Contract No. : KU.08.08/Kontrak/Pamsimas/173/VIII/2013 Regional Oversight Management Services (ROMS) - 4 Contract Date

Transcription

1 GOVERNMENT OF REPUBLIC OF INDONESIA MINISTRY OF PUBLIC WORK Contract : KU.08.08/Kontrak/Pamsimas/173/VIII/2013 Regional Oversight Management Services (ROMS) 4 Contract Date : 27 August 2013 Community Based Water Supply Project (PAMSIMAS 2) Amendment 1 Amendment 2 : 25 Nov 2013 : 30 Mei 2014 Advance Payment / Invoice Period Of Invoice : 11 : Training Asosiasi BPSPAM 2014 Contract Amandement 2 Previous Total Claim Total Discription Amount Amount Amount Amount Amount Amount Amount (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (1) (2) (3) (3) (4) (5) (6)=(4)+(5) (7) = (3)(6) A REMUNERATION Regional Team Provincial Team District Team B REIMBURSABLE COST Duty Travel Management Fee % of [ ] Mobilization and Demobilization Management Fee % of [ ] Office Space Utilities Expenses Office Equipment Vehicle Rental Communication Management Fee... % of [ ] Training Total Management Fee Training Activity Reporting Training STBM Pelatihan STBM Pamsimas II Management fee 10% Additional Training Provincial Training for District Assosiation ( IDA CR IND ) Management Fee 10% of Cost For Remuneration ( FK & FM ) Cost For Facilitator ( FK & FM ) APBN RM Management fee 15% Facilities & Operational Cost For Facilitator ( FK & FM ) APBN RM Management fee 10% C TOTAL COST OF SERVICES {Excluded VAT} D ADVANCE PAYMENT E ADVANCE PAYMENT ( 80% OF IBRD PORTION ) F ADVANCE PAYMENT ( 20% OF APBN RM PORTION ) G Amount Eligible for Trust Fund Funding { 100% } H IDA Financing ( IDA CR IND ) I APBN RM ( 100% ) Facilitator J PPN [ 10 % ] FOR APBN RM PORTION FACILITATOR K IBRD PORTION ( 80% ) X TOTAL CONTRACT L REPAYMENT OF ADVANCE PAYMENT ( % OF IBRD PORTION ) M TOTAL CLAIM THIS INVOICE IBRD PORTION ( HI) N APBN RM PORTION ( 20% ) X TOTAL CONTRACT O REPAYMENT OF ADVANCE PAYMENT ( % OFAPBN RM PORTION ) P APBNRM PORTION ( 20% ) REPAYMENT OF ADVANCE PAYMENT ( NO ) Q PPN (10 % ) FOR APBN RM PORTION R TOTAL CLAIM THIS INVOICE GOI PORTION ( M+N) S Volue of Contract {Including VAT 10% on the APBN Portion} GRAND TOTAL CLAIM

2 GOVERNMENT OF REPUBLIC OF INDONESIA MINISTRY OF PUBLIC WORK Contract : KU.08.08/Kontrak/Pamsimas/173/VIII/2013 Regional Oversight Management Services (ROMS) 4 Contract Date : 27 August 2013 Community Based Water Supply Project (PAMSIMAS 2) Amendment 1 : 25 Nov 2013 Amendment 2 : 30 mei 2014 Advance Payment / Invoice : 11 Period of Invoice : Training Asosiasi BPSPAM 2014 B. REIMBURSABLE (AT COST) Total Previous Payment Claim This Invoice Total 1 DUTY TRAVEL ,1 Spot Checking Provincial Team Province to District Village (10%) Province Central Java Inland Transport Accomodation OSA (Fixed) Province DIY Inland Transport Accomodation OSA (Fixed) Province East Java Inland Transport Accomodation OSA (Fixed) District Team District to Village (50%) District Coordinator Central Java District Coordinator DIY District Coordinator East Java Financial Management Ass.Central Java Financial Management Ass.DIY Financial Management Ass. East Java Management Fee...% of [ ]

3 Payment Claim This Invoice Total 2 MOBILIZATION AND DEMOBILIZATION ,1 Regional Team Jakarta Province to Province to Jakarta Project Manager , , , Data Management , , , LG Specialist , , , Trainer Coordinator , , , Local Transport , ,2 Provincecial Team Jakarta to Province to Jakarta Provincial Coordinator/LG Central Java , , , Central Java , , , Central Java , , , DIY , , , East Java , , , Financial Management Specialist Central Java , , , Central Java , , , Central Java , , , DIY , , , East Java , , , Quality Assurance Specialist Central Java , , , Central Java , , , Central Java , , , DIY , , , East Java , , , Local Transport , , , ,3 District Team Jakarta to Province to Jakarta District Coordinator Central Java , , , DIY , East Java , Financial Management Assistant Central Java , , , DIY , East Java , Local Transport (Province to District) Management Fee... % of [ ] OFFICE SPACE ,1 Regional Team & Prov. Team Regional Team & Provincial Central Java , Provincial DIY , Provincial East Java , Office Running Cost Regional Team & Provincial Central Java , Office Running Cost Provincial DIY , Office Running Cost East Java , ,2 District Team District Team in central Java , District Team in DIY , District Team in East Java , Office Running Cost Old District Team , Office Running Cost New District Team ,

4 Payment Claim This Invoice Total 4 UTILITIES EXPENSES ,1 Regional and Province Office Supply and Consumable Cost Regional Team & Provincial Central Java , Office Supply and Consumable Cost Provincial DIY , Office Supply and Consumable Cost Provincial East Java , ,2 District Office Supply and Consumable Old District Team , Office Supply and Consumable New District Team , OFFICE EQUIPMENT ,1 Notebook Computer (Regional+Provincial+District) ,2 Portable Computer for Supporting Regional ,3 Portable Computer + Printer for Supporting District ,4 Printer Laserjet ,5 Printer Colour A ,6 scanner ,7 Facsimile ,8 Digital Camera ,9 GSM Modem + SIM CARD Router, LAN Peripheral GPS VEHICLE RENTAL ,1 Car including O&M and Driver (Regional Team) ,2 Car including O&M and Driver (Provincial Team) Central Java Central Java Central Java DIY East Java ,3 Car including O&M (District Team) Old District New District COMMUNICATION ,1 Regional and Province Telephone and Postage Regional Team , Provincial Central Java , Provincial DIY , Provincial East Java , Internet Connection fo Office Regional Team & Provincial Central Java , Provincial DIY , Provincial East Java , ,2 District Telephone and Internet Connection Old District , New District , Management Fee % of [ ]

5 Payment Claim This Invoice Total 8 TRAINING ,1 Pelatihan FM Ass. Dan Data Entry Operator Peserta a Paket Full Board b Transportation Participant Pelatih (air transport economy class) a Financial Management Spec. b Financial Management Spec. c Inland Transport d Accomodation e OSA (Fixed) Training Material + Kit Management Fee % of [8.1.1a+8.1.2g] ,2 Expert Group Meeting Central Regional Team Air Fare Province to akarta Provincial team Air Fare Province to Jakarta Inland Transport Regional and Provincial Team OSA (fixed) Regional Team OSA (fixed) Provincial Team Management Fee % of [ ] ,3 Expert Group Meeting Regional a Fullboard Pacakage for District Team b Fullboard Pacakage for Provincial Team c Fullboard Pacakage for Regional Team Air Transpoet (Economy Class) a Regional Team Semarang Inland Transport a District Team Semarang b District Team Yogyakarta c District Team Surabaya OSA (Fixed) Management Fee % of [ ] ,4 OJT Fasilitator Training Material + Kit Meals, Snack ,5 Pelatihan Penguatan BPSPAM Paket Fullboard Participant Paket Fullday for DPMU + TKK Uang Saku Participant Uang Transport Participant Training Material + Kit Spanduk

6 Payment Claim This Invoice Total Management Fee % of [ ] ,6 Pelatihan Kader AMPL Paket Fullboard Participant Paket Fullday for DPMU + TKK Uang Saku Participant Uang Transport Participant Training Material + Kit Spanduk Management Fee % of [ ] ,7 Workshop RAD AMPL Management Fee % of [8.7] ,8 Workshop Forum/Assosiasi BPSPAM in Province Paket Fullboard Participant Uang Transport Participant Training Material + Kit Spanduk Management Fee % of [ ] ,9 Pelatihan Pengelola Program Kabupaten (DPMU+TKK+Satker) in Province Paket Fullboard Participant Uang Transport Participant Training Material + Kit Spanduk Management Fee % of [ ] Printing/Media Spanduk Poster Leaflet Total Management Fee Training Activity [ ] REPORTING ,1 Inception Report ,2 Monthly Report ,3 Quarterly Report ,4 Special Report ,5 Annual Report ,6 Financial Management Report (FMR) ,7 Draft Final Report ,8 Final Report ,9 Training Program Report

7 Payment Claim This Invoice Total 10 Training STBM Perdiem a Central Government b Provincial Government c Advisor d Event Organizer e Pemandu STBM (Province & Districts) f Participants (Sanitarian/Kader/Natural leader/bidan) Transportation a Tickets Central Government Advisor b Inland/Local transport Taxi (pp) for Central Personnels Provincial Government Pemandu STBM (Province) Pemandu STBM (Districts) Participants (Sanitarian/Kader/Natural leader/bidan) Fullboard Package a Central Govemment b Provincial Govemment c TDS / CMAC d Advisor e Pemandu STBM ( Provincial dan District ) f Participant ( Sanitarian/Kader/Natural Leader/Bidan g Event Organizer Training Kit ( Tas Punggung, Kaos, Topi ) Training Material Stationery Equipment a Video Camera Rental b Banner c Backdrop d Additional Classroom e Additional Infocus Rental f Preparation Meeting (Snack & Lunch) g Car Rental h Computer/Laptop Rental i Printer Rental j Bus Rental (Field Visit) Training Report Management fee. 10%

8 Total Previous Payment Claim This Invoice Total 11,1 Provincial Training for District Assosiation ,2 Perdiem a Central Government b Provincial Government c Advisory CPMU d Panitia lokal e Pemandu Asosiasi (Regional & Districts) f Participants Asosiasi ( Pengurus Asosiasi/SKPD Asosiasi FK ) ,3 Transportation a b Tickets Central Government Advisor CPMU Inland/Local transport Taxi (pp) for Central Personnels Provincial Government Pemandu Asosiasi (Regional & Districts) Pemandu Asosiasi ( Districts) Participants Asosiasi ( Pengurus Asosiasi/SKPD Asosiasi FK ) ,4 Fullboard Package a Central Govemment b Advisor CPMU c Pemandu Asosiasi (Regional & Districts) d Participant ( Sanitarian/Kader/Natural Leader/Bidan e Panitia Lokal ,5 Fullday Package Provincial Government ,6 Training Kit and Material ,7 Stationery ,8 Equipment a Horizontal Banner b Additional Classroom c Preparation Meeting (Snack & Lunch) d Car Rental e Computer/Laptop Rental/Printer f Rental Printer ,9 Training Report Management Fee 10% of [ s/d ]

9 Total Previous Payment Claim This Invoice Total 12 Cost For Facilitator ( FK & FM ) APBN RM A Remuneration For Facilitator 1 Remuneration for Sustainable Facilitator (FK) Provincial Jawa Tengah Facilitator Keberlanjutan ( Periode Januari To April 2014 ) Remuneration for Sustainable Facilitator (FM) Provincial Jawa Tengah Facilitator Masyarakat ( Periodie Januari To April 2014 ) Provincial DI.Yogyakarta Facilitator Masyarakat ( Peride Januari To April 2014 ) Provincial Jawa Timur Facilitator Masyarakat ( Peride Januari To April 2014 ) Managemen feee 15% of ( 1.2 ) Facilities & Operational Cost For Facilitator ( FK & FM ) APBN RM Sustainable Facilitator (FK) Provincial Jawa Tengah Duty Trip For Facilitator Keberlanjutan ( FK ) ( Periode Januari To April 2014 ) Sustainable Facilitator Masyarakat ( FM ) Provincial Jawa Tengah Duty Trip For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Operational Cost For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Sustainable Facilitator Masyarakat ( FM ) Provincial DI.Yogyakarta Duty Trip For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Operational Cost For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Fasilitator Masyarakat ( FM ) Jawa Timur Provincial DI.Yogyakarta Duty Trip For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Operational Cost For Facilitator Keberlanjutan ( FM ) ( Periode Januari To April 2014 ) Management Fee 10% of [12.4 ] TOTAL B REIMBURSABLE COST [IDR]