 ,5 ULP ,+ + ,+

*-,',+,',+ P*-9,+ P*+*, B,5,+%#,,. A+&2, P&';, ULP 2*

D,*5,9<

,,-,9 L*3,5 D,2, K,-/', ,+ *,2 '*2*+2,+ ,+ +/&5,

*5-',+ *+*, 3,5,+%;,, ,+2,5, -,+ ,-, *+,,',+ *+

,'2, +2*52,<

,,-,9 A,5,2 P*+,>,,+ I+2*5+ P**5+2,9 (APIP) ,+ *-,+;2+,

P**5+2,9 D,*5,9 % I+22 3*52, *-,'',+ *+,>,,+ *-'*,2,+ *+,>,,+ -,+ 2*59,, *+*-*+,5,,+ 2, ,+ /+ &

,,-,9 3,,+ ,9, ,+ *+*,',+%*-,',+,',+ P*'*5;,,+ #,, K


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- LDK

- APIP

- Penyeia

- PPK

- K/L/D/I

,,-,9 P*;,3,2+ P*3,2 K&2*+ ,+ 3*52,++ ;,>,3 ,2, *-,

,,-,9 K**+2*5,+ % L*3,, % S,2,+ K*5;, P*5,+',2 D,*5,9 % I+2

,+ B*-,+;, N*,5, (APBN) ,+%,2, A+,5,+ P*+,,2,+ ,+ B*-,+

- LPS! L,,+,+ P*+,,,+ S*=,5, E-*'25&+' ,,-,9 +2 '*5;, K%L%D%I ,

*-,,+,+ *+,,,+ 3,5,+%;,, *=,5, *-*'25&+'<

Aplikasi SPS! ,-', *5,+',2 -+,' S2* P*+,,,+ S*=,5,E-*'25&+' 3*53, >*3 ,+ 2*5,,+ *5@*5 LPSE

,+ ,,2 ,'* *-,- >*32* LPSE<

- "orm Isian !lektronik

- "orm Isian !lektronik Data

Kuali#ikasi

2,-,+%,+2,5 ', *,', 3*53*+2' 5,/ 3*5 '&&+*+ ,+

/&5 ,+ *-*'25&+' ,, ,-', SPSE ,+ +,',+ *+

*+5',+ ,2, ',-/',.

C. P*+,,,+ *-,- 5,',-/', + 3,, ,5 3*5 *+,+,,+ ,+ 2*5=,+2 ,-, LDK.

D. P5,',-/', + 2*53', ,+ ,,2 '2 &-*9 *, **52, 2+,- ,2, '*25,,+%KSO.

2



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BAB II

P!$%UMUMA$ P&AKUALI"IKASI

KEMENTERIAN PEKERJAAN

UMUM DAN PERUMAHANRAKYAT

DIREKTORAT JENDERAL BINAMARGA

BALAI PELAKSANAAN JALAN NASIONAL I( MALUKU DAN MALUKUUTARA

UNIT LAYANAN PENGADAAN )ULP*KELOMPOK KERJA PENGADAAN JASA KONSULTANSI PRO+INSI MALUKU

Jl#' Ir' M' Puttu*"#a + ,a$l"la T"l-./a0' (133) 4253678 A!9# 625

P !$%UMUMA$ P&AKUALI"IKASI

N&&5 : 01.1"%UMUM.P% BL.I$P#N%%KKP#.K&+?MAL%01"

P&';,P*+,,,+ #,, K&+-2,+ P5&@+ M,-' ULP B,-, P*-,',+,,+ #,-,+ N,&+,- I$

(M,-' M,-' U2,5,) ,, S,2,+ K*5;, B,-, P*-,',+,,+ #,-,+ N,&+,-

I$,',+*-,',+,',+P*+**-*',+U*+,+5,',-/', *+,+ Sistem LPS! "ull

!'Prourement +2' ,'*2 *'*5;,,+ '&+-2,+ *3,, 3*5'2 :

1. P,'*2 P*'*5;,,+

,). N,, P,'*2 : PENGAASAN TEKNIS #EMBATAN DI PULAU BURU

3). N-, HPS : R 1.476.116.000? ( S,2 M-,5 E,2 R,2 T;9 P-9

E+, #2, S*5,2 E+, B*-, R3 R,9 ) 2*5,' PPN

=). S3*5 *+,+,,+ : APBN T,9+ A+,5,+ 016

). L+' *'*5;,,+ : M*+,>, *'*5;,,+ ;,-,+ ,+ ;*3,2,+ ,,5 3*5;,-,+ */*+

,+ */*'2/ *52, *, *+,+ *,+ */', ,++,',+ *3,, ,,5 *-,',+,,+

. P*5,5,2,+ P**52,

P*'*5;,,+ + 2*53', 3, P*+*, #,, K&+-2,+ ,+ **+9 *5,5,2,+ I;+ U,9,

*+,+ K-,/', *3,, 3*5'2 :

Ke)iatan Usa*a +Jasa Konsultansi Konstruksi (Perenanaan /

Pen)a,asan-

Layanan/ Bian) +Jasa !n)ineerin) "ase Konstruksi an Instalasi

.eknik Sipil .ransportasi

Su Layanan/ Su ian) + Jasa Pen)a,as Pekerjaan Konstruksi .eknik

Sipil .ransportasi

*52, ',-/', ,+ *5,5,2,+ -,++, *3,,,+, ,25 ,-, &'*+ ',-/', +.

!. P*+,/2,5,+ ,+ *+,3-,+ D&'*+ ',-/',

(1) P*+,/2,5,+ ,+ *+,3-,+ &'*+ ',-/', -,'',+ ,, 9,5 2,+,- ,+

2*,2 *3,,,+, 2*5=,+2 ,-, >*32* LPSE K**+2*5,+ PU

http://www.pu.go.id ,-', LPSE Full E-Procurement ;

() P**52, 9,5 *+,/2,5',+ 5 *-,- +2*5+*2 ,, >*32* LPSE K**+2*5,+ PU

http://www.pu.go.id , ,-', LPSE Full E-Procurement +2' *+,,2',+ user id

*3,, **52, ,-, P5,',-/', *, ,'*2 ,+ +,2<

(!) P,, ,,2 *+,/2,5 *-,- +2*5+*2 P**52, 9,5 *+=,+2',+%*+

,-,,2%,'+e-mail ,+ N&. F,'-* *5,9,,+ ,+ *5,',+ meia

koresponensi resmi0

(4) A-,,2%,'+ e-mail P&';, ,,-,9: &';,'&+-.,-,-.=&

http://www.pu.go.id/http://www.pu.go.id/http://www.pu.go.id/http://www.pu.go.id/


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(") S*, +/&5, ,',+ ,,',+ *-,- E?,- ,2, F,'-*<

(6) P*+,3-,+ &'*+ ',-/', -,'',+ *+,+ =,5, *++9 (download )

*-,- >*32* LPSE K**+2*5,+ PU http://www.pu.go.id

4. A,3-, ,-, &'*+ ,+,5,+ ,+ 2*-,9 ,9',+ (DIPA 2,9+ ,+,5,+ 016 3*5'2

5*@+,) ,+,+, 2,' 2*5*, ,2, 2,' =' 2*5*, ,+ ,',+ *+,'3,2',+

-,,+, 3,2, ,+,5,+ ,+ 2*5*, +2' '*,2,+ 2*5*32 ,', *-9,+ *+*, 3,5,+%;,, ,+ 2*-,9 -,',+,',+ 3,2,- * 9' ,+ *+*, 3,5,+%;,,

2,' ,,2 *++22 ,+2 5 ,-, 3*+2' ,,+.

". S**&5,+ -,5,+ *>,'- -*39 ,5 1 (,2) *5,9,,+ ,-, *+,/2,5 ,+ *+,3-

D&'*+ P*+,,,+.

D*',+ ,,',+ +2' *+;, *59,2,+.

4 N&@*3*5 01"

P&';, ULP

http://www.pu.go.id/http://www.pu.go.id/http://www.pu.go.id/


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9/49

,+

P*52*

+2,+

,+

K**

+2+,+

*5,++, 9,5 *+9+,5 ,+ *+=*,9

*52*+2,+,+ '**+2+,+ ,5, 9,' ,+ 2*5',2 3,'

*=,5, -,++ ,+ 2,' -,++.

!..P*5,+ '**+2+,+ *3,,,+, ,' ,+', !.1

,2, ,+2,5, -,+ *-2 :

,. S*&5,+ ,+&2, D5*' ,2, D*>,+ K&,5 ,2 B,,+U,9, 2,' 3&-*9 *5,+', *3,, ,+&2, D5*' ,2,

D*>,+ K&,5 ,, B,,+ U,9, -,++, ,+ *+;,

**52, ,, P*-*-,+,+ *'*5;,,+ ,+ ,,<

3. P*+*, ,+ 2*-,9 2+;' *3,, '&+-2,+ ,+,;**+

'&+25' 3*5*5,+ *3,, '&+-2,+ *5*+=,+, ,+%,2,

'&+-2,+ *+,>,<

=. P*+5 '&*5, *,>, ,-, ,2 K%L%D%I ,2, ,+,'

*5,9,,+ ,, BUMN%BUMD ,+ *+'2 P*+,,,+

,+ 3*5,+ *+,+ *5,9,,+ -,++, *5,+', *3,,

,+&2, P&';, ULP ,2, *;,3,2 ,+ 3*5>*+,+

*+*+2',+ **+,+ S*-*'.. PPK ,+%,2, ,+&2, P&';, ULP 3,' -,++ ,+

2,' -,++ *+*+,-',+ ,2, *+;,-,+',+ *5,9,+

3**52,<

*. H3+,+ ,+2,5, (,) *5,9,+ ,+ '*+,-',+ 3,'

-,++ ,+ 2,' -,++ &-*9 9,' ,+ ,, ,2

-*39 ,5 "0 (-, -9 *5 *5,2) **,+ ,9,.

!.!.P*,>, K%L%D%I -,5,+ *+;, **52, '*=,- =2

-,5 2,++,+ K%L%D%I.

4. S,2

D&'*+

K,-

/',

T,

P**52

,

4.1.S*2, **52, 3,' ,2, +,, *+5 ,+ *3,,

,+&2, '*25,,+%KSO 9,+, *53&-*9',+ +2' *+,,',+ ,2 D,2, K,-/',.

4..S*2, **52, ,+ 2*5,' ,-, '*25,,+%KSO

-,5,+ *+;, **52, 3,' *=,5, *+5 ,+

*3,, ,+&2, '*25,,+%KSO ,+ -,+ ,, ,'*2

*'*5;,,+ ,+ ,,.

B1 Dokumen Kuali#ikasi

". P*+,

3-,

+

D&'

*+

K,-

/',

".1.S*, **52, >,;3 *-,'',+ *+,/2,5,+ *3*-

*+,3- D&'*+ K,-/',.

"..P**52, ,,2 *+,3- D&'*+ K,-/', *,

9,5 2,+,- >,'2 ,+ 2*,2 *+,3-,+ ,+

2*+2',+ ,-, *+,+.

".!.S**&5,+ -,5,+ *>,'- -*39 ,5 1 (,2)

*5,9,+ ,-, *+,/2,5,+ ,+ *+,3-,+

&'*+.

6. I

D&'

*+

K,-/',

6.1.I,+ D&'*+ K,-/', *-2:

,. U<

3. P*+,+ P5,',-/',<=. I+25' K*,, P**52,<

. L*3,5 D,2, K,-/',


10/49

*. B*+2' P,'2, I+2*52,<

/. B*+2' F&5-5 I,+

K,-/',<

. P*2+;' P*+,+ F&5-5

I,+ K,-/',<9. B*+2' P*5;,+;,+

K*25,,+%KSO<

. T,2, C,5, E@,-, K,-/',<

6..P**52, 3*5'*>,;3,+ **5', '*'*-59,+

D&'*+ K,-/',. K*-,-,,+ *+,,',+

'*2*5,+,+ ,+ ,5,2',+ ,-, D&'*+

K,-/', **+9+, *5,',+ 5*'& **52,.

6.!.P**52, ,,2 *+2, *+;*-,,+ *=,5, 2*52-

*+*+, D&'*+ K,-/',.

6.4.P&';, ULP >,;3 *+,+, *2, *5+2,,+

*+;*-,,+ ,+ ,;',+ **52, *=,5, 2*52-.

7. B,9,

,

D&'

*+

K,-

/',

D&'*+ K,-/', 3**52, *-59 '&5*&+*+ 2*52- ,-,

5&* ',-/', *++,',+ B,9,, I+&+*,.

8. P*53

,9,+D&'

*+

K,-

/',

A*+

8.1.S*3*- 3,2, ,'95 >,'2 *+,,,+ D&'*+

K,-/', P&';, ULP ,,2 *+3,9 D&'*+K,-/', *+,+ *+*2,',+ A*+ D&'*+

K,-/',.

8..S*2, A*+ ,+ 2*2,',+ *5,',+ 3,,+

,+ 2,' 2*5,9',+ ,5 D&'*+ K,-/', ,+

,,',+ '*,, *, **52,.

8.!.P&';, ULP ,,2 *+',+ A*+ D&'*+

K,-/', *+,+ =,5, *++,9 (-&,) /-*

,*+ &'*+ ',-/', *-,- ,-', SPSE

,-+ -,3,2 (,) 9,5 *3*- 3,2, ,'95

*,',+ D,2, K,-/',. A,3-, P&';, ULP ,',+*++,9 (-&,) /-* ,*+ D&'*+

K,-/', '5,+ ,5 (,) 9,5 *3*- 3,2,

,'95 *,',+ D,2, K,-/', ,', P&';, ULP

>,;3 *++5',+ 3,2, ,'95 *,',+ D,2,

K,-/',.

8.4.P**52, ,,2 *+9 (&>+-&,) /-* A*+

D&'*+ K,-/', ,,3-, ,, *-,- SPSE

8.".P&';, ULP ,,2 *++5',+ 3,2, ,'95 >,'2

*+,,,+ D&'*+ K,-/', ,,3-, ,,

A*+ D&'*+ K,-/',.

. B*5-,

'+,

K,-

K,-/', + 9,+, 3*5-,' +2' ,'*2 *'*5;,,+ ,+ 2*5=,+2

,-, LDK.


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/',

10. B,,

K,-

/',

10.1.P**52, **+9+, *+,++ 3,, +2'

*+'2 ',-/', +.

10..P&';, ULP 2,' 3*52,++ ;,>,3 ,2, '*5,+

,,+ ,+ 2,++ &-*9 **52,.

21 Penyiapan Dokumen Isian Kuali#ikasi

11. B*+2

'

D&'

*+

I,+

K,-

/',

D,2, K,-/', ,+ ,,',+ &-*9 **52, 3*5, D,2, K,-/',

,+ 2*-,9 ,, /&5 ,+ *-*'25&+' ,2, ',-/', ,, ,-',

SPSE.

1. P,'2,

I+2*5

2,

1.1.P,'2, I+2*52, 3*5 '5,5 +2' *+=*,9 ,+ 2,'

*-,'',+ ,+ ,',+ *-,&5',+ 2*5;,+, '&-

'&5 ,+ +*&2* (KKN) 2*5,'

*+,-,9+,,+ >*>*+,+ ,-, *+,,,+

*'*5;,,+ '&+-2,+ *52, ,',+ *+'2 5&*

*+,,,+ *=,5, 3*59 25,+,5,+ ,+ 5&/*&+,-.

1..D*+,+ *+,/2,5 *3,, **52, *-*' ,, ,2

,'*2 *'*5;,,+ *-,- ,-', SPSE ,', **52,

2*-,9 *+,+,2,+,+ P,'2, I+2*52, '*=,- +2'

*+*, 3,5,+%;,, ,+ *-,'',+ K*25,,+%K*5;,S,, O*5, (KSO) 3,,+ ,9, ,+ 2+;'

*>,'- K*25,,+%K*5;, S,, O*5, (KSO) >,;3

*+,,',+ ,'2, +2*52, *-,- /,-2,

+,9,+ -,++, ,, /&5 ,+ *-*'25&+' ,2,

',-/', ,-', SPSE.

1!. P*+

,+

D,2,

K,-

/',

1!.1.P*+,+ D,2, K,-/',.

,. D,2, ',-/', ,,',+

*-,- /&5 *-*'25&+'

',-/', ,+ 2*5*, ,,

,-', SPSE<

3. #', /&5 ,+ *-*'25&+'

',-/', ,+ 2*5*, ,,

,-', SPSE 3*-

*+,'&&5 ,2, ',-/',

,+ ,52,',+ P&';, ULP

,', ,2, ',-/', 2*5*32

+,9 (-&,) ,, /,-2,

*++,9,+ -,+ ,+ 2*5*,

,, ,-', SPSE<

=. D*+,+ *+5',+ ,2,',-/', *=,5, *-*'25&+'

**52, *+*2; *5+,2,,+

*3,, 3*5'2:


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4)


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")


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6)


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. +2' **52, ,+ 3*53*+2'

'&+&5 % '*25,,+ % 3*+2'

'*5;,,, -,+ *,',+

',-/', -,'',+ &-*9 3,,+

,9, ,+ 2+;' *>,'-

'&+&5 % '*25,,+ % 3*+2'

'*5;,,, -,+.

1!..P**52, 3*5'*>,;3,+ +2' *+*2; P,'2,

I+2*52, ,+ *+ /&5 ,+ *-*'25&+' ,2,

',-/', ,-, ,-', SPSE.

1!.!.P,'2, I+2*52, ,+ D,2, K,-/', ,+, 2*-,9

*2; ,+ 2,+,2,+,+ &-*9 **52, *+,,,+

'*=,- +2' **52, ,+ *-,'',+ K*25,,+ %

K*5;, S,, O*5, (KSO) P,'2, I+2*52, ,+ D,2,

K,-/', 2,+,2,+,+ &-*9 P*;,3,2 ,+ *+52

*5;,+;,+ K*25,,+ % K*5;, S,, O*5, 3*59,'

*>,'- K*25,,+ % KSO.

D1 Pemasukan Data Kuali#ikasi

14. P*, 14.1. P**52, *+5',+ D,2, K,-/', *-,-


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',+

D,2,

K,-

/',

,-', SPSE '*,, P&';, ULP *, ;,>,- ,+

2*2,',+.

14..P**52, ,,2 *+5',+ '*'5,+,+ ,2,

',-/', *-,- /,-2, *+5,+ ,2, ',-/',

,+ 2*5*, ,, ,-', SPSE *3*- 3,2, ,'95

*,',+ ,2, ',-/',.

14.!.D,2, ',-/', 9,5 ,,',+ *-,- ,-',

SPSE '*,, P&';, ULP ,-+ -,3,2 ,, >,'2

,+ 2*+2',+ &-*9 P&';, ULP.

14.4.D,2, ',-/', ,,2 3', ,, ,,2 D,2,

K,-/', 2*5, P&';, ULP ,, ,-', SPSE.

1". D,2,

K,-

/',

T*5-,3,2

S*2*-,9 3,2, ,'95 >,'2 *,',+ D,2, K,-/', ,-', SPSE

*+&-,' *2, D,2, K,-/', ,+ ,',+ '5.

!1 !3aluasi Kuali#ikasi

16. K*5,9

,,,

+

P5&*

16.1.P5&* *@,-, ',-/', 3*5/,2 5,9,, ,+

-,',+,',+ &-*9 P&';, ULP *=,5, +**+*+.

16..I+/&5, ,+ 3*5',2,+ *+,+ *@,-, ',-/',

2,' 3&-*9 +',',+ '*,, ,5, **52, ,2,

9,' -,+ ,+ 2,' 3*5'**+2+,+ 9+, 9,-

',-/', ',+.

16.!.S*2, ,9, **52, *+=,5 5&* *@,-,

',-/', ,',+ *+,'3,2',+ 2&-,'+, D,2,

K,-/', ,+ 3*5,+'2,+.

17. K-,5/

',

D,+

K&+/

5,

K,-

/',

17.1.D,-, *+*@,-, ,2, ',-/', P&';, ULP

,,2 *-,'',+ '-,5/', 2*59,, 9,-?9,- ,+ 2,'

;*-, ,-, ,2, ',-/',. P**52, 9,5 *3*5',+

2,+,,+ ,2, '-,5/',. K-,5/', 2,' 3&-*9

*+3,9 32,+. K-,5/', ,+ 2,+,,+ ,2,

'-,5/', 9,5 -,'',+ *=,5, 2*52-.

17..T*59,, 9,-?9,- ,+ 5,',+ 3*5',2,+ *+,+,2, ',-/', P&';, ULP ,,2 *-,'',+

'&+/5, '*3*+,5,++, 2*5,' *++;,,+

-,,+,+ '*,, 9,'?9,'%+2,+ 2*5',2.

17.!.H,- '-,5/',%'&+/5, ,,2 *+5',+

*+,>,5,+.

18. E@,-

,

K,-

/',

18.1.E@,-, ',-/', 9,+, 3*5,,5',+ F&5-5 I,+

K,-/', ,+ 2*55 ,2,:

,. P*+-,,+ *5,5,2,+ A+25, K,-/', ,+-,'',+*+,+ S2* G5< ,+

3. P*+-,,+ P*5,5,2,+ T*'+ K,-/', ,+ -,'',+

*+,+ S2* N-, +2' *+9,-',+ C,-&+ D,/2,5


29/49

P*+*'.

18..P,'2, I+2*52, 2*-,9 ,+ 2,+,2,+,+ &-*9

**52, *3*- -,'',+ *@,-, ,,3-, 2,'

2,+,2,+,+ ,', 2,' *@,-, -*39 -,+;2.

18.!.T,2, =,5, *@,-, ',-/', -,'',+ *, *+,+B,3 I$ D&'*+ K,-/', +.

18.4.D,-, 9,- *-*' ,,3-, **52, ,+ --

*@,-, ',-/', '5,+ ,5 ! (2,) ,', *-*'

+,2,',+ ,,-.

1. P*3

'2,

+

K,-

/',

1.1.P*3'2,+ ',-/', 2*59,, **52, ,+

**+9 *5,5,2,+ ',-/', -,'',+ *2*-,9

*@,-, ',-/', % *3*- *+,+ ,/2,5

*+*' '&+-2,+.

1..P*3'2,+ ',-/', -,'',+ *+,+ =,5, *-9,2

'*,-,+ &'*+ ,5 &'*+ ,- ,2, ,-+,+

&'*+ ,+ ,9 -*,-5 &-*9 *;,3,2 ,+

3*5>*+,+ ,+ *+2, ,-+,+ &'*+ 2*5*32.

D,-, *3'2,+ ',-/', 9,5 9,5 &-*9 >,'-

,+ *+*5, ',, ,+ ,9.

1.!.P*3'2,+ ',-/', +2' *+-, *+,-,,+

,+ *;*+ ,+ 3*,5,+ +-, *'*5;,,+ ,+ *,

*+,+ +-, *'*5;,,+ ,+ ,',+ '&*2',+

-,'',+ *+,+ *-9,2 &'*+ '&+25,' ,- ,+

B*52, A=,5, S*5,9 T*5, P*'*5;,,+ *52, 3'2 *2&5 ,;,' PPN ,5 *'*5;,,+ ,+ 2*-,9 *-*,',+

*3*-+,.

1.4.A,3-, **52, 2,' 9,5 ,-, *3'2,+

',-/', ,+ 2*-,9 3*5',+ '**,2,+ *52,

2*+,+ >,'2 ,+ -& ,+ =' ,', **52,

5',+ ,+ ,'',+ ,-, ,/2,5 92,.

1.".P&';, ULP *-,'',+ '-,5/', ,+%,2, @*5/',

'*,, *+*532 &'*+ ,,3-, &'*+ ,+

+,',+ ,-, *3'2,+ ',-/', ,9

5,',+ '*3*+,5,++,.

1.6.A,3-, 9,- *3'2,+ ',-/', 2*',+ ,2,

2,' 3*+,5 % *,-,+ ,2, % 2,' ,,2

*++;'',+ &'*+ ,- ,2, ,-+,+ &'*+ ,+

,9 -*,-5 ,', **52, 5',+ 3,,+ ,9,

,+%,2, *+5+, ,'',+ ,-, D,/2,5

H2,.

1.7.A,3-, **52, ,+ -- *3'2,+ ',-/',

'5,+ ,5 ! (2,) ,', *-*' +,2,',+ ,,-.

"1 Hasil Kuali#ikasi

0. P*+*2 0.1. S*, **52, ,+ -- *3'2,+ ',-/',


30/49

,,+

H,-

K,-

/',

,'',+ &-*9 P&';, ULP '* ,-, ,/2,5 *+*'

( shorlist ) ,-+ '5,+ ! (2,) ,+ ,-+ 3,+,' "

(-,) **52, ,+ 2*-,9 -- *3'2,+ ',-/',.

0..P&';, ULP *++2',+ ,/2,5 *+*' ,, ,-',

SPSE.

1. K,-

/',

U-,+

1.1.D,-, 9,- *-*' ,,3-, ;-,9 **52, ,+

-- ',-/', '5,+ ,5 ! (2,) ,', -,'',+

*+,+ -,+ 5,',-/', +2' *+=,5

**52, 3,5 *-,+ **52, ,+ 2*-,9 -- *+-,,+

',-/',. P**52, ,+ ,9 -- *+-,,+

',-/', 2,' *5- -,'',+ *+-,,+ '*3,-

'*=,- ,, *53,9,+ D&'*+ K,-/',.

1..D,-, 9,- *-*' ;', *2*-,9 ',-/', -,+

2*5+,2, **52, ,+ -- ',-/', ,9 '5,+

,5 ! (2,) ,', P&';, ULP *-,+;2',+ 5&*

*-*'.

. U+,

+,+

'*,

,

P**52

,

,+

L-

K,-

/',

P**52, +, ,' ,-, ,/2,5 **52, ,+ -- ',-/',

+,+ *+,3- D&'*+ P*-9,+ +2' *,'',+

*+,>,5,+.


31/49

BAB I4

L!MBA& DA.A KUALI"IKASI (LDK-

A. L+'

K,-/',

1. N,, P&';, ULP :

T,3*-?01 N,, ,+ ,-,,2 P&';, ULP

N,, ULP U+2 L,,+,+ P*+,,,+ -,,9 M,-'

N,, P&';,

ULP

P&';, P*5*+=,+,,+ ,+ P*+,>,,+ #,-,+

N,&+,- BP#N I$ M,-' ,+ M,-' U2,5,

S,2'*5 P*5*+=,+,,+ ,+ P*+,>,,+ #,-,+ N,&+,-

P5&@+ M,-'

A-,,2 #-. I5. M. P229*+, ,-*-, A3&+

E,- P&';, &';,'&+-.,-,-.=&

*32* 922:%%>>>..&.

A-', LPSE K**+2*5,+ PU SPSE

. ,. N,, ,'*2 ,+ -+' *'*5;,,+ :

PENGAASAN TEKNIS #EMBATAN DI PULAU BURU

3. U5,,+ +',2 *'*5;,,+ :

M*-,'',+ *+,>,,+ 2*'+ ;,-,+ ,+ ;*3,2,+ *=,5, 5&/*&+,- ,+ ,5,2',+ ,-, */', 2*'+ *-2 2*,2

2 2*,2 >,'2 ,+ 2*,2 3,,.

B. S3*5 D,+, P*'*5;,,+ + 3,, ,5 3*5 *+,+,,+ APBN T,9+ A+,5,+ 016.

C. P*,',+ D,2,

K,-/',

S*, *+,+ ;,>,- ,+ 2*,2 ,+ 2*5=,+2 ,-, LPSE

K**+2*5,+ PU F--?E5&=5**+2.

H,5 . : K, % K,

T,+77,- : 0" N&@*3*5 01" % 1 N&@*3*5 01"

P'- :00.00 IT. !." IT

T*) 4,2 : LPSE K**+2*5,+ PU F--?E5&=5**+2

D. P*5,5,2,+

K,-/',

51 P**52, K,-/', 3,,+ ,9, 9,5 *-' 5,2 + ,9, ;,,

'&+25' Bidang Jasa !n)ineerin) "ase Konstruksi an

Instalasi Pekerjaan .eknik Sipil .ransportasi Sub Bidang Jasa

Pen)a,as Pekerjaan Konstruksi .eknik Sipil .ransportasi1

. P**52, K,-/', B,,+ U,9, #,, K&+-2,+ A+ 9,5

*-' 3'2 I;+ P*5>,'-,+ #,, K&+-2,+ A+

I+&+*,<

3. M*-' NPP ,+ 2*-,9 **+9 '*>,;3,+ *5,;,',+ 2,9+

,;,' 2*5,'95 (SPT 2,9+,+). P*5,5,2,+ + '*=,-',+ +2'

*+*, ,+ ('9 +2' International Competitive Bidding ).

mailto:[email protected]://www.pu.go.id/mailto:[email protected]://www.pu.go.id/


32/49

SPT 2,9+,+ ,+ +2, +2' 2,9+ 014

4. M**5&-*9 ,-+ *'2 1 (,2) *'*5;,,+ *3,, *+*,

;,, '&+-2,+ ,-, '5+ >,'2 4 (*,2) 2,9+ 2*5,'95 3,'

-+'+,+ **5+2,9 ,+ >,2, 2*5,' *+,-,,+

3'&+25,' '*=,- 3, *+*, ,+ 3,5 3*55 '5,+ ,5 !

(2,) 2,9+<

". M*+,,',+ *5+,2,,+%*+,',+ 2*52- 3,9>, 3,,+ ,9,

,+ 3*5,+'2,+ 2,' ,-, *+,>,,+ *+,-,+ 2,'

,-2 ,+ 2,' *,+ 9*+2',+ '*,2,+ ,9,+,<

6. S,-,9 ,2 ,+%,2, *, *+5 3,,+ ,9, 2,' ,'

,-, ,/2,5 92,<

7. U+2' *'*5;,,+ '&-*' ,,2 *-' *52/',2 ,+,;**+

2 ISO ,2, *5,5,2,+ -,+ **52 *5,-,2,+ '9 2*+,,

,9- *,- ,+ *5-',+ ,2, *,-,,+ 2*52*+2<

8. M*-' '*,,+ *+*,',+ *5&+- ,+ *5-',+

+2' *-,',+,,+ *'*5;,,+<

. M*-' '*,,+ *+*,',+ /,-2, ,+ *5,-,2,+

,+ *5-',+ +2' *-,',+,,+ *'*5;,,+ (,,3-,

*5,5,2',+)<

10. M*-' *+,-,,+ *'*5;,,+ ,, 33,+ Jasa

Pengawas Pekerjaan Konstruksi Teknik Sipil Transportasi *+,+

2&2,- 3&3&2 *+-,,+ *3*,5 100 2*55 ,5 :

,. P*+

,-,,+

,

,

*'

*5;,

,+

*;*

+

*+

,+

3&3&2

"0

<

3. K*

*

,,+

3*

,5,+

+-,

*'

*5;,

,+


33/49

*;*

+

,+

*5

+,9*

-*,

',+

*+

,+

+-,

*'

*5;,

,+

,+

,',

+

'

&

*2

',

+

*+

,+

3&3

&2

!"

<

=. P*+

,-,

,+

*'

*5;,

,+

,,

-&',

,+

,

,

,

,

2+

',2K,3

,2

*+%


34/49

K&2

,

*+

,+

3&3

&210

<

. D&

-

*5

,

9,+

+

' (2+

,'2

P5&

@+

%K,

3

,2*+

%K&

2,

'*=

,-P5&

@+

DK

I

#,'

,52,

)

*+

,+

3&3&2

"<

*. T&2

,-

;

-,9

,.

3.

=.

,+.

,

,


35/49

*+

,+

100

.

/. D,-

,

9,-

*+

*

,

*

*52

32

5

D.4

*+,

,2

3&3

&2

".

11. M*-' T*+,, ,9- T*2, *+,+ ',-/', keahlian Jalan dan

Jembatan *52, 9,5 **+9 *5,5,2,+: memiliki Surat

Keterangan hli sesuai bidang !"ang masih berlaku#;

1. D,-, 9,- **52, ,',+ *-,'',+ '*25,,+ :

,. >,;3 *+, P*5;,+;,+ K*5;, S,, O*5,%K*25,,+,+ *,2 *5*+2,* '*25,,+ ,+ *5,9,+ ,+

*>,'- '*25,,+ 2*5*32< ,+

3. *+-,,+ ',-/', ,, ,+', 1 % 6 -,'',+ 2*59,,

*2, **52, ,+ 2*5,3+ ,-, KSO%K*25,,+.

=. *+-,,+ ',-/', ,, ,+', 7810 ,+ 11 -,'',+

2*59,, ,3+,+ ,5 **52, ,+ *-,'',+

KSO%K*25,,+.

. '*=,- ,, ,+', 10.3 *+-,,+ -,'',+ +2' -*,/5

3, **52, ,+ *-,'',+ KSO%K*25,,+.1!. A+', 11 2,' *+;, 3,9,+ *+-,,+ 3,,+ ,9, ,-,

,/2,5 *+*' *+*, ;,,.


36/49

BAB 4

B!$.UK PAK.A I$.!%&I.AS

Contoh Pakta Integritas Badan $saha Tanpa Kemitraan%KS&J

PAK.A I$.!%&I.AS

S,, ,+ 3*52,+, 2,+,+ 3,>,9 +:

N,, : +,, >,'- ,9 3,,+ ,9,J

#,3,2,+ : ..

B*52+,' +2' ,+ ,2, +,, :PT%CV%F5,%,2, -,++, . pilih "ang sesuai dan

'antumkan namaJ

,-, 5,+', *+,,,+ . isi nama paket J ,, . isi sesuai dengan

nama Pokja $(P J *+,+ + *+,2,',+ 3,9>, :

1. 2,' ,',+ *-,'',+ 5,'2*' K&5 K&- ,+ N*&2* (KKN)<

. ,',+*-,&5',+'*,,APIPK%L%D%I,+%,2,LKPP,,3-,*+*2,9 ,, +', KKN

,-, 5&* *+,,,+ +<

!. ,',+*+'25&**+,,,+*=,5,3*5925,+,5,+,+5&/*&+,-+2' *3*5',+

9,- '*5;, 2*53,' *,'*2*+2,+*5,25,+ *5+,+?+,+,+<

4. ,,3-, *-,+,5 9,-?9,- ,+ +,2,',+ ,-, PAKTA INTEGRITAS +3*5*,

*+*5, ,+' ,+25,2/ *+*5, ,+' *+=,+2,+,-, D,/2,5 H2,

,2 *=,5, *5,2, ,+%,2, -,&5',+ *=,5,,+,.

tempat J tanggal J . bulanJ 0. tahunJ

)ama Pen"ediaJ

tanda tanganJ

nama lengkapJ


37/49

C&+2&9 P,'2, I+2*52, B,,+ U,9, D*+,+ K*25,,+%KSOJ

PAK.A I$.!%&I.AS

K, ,+ 3*52,+, 2,+,+ 3,>,9 +:1. N,, : nama wakil sah badan usahaJ

#,3,2,+ :

B*52+,' +2' ,+ ,2, +,, : PT%CV%F5,%,2, -,++, .. pilih"angsesuaidan

'antumkan namaJ

. N,, : . nama wakil sah badan usahaJ

#,3,2,+ : ..

B*52+,' +2' ,+ ,2, +,, : PT%CV%F5,% ,2, -,++, .. pilih "ang sesuai

dan 'antumkan namaJ

!. . dan seterusn"a* diisi sesuai dengan jumlah anggota kemitraan%KS&J

,-, 5,+', *+,,,+ isi nama paket J ,, isi sesuai dengan nama

Pokja $(P J *+,+ + *+,2,',+ 3,9>,:

1. 2,' ,',+ *-,'',+ 5,'2*' K&5 K&- ,+ N*&2* (KKN)<

. ,',+ *-,&5',+ '*,, APIPK%L%D%I,+%,2, LKPP ,,3-, *+*2,9 ,, +',

KKN ,-, 5&* *+,,,+ +<

!. ,',+ *+'2 5&* *+,,,+ *=,5, 3*59 25,+,5,+ ,+ 5&/*&+,- +2'

*3*5',+ 9,- '*5;, 2*53,' *, '*2*+2,+ *5,25,+ *5+,+?+,+,+<

4. ,,3-, *-,+,5 9,-?9,- ,+ +,2,',+ ,-, PAKTA INTEGRITAS +3*5*,*+*5, ,+' ,+25,2/ *+*5, ,+' *+=,+2,+,-, D,/2,5 H2,

,2 *=,5, *5,2, ,+%,2, -,&5',+ *=,5,,+,.

.. tempat J tanggal J .. bulanJ 0.tahunJ

+)ama Pen"edia, +)ama Pen"edia, +)ama Pen"edia,

+tanda tangan,* +tanda tangan,* +tanda tangan,*

+nama lengkap, +nama lengkap, +nama lengkap,

'antumkan tanda tangan dan nama setiap anggota Kemitraan%KS&J


38/49

BAB 4I

B!$.UK "O&MULI& ISIA$ KUALI"IKASI

"O&MULI& ISIA$ KUALI"IKASI

U$.UK BADA$ USAHA

S,, ,+ 3*52,+, 2,+,+ 3,>,9 + :

N,, : .. nama wakil sah badan usahaJ

#,3,2,+ : . diisi sesuai jabatan dalam akta

pendirianperusahaan dan perubahann"aJ

B*52+,' +2' ,+ ,2, +,, : FT%CV%F5,% ,2, -,++, pilih "ang

sesuaidan 'antumkan nama badan usahaJ

A-,,2 : ..

N&. T*-*&+ :

N&. F, : E?,- : ..

*+,2,',+ *+,+ *+9+, 3,9>,:

1. ,, *=,5, 9' *+, ',,2, *+,+,2,+,+ '&+25,' 3*5,,5',+ A'2* N&2,5

.. +sesua iakta pendirian%perubahann"a%surat kuasa* disebutkan se'ara jelas nomor

dan tanggal akta pendirian%perubahan%surat kuasa Jika kemitraan%KS& maka di'antumkan

tambahan SuratPerjanjian Kemitraan%KS&,<

. ,, 3',+ *3,, *,>, K%L%D%I 3, *,>, K%L%D%I ,+ *,+=2 -,5

2,++,+ K%L%D%I 2- *3,, 3*5'2 : S,, *5,',+*,>, K%L%D%I ,+ *,+

=2 -,5 2,++,+ K%L%D%IJ<!. ,, 2,' *,+ *+;,-,+ ,+' ,+,<

4. ,, 2,' *,+ ,+ 2,' ,',+ 2*5-3,2 *52*+2,+,+ '**+2+,+*+,+ ,5, 9,' ,+

2*5',2 -,++ ,+ 2,' -,++ ,-,5&* *+,,,+ +<

". 3,,+ ,9, ,+ ,, >,'- 2,' ,' ,-, D,/2,5 H2, 2,',-, *+,>,,+

*+,-,+ 2,' ,-2 ,+ '*,2,+ ,9,+, 2,'*,+ 9*+2',+<

6. ,-,9 ,2 ,+%,2, *, *+5 3,,+ ,9, ,+ ,, >,'- 2,',' ,-, D,/2,5

H2,<

7. ,2,?,2, ,,%3,,+ ,9, ,+ ,, >,'- ,,-,9 *3,, 3*5'2 :


39/49

A. D,2, A+25,

1. N,,(PT%CV%F5,%,2, -,++,.) : ..

. S2,2 : ❑ P,2 ❑ C,3,+

!. A-,,2 K,+2&5 P,2 : ..

N&. T*-*&+ : ..

N&. F, : ..

E?,- : ..

4. A-,,2 K,+2&5 C,3,+ : ..

N&. T*-*&+ : ..

N&. F, : ..

E?,- : ..

B. I+ U,9,

1. S5,2 I+ U,9, #,, K&+25' : ,. N&&5

3. T,+,- .

. M,, 3*5-,' + ,9, : ..

!. I+2,+ *3*5 + ,9, : ..

4. K*,2,+ U,9, : ..

C. I+ ,2, S,5,2 L,++,

S*52/',2 B,,+ U,9, (SBU)

1. ,. N&&5 : ..

3. T,+,- : ..

=. B,+%L,,+,+ : ..

. S3 3,+%S3 -,,+,+ : ..

. M,, 3*5-,' : ..

!. I+2,+ P*+*532 : ..

D. L,+,,+ H' P*+5,+ B,,+ U,9,

1. A'2, P*+5,+ PT%CV%F5,%,2, -,++,


40/49

,. N&&5 A'2, : ..

3. T,+,- : ..

=. N&&5 N&2,5 : ..

. N&&5

P*+*,9,+K**+2*5,+

H' ,+

HAM (+2'

,+ 3*53*+2'

PT)

: ..

. A'2, P*53,9,+ T*5,'95

,. N&&5 A'2, : ..

3. T,+,- : ..

=. N&&5 N&2,5 : ..

. N&&5

P*+*,9,+

K**+2*5,+

H' ,+

HAM (+2'

,+ 3*53*+2'

PT)

: ..

E. P*+*-&-, B,,+ U,9,

1. K&,5%P*+,>, +2' P*5*5&,+ T*53,2, (PT)

N&. N,, N&. KTP #,3,2,+ D,-, B,,+

. D5*'%P*+5 B,,+ U,9,

N&. N,, N&. KTP #,3,2,+ D,-, B,,+

F. D,2, K*,+,+1. S+,+ K**-',+ S,9,(+2' PT)%S+,+ P**5& (+2' CV%F5,)

N&. N,, N&. KTP P*5*+2,*


41/49

. P,;,'

,. N&&5 P&'&' ,;3 P,;,' :

3. B'2 L,&5,+ P,;,' T,9+ 2*5,'95 : N& .. T,+,- .

G. D,2, P*5&+,-, (T*+,, ,9- 2*2, 3,,+ ,9,)

N& N,,T-%3-+%29+

-,95 T+',2

P*+',+

#,3,2,+,-,

*'*5;,,+

P*+,-,,+K*5;, (2,9+)

P5&/*%'*,9-,+

T,9+S*52/',2%

I;,,9

1 ! 4 " 6 7 8

H. D,2, F,-2,%P*5,-,2,+%P*5-*+',,+

N&#*+

F,-2,%P*5,-,2,+% P*5-*+',,+

#-,

9

K,,2,,2,

output

,, ,,2

+

M*5' ,+2*

T,9+ *3,2,

+

K&+

()

L&',

S*',5,+

S2,2K**-',+%

D'+,+S*>,

1 ! 4 " 6 7 8

I. D,2, P*+,-,,+ P*5,9,,+ ,+ ,, % *;*+ ,-, '5+ >,'2 10 2,9+ 2*5,'95

N& N,,P,'*2

P*'*5;,,+

S3B,+

P*'*5;,,+

L&',(K,3.%

K&2,)

P*3*5 T, %

P*;,3,2 P*3,2K&2*+

K&+25,' T,+,- S*-*,

M*+52

N,,A-,,2 ,+

T*-*&+

N&&5

,+T,+,-

N-,(R)

K&+25,'

BA S*5,9

T*5,(PHO)

1 ! 4 " 6 7 8 10

K*2*5,+,+: D,2, + +,',+ +2' *+-, *5,5,2,+ 2*'+ ',-/',

#. D,2, P*+,-,,+ P*5,9,+ D,-,K5+ ,'2 4 T,9+ T*5,'95

(P*+*, ,+ 3,5 3*55 '5,+ ,5 ! 2,9+ 2,' >,;3 *+ 2,3-* +)

N& N,,P,'*2

P*'*5;,,+

R+',,+L+'P*'*5;,,+

L&', P*3*5 T, %P*;,3,2 P*3,2

K&2*+

K&+25,' T,+,- S*-*,

M*+52


42/49

N,,A-,,2

,+T*-*&+

N&&5 ,+

T,+,-

N-,(R)

K&+25,'

BA S*5,9

T*5,

(PHO)

1 ! 4 " 6 7 8 10

D*',+ *5+,2,,+ + ,, 3,2 *+,+ *3*+,5+, ,+ *+9 5,, 2,++ ;,>,3. #',

'*,+ 9,5 2* 3,9>, ,2,%&'*+ ,+ ,, ,,',+ 2,' 3*+,5 ,+%,2, ,,

*,-,+ ,', ,, ,+ 3,,+ ,9, ,+ ,, >,'- 3*5*, '*+,',+ ,+' 3*5, ,+'

,+25,2/ ,+' *+=,+2,+ ,-, D,/2,5 H2, ,2,+ *=,5, *5,2, ,+%,2, *-,&5,+

*=,5, ,+, '*,, 9,' 3*5>*+,+ *, *+,+ '*2*+2,+ *5,25,+ *5+,+?+,+,+.

tempat J tanggal J .. 3-,+J 0. tahunJ

PT%CV%F5,%,2, -,++,

.. pilih "ang sesuai dan 'antumkan namaJ

rekatkan meterai .p /000*-

dan tanda tanganJ

(nama lengkap wakil sah badan usaha)

jabatan pada badan usahaJ


43/49

BAB 4II

P!.U$JUK P!$%ISIA$ "O&MULI& KUALI"IKASI

I. B,,+ U,9, *-,+ K*25,,+ % KSO

P*2+;' *+,+ +2' **52, 3',+ '*25,,+ % KSO *+'2 *2+;' ,+

*++,,+ ,-', SPSE ($ser 1uide)

II. K*25,,+ % KSO

U+2' **52, ,+ 3*53*+2' '*25,,+ % KSO ,+? ,+ ,+&2, '*25,,+ % KSO

>,;3 *+ /&5-5 ,+ ',-/', +2-' ,+?,+ ',-/', 3,,+ ,9,+,

*+,+ *2+;' *+,+ /&5-5 ',-/', *3,, 3*5'2:

A. D,2, A+25,

1. D *+,+ +,, 3,,+ ,9, **52,.

. P-9 2,2 3,,+ ,9, (P,2%C,3,+).

!. D *+,+ ,-,,2 +&&5 2*-*&+ +&&5 /, ,+ *?,- 3,,+ ,9, **52, ,+

,,2 93+.4. D *+,+ ,-,,2 +&&5 2*-*&+ +&&5 /, ,+ *?,- ',+2&5 ,2 ,+ ,,2

93+ ,,3-, **52, 3*52,2 ',+2&5 =,3,+.

B. I+ U,9,

1. D *+,+ ;*+ 5,2 + ,9, +&&5 ,+ 2,+,- *+*532,++,.

. D *+,+ ,, 3*5-,' + ,9,.

!. D *+,+ +,, +2,+ *+*532 5,2 + ,9,.

C. S*52/',2 B,,+ U,9,

1. D*+,+ +&&5 ,+ 2,+,- *+*532,+.

. D *+,+ ,, 3*5-,'.!. D *+,+ +,, +2,+ *+*532.

K*2*5,+,+:

#*+ + ,9, *,',+ *+,+ 3,+ ,9, ,+ *5,25,+ *5+,+?+,+,+.

U+2' *5,5,2,+ *5+,+ 3, *+*, ,+ *,',+ *+,+ 5,'2*' 3+

+2*5+,&+,- ,+%,2, '*2*+2,+ N*,5, ,,- *+*, ;,,.

D. L,+,,+ H' P*+5,+ B,,+ U,9,

1. D *+,+ +&&5 2,+,- ,+ +,, +&2,5 *+*532 ,'2, *+5,+ 3,,+ ,9, *52,

+2' 3,,+ ,9, ,+ 3*53*+2' P*5*5&,+ T*53,2, +&&5 *+*,9,+

K**+2*5,+ H' ,+ HAM.. D *+,+ +&&5 2,+,- ,+ +,, +&2,5 *+*532 ,'2, *53,9,+ 2*5,'95 3,,+

,9, ,,3-, ,,. K9 +2' P*5*5&,+ T*53,2, ;', 2*5,,2 *53,9,+ +,,

,+&2, D5*' ,+%,2, D*>,+ K&,5 ,, *3'2,+ ',-/', **52,

*++;'',+ ,- ,+ *3*5',+ ,-+,+ B'2 *3*52,9,+ ,5 N&2,5 *-,'

',, D5*' ,+ 2*-,9 ,;',+ *-,- S+3,' ,2, A'2, P*53,9,+ T*5,'95.

E. P*+*-&-, B,,+ U,9, (P*+,>,%P*+5)

1. D *+,+ +,, +&&5 KTP ,+ ;,3,2,+ ,-, 3,,+ ,9, ,,3-, 3*53*+2'

P*5*5&,+ T*53,2,.

. D *+,+ +,, +&&5 KTP ,+ ;,3,2,+ ,-, 3,,+ ,9,.

F. D,2, K*,+,+

1. D *+,+ +,, +&&5 KTP ,+ *5*+2,* '**-',+ ,9,%**5& ,+

*5*+2,* '**-',+ ,9,%*5*5&.

. P,;,' :


44/49

,. D *+,+ NPP 3,,+ ,9,.

3. D *+,+ +&&5 ,+ 2,+,- 3'2 -,&5,+ ,;,' 2,9+ 2*5,'953*5, SPT

T,9+,+.

P*5,5,2,+ **+9,+ '*>,;3,+ ,;,' 2,9+ 2*5,'95 *+,+ *+,,,+ SPT

T,9+,+.

!. +Pers"aratan pajak sebagaimana dimaksud pada nomor 2* dike'ualikan untuk pen"edia

asing !khusus untuk International Competitive Bidding#,.

G. D,2, P*5&+-

D *+,+ +,, 2,+,-%3-,+%2,9+-,95 2+',2 *+',+ (SLTP%SLTA%S1%S%S!)

;,3,2,+ ,-, *'*5;,,+ ,+ *5+,9 -,',+,',+ -,, *+,-,,+ '*5;, 5&/*%'*,9-,+

*, *+,+ S5,2 K*2*5,+,+ A9-%S5,2K*2*5,+,+ T*5,- ,+ 2,9+ *+*532,+

*52/',2%;,,9 ,5 *2, 2*+,, ,9-%2*'+ *, *+,+ ,+ *5-',+ +2' *'*5;,,+

,+ *-*'',+.

H. D,2, F,-2,%P*5,-,2,+%P*5-*+',,+

D *+,+ ;*+ ;-,9 ',,2, ,2, &22 ,+ ,,2 =,, ,, ,,2 + *5*' ,+

2* 2,9+ *3,2,+ '&+ (,-, *5*+2,*) -&', '*3*5,,,+ ,,2 + ,+ 2,2'**-',+%'+,+ *>, (-' *+5%*>,3*-%*>,) ,5 ,+?,+

/,-2,%*5,-,2,+% *5-*+',,+ *, *+,+ ,+ *5-',+ +2' *'*5;,,+ ,+

*-*'',+. B'2 2,2 '**-',+ 9,5 ,,2 2+;'',+ ,, >,'2 P*3'2,+

K,-/',.

I. D,2, P*+,-,,+ P*5,9,,+ ,+ ,,%*;*+ ,-, '5+ >,'2 10 2,9+ 2*5,'95

D *+,+ +,, ,'*2?,'*2 *'*5;,,+ ,+ -9 -, ,5 +-, ,'*2 2*52+ 3

3,+ *'*5;,,+ ,+ *5,5,2',+ -&', 2*,2 *-,',+,,+ *'*5;,,+ +,, ,+

,-,,2%2*-*&+ ,5 *3*5 2,%P*;,3,2 P*3,2 K&2*++&&5%2,+,- ,+

+-,'&+25,' 2,+,- *-*, ,'*2 *'*5;,,+ *+52 '&+25,' ,+ 2,+,- B*52, A=,5, *5,9

2*5, (PHO)+2' ,+?,+ ,'*2 *'*5;,,+ *-,, 10 (*-9) 2,9+ 2*5,'95.

#. D,2, P*+,-,,+ P*5,9,+ D,-, K5+ ,'2 4 T,9+ T*5,'95

D *+,+ +,, ,'*2 *'*5;,,+ 5+',,+ -+' *'*5;,,+ -&', 2*,2 *-,',+,,+

*'*5;,,+ +,, ,+ ,-,,2%2*-*&+ ,5 *3*5 2,%P*;,3,2 P*3,2 K&2*+

+&&5%2,+,- ,+ +-, '&+25,' *52, 2,+,- *-*, ,'*2 *'*5;,,+ *+52 '&+25,' ,+

2,+,- B*52, A=,5, *5,9 2*5, (PHO). U2+' P*+*, ,+ 3,5 3*55 '5,+ ,5 !

2,9+ 2,' >,;3 *+ 2,3-* +.

K. K*25,,+%KSO

U+2' **52, ,+ 3*53*+2' '*25,,+%KSO ,+?,+ ,+&2, '*25,,+%KSO >,;3

*+ /&5-5 ,+ ',-/', +2' ,+?,+ ',-/', 3,,+ ,9,+,.

BAB 4III

B!$.UK SU&A. P!&JA$JIA$ K!MI.&AA$/K!&JA SAMA OP!&ASI


45/49

(KSO-

2O$.OH

SURAT PER#AN#IAN KEMIIRAAN%KER#A SAMA OPERASI (KSO)

S*93+,+ *+,+ *+,+ **-*',+ *'*5;,,+ ,+ *3',,+

*+,>,5,++, ,',+ -,'',+ ,,2,+,- . 0 ,', ',:

. nama peserta 3J

. nama peserta 2J

. nama peserta 4J

. dan seterusn"aJ

3*5,' +2' *+'2 **-*',+ ,+ *-,',+,,+ '&+25,' *=,5, 3*5,,?,, ,-,

3*+2' '*25,,+%K*5;, S,, O*5, (KSO).

K, *+*2; ,+ *2',+ 3,9>, :

1. S*=,5, 3*5,,?,, :

,. M*3*+2''*25,,+%KSO*+,+ +,, '*25,,+%KSO ,,-,9

3. M*++;' nama peserta3J *3,,*5,9,,+2,, (leading

5irm)+2''*25,,+%KSO ,+ *>,'- *52,3*52+,' +2' ,+ ,2, +,,

'*25,,+%KSO.

=. M*+*2; ,,3-, 2+;' *3,, **+,+>,;33*52,++ ;,>,3 3,' *=,5,

3*5,,?,, ,2, ,+?,+ ,2, *,'*>,;3,+ *, '*2*+2,+ &'*+

'&+25,'.

. K*'2*52,,+ &,- ( sharing ) *2, *5,9,,+ ,-, '*25,,+%KSO,,-,9:

. nama peserta 3J *3*,5. (. *5*+). nama peserta 2J *3*,5. (. *5*+)

. nama peserta 4J *3*,5. (. *5*+)

. dan seterusn"aJ *3*,5. (. *5*+)

!. M,+?,+ **52, ,+&2, '*25,,+%KSO ,',+ *+,3- 3,,+*, 9,5+

2*5*32 ,, 325 . ,-, 9,- *+*-,5,+ '*+2+,+ ,+ '*5,+ ,5

'*25,,+%KSO.

4. P*3,,+ 9,5+ ,-, '*25,,+%KSO + 2,' ,',+ 3,9 3,'*-,, ,,

*+,>,5,+ ,+ *,+;,+ ,, '&+25,' '*=,- *+,+*5*2;,+ 2*52- 2*5-*39

,9- ,5 P*;,3,2 P*3,2 K&2*+ (PPK),+ *5*2;,+ 3*5,, *=,5, 2*52- ,5

,+?,+ ,+&2,'*25,,+%KSO.". T*5-*, ,5 sharing ,+ 2*2,',+ ,2, ,+?,+ ,+&2,'*25,,+%KSO ,',+

*-,'',+ *+,>,,+ *+9 2*59,, *, ,*'*-,',+,,+ ,5 *5;,+;,+ +

2*5,' 9,' +2' **5', '*,+,+*5+2,9 *3*-,+ 2,+, 2*5, ,/2,5

*5,-,2,+ ,+ 2*+,, '*5;,*5;,+;,+ 3'&+25,' 5,2?*+5,2 ,+ -,+?-,+.

6. *>*+,+*+,+,2,+,+*+,>,5,++2',+,2,+,, '*25,,+%KSO3*5',+'*,,

. namawakilpesertaJ ,-, '*',++, *3,, 5*'25 2,,%5*'25

*-,',+, .. nama peserta3J3*5,,5',+ *5*2;,+ 2*52-(5,2 ',,) ,5

*-59 ,+&2, '*25,,+%KSO.

7. P*5;,+;,+ + 3*5-,' *;,' 2,+,- 2,+,2,+,+.


46/49

8. P*5;,+;,+ + *=,5, &2&,2 *+;, 3,2,- ,+ 2,' 3*5-,' -, 3-,**-*',+ 2,'

*+,+',+ &-*9 *5,9,,+ '*25,,+%KSO.

. P*5;,+;,+ + 3,2 ,-, 5,+', .. ( .. ) ,+ ,+?,+*+,

'*',2,+ 9' ,+ ,,.

DENGAN KESEPAKATAN + *, ,+&2, '*25,,+%KSO *339',+2,+, 2,+,+

.. ,, 9,5 . 2,+,- . 3-,+ 2,9+

P**52, IJ P**52, J

(.........................) (...................)

P**52, !J 2J

(.........................) (...................)

C,2,2,+ :

P,, 2,+, 2,+,+ *5,9,,+ ,+ *>,'- '*25,,+ 3*5,2*5, ='.


47/49

BAB I6

.A.A 2A&A !4ALUASI KUALI"IKASI

A. E@,-, K,-/', 9,+, 3*5,,5',+ F&5-5 I,+ K,-/',. D,2, K,-/',

9,5 **+9 *5,5,2,+ *3,, 3*5'2:1. D,2, ',-/', +2' **52, ,+ *-,'',+ K*25,,+%K*5;, S,, O*5,

,,',+ &-*9 *;,3,2 ,+ *+52 P*5;,+;,+ K*25,,+%K*5;, S,, O*5,

3*59,' *>,'- K*25,,+%KSO.

. *-' + ,9, '&+25' ,+ *52/',2 3,,+ ,9, *, *+,+ *5,25,+

*5+,+?+,+,+<

!. *+,,',+ *5+,2,,+%*+,',+ 2*52- 3,9>, 3,,+ ,9,,+ 3*5,+'2,+

,+ ,+,;**++, 2,' ,-, *+,>,,+ *+,-,+ 2,' 3,+'52 ,+ 2,'

*,+ 9*+2',+ '*,2,+ ,9,+,<

4. ,-,9 ,2 ,+%,2, *, *+5 ,+ 3,,+ ,9,+, 2,' ,' ,-, D,/2,5

H2,<

". *-' NPP ,+ 2*-,9 **+9 '*>,;3,+ *5,;,',+ 2,9+,;,' 2*5,'95 (SPT

T,9+,+)<

6. **5&-*9 ,-+ *'2 1 (,2) *'*5;,,+ *3,, *+*, ,-, '5+ >,'2 4

(*,2) 2,9+ 2*5,'95 3,' -+'+,+ **5+2,9 ,+ >,2, 2*5,'

*+,-,,+ 3'&+25,' '*=,- 3, *+*, ,+ 3,5 3*55 '5,+ ,5 ! (2,)

2,9+<

7. *-' '*,,+ ,, 3,+ (,9, '*=-)%3 3,+ ,+ *2,5,',2',+

*+,+ *+,-,,+ *'*5;,,+ ,+ *,<

8. *-' '*,,+ *+*,',+ /,-2, ,+ *5,-,2,+ *52, *5&+- ,+

*5-',+ +2' *-,',+,,+ *'*5;,,+<

. *+,+,2,+,+ P,'2, I+2*52,

10. ,-, 9,- *'*5;,,+ '&-*' ,,2 ,5,2',+ *-' *52/',2 ,+,;**+ 2

ISO ,2, *5,5,2,+ -,+ **52 *5,-,2,+ '9 2*+,, ,9- *,- ,+*5-',+ ,2, *+,-,,+ 2*52*+2<

11. ,-, 9,- **52, ,',+ *-,'',+ '*25,,+%KSO :

,. **52, >,;3 *+, *5;,+;,+K*5;, S,, O*5,%K*25,,+ ,+

*,2 *5*+2,* K*25,,+%KSO ,+ *5,9,,+ ,+ *>,'-

K*25,,+%KSO 2*5*32<

3. *@,-, *5,5,2,+ ,, ,+', 1,, *+,+ ,+', 7 ,+ ,+',

-,'',+ +2' *2, *5,9,,+ ,+ *-,'',+ K*25,,+%KSO< ,+

=. *@,-, *5,5,2,+ ,, ,+', 8 ,+ ,+', 10 *@,-, *5,5,2,+

,3+',+ *3,, *@,-, K*25,,+%KSO.

1. M*-' S*52/',2 M,+,;**+ K**-,,2,+ ,+ K**9,2,+ K*5;, (K!) ,,3-,

,5,2',+. +$ntuk badan usaha "ang bermitra%KS&* pers"aratan ini dapat

dis"aratkan bagi perusahaan "ang melaksanakan pekerjaan "ang membutuhkan


48/49

Serti5ikat IS& dan%atau pers"aratan Serti5ikat K4,.

B. P&';, ULP **5', ,+ *3,++',+ ,2, ,+ **52, ,-, D,2, K,-/',

*+,+ *5,5,2,+ ',-/', ,-, 9,-:

1) '*-*+',,+ ,+

'*,3,9,+ D,2,

K,-/', (2*

5)< ,+

) **+9,+

*5,5,2,+ 2*'+

',-/', (2*

+-,) *+,+

=52*5, *+-,,+

*+,-,,+

*5,9,+ ,,

*'*5;,,+ *;*+

,+ '&-*'2,

,+ *2,5, *52,

'*',+ **52,

*3,, 3*5'2:

,) P*+,-,,+ ,, *'*5;,,+

*;*+ *+,+ 3&3&2 40?""<

3) K**,,+ 3*,5,+ +-,

*'*5;,,+ *;*+ ,+ *5+,9

*-*,',+ *+,+ +-,

*'*5;,,+ ,+ ,',+

'&*2',+ *+,+ 3&3&2 !"?

4"<

=) P*+,-,,+ *'*5;,,+ ,, -&',

,+ ,, ,, 2+',2

K,3,2*+%K&2, *+,+ 3&3&2 "?

1"<

) D&- *5,9,+ +'

(2+',2 P5&@+%K,3,2*+%K&2,

'*=,- P5&@+ DKI #,',52,)

*+,+ 3&3&2 "<

*) #-,9 ,) 3) =) ,+ ) ,,

*+,+ 100.

!) D,-, 9,-

*5,9,+ *,

325 A.6 *+,,2

3&3&2 "

C. F&5-5 I,+ K,-/', ,+ 2,' 339 ,2*5, 2,' 5',+ **52,

+2, +2' *339 ,2*5, *+-, R1.00000 (, 3*-, 53 5,9).


49/49

D. A,3-, 2*',+ 9,-?9,- ,+%,2, ,2, ,+ '5,+ ;*-, ,', P&';, ULP ,,2

*+2, **52, +2' *+,,',+ '-,5/', *=,5, 2*52- 2*5,' ,,2

*-,'',+ *++;,,+ -,,+,+ ,, 9,'?9,'%+2,+ 2*5',2 +,+ 2,' 3&-*9

*+3,9 32,+ /&5-5 ,+ ',-/',.

E. D,2, ,+ '5,+ ,,2 -*+', ,-+ -,3,2 *3*- 3,2, ,'95 *,',+

D&'*+ K,-/',.

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