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 Contract No. : KU.08.08/Kontrak/Pamsimas/175/VIII/2013 REGIONAL OVERSIGHT MANAGEMENT SERVICES (ROMS) - 6 Contract Date : August 27, 2013 COMMUNITY BASED WATER SUPPLY PROJECT (PAMSIMAS II) Invoice No. 7 : Maret 2014 NO. AMOUNT (IDR) AMOUNT (IDR) AMOUNT (IDR) AMOUNT (IDR) A REMUNERATION 17,938,800,000 2,178,834, ,550,000 2,659,384,250 15,279,415,750 1 Regional Team 1,706,400, ,280,000 47,400, ,680,000 1,421,720,000 2 Provincial Team 3,304,800, ,180,000 91,800, ,980,000 2,726,820,000 3 District Team 12,927,600,000 1,455,374, ,350,000 1,796,724,250 11,130,875,750 B REIMBURSABLE 17,505,100,000 1,815,979, ,629,564 2,011,608,567 15,493,491,433 1 Duty Travel 673,920,000 4,350,000-4,350, ,570,000 Management Fee of [ ] 67,392, , ,000 66,957,000 2 Mobilization and Demobilization 256,100,000 24,445,500-24,445, ,654,500 Management Fee of [2.1] 25,610,000 2,444,550-2,444,550 23,165,450 3 Office Space 2,254,590, ,320,000 21,000, ,320,000 1,673,270,000 4 Utilities Expenses 774,390, ,960,000 19,400, ,360, ,030,000 5 Office Equipment 437,000, ,750, ,750,000 44,250,000 6 Vehicle Rental 5,829,030, ,040, ,570, ,610,000 4,985,420,000 7 Communication 556,800,000 2,485,412 1,833,067 4,318, ,481,521 Management Fee of [ ] 55,600, , , ,848 55,168,152 8 Training 6,209,060,000 7,500,000 16,652,900 24,152,900 6,184,907,100 Management Fee of [ ] 325,233, , ,290 1,740, ,492,710 9 Reporting 40,375,000 4,250,000 2,000,000 6,250,000 34,125, TOTAL PELATIHAN STBM PAMSIMAS II 352,423, ,407, ,407,500 49,016,000 Pelatihan STBM Pamsimas II 320,385, ,825, ,825,000 44,560,000 Management Fee of ( 10 ) 32,038,500 27,582,500-27,582,500 4,456,000 C TOTAL COST OF SERVICES {Excluded VAT} 35,796,323,500 4,298,220, ,179,564 4,974,400,317 30,821,923,183 D Amount Eligible for IBRD Funding 80% x { A + B } 28,355,120,000 3,195,850, ,943,651 3,736,794,254 24,618,325,746 E Advance Payment {of IBRD Portion} 2,925,800,000 2,925,800,000-2,925,800,000 - Repayment of Advance Payment {of IBRD Portion} 2,925,800,000 1,462,900, ,816,667 1,706,716,668 1,219,083,332 F Total Claim This Invoice IBRD Portion 28,355,120,000 4,658,750, ,126,984 4,955,877,586 23,399,242,414 G Amount Eligible for TF Funding { 10 } 352,423, ,407, ,407,500 49,016,000 H Amount Eligible for APBN-RM Funding 20% x { A + B } 7,088,780, ,962, ,235, ,198,563 6,154,581,437 I Advance Payment {of APBN-RM Portion} 731,450, ,450, ,450,000 - Repayment of Advance Payment {of APBN-RM Portion} 731,450, ,725,001 60,954, ,679, ,770,833 J Claim This Invoice APBN-RM Portion 7,088,780,000 1,164,687,650 74,281,746 1,238,969,396 5,849,810,604 K VAT 10 % on the APBN RM Portion 708,878, ,468,765 7,428, ,896, ,981,060 L Total Claim This Invoice APBN-RM Portion { J + K } 7,797,658,000 1,281,156,415 81,709,921 1,362,866,336 6,434,791,664 M Volue of Contract {Including VAT 10% on the APBN Portion} 36,505,201,500 6,243,314, ,836,905 6,622,151,422 29,883,050,078 Jakarta, 28 April 2014 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) : Maret 2014 NO. Amount Amount Amount Amount Amount B REIMBURSABLE COST 17,505,100,000 1,815,979, ,629,564 2,011,608,567 15,493,491,433 1 DUTY TRAVEL 673,920,000 4,350,000-4,350, ,570, 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, , , , ,400,000 Accomodation 3 person ,000 57,600, , , , ,800,000 OSA (Fixed) 3 person ,000 86,400, ,600, , ,600, ,800,000 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, ,000 50, , ,350,000 District Coordinator Sulteng 10 district 1,200 50,000 60,000, , , ,000,000 District Coordinator Sulut 2 district ,000 12,000, , ,000,000 District Coordinator Maluku 5 district ,000 30,000, ,000 50, , ,600,000 District Coordinator Malut 3 district ,000 18,000, , ,000,000 Financial Management Ass. Gorontalo 4 district ,000 19,200, ,000 50, , ,700,000 Financial Management Ass. Sulteng 10 district ,000 48,000, , ,000,000 Financial Management Ass. Sulut 2 district ,000 9,600, , ,600,000 Financial Management Ass. Maluku 5 district ,000 24,000, , ,000,000 Financial Management Ass. Malut 3 district ,000 14,400, , ,400,000 Management Fee 10% of [1.1] 67,392, , ,000 66,957,000-2 MOBILIZATION AND DEMOBILIZATION 256,100,000 24,445,500-24,445, ,654, 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, ,256,000 4,770, ,256, ,514, LG Specialist Jakarta - Manado - Jakarta 1 4,770,000 4,770, ,308,000 4,770, ,308, ,462, 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, ,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, ,522,000 4,770, ,522, ,248,000 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, ,510, ,510,000 Jakarta - Palu - Jakarta 1 3,280,000 3,280, ,178,000 3,280, ,178, ,102, Local Transport 9 200,000 1,800, ,600, , ,600, , 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, ,280, ,800,000 Jakarta - Manado - Jakarta 2 4,770,000 9,540, ,770, ,540,000 Jakarta - Ambon - Jakarta 5 6,620,000 33,100, ,000 6,620, , ,150, Financial Management Assist Jakarta - Manado - Jakarta 4 4,510,000 18,040, ,510, ,040,000 Jakarta - Gorontalo - Jakarta 10 3,280,000 32,800, ,000 3,280, , ,326,000 Jakarta - Palu - Jakarta 2 4,770,000 9,540, ,770, ,540,000 Jakarta - Ambon - Jakarta 4 6,620,000 26,480, ,453,000 6,620, ,453, ,027, Local Transport (Province to District) ,000 16,400, ,500, , ,500, ,900,000 Management Fee 10% of [ ] 25,610,000 2,444,550-2,444,550 23,165,450

3 Amount Amount Amount Amount Amount 3 OFFICE SPACE (Rental) 2,254,590, ,320,000 21,000, ,320,000 1,673,270, Regional Team & Prov. Team Provincial Team Gorontalo 36 2,320,000 83,520, ,840,000 2,320, ,840, ,680, Regional & Provincial Team Manado 36 3,760, ,360, ,120,000 3,760, ,120, ,240, Provincial Team Palu 36 2,320,000 83,520, ,840,000 2,320, ,840, ,680, Office Running Cost 108 2,000, ,000, ,000, ,000,000 6,000, ,000, ,000, District Team District Team in Gorontalo 4 office 144 1,305, ,920, ,640,000 1,305, ,640, ,280, District Team in Sulawesi Ten 10 office 360 1,305, ,800, ,600,000 1,305, ,600, ,200, District Team in Sulawesi Uta 2 office 66 1,305,000 86,130, ,320,000 1,305, ,320, ,810, District Team in Maluku 5 office 180 1,305, ,900, ,300,000 1,305, ,300, ,600, District Team in Maluku Utara 3 office 108 1,305, ,940, ,660,000 1,305, ,660, ,280, Office Running Cost old district , ,000, ,000, ,000 7,500, ,500, ,500,000 new district , ,500, ,000, ,000 7,500, ,500, ,000,000 4 UTILITIES EXPENSES 774,390, ,960,000 19,400, ,360, ,030, Regional and Province Office Supply and Consumable 108 1,500, ,000, ,500, ,500,000 4,500, ,000, ,000, District Office Supply and Consumable old district , ,200, ,700, ,000 7,450, ,150, ,050,000 new district , ,190, ,760, ,000 7,450, ,210, ,980, OFFICE EQUIPMENT 437,000, ,750, ,750,000 44,250, Notebook Computer (Regional+Provincial+District) 37 7,000, ,000, ,000,000 7,000, ,000, Portable Computer for Supporting Regional 2 5,000,000 10,000, ,000,000 5,000, ,000, ,000, Portable Computer + Printer for Supporting District 24 5,000, ,000, ,000,000 5,000, ,000, ,000, Printer Laserjet 3 2,500,000 7,500, ,500,000 2,500, ,500, Printer Colour A3 3 2,500,000 7,500, ,500,000 2,500, ,500, Scanner 3 1,250,000 3,750, ,750,000 1,250, ,750, Facsimilie 3 1,500,000 4,500, ,500, ,500, Digital Camera 3 1,250,000 3,750, ,250, ,750, GSM Modem + SIM Card 3 500,000 1,500, , ,500, Router, LAN Peripheral 3 1,500,000 4,500, ,500, ,500, GPS 6 2,500,000 15,000, ,500, ,000,000 6 VEHICLE RENTAL 5,829,030, ,040, ,570, ,610,000 4,985,420, Car including O&M and Driver (Regional Team) 36 7,000, ,000, ,000, ,000,000 7,000, ,000, ,000, Car including O&M and Driver (Provincial Team) 108 7,000, ,000, ,000, ,000,000 21,000, ,000, ,000, Car including O&M (District Team) old district 360 5,865,000 2,111,400, ,170, ,865,000 58,650, ,820, ,712,580,000 new district 462 5,865,000 2,709,630, ,870, ,865,000 46,920, ,790, ,439,840,000 7 COMMUNICATION 556,800,000 2,485,412 1,833,067 4,318, ,481, Regional and Province Telephone and Postage 108 1,000, ,000, ,024, ,000, , ,807, ,192, Internet Connection for Office ,000 37,800, , ,800, District Telephone and Internet Connection old district , ,000, , , , , ,494,356 new district , ,000, , , , ,005, ,994,356 Management Fee 10% of [ ] 55,600, , , ,848 55,168,152

4 Amount Amount Amount Amount Amount 8 TRAINING 6,209,060,000 7,500,000 16,652,900 24,152,900 6,184,907, Pelatihan FM Ass. dan Data Entry Operator Peserta a Paket Fullboard ,000 36,000, ,000 6,000, ,000, ,000,000 b Transportation ,000 9,600, , , , ,800, Pelatih a Financial Management Spec. manado - ambon 1 11,390,000 11,390, ,390,000 2,898, ,898, ,491,200 b Inland Transport 1 200, , , , , c Accomodation 3 250, , , , , d OSA (Fixed) 4 200, , , , , Training Material + Kit ,000 4,800, , , , ,395,900 Management Fee 10% of [8.1.1b a b d ] 2,679, , ,290 2,168, 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, ,200, ,000 1,200, ,400, ,200, OSA (Fixed) - Provincial Team ,000 48,600, ,300, ,000 3,600, ,900, ,700,000 Management Fee 10% of [ ] 7,020, , ,000 1,230,000 5,790, 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, ,920, ,080,000 b Regional Team/ Manado manado - palu 24 9,550, ,200, ,550, ,200,000 d Regional Team/ Manado manado - ambon 24 11,390, ,360, ,390, ,360,000 h Provincial Team/ Ambon manado - ambon 18 11,390, ,020, ,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, , , ,800,000 Management Fee 10% of [ ] 127,806, ,806, OJT Fasilitator Training Material + Kit 3 years x 2,592 25,000 64,800, , , ,800, Meals, Snack 3 years x 2,592 17,500 45,360, , , ,360, Pelatihan Penguatan BPSPAM Paket Fullboard Participant 4, , ,000, , , ,000, Paket Fullday for DPMU + TKK ,000 38,400, , ,400, Uang Saku Participant 4,800 50, ,000, , , ,000, Uang Transport Participant 1, , ,000, , , ,000, Spanduk ,000 13,440, , ,440, Training Material + Kit 1, , ,000, , , ,000,000 Management Fee 10% of [ ] 49,344, ,344, Pelatihan Kader AMPL Paket Fullboard Participant 4, , ,000, , , ,000, Paket Fullday for DPMU + TKK ,000 38,400, , ,400, Uang Saku Participant 4,800 50, ,000, , , ,000, Uang Transport Participant 1, , ,000, , , ,000, Spanduk ,000 13,440, , ,440, Training Material + Kit 1, , ,000, , , ,000,000 Management Fee 10% of [ ] 49,344, ,344,000

5 Amount Amount Amount Amount Amount 8.7 Workshop RAD AMPL 144 5,000, ,000, ,000, ,000,000 Management Fee 10% of [8.7] 72,000, ,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, ,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, ,496, Printing/ Media: Spanduk , ,520, , ,520, Poster 10 22,100 5, ,180, , , ,180, Leaflet 4 39,560 2,000 79,120, , , ,120,000 Total Management Fee Training Activity [ ] 325,233, , ,290 1,740, ,492, REPORTING 40,375,000 4,250,000 2,000,000 6,250,000 34,125, Inception Report 25 50,000 1,250, ,250,000 50, ,250, Monthly Report ,000 13,500, ,000, , , ,500, ,000, Quarterly Report ,000 9,000, ,000,000 50, ,000, ,000, Special Report 60 25,000 1,500, , ,500, Annual Report 60 75,000 4,500, , ,500, Financial Management Report (FMR) 60 25,000 1,500, , ,500, Draft Final Report 20 75,000 1,500, , ,500, Final Report ,000 2,000, , ,000, Training Program Report ,000 5,625, ,000 1,500, ,500, ,125, PELATIHAN STBM PAMSIMAS II 320,385, ,825, ,825,000 44,560,000 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, , ,575, Pemandu STBM (Province & Districts) ,000 3,675, ,675, , ,675, Participants (Sanitarian/Kader/Natural leader/bidan) ,000 39,900, ,900, , ,900, Transportation a. Tickets - Central Government 2 4,780,000 9,560, ,780, ,560,000 - Advisor 1 4,780,000 4,780, ,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, , , , , Pemandu STBM (Districts) 6 400,000 1,800, ,800, , ,800, Participants (Sanitarian/Kader/Natural leader/bidan) - Donggala, Parigi Mountong - Palu (pp) ,000 4,375, ,050, , ,050, ,000 - Buol - Palu (pp) 7 550,000 3,850, ,850, , ,850, Poso - Palu (pp) ,000 3,000, ,000, , ,000, Morowali, Tojo Una una - Palu (pp) ,000 7,650, ,480, , ,480, ,000 - Banggai Kepulauan - Palu (pp) ,000 13,600, ,830, , ,830, ,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, ,220, , ,220, ,000 - Participants (Sanitarian/Kader/Natural leader/bidan) , ,000, ,960, , ,960,000-3,040,000 c. Panitia Lokal ,000 4,500, ,380, , ,380, ,000 5 Training Kit (Tas Punggung, Kaos, Topi) ,000 20,750, ,750, , ,750, Training Material ,000 22,825, ,500, , ,500,000-3,325,000 7 Stationery 2 2,000,000 4,000, ,000,000 2,000, ,000, Equipment a. Video Camera Rental 5 260,000 1,300, , ,300,000 b. Banner 1 500, , , , , c. Backdrop 1 1,250,000 1,250, ,250,000 1,250, ,250, d. Additional Classroom 8 1,500,000 12,000, ,000,000 1,500, ,000, ,000,000 e. Additional Infocus Rental 8 350,000 2,800, , ,800,000 f. Preparation Meeting (Snack & Lunch) 40 48,000 1,920, ,920,000 48, ,920, g. Car Rental 5 580,000 2,900, ,900, , ,900, h.computer/laptop Rental ,000 4,500, ,750, , ,750, ,000 i. Printer Rental ,000 3,000, ,500, , ,500, ,000 g. Bus Rental (Field Visit) 5 2,000,000 10,000, ,000,000 2,000, ,000, ,000,000 9 Training Report 5 100, , , , , Management Fee 10% of [ 10 ] 32,038,500 27,582,500-27,582,500 4,456,000

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