copy tpg page 18 sd page 56 (2).xlsx

Page 18DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.1 - TACSRNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

A.Stranded Conductor

1Appropriate standardsASTM/JEC2Manufacturer's nameTo be mentioned3Sectional area of Aluminiummm4144Sectional area of steelmm67.35Total sectional areamm481.36Number and diameter Aluminium Wirenumber/mm26/4.57Number and diameter Aluminium-clad Steel Wirenumber/mm7/3.58Overall diameter approximatelymm28.59Linear mass (approximately)kg/kmTo be mentioned10Rated strength (minimum)kN136.111DC resistance at 20C/km0.071412Modulus of electricityGpaTo be mentioned13Coefficient of linear expansionper CTo be mentioned14Length of one drumm1500-200015Approximate gross weight of one drumkgTo be mentioned16Approximate net weight of one drumkgTo be mentioned17Dimension of drum (diameter x weight)mm x mmTo be mentioned18Direction of stranding of outermost layerRight-hand lay

BIDDER'S SIGNATUREMANUFACTURER SIGNATURE

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Page 19DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.1 - TACSRNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

B.Individual WireFor Thermal Aluminium Wires1Appropriate standardASTM/JEC2MaterialThermal Alumunium4Diametermm4.55Tolerance of diameter%-/+ 16Resistivity at 20C (corresponding to 60% IACS conductivity)nmTo be mentioned7Density at 20Ckg/dmTo be mentioned8Coefficient of linear expansionper CTo be mentioned9Constant-mass temperature coefficient of resistance at 20 Cper CTo be mentioned10Minimum tensile strengthMpaTo be mentioned11Final modulus of elasticityGpaTo be mentionedFor Zinc-Coated Steel Wires1Appropriate standardIEC 608882MaterialRegular strength steel3Designation according to IEC 61089S1B4Diametermm3.55Tolerance of diametermm-/+ 0.076Density at 20Ckg/dmTo be mentioned7Coefficient of linear expansionper CTo be mentioned8Minimum tensile strengthMpaTo be mentioned9Final modulus of elasticityGpaTo be mentioned10Minimum mass of zinc coatingg/mm49011Initial stressMpa30012Initial setting of oxtensometer (gauge length 250 mm)0.37513Minimum number of twisting on length of 100 x diatimesRequired


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Page 20DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.3 - GROUND STEEL WIRENODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

A.Stranded Groundwires1Appropriate standardIEC610892Designation70-S1B-73Manufacturer's nameRequired4Common nameGSW 705Number and diameter of steel wirenumber/mm7/3.606Overall diameter (approximately)mm10.87Sectional area of conductormm71.28Linear mass (approximately)kg/km559.489Rated Strength (minimum)kN84.7310Modules of elasiticitykg/mmRequired11Coefficient of linear expansionGpa11.5 x 10612Length of one drumper C200013Approximate gross weight of one drummRequired14Approximate net weight of one drumkgRequired15Dimension of drum (diameter x weight)kgRequired16Direction of stranding of outermost layerZ-type17Short circuit current capacity (mm)kA - sec35B.Individual WiresFor Zinc-Coated Steel Wires1Appropriate standardIEC608882MaterialRegular strength steel3Diametermm3.64Tolerance of diametermm-/+ 0.065Density at 20Ckg/dm7.786Coefficient of linear expansionper C11.5 x 1067Minimum tensile strengthMpa11908Initial stressMpa3009Initial stetting of extensometer (gauge length 250 mm)0.37510Minimum number of twisting on length of 100 x diatimesRequired11Minimum mass of zinc coatingg/mm520


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Page 21DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.6 - CONDUCTOR & EARTHWIRE FITTINGS AND ACCESSORIESNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

IFittings And Accessories for Conductor1Joint SleevesRequired- Manufaturer's nameAlumunium Alloy and Galvanzed Steel- MaterialsComply with conductor type- Applied conductorCompression- Type95% of the ultimate breaking strength of conductor- Min. Tensile strength after compressed

2Repair Sleeves- Manufaturer's nameRequired- MaterialAlumunium Alloy- Applied conductorComply with conductor type- TypeCompression

3Vibration Dampers- Manufacturer's nameRequired- Material : * Counter weightGalvanized Steel * Clamp bodyAlumunium Alloy * Damper conductor (cable)Steel Wire Galvanized- TypeRequired- WeightkgRequired


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4Spacer- Manufaturer's nameRequired- MaterialsAlumunium Alloy and Galvanzed Steel- TypeRequired- WeightkgRequired

5Spacer Damper- Manufaturer's nameRequired- MaterialAlumunium Alloy and Galvanzed Steel- TypeRequired- WeightkgRequired

IIFor Earthwire1Joint sleeves- Manufacturer's nameRequired- Material : * For GSWGalvanized Steel * For ASAlumunium-Clad Steel- TypeCompression- Minimum tensile strength after compressedkg95% of the ultimate breaking strength of earthwire2Repair sleeves- Manufaturer's nameRequired- MaterialAlumunium Alloy- TypeCompression


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3Dampers - Manufaturer's nameRequired- Materials * Counter WeightGalvanized Steel * Clamp Body - For GSWGalvanized Steel - For ASAlumunium Alloy * Damper conductor (cable)Galvanized Steel- TypeRequired- WeightkgRequired

4Suspensions clamps- Manufaturer's nameRequired- Applied conductorComply with earthwire type- Materials (body)Galvanized Steel- TypeRequired- Slip strengthRequired- Ultimate breaking strengthkNRequired5Tension clampskN- Manufaturer's nameRequired- Materials (body)Comply with earthwire type- TypeGalvanized Steel- Applied conductorRequired- Ultimate breaking strengthkNRequired- Slip strengthkNRequired


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Page 24DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.7 - INSULATOR AND FITTINGS INSULATOR UNITNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

IFor Medium Pollution

1Appropriate IEC Standars603052DesignationU 120 B3Material of InsulatorPorcelain / Glass4Dimensionmm x mm255 (max.) x 1465Minimum nominal creepage distancemm2956Electromechanical or mechanical failing loadkN1207Type of Coupling (IEC)mm168Impulse pucture testing in airkVRequired9Withstand Voltage :- Wet power-frequency withstand votage testkV4010Impulse Withstand Voltage (1.2 x 50 us) :- Dry lightning impulse withstand voltage testkV10011Net Weight of one unitkgRequired12Colour of the insulator :- PorcelainBrown- GlassRequired


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Page 25DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.5 - GROUNDWIRES (OPGW) AND ACCESSORIESNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

1Properties of OPGW as GroundwireManufacturerStandard : * Optical FibreIEC 60793, IEC 60794, ITU - T G. 652D * Alumunium clad steel (AS) wireIEC 61232 * Alumunium Alloy wireIEC 60104No. of different coloured fiberCoreas requiredNo. of bufer tubeas requiredConstruction- Alloy wireNosas required- Alumunium clad steel (AS) wireNosas required- Fiber Optic metalic tubeNos (metalic tube)Alumunium tube or alumunium coated stainless steel tubeOverall diameter (approximately)mmas requiredCross Section Area : * AS Wire (approximately)mmas required * Hard drawn Alumunium or Alumunium Alloy Wiremmas required Alloy Wier (approximately)Nominal weight (max)kg/kmas requiredModules of elasticityN/mmas requiredCoeffient of linear expansionx 106 / Cas requiredRated tensile strength (min)kN90.4Ultimate tensile strength (min)kNas requiredMaximun tension stressN/mmas requiredEveryday stressN/mmas requiredPermanent tensile stressN/mmas requiredMax. allowable temperature :- ContinousCas required- For one secCas requiredD.C. Resistance at 20 C (max)Ohm/kmas required * Mean sub-span with spacer/dampersmas required * Number of Vabrication dampers per span : - Span up to 400 metrespcsas required - Span over to 400 metresspcsas required * Short circuit current capacity (min)kA - sec35


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Page 26DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.5 OPTICAL GROUNDWIRES (OPGW) AND ACCESSORIESNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

2Commponent Wire

Type-as requiredNominal diametermmas requiredMin. Braking strengthN/mmas requiredNominal Weightkg/kmas requiredMax. D.C. Resistance at 20 Cohm/kmas requiredCalculated cross section areammas requiredPermissible variations in%as required * Specified * DiameterMinimum Tickhness of Alumuniummmas requiredNumber of Twist (min)Nos as requiredStress at 1% elongationN/mmas required


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3Construction and Properties of Optical FibreITU-T G.652D9.3 + 0.5Mode Field Diameter at 1310 mm125 + 1.0Cladding diametermMax 0.8Mode field Concentricity errormMax 1.0Cable cut off wavelength%< 1260Attenuation at 1310 mmdB/km0.35Attenuation at 1383 mmdB/km0.33Attenuation at 1550 mmdB/km0.23Attenuation at 1625 mmdB/km-Chromatic dispersion at 1310 mmps/(nm.km)Max 3.5Chromatic dispersion at 1550 mmps/(nm.km)Max 18Chromatic dispersion at 1530 ~ 1565 mmps/(nm.km)-Chromatic dispersion at 1565 ~1625 mmps/(nm.km)-Primary coatingUV ArcylateNominal coating diametermm245 + 5Zero dispersion wavelengthsnm1300 - 1322Polarization Mode dispersion (PMD)ps/km1/2Max 0.1Zero dispersion Slopeps/nmkmMax 0.092


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4Joint Boxes, Gantry Boxes

4.1Joint BoxesManufacturer-as requiredType-as requiredManual-Stainless SteelIndex Proection Level-IP 65CapacityNumber of cableunitas requiredCable diameter (max)mmas requiredNumber of Splice Trayunitas requiredNumber of Splice per Trayunitas requiredDimensionalHeightmmas requiredWidthmmas requiredDepthmmas requiredTotal Weightkgas requiredPermisible Temperature RangeTransportationC-40 to +70StorageC-40 to +70OperationC-40 to +70Relative Humidity%90


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4.2Gantry Box

Manufacturer-as requiredType-as requiredMaterial-Stainless SteelIndex Proection Level-IP 65CapacityNumber of cableunitas requiredCable diameter (max)mmas requiredNumber of Splice Trayunitas requiredNumber of Splice per Trayunitas requiredDimensionalHeightmmas requiredWidthmmas requiredDepthmmas requiredTotal Weightkgas requiredPermisible Temperature RangeTransportationC-40 to +70StorageC-40 to +70OperationC-40 to +70Relative Humidity%90


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Page 30DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.7 - INSULATORS AND FITTINGS INSULATOR UNITNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

IIFor Medium Pollution 1Appropriate IEC Standars603052DesignationU 210 B3Material of InsulatorPorcelain / Glass4Dimensionmm x mm300 (max) x 1705Minimum nominal creepage distancemm3706Electromechanical or mechanical failing loadKN2107Type of Coupling (IEC)mm208Impulse Puncture testing in airkVRequired9Withstand Voltage :-Wet power-frequency withstand voltage testkV4510Impulse Withstand Voltage (1.2 x 50 us) :- Dry lightning impulse withstand voltage test (1.2 x 50 us)kV11011Net weight of one unit kgRequired12Colour of the insulator :-Porcelain-GlassBrownRequired


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SingleDoubleSingleDoubleSuspension setSuspension setTension SetTension SetIXInsulator sets for 2 x ACSR 450-A1/S1B-54/7 and2 x ACSR 450-A1/SA1A-54/71Number of strings and dics per string :- For Medium pollution (U 120 B and U 210 B)unit-2 x 12-2 x 122Length of string when strechedmm-Required-Required3Overall creepage distancemm-Required-Required4Net weight of one set kg-Required-Required5Ultimate breaking strength of stringkN-2 x 120-2 x 2106Withstand voltage withhout arcing horn :- Wet power-frequency withstand voltage testkV-Required-Required- Dry lightining impulse withstand voltage test (1.2 x 50 us)kV-Required-Required7Withstand voltage with arcing horn :- Wet power-frequency withstand voltage testkV-Required-Required- Dry lightining impulse withstand voltage test (1.2 x 50 us)kV-Required-Required8Arcing horn gap (approximately) :- For Medium pollution (U 120 B and U 210 B)mm-1402-1168- For Heavy Pollution (U 120 BP and U 210 BP)mm-1496-1360


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XISingle Suspension Insulator StringFor Medium Pollution (U 120 B)For Heavy Pollution (U 120 BP)

1Number of strings and dics per string (for jumper)2Length of string when strechedmm1 x 12 1 x 12 3Overall Creepage distancemmRequiredRequired4Wet weight of one setkgRequiredRequired5Ultimate breaking strength of stringkNRequiredRequired6Withstand voltage without arcing horn :- Wet power-frequency withstand voltage testkVRequiredRequired- Dry lightining impulse withstand voltage test (1.2 x 50 us)kVRequiredRequired


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XIIFittings1Suspension ClampsManufactur'sMaterials (Body)RequieredTypeAlumunium Alloy + Galvanized steelAppiled conductorRequiredArmour rodComply with conductor type + armour rodUltimate breaking strengthkNRequiredSlip strengthkNRequired


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2Tension Clamps Coppression TypeManufacturers's nameRequiredMaterial :* Dead end body and jumper connectorAlumunium alloy + Galvanized steel* Steel core with clevisGalvanized steel* BoltGalvanized steelMinimum tensile strength :* Dead end clampkNRequired* Jumper connectorkNRequiredUltimate breaking strengthkNRequired3Arcing HornManufacturers's nameRequiredMaterialGalvanized steelInsulationRequiredNumber InsulatorComply with number of disc per string insulatorBoltGalvanized steel4Armour RodManufacturers's nameRequiredMaterialAlumunium AlloyApplied conductorComply with conductor typeType of end fromBallDiametermmRequiredLengthmmRequiredSlip strengthRequiredMinimum tensile strengthRequiredDirection of layComply with conductor type


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5Fitting for Suspension String Sets (Suspension Clamp)Manufacturer's nameRequiredMaterialGalvanized SteelMinimum tensile strengthkNComply with designation of insulator and number of string

6Fitting for Tension String Stes (Tension Clamp)Manufacturer's nameRequiredMaterialGalvanized SteelMinimum tensile strengthkNComply with designation of insulator and number of string


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Page 36DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.8 - Steel Tower NODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

B.For wind loading conditions the following shall be applied

B.1Temperature of ConductorCa. Highest Temp.150 for TACSRb. Average Temp30c. Lowest Temp10

B.2Wind Pressurekg/mmTWR StdWind pressure shall be calculated according to IEC 60826 based on wind data which obtain from the nearest meteorogical stationa. Conductor and Groundwires, on the projected area of eatch of them40b. Insulator strings, on the projected of each area of them60c. Tower, on the projected area of members of the sides the wind120pressure shall be applied according to the values above


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Standar DesignA.General Design Conditionsa. VoltagekV150b. Number of Circuit4c. Basic Spanm350d. Loading Span - Wind Span All Tower - Normal Conditionm500 - Broken wire conditionm400 - Weight Span Suspension tower - Normal Conditionm700 - Broken wire conditionm400 Tension Tower - Normal Conditionm700 - Broken wire conditionm400e. Conductormm2 x TACSR 410f. Maximum Working Tension (T) per Conductorkg3400g. Ground WiremmGSW 70 mm and OPGW 70 mmh. Maximum Working Tension (T) ground wirekg1400


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C.Tower Design DetailStandar DesignC.1Minimum thickness of members before galvanizinga. Main angle membersmm6b. Secondary membersmm5c. Secondary untressed membersmm4d. Tension membersmm5e. Gusset platemm5mm16C.2Minimum diameter of BoltNumber of immersion in uniformity testC.3Minimum Zinc massg/m610a. membersg/m550b. Bolt, Nut, WasherC.4Slenderness ratioa. Tower legs & main members in cross arm and groundwire peaks120b. All orther compression members200c. Secondary members for renforcement of compression members250d. Tension members400C.5Safety Factora. Normal loading conditions1.5b. Broken wire conditions1.1


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D. Material for SupportHight Strength Steel material- Minimum tensile strengthN/mm370- Minimum yield strengthN/mmRequired- Minimum elogation on 200 m%RequiredMild Strength Steel material- Minimum tensile strengthN/mm250- Minimum yield strengthN/mmRequired- Minimum elogation on 200 m%RequiredShear on Bolts- Mild steel strengthN/mm234- Hight tension steelN/mm350Bearing on Bolt- Mild steel strengthN/mm465- Hight tension steelN/mm700Galvanizing- Minimum quatity of zinc coatingg/m610


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E.Clearance Internal to LinesThe configuration of double and four circuit towerswill take info account the following internal clearance

E.1Groundwirea. Number per tower2b. Shield angle (max)deg.15E.2Distance between tower arm and jumperm1.9E.3Maximum allowable swing anglea. Suspensiondeg.40b. Tension (jumper)deg.20E.4Normal Insulation spacingm1.8E.5Minimum Insulation spacingm1.3(under swing condition)


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Page 41DAFTAR ISIAN 3 : TECHNICAL PARTICULAR AND GUARANTEETPG V.3.8 Steel TowerNODESCRIPTIONUNITREQUIREDPROPOSED AND GUARANTEE

AABBCCDDDDREEAABBCCDDDDREE

1Type of insulator setSuspensionTensionTensionTensionTensionTension2Maximum angle of deviationdeg320406060603Basic spanm3503503503503503504Maximum tower base (extension + 0) dimension at ground level(transerverse x longitudinal)m x mReqiured


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Page 42

[NAMA PROYEK]

DAFTAR ISIAN 4 : PENYIMPANGAN TERHADAP DOKUMEN PENGADAAN(1) - Kontraktor harus menyampaikan dalam form ini bahwa penawarannya sesuai atau sesuai sebagian dengan dokumen lelang(2) - Bila ada penyimpangan / deviasi harus ditulis dalam form ini dan juga bila ada interpretasi lain dari dokumen lelang

NOPERNYATAAN TERHADAP DOKUMEN LELANGSTATEMENT OF THE BIDDER (Please state : YES or DEVIATES as in the list below)I - 1Apa penawaran sudah lengkap dan sesuai dengan semua yang diminta.. dalam dokumen lelangI - 2Apa kontraktor akan melengkapi semua kebutuhan yang diminta.. dalam dokumen lelangNODAFTAR PENYIMPANGAN / DEVIASIBAB / No. ITEMBUKU A, B atau CURAIAN DARI PENYIMPANGAN / DEVIASIII - 1II - 2II - 3II - 4II - 5II - 6

TANGGAL :NAMA KONTRAKTOR :TANDA TANGAN KONTRAKTOR

Page 43

[NAMA PROYEK]DAFTAR ISIAN 5 : NAMA DAN TEMPAT PABRIK, PENGUJIAN DAN INSPEKSI(Harus di isi untuk setiap peralatan / material)

NOURAIANNAMA PABRIKANALAMAT PABRIKANALAMAT TESTING AND INSPECTIONSTANDART UNTUK TESTING DAN INSPEKSI

1Conductor TACSR2Earthwire GSW3OPGW4Insulator Unit5Insulator Fittings6Hardwares For Conductoers TACSR7Hardwares For Earthwire GSW8Accessories For OPGW9Steel Tower


Page 44

[NAMA PROYEK]DAFTAR ISIAN 6 : SERTIFIKAT HASIL UJI PERALATAN YANG DIMASUKAN DALAM PENAWARAN(Harus Dilampirkan dalam dokumen penawaran)

NOURAIANNAME OF MANUFACTURERPLACE OF MANUFACTURERDATE OF TESTNAME OF LABORATORYPLACE OF TESTING AND INSPECTION

1Conductor TACSR2Earthwire GSW3OPGW4Insulator Unit5Insulator Fittings6Hardwares For Conductoers TACSR7Hardwares For Earthwire GSW8Accessories For OPGW9Steel Tower


Page 45

[NAMA PROYEK]DAFTAR ISIAN 7 : PENGALAMAN DAN KEMAMPUAN PABRIKAN PERALATAN YANG DIMASUKKAN DALAM PENAWARAN(Kontraktor harus menyampaikan daftar pengalaman dan kemapuan pabrikan dari setiap peralatan / material)

NONAMA PERALATAN / MATERIALNAMA PABRIKAN & ALAMATNAMA / LOKASI PROYEKTAHUN OPERASIVOLUMETANGGAL


Page 46

[NAMA PROYEK]DAFTAR ISIAN 8 : PENGALAMAN DAN KEMAMPUAN KONTRAKTOR YANG DIMASUKAN DALAM PENAWARAN(Kontraktor harus menyampaikan daftar pengalaman dan kemapuan pabrikan dari setiap peralatan / material)

NOURAIAN PROYEKNAMA & ALAMATNAMA / LOKASI PROYEKTAHUN OPERASIVOLUMEADA SERTIFIKAT


Page 47

[NAMA PROYEK]DAFTAR ISIAN 9 : SPARE PART & TOOLS (MANDATORY)(1) kontraktor harus mengisi semua type / jenis peralatan (Spare part & Tool), lengkap dengan kapasitas peralatan (bila ada), pabrikan yang memproduksidan asal negara (bila ada) sesuai jumlah / quantity pada BOQ, semua jenis peralatan yang ditulis adalah merupakan pengadaanMandatory Peralatan yang harus diserahkan ke PLN (Owner).

NOITEM SPARE PART & TOOLSUNITTYPEMERKCAPACITYMANUFACTURERCOUNTRYTEST CERTIFICATE


Page 48

[NAMA PROYEK]DAFTAR ISIAN 10 : SUBCONTRACOR PROPOSED BY THE BIDDER

The Bidder Shall provide detailed information of subcontractors to be empolyed for execution of a part orparts the Contact (complete a separate sheet for each subcontractor).

a. Name and incorparated status of the Subcontractor :

b. Registered address of the Subcontractor :

c. Work to be Subcontractor :

d. Subcontractor period :

e. Tools and equipment owned by the Subcontractor :


Page 49[NAMA PROYEK]DAFTAR ISIAN 11 : BIDDER'S FINANCIAL QUALIFICATION

The Following information shall be supplied by the Bidders whose attention is drawn to the Section IIIEvaluation and Qualification Criteria

a. SIZE OF OPERATION :

YearTurnover (Rp)12345Average :

b. FINANCIAL POSITION :

YearNet Income (Loss) (Rp)12345Average :

c.CASHFLOW CAPACITY :(Rp)

Note : Evidences for the above shall be submitted with the Bid


Page 50

DAFTAR ISIAN 12.1 : TKDN gabungan barang dan jasa untuk material langsung (Bahan baku)

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianSpesifikasiPemasok / Negara asalTKDN (%)JumlahSatuanHarga satuan (Ribu Rp)Biaya (Rp)TKDN Barang (%)KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(5)x(6)x(8)(100%-(5))x(6)x(8)DN + LN123

Material Langsung (Bahan Baku)SUB TOTAL

Ket :Kolom (9) DN : kolom (5) x kolom (6) x kolom (8)Kolom (9) LN : (1-kolom(5)) x kolom (6) x kolom (8)

Page 51

DAFTAR ISIAN 12.2 : TKDN gabungan barang dan jasa untuk peralatan (Barang Jadi)

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianSpesifikasiPemasok / Negara asalTKDN (%)JumlahSatuanHarga satuan (Ribu Rp)Biaya (Rp)TKDN Barang (%)KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(5)x(6)x(8)(100%-(5))x(6)x(8)DN + LN123

Peralatan (Barang Jadi)SUB TOTAL

Ket :Kolom (9) DN : kolom (5) x kolom (6) x kolom (8)Kolom (9) LN : (1-kolom(5)) x kolom (6) x kolom (8)

Page 52

DAFTAR ISIAN 12.3 : TKDN gabungan barang dan jasa untuk Manajemen Proyek dan Perekayasaan

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianKualifikasiWarga NegaraTKDN (%)JumlahSatuan / DurasiHarga satuan (Ribu Rp)Biaya (Ribu Rp)TKDN Jasa (%)KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(5)x(6)x(8)(100%-(5))x(6)x(8)DN + LN123

Manajemen Proyek dan PerekayasaanSUB TOTAL

Ket :Kolom (9) DN : kolom (5) x kolom (6) x kolom (7) x kolom (8)Kolom (9) LN : (1-kolom(5)) x kolom (6) x kolom (7) x kolom (8)

Page 53

DAFTAR ISIAN 12.4 : TKDN gabungan barang dan jasa untuk Alat Kerja / Fasilits Kerja

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianSpesifikasi / pemasokKepemilikan Alat KerjaJumlahSatuan / DurasiBiaya Depresiasi / Sewa (Ribu Rp)Biaya (Ribu Rp)TKDN Jasa (%)DibuatDimilikiTKDN %KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(4)x(5)x(6)x(7)(100%-(4))x(5)x(6)x(7)DN + LN123

Alat Kerja / Fasilitas KerjaSUB TOTAL

Ket :Kolom (9) DN : kolom (4) kolom (5) x kolom (6) x kolom (7)Kolom (9) LN : (1-kolom (4)) x kolom (5) x kolom (6) x kolom (7)

Page 54

DAFTAR ISIAN 12.5 : TKDN gabungan barang dan jasa untuk Kontruksi / Fabrikasi

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianKewarganegaraanTKDN %JumlahDurasiHarga satuan upah (Ribu Rp)Biaya (Ribu Rp)TKDN Jasa (%)KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(4)x(5)x(6)x(7)(100%-(4))x(5)x(6)x(7)DN + LN123

Konstruksi / FabrikasiSUB TOTAL


Page 55

DAFTAR ISIAN 12.6 : TKDN gabungan barang dan jasa untuk Jasa Umum

Nama Penyedia Barang / Jasa:Alamat:Nama Pekerjaan:Pemilik Pekerjaan:No. Dokumen:No.uraianPemasokKepemilikan KDN %JumlahSatuan / DurasiHarga satuan (Ribu Rp)Biaya (Ribu Rp)TKDN Jasa (%)KDNKLNTOTAL(1)(2)(3)(4)(5)(6)(7)(8)(9)(4)x(5)x(6)x(7)(100%-(4))x(5)x(6)x(7)DN + LN123

Jasa UmumSUB TOTAL


Page 56

DAFTAR ISIAN 12.7 : Rekapitulasi penilaian TKDN Gabungan Barang dan JasaA.Nama Penyedia barang / Jasa:B.Alamat:C.Nama pekerjaan:D.Pemilik Pekerjaan:E.No Dokumen:URAIANNilai Gabungan Barang dan Jasa TKDN %(Ribu Rp)KDNKLNTOTALBarang / Jasa GabunganRibu Rp% KDN(1)(2)(3)(4)(5)(6)(7)BarangI.Material Langsung(Bahan Baku)II.Peralatan(Barang Jadi)F. Sub Total BarangIII.Manajemen ProyekDan PerekayasaanIV.Alat Kerja / FasilitasKerjaV.Kontruksi danFabrikasiVI.Jasa Umum

G. Sub Total JasaH. TOTAL Biaya (F+G)

copy tpg page 18 sd page 56 (2).xlsx

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