Financial Spreadsheet 12920 | Formulir Kualifikasi Material Ptk007 Rev 3 Gm37772 1

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PT MEDCO E&P LEMATANG
FORMULIR PENILAIAN KUALIFIKASI TENDER BARANG-BARANG
MATERIALS TENDER QUALIFICATION EVALUATION FORM
NO. TENDER / TENDER NO.:
GM37772-1
JUDUL TENDER / TENDER TITLE:
“ SWEET GAS COOLER ”
Daftar Isi
1. UMUM .......................................................................................................................................
GENERAL
1.1. Perusahaan ......................................................................................................................
Company
1.2. Lingkup Pekerjaan ............................................................................................................
Scope of Works
1.3. Tempat Kerja ....................................................................................................................
Work Location
1.4. Tata Cara Pendaftaran ......................................................................................................
Registration Procedures
1.5. Tata Cara dan Metode Penilaian Kualifikas i .......................................................................
Qualification Evaluation Procedure and Method
1.6. Tata Cara Kualifikas i .........................................................................................................
Qualification Procedures
2. PERSYARATAN KUALIFIKAS I ......................................................................................................
QUALIFICATION REQUIREMENTS
2.1. Aspek Administras i ...........................................................................................................
Administrative Aspect
2.2. Aspek Teknis ....................................................................................................................
Technical Aspect
2.3. Kemampuan Keuangan ....................................................................................................
Financial Aspect
3. DOKUMEN PENILAIAN KUALIFIKASI ...........................................................................................
QUALIFICATION EVALUATION DOCUMENTS
3.1. Aspek Administras i ...........................................................................................................
Administrative Aspect
3.2. Aspek Teknis ....................................................................................................................
Technical Aspect
3.3. Aspek Permodalan ............................................................................................................
Capital Aspect
4. PENGIRIMAN DOKUMEN PENILAIAN KUALIFIKAS I ......................................................................
QUALIFIVATION EVALUATION DOCUMENT SUBMISSION
5. DAFTAR PESERTA TENDER ........................................................................................................
BIDDERS LIST
6. KETENTUAN UMUM ...................................................................................................................
GENERAL CONDITIONS
LAMPIRAN 1 - SURAT PERNYATAAN TKDN .......................................................................................
ATTACHMENT 1 –LOCAL CONTENT STATEMENT LETTER
LAMPIRAN 2 - SURAT PERNYATAAN KEIKUTSERTAAN KUALIFIKASI ...................................................
ATTACHMENT 2 - QUALIFICATION PARTICIPATED STATEMENT LETTER
LAMPIRAN 3 – PERHITUNGAN NILAI PAKET TERTINGGI DAN SISA KEMAMPUAN PAKET.....................
ATTACHMENT 3 – CALCULATION OF HIGHEST WORK PACKAGE VALUE, WORK PACKAGE
RESIDUAL CAPABILITY
TAMBAHAN 1 TERHADAP LAMPIRAN 3 – PENENTUAN NPt ...................................................
APPENDIX 1 of ATTACHMENT 3 - NPt CALCULATION
LAMPIRAN 4 – PERSYARATAN KONSORSIUM ....................................................................................
ATTACHMENT 4 – CONSORTIUM REQUIREMENTS
LAMPIRAN 5 – PERSYARATAN PERUSAHAAN DALAM NEGERI ATAU PENYEDIA BARANG/JASA
AFILIASI BUMN KEGIATAN USAHA HULU MIGAS...........................................................................
ATTACHMENT 5 – REQUIREMENTS FOR LOCAL COMPANY OR BUMN AFFILIATION OF OIL AND GAS
UPSTREAM
LAMPIRAN 6 – PERSYARATAN TEKNIS TAMBAHAN ............................................................................
ATTACHMENT 6 – ADDITIONAL TECHNICAL REQUIREMENTS
Formulir Penilaian Kualifikasi Tender No._______ Page 2 of 19
1.UMUM 1.GENERAL
1.1.Perusahaan 1.1.Company
PT MEDCO E&P LEMATANG PT MEDCO E&P LEMATANG
(“PERUSAHAAN”) adalah sebuah (“COMPANY”) is a company established
perusahaan yang didirikan berdasarkan under the law of the Republic of
hukum Republik Indonesia, berkantor di Indonesia, having its office at Gedung
Gedung The Energy, lt 23, 26, 33, 35, The Energy, lt 23, 26, 33, 35, 36, 37,
36, 37, 38, dan 39, SCBD Lot. 11A Jl. 38, dan 39, SCBD Lot. 11A Jl. Jend.
Jend. Sudirman Kav. 52-53, Senayan, Sudirman Kav. 52-53, Senayan,
Kebayoran Baru, Jakarta Selatan, Jakarta Kebayoran Baru, Jakarta Selatan,
12190, Indonesia dan beroperasi di Jakarta 12190, Indonesia and operates
Indonesia. in Indonesia.
Dalam proses pelaksanaan tender ini, In this tender process, COMPANY, acting
PERUSAHAAN bertindak untuk dan atas on behalf of itself and/or as a
namanya sendiri dan/atau afiliasinya. representative of its affiliation.
Penyedia barang/jasa yang ikut dalam Services/Material Supplier(s) that
penialian kualifikasi disebut sebagai participate in qualification evaluation
“Calon Peserta Tender”. process hereinafter refer as
“Prospective Bidders”.
1.1. Lingkup Pekerjaan 1.2. Scope of Works
Untuk mendukung kegiatan operasinya, In order to support its operational
PERUSAHAAN bermaksud melaksanakan activities, COMPANY intends to procure
tender barang-barang SWEET GAS SWEET GAS COOLER materials
COOLER (”Barang”) di Tempat Kerja (”Material”) at Work Location as stated
sebagaimana ditetapkan di bawah ini. below. The Material shall include the
Adapun Barang tersebut meliputi following Services:
pekerjaan-pekerjaan sebagai berikut:
No KIMAP SHORT TEXT Description Quantity UOM Currency
43529910 One (1) unit completed set Tube Bundle Description : 1.000 SET IDR
00 Assembly for Air Cooled Heat HEATER,
Exchanger for 35-HAL-210, estimated FIRED,
size of bundle 2,057mm W x 4,877mm INDIRECT
L, including : a) Main components, fin Attachment
tube bundles c/w headers and nozzles. :
b) Vent and drain nozzles complete with
blind flanges at header. c) Gasket, bolt
and nuts for all blind flanges. d) Tube
spacers and intermediate support, side
1 frames c/w stiffeners. e) Name plate
c/w bracket and lifting lugs. With
Corrosion Protection External surface of
Stainless Steel header : pickling and
passivation, Structural – Hot dip
galvanized in accordance ASTM 123.
Technical Detail refer to Datasheet.
1.2. Tempat Kerja 1.3.Work Location
Tempat dan ketentuan penyerahan Point and terms of Delivery, that
Barang, yaitu : includes:
Formulir Penilaian Kualifikasi Tender No._______ Page 3 of 19
Terhadap Barang produksi luar negeri, ketentuan pengiriman barang yang digunakan
mengacu kepada Incoterm 2010 sebagai berikut:
 [FRANCO] GUDANG MEDCO LEMATANG, alamat : Gudang PT Medco E&P Lematang Dusun
Sukamenanti, Desa Bangun Sari, Kec Gunung Megang, Kab Muara Enim, Sumatera
Selatan
1.3. Tata Cara Pendaftaran 1.4.Registration Procedures
1.4.1. Penyedia Barang/Jasa yang 1.1.1. Services/Material Supplier(s)
berminat mengikuti proses interested in this qualification
penilaian kualifikasi diharuskan process shall be registered in
terdaftar di dalam Centralized and Centralized and Integrated
Integrated Vendor Database Vendor Database (”CIVD”) and
(”CIVD”) dan memiliki Sertifikat obtains valid Sertifikat Pengganti
Pengganti Dokumen Administrasi Dokumen Administrasi (”SPDA”).
(”SPDA”) yang masih berlaku.
1.4.2. Hanya penyedia barang/jasa 1.1.2. Only Services/Material
yang memiliki SPDA yang masih Supplier(s), that obtain valid SPDA
berlaku dalam CIVD yang dapat in CIVD is allowed to register in
melakukan pendaftaran Kualifikasi. this Qualification process.
1.4.3. Penyedia Barang/Jasa yang 1.1.3. Services/Material Supplier(s)
berminat mengikuti penilaian interested in participating in the
kualifikasi wajib mendaftarkan diri qualification evaluation process is
via e-proc dengan mengunggah required to register themselves
alamat e-mail Contact Person (CP) via e-proc by uploading their
dari Penyedia Barang/Jasa dan Contact Person’s e-mail address
Surat Pernyataan TKDN. and Local Content Level (”TKDN”)
Statement Letter.
1.4.4. Setelah Calon Peserta Tender 1.1.4. After the Prospective Bidders
melakukan apa yang disampaikan have fulfilled the requirements
dalam angka 1.4.3 di atas, Calon stated in the point 1.4.3 above,
Peserta Tender wajib melengkapi the Prospective Bidders must
Dokumen penilaian kualifikasi complement the qualification
sesuai Bab 4 Pengiriman Dokumen evaluation documents according
Penilaian Kualifikasi di bawah ini. to Chapter 4 Qualification
Evaluation Documents Submission
below.
1.4.5. Calon Peserta Tender yang tidak 1.1.5. Prospective Bidders that do not
memenuhi salah satu persyaratan meet the requirements according
sebagaimana disebutkan pada to point 1.4.3 and 1.4.4 above will
angka 1.4.3 dan 1.4.4 di atas not pass the qualification
dinyatakan tidak lulus penilaian evaluation process.
kualifikasi.
1.2.Tata Cara dan Metode Penilaian 1.5. Qualification Evaluation
Kualifikasi Procedure and Method
Penilaian kualifikasi ini menggunakan This qualification evaluation is using a
metode “Lulus/Tidak Lulus” dimana “Pass/Fail” method whereby Prospective
Calon Peserta Tender wajib memenuhi Bidders are required to comply with all
seluruh persyaratan yang ditetapkan. of the requirements. Failure to
Kegagalan memenuhi persyaratan akan comply with any one of the
mengakibatkan tidak lulus penilaian requirements will cause failure in this
kualifikasi. Dikecualikan pada ketentuan qualification evaluation process. This
ini adalah untuk persyaratan sebagai provision is not applicable for domestic
Perusahaan Dalam Negeri yang terdapat company requirements as stipulated in
Formulir Penilaian Kualifikasi Tender No._______ Page 4 of 19

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...Pt medco e p lematang formulir penilaian kualifikasi tender barang materials qualification evaluation form no gm judul title sweet gas cooler daftar isi umum general perusahaan company lingkup pekerjaan scope of works tempat kerja work location tata cara pendaftaran registration procedures dan metode kualifikas i procedure and method persyaratan requirements aspek administras administrative aspect teknis technical kemampuan keuangan financial dokumen documents permodalan capital pengiriman qualifivation document submission peserta bidders list ketentuan conditions lampiran surat pernyataan tkdn attachment local content statement letter keikutsertaan participated perhitungan nilai paket tertinggi sisa calculation highest package value residual capability tambahan terhadap penentuan npt appendix konsorsium consortium dalam negeri atau penyedia jasa afiliasi bumn kegiatan usaha hulu migas for or affiliation oil upstream additional page adalah sebuah is a established yang didirikan berdasa...

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