PT. KOGAS DRIYAP KONSULTAN in JV with PT. PERENTJANA DJAJA

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1 PT. KOGAS DRIYAP KONSULTAN in JV with PT. PERENTJANA DJAJA REGIONAL OVERSIGHT MANAGEMENT SERVICES (ROMS) 6 COMMUNITY BASED WATER SUPPLY PROJECT (PAMSIMAS II) NO. Contract No. : KU.08.08/Kontrak/Pamsimas/175/VIII/2013 Contract Date : August 27, 2013 Invoice No. 2 : Oktober 2013 AMOUNT (IDR) AMOUNT (IDR) AMOUNT (IDR) AMOUNT (IDR) A REMUNERATION 17,938,800, ,940, ,600, ,540,000 17,453,260,000 1 Regional Team 1,706,400,000 32,360,000 31,400,000 63,760,000 1,642,640,000 2 Provincial Team 3,304,800,000 55,080,000 68,400, ,480,000 3,181,320,000 3 District Team 12,927,600, ,500, ,800, ,300,000 12,629,300,000 B REIMBURSABLE 17,505,100, ,041, ,873, ,914,221 17,038,185,779 1 Duty Travel 673,920, , , , ,120,000 Management Fee of [ ] 67,392,000 55,000 25,000 80,000 67,312,000 2 Mobilization and Demobilization 256,100,000 13,336,500 13,336, ,763,500 Management Fee of [2.1] 25,610,000 1,333,650 1,333,650 24,276,350 3 Office Space 2,254,590, ,580,000 44,820, ,400,000 1,972,190,000 4 Utilities Expenses 774,390,000 10,450,000 11,950,000 22,400, ,990,000 5 Office Equipment 437,000, ,000,000 6 Vehicle Rental 5,829,030,000 72,650,000 73,785, ,435,000 5,682,595,000 7 Communication 556,800,000 78,140 39, , ,682,663 Management Fee of [ ] 55,600,000 7,814 3,920 11,734 55,588,266 8 Training 6,209,060,000 6,209,060,000 Management Fee of [ ] 325,233, ,233,000 9 Reporting 40,375,000 40,375, TOTAL PELATIHAN STBM PAMSIMAS II 352,423, ,423,500 Pelatihan STBM Pamsimas II 320,385, ,385,000 Management Fee of ( 10 ) 32,038,500 32,038,500 C TOTAL COST OF SERVICES {Excluded VAT} 35,796,323, ,981, ,473, ,454,221 34,843,869,279 D Amount Eligible for IBRD Funding 80% x { A + B } 28,355,120, ,384, ,578, ,963,377 27,593,156,623 E Advance Payment {of IBRD Portion} 2,925,800,000 2,925,800,000 Repayment of Advance Payment {of IBRD Portion} 2,925,800,000 2,925,800,000 F Total Claim This Invoice IBRD Portion 28,355,120, ,384, ,578, ,963,377 27,593,156,623 G Amount Eligible for TF Funding { 10 } 352,423, ,423,500 H Amount Eligible for APBNRM Funding 20% x { A + B } 7,088,780, ,596,221 84,894, ,490,844 6,898,289,156 I Advance Payment {of APBNRM Portion} 731,450, ,450,000 Repayment of Advance Payment {of APBNRM Portion} 731,450, ,450,000 J Claim This Invoice APBNRM Portion 7,088,780, ,596,221 84,894, ,490,844 6,898,289,156 K VAT 10 % on the APBN RM Portion 708,878,000 10,559,622 8,489,462 19,049, ,828,916 L Total Claim This Invoice APBNRM Portion { J + K } 7,797,658, ,155,843 93,384, ,539,929 7,588,118,071 M Volue of Contract {Including VAT 10% on the APBN Portion} 36,505,201, ,540, ,962, ,503,305 35,533,698,195 Jakarta, Oktober 2013 Project Manager/ PPK Kegiatan Wilayah II, PT. KOGAS DRIYAP KONSULTAN Satuan Kerja Pembinaan Pamsimas in JV with : PT. PERENTJANA DJAJA DIAH SURYANINGTYAS, SIP. MM NIP YENNI SITI ROSTIANI President Director

2 REGIONAL OVERSIGHT MANAGEMENT SERVICES (ROMS) 6 COMMUNITY BASED WATER SUPPLY PROJECT (PAMSIMAS II) : Oktober 2013 NO. Amount Amount Amount Amount Amount B REIMBURSABLE COST 17,505,100, ,041, ,873, ,914,221 17,038,185,779 1 DUTY TRAVEL 673,920, , , , ,120, Spot Checking Provincial Team Province to District to Village Gorontalo Inland Transport 3 person ,000 11,520, , ,520,000 Accomodation 3 person ,000 23,040, , ,040,000 OSA (Fixed) 3 person ,000 34,560, , ,560,000 Sulawesi Tengah Inland Transport 3 person ,000 28,800, , ,800,000 Accomodation 3 person ,000 57,600, , ,600,000 OSA (Fixed) 3 person ,000 86,400, , ,400,000 Sulawesi Utara, Maluku, Malut Inland Transport 3 person ,000 28,800, , ,800,000 Accomodation 3 person ,000 57,600, , ,600,000 OSA (Fixed) 3 person ,000 86,400, , ,400, District Team District to Village District Coordinator Gorontalo 4 district ,000 24,000, , , , , ,550,000 District Coordinator Sulteng 10 district 1,200 50,000 60,000,000 50,000 1, ,000,000 District Coordinator Sulut 2 district ,000 12,000,000 50, ,000,000 District Coordinator Maluku 5 district ,000 30,000,000 50, ,000,000 District Coordinator Malut 3 district ,000 18,000,000 50, ,000,000 Financial Management Ass. Gorontalo 4 district ,000 19,200, , , , , ,850,000 Financial Management Ass. Sulteng 10 district ,000 48,000,000 50, ,000,000 Financial Management Ass. Sulut 2 district ,000 9,600,000 50, ,600,000 Financial Management Ass. Maluku 5 district ,000 24,000,000 50, ,000,000 Financial Management Ass. Malut 3 district ,000 14,400,000 50, ,400,000 Management Fee 10% of [1.1] 67,392,000 55,000 25,000 80,000 67,312,000 2 MOBILIZATION AND DEMOBILIZATION 256,100,000 13,336,500 13,336, ,763, Regional Team Jakarta to Province to Jakarta Project Manager Jakarta Manado Jakarta 1 4,770,000 4,770, ,000 4,770, , ,999, Data Management Jakarta Manado Jakarta 1 4,770,000 4,770,000 4,770, ,770, LG Specialist Jakarta Manado Jakarta 1 4,770,000 4,770, ,954,000 4,770, ,954, ,816, Trainer Coordinator Jakarta Manado Jakarta 1 4,770,000 4,770, ,178,000 4,770, ,178, ,592, Local Transport 4 200, , , , , , Provincial Team Jakarta to Province to Jakarta Provincial Coordinator / LG Jakarta Manado Jakarta 1 4,770,000 4,770,000 4,770, ,770,000 Jakarta Gorontalo Jakarta 1 4,510,000 4,510, ,255,000 4,510, ,255, ,255,000 Jakarta Palu Jakarta 1 3,280,000 3,280, ,178,000 3,280, ,178, ,102, Financial Management Specia Jakarta Manado Jakarta 1 4,770,000 4,770,000 4,770, ,770,000 Jakarta Gorontalo Jakarta 1 4,510,000 4,510, ,255,000 4,510, ,255, ,255,000 Jakarta Palu Jakarta 1 3,280,000 3,280, ,178,000 3,280, ,178, ,102, Quality Assurance Specialist Jakarta Manado Jakarta 1 4,770,000 4,770, ,000 4,770, , ,098,000 Jakarta Gorontalo Jakarta 1 4,510,000 4,510,000 4,510, ,510,000 Jakarta Palu Jakarta 1 3,280,000 3,280, ,178,000 3,280, ,178, ,102,000

3 Amount Amount Amount Amount Amount Local Transport 9 200,000 1,800, ,200, , ,200, , District Team Jakarta to Province to Jakarta District Coordinator Jakarta Gorontalo Jakarta 4 4,510,000 18,040, ,500 4,510, , ,122,500 Jakarta Palu Jakarta 10 3,280,000 32,800,000 3,280, ,800,000 Jakarta Manado Jakarta 2 4,770,000 9,540,000 4,770, ,540,000 Jakarta Ambon Jakarta 5 6,620,000 33,100,000 6,620, ,100, Financial Management Assista Jakarta Manado Jakarta 4 4,510,000 18,040,000 4,510, ,040,000 Jakarta Gorontalo Jakarta 10 3,280,000 32,800,000 3,280, ,800,000 Jakarta Palu Jakarta 2 4,770,000 9,540,000 4,770, ,540,000 Jakarta Ambon Jakarta 4 6,620,000 26,480,000 6,620, ,480, Local Transport (Province to District) ,000 16,400, , ,400,000 Management Fee 10% of [ ] 25,610,000 1,333,650 1,333,650 24,276,350 3 OFFICE SPACE (Rental) 2,254,590, ,580,000 44,820, ,400,000 1,972,190, Regional Team & Prov. Team 3.2 District Team 4 UTILITIES EXPENSES 774,390,000 10,450,000 11,950,000 22,400, ,990, Regional and Province 4.2 District 5 OFFICE EQUIPMENT 437,000, ,000, Notebook Computer (Regional+Provincial+District) 37 7,000, ,000,000 7,000, ,000, Portable Computer for Supporting Regional 2 5,000,000 10,000,000 5,000, ,000, Portable Computer + Printer for Supporting District 24 5,000, ,000,000 5,000, ,000, Printer Laserjet 3 2,500,000 7,500,000 2,500, ,500, Printer Colour A3 3 2,500,000 7,500,000 2,500, ,500, Scanner 3 1,250,000 3,750,000 1,250, ,750, Facsimilie 3 1,500,000 4,500,000 1,500, ,500, Digital Camera 3 1,250,000 3,750,000 1,250, ,750, GSM Modem + SIM Card 3 500,000 1,500, , ,500, Router, LAN Peripheral 3 1,500,000 4,500,000 1,500, ,500, GPS 6 2,500,000 15,000,000 2,500, ,000,000 6 VEHICLE RENTAL 5,829,030,000 72,650,000 73,785, ,435,000 5,682,595,000 7 COMMUNICATION 556,800,000 78,140 39, , ,682, Regional and Province Telephone and Postage 108 1,000, ,000, , ,000,000 39, , ,882, Internet Connection for Office ,000 37,800, , ,800, District Telephone and Internet Connection old district , ,000, , ,000,000 new district , ,000, , ,000,000 Management Fee 10% of [ ] 55,600,000 7,814 3,920 11,734 55,588,266

4 Amount Amount Amount Amount Amount 8 TRAINING 6,209,060,000 6,209,060, Pelatihan FM Ass. dan Data Entry Operator Peserta a Paket Fullboard ,000 36,000, , ,000,000 b Transportation ,000 9,600, , ,600, Pelatih a Financial Management Spec. manado ambon 1 11,390,000 11,390,000 11,390, ,390,000 b Inland Transport 1 200, , , ,000 c Accomodation 3 250, , , ,000 d OSA (Fixed) 4 200, , , , Training Material + Kit ,000 4,800, , ,800,000 Management Fee 10% of [8.1.1b a b d ] 2,679,000 2,679, Expert Group Meeting Central Regional Team Air Fare Province to Jakarta Provincial Team Air Fare Province to Jakarta Inland Transport Regional and Provincial Team OSA (Fixed) Regional Team ,000 21,600, , ,600, OSA (Fixed) Provincial Team ,000 48,600, , ,600,000 Management Fee 10% of [ ] 7,020,000 7,020, Expert Group Meeting Regional Fullboard package for district team , ,800, , ,800,000 Fullboard package for provincial team ,000 45,000, , ,000,000 Fullboard package for regional team ,000 9,600, , ,600, Air Transport [Economy Class] a Regional Team/ Manado manado gorontalo 24 8,920, ,080,000 8,920, ,080,000 b Regional Team/ Manado manado palu 24 9,550, ,200,000 9,550, ,200,000 d Regional Team/ Manado manado ambon 24 11,390, ,360,000 11,390, ,360,000 h Provincial Team/ Ambon manado ambon 18 11,390, ,020,000 11,390, ,020, Inland Transport a District Team/ Gorontalo ,000 14,400, , ,400,000 b District Team/ Palu ,000 36,000, , ,000,000 c District Team/ Manado ,000 7,200, , ,200,000 d District Team/ Ambon ,000 18,000, , ,000, OSA (Fixed) 1, , ,800, ,000 1, ,800,000 Management Fee 10% of [ ] 127,806, ,806, OJT Fasilitator Training Material + Kit 3 years x 2,592 25,000 64,800,000 25,000 2, ,800, Meals, Snack 3 years x 2,592 17,500 45,360,000 17,500 2, ,360, Pelatihan Penguatan BPSPAM Paket Fullboard Participant 4, , ,000, ,000 4, ,000, Paket Fullday for DPMU + TKK ,000 38,400, , ,400, Uang Saku Participant 4,800 50, ,000,000 50,000 4, ,000, Uang Transport Participant 1, , ,000, ,000 1, ,000, Spanduk ,000 13,440, , ,440, Training Material + Kit 1, , ,000, ,000 1, ,000,000 Management Fee 10% of [ ] 49,344,000 49,344, Pelatihan Kader AMPL Paket Fullboard Participant 4, , ,000, ,000 4, ,000, Paket Fullday for DPMU + TKK ,000 38,400, , ,400, Uang Saku Participant 4,800 50, ,000,000 50,000 4, ,000, Uang Transport Participant 1, , ,000, ,000 1, ,000, Spanduk ,000 13,440, , ,440, Training Material + Kit 1, , ,000, ,000 1, ,000,000 Management Fee 10% of [ ] 49,344,000 49,344,000

5 Amount Amount Amount Amount Amount 8.7 Workshop RAD AMPL 144 5,000, ,000,000 5,000, ,000,000 Management Fee 10% of [8.7] 72,000,000 72,000, Workshop Forum/Asosiasi BPSPAM in Province Paket Fullboard Participant + DPMU + TKK ,000 96,000, , ,000, Uang Transport Participant ,000 48,000, , ,000, Training Material + Kit ,000 24,000, , ,000, Spanduk ,000 13,440, , ,440,000 Management Fee 10% of [ ] 8,544,000 8,544, Pelatihan Pengelola Program Kabupaten (DPMU+TKK+Satker) in Province Paket Fullboard Participant , ,800, , ,800, Uang Transport Participant ,000 43,200, , ,200, Training Material + Kit ,000 21,600, , ,600, Spanduk ,000 20,160, , ,160,000 Management Fee 10% of [ ] 8,496,000 8,496, Printing/ Media: Spanduk , ,520, , ,520, Poster 10 22,100 5, ,180,000 5,890 22, ,180, Leaflet 4 39,560 2,000 79,120,000 2,000 39, ,120,000 Total Management Fee Training Activity [ ] 325,233, ,233,000 9 REPORTING 40,375,000 40,375, Inception Report 25 50,000 1,250,000 50, ,250, Monthly Report ,000 13,500,000 25, ,500, Quarterly Report ,000 9,000,000 50, ,000, Special Report 60 25,000 1,500,000 25, ,500, Annual Report 60 75,000 4,500,000 75, ,500, Financial Management Report (FMR) 60 25,000 1,500,000 25, ,500, Draft Final Report 20 75,000 1,500,000 75, ,500, Final Report ,000 2,000, , ,000, Training Program Report ,000 5,625,000 25, ,625, PELATIHAN STBM PAMSIMAS II 320,385, ,385,000 1 Honorarium Trainer/Fasilitator/Instruktur khusus 2 Perdiem Central Government 6 105, , , ,000 Provincial Government 6 105, , , ,000 Advisor 5 105, , , ,000 Panitia Lokal ,000 1,575, , ,575,000 Pemandu STBM (Province & Districts) ,000 3,675, , ,675,000 Participants (Sanitarian/Kader/Natural leader/bidan) ,000 39,900, , ,900,000 3 Transportation a. Tickets Central Government 2 4,780,000 9,560,000 4,780, ,560,000 Advisor 1 4,780,000 4,780,000 4,780, ,780,000 b. Inland/Local Transport Taxi (pp) for Central Personnels 3 420,000 1,260, , ,260,000 Provincial Government 2 110, , , ,000 Pemandu STBM (Province) 1 110, , , ,000 Pemandu STBM (Districts) 6 400,000 1,800, , ,800,000 Participants (Sanitarian/Kader/Natural leader/bidan) Donggala, Parigi Mountong Palu (pp) ,000 4,375, , ,375,000 Buol Palu (pp) 7 550,000 3,850, , ,850,000 Poso Palu (pp) ,000 3,000, , ,000,000 Morowali, Tojo Una una Palu (pp) ,000 7,650, , ,650,000 Banggai Kepulauan Palu (pp) ,000 13,600, , ,600,000

6 Amount Amount Amount Amount Amount 4 Fullboard Package a. Central Central Government 4 375,000 1,500, , ,500,000 Provincial Government 4 375,000 1,500, , ,500,000 TDS / CMAC 4 375,000 1,500, , ,500,000 Advisor 4 375,000 1,500, , ,500,000 b. Local Participants Pemandu STBM (Province & Districts) ,000 10,500, , ,500,000 Participants (Sanitarian/Kader/Natural leader/bidan) , ,000, , ,000,000 c. Panitia Lokal ,000 4,500, , ,500,000 5 Training Kit (Tas Punggung, Kaos, Topi) ,000 20,750, , ,750,000 6 Training Material ,000 22,825, , ,825,000 7 Stationery 2 2,000,000 4,000,000 2,000, ,000,000 8 Equipment a. Video Camera Rental 5 260,000 1,300, , ,300,000 b. Banner 1 500, , , ,000 c. Backdrop 1 1,250,000 1,250,000 1,250, ,250,000 d. Additional Classroom 8 1,500,000 12,000,000 1,500, ,000,000 e. Additional Infocus Rental 8 350,000 2,800, , ,800,000 f. Preparation Meeting (Snack & Lunch) 40 48,000 1,920,000 48, ,920,000 g. Car Rental 5 580,000 2,900, , ,900,000 h.computer/laptop Rental ,000 4,500, , ,500,000 i. Printer Rental ,000 3,000, , ,000,000 g. Bus Rental (Field Visit) 5 2,000,000 10,000,000 2,000, ,000,000 9 Training Report 5 100, , , ,000 Management Fee 10% of [ 10 ] 32,038,500 32,038,500

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