dokumen kualifikasi pengawasan

7/26/2019 dokumen kualifikasi pengawasan

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STANDAR DOKUMEN KUALIFIKASIPENGADAAN JASA KONSULTANSI

(BADAN USAHA)



D O K UM E N K U AL I F I K A S I

Nomor : ………………………………………………

Tanggal : ! D"#"m$"r %&

'n'

P"nga*aan

P""r+aan Pengawasan Pembangunan Jalan Poros Desa Kawasan SP

Distrik Mimika Kabupaten Mimika

P"+a$a P"m$'a Kom,m"n : PENGEMBANGAN KAWASAN PERMUKMAN

PERDESAAN

Sam,nal : !P"A KAR#A

K"m"n"r,an P""r+aan Um'm

Ta-'n Anggaran: %&%

K E M E N T E R I A N P E K E R J A A N U M U M

DIREKTORAT JENDERAL CIPTA KARYASATKER PENGEMBANGAN PERMUKIMAN DAN PERBATASAN PAPUAPELAKSANAAN KEGIATAN PENGEMBANGAN KAWASAN PERMUKIMAN PERDESAANAlamat : Jln. Sumatera Nmr. !" D# I$ Tel%. &'()*+ ""'!,' - a/. &'()*+ ""'!,' Ja0a%ura



DAFTAR ISI

BABI UMUM .................................................................................... 1

BABII PENGUMUMAN PRAKUALIFIKASI ....................................... 3

BAB III INSTRUKSI KEPADA PESERTA (IKP) .................................. 4

BABIV LEMBAR DATA KUALIFIKASI(LDK) .................................... 15

BAB V SURAT PERJANJIAN KEMITRAAN ..................................... 17

BAB VI PAKTA INTEGRITAS…………………………………………… 19

BAB VII FORMULIR ISIAN KUALIFIKASI …………............................ 22

BAB VIII PETUNJUK PENGISIAN FORMULIR ISIAN

KUALIFIKASI ........................................................................ 2

BABI! TATA "ARA EVALUASI KUALIFIKASI ................................ 31



BAB. I UMUM

A. D#$%&' K%*+,+$-+ ++ +-%-% /'0-0$ P'0%0 P0'-+' R'%/*+$I#'-+ N#&#0 54 T% 21 ' P' B06J- P'&'0+.

B. D*& D#$%&' K%*+,+$-+ ++ +'0%$ ''0+ +-+* -+$-'/+ /'0+$%8

/ Ja#a Kon#'lan#, 8 - *: 0#,'-+#* :&'&/%%$ $'*+ '0'% +/'0/+/+ $'+*&% : &'%&$: #* +$'0 (brainware);

< Harga P"r,raan S"n*,r, (HPS) 8 -+* '0+% -'*%0% =#*%&''$'0 +$*+$ ' >0 S%+&/ ' -'*%0% /'/ $ $'%%;

/ K"m,raan 8 $'0 -& %- 0 ':'+ :&-+<&-+ +$ &'&%:+ $$'?+/ % ?/ : '*-/'0-0$ '0+ '0%*+-;

/ LDK 8 L'&/0 D K%*+,+$-+;/ Pan,,a P"nga*aan 8 K'*#&#$ K'0 : /'0,%-+ %%$

&'*$-$ '&+*+ ':'+/06- *& P'B06J-.

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E. P++ P' &'%&%&$ '*$- 0$%*+,+$-+ &'**%+ *&website ???.%.#.+ '%&%& 0'-&+ %%$ &-:0$ P#0*P' N-+#* &'**%+ LPSE.

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BAB II PENGUMUMAN PRAKUALIFIKASI



PENGUMUMAN PRAKUALIFIKASI

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/'0+$%8

. Pa" P""r+aan

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Ka3a#an SP D,#r, M,m,a Ka$'2a"n M,m,a

L+$% '$'0 8 P"nga3a#an P"m$ang'nan Jalan Poro#.

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S%&/'0 ' 8 APBN Ta-'n Anggaran %&%

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5. P"n*a6aran *an P"ngam$,lan Do'm"n K'al,6,a#,8

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C$% 8 9. C+ -. 15. C+.

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Pan,,a P"nga*aan

K E M E N T E R I A N P E K E R J A A N U M U M

DIREKTORAT JENDERAL CIPTA KARYA

SATKER PENGEMBANGAN PERMUKIMAN DAN PERBATASAN PAPUAPELAKSANAAN KEGIATAN PENGEMBANGAN KAWASAN PERMUKIMAN PERDESAANAlamat : Jln. Sumatera Nmr. !" D# I$ Tel%. &'()*+ ""'!,' - a/. &'()*+ ""'!,' Ja0a%ura



BAB III. INSTRUKSI KEPADA PESERTA IKP

A. UMUM. Pan,,a

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B. DOKUMEN KUALIFIKASI

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D.P"ma#'an Do'm"n K'al,6,a#,

7. P"ma#'anDo'm"nK'al,6,a#,

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!. Do'm"nK'al,6,a#,T"rlam$a

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E. P"r#4araan P"#"ra K'al,6,a#,

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-'*'$-+ +*%$.

%5. Un*angan"2a*aP"#"raK'al,6,a#,4ang L'l'#

J+$ +$ - %- +#*$ &$ '-'0 :&-%$ *& D,0 P''$ +%%%$ &'&/+* D#$%&' P'&+*+%%$ &'&-%$$ '?0.



BAB I>. LEMBAR DATA KUALIFIKASI (LDK)

A. Pan,,aP"nga*aan *anL,ng'2P""r+aan

1. N& P++ P' 8 Satker Pengembangan

Kawasan Permukiman

-an Perbatasan Papua A*& P++ P' 8 Jl$ Sumatera No$ %.

Dok$ / Ja0apura A*& C'/-+' 8 www$pu$go$i-

2. N& P$' P'$'0 8 Pengawasan

Pembangunan Jalan

Poros Desa Kawasan

SP Distrik Mimika

Kabupaten Mimika

3. L+$% P'$'0 8 Pengawasan

Pembangunan JalanPoros Kawasan SP

Distrik Mimika Kab$

Mimika

B. S'm$"r Dana P' ++ +/+:+ 0+ -%&/'0 '8 APBN

T% A0 212

<. B"rla'n4aK'al,6,a#,

K%*+,+$-+ ++ : /'0*$% %%$ $' '$'0

Pengawasan Pembangunan Jalan Poros Desa Kawasan

SP Distrik Mimika Kabupaten Mimika

D. P"n4am2a,anDo'm"nK'al,6,a#,

>0+ 8 S'*-T* 8 27 D'-'&/'0 211P%$%* 8 9. C+. -.. 15. C+.T'& 8 J*. S%&'0 N#. 15 D#$. IV J:%0.

E. P"r#4araanK'al,6,a#,

1. P'-'0 $%*+,+$-+ : /'0/ %- 0%- &'&+*+$+

-%0 ++ %- J- I-'$-+.

2. &'&+*+$+ ,-+*+- 6 '0* 6 '0-#+* %%$ &'*$-$'$'0 - $#-%*-+ ++ :+%8 K#&%'0 P0+'0 A3

"&'0 D++* GPS.

F. P"r#4araanT"n,#K'al,6,a#,

1. &'&+*+$+ '*& '$'0 J- I-'$-+

' #* /#/# '+*+ -'/'-0 @ .



2. &'&+*+$+ T' A*+ T' ' $%*+,+$-+ $'*+

B+ S++* A0-+'$%0 L+$% '

'*& &++&* 1 (-%) % ' #* /#/#

'+*+ -'/'-0 4 ;

3. A/+* +'0-:0$ '$'0 $#&*'$- &$ 0%-

&'&+*+$+ -'0+,+$ &'&' &%% ISO % '0-:0

*+ -''0+ '0* $%-%- ' *+ -'-+*+- :

+'0*%$ % '*& '0'% %%$ '$'0

$#&*'$- ' /#/# : /'-0: &'%0+

/#/# '*& '0%- -'/'-0

G. Sangga- T'&/%- - +-&+$ $'8

1. PPK . P''&/ K?- P'0&%$+&

P'0'- P%

2. KPA . S$'0 P''&/ K?- P'0&%$+&

P'0/- P%

3. -.



BAB >. SURAT PERJANJIAN KEMITRAAN

BENTUK SURAT PERJANJIAN KEMITRAAN 1 KERJA SAMA OPERASI (KSO)

SURAT PERJANJIAN KEMITRAAN 1

KERJA SAMA OPERASI (KSO)

MENIMBANG :

BA1WA(

S'%/% ' -'*'$-+ '$'0 ..................... : '&/%$ '?0:

$ +*$%$ + .................. * .......... 2...... &$ 8

.................................. [nama peserta 1],

.................................. [nama peserta 2],

..................................[nama peserta 3],

...................................[dan seterusna]!

/'0&$-% %%$ &'+$%+ '*'* '*$- $#0$ -'0 /'0-&<-&

*& /'%$ $'&+06K'0 S& O'0-+ (KSO).

MEN?ETUJUI DAN MEMUTUSKAN :

BA1WA(

1. S'0 /'0-&<-&8

1. M'&/'%$ $'&+06KSO ' & $'&+06KSO * ............2. M'%%$ ................... [nama peserta 1] -'/+ '0%- %& "leading #irm$

%%$ $'&+06KSO &'?$+*+ -'0 /'0+$ %%$ - &

$'&+06KSO.

3. M':'%%+ /+* +%%$ -'/+ '&' ?+/ /'0% ?/ /+$

-'0 /'0-&<-& % &-+<&-+ - -'&% $'?+/ -'-%+

$''% #$%&' $#0$.

2. K'+$%-'0 "sharing$ -'+ '0%- *& $'&+06KSO *8

P'-'0 1 ............ (....................'0-') 0+ &#* 6% ' *+

P'-'0 2 ............ (....................'0-') 0+ &#* 6% ' *+P'-'0 3 ............ (....................'0-') 0+ &#* 6% ' *+

................ -''0%-:.

3. M-+<&-+ '-'0 # $'&+06KSO $ &'&/+* /+ -'-%+

sharing '0-'/% /%+0 2. *& * ''*%0 $'%% $'0%+ 0+

$'&+06KSO. P'&/+ sharing *& $'&+06KSO ++ +$ $ +%/ /+$

"ONTO>



-'*& &- '?0 &%% -' &- $#0$ $'%*+ '

'0-'%% '0%*+- '0*'/+ %*% 0+ P++ ' % P'/ P'&/%

K#&+&' (PPK) '0-'%% /'0-& -'0 '0%*+- 0+ &-+&-+

# $'&+06KSO. T'0*'- 0+ sharing : +'$ +- &-+<

&-+ # $'&+06KSO $ &'*$%$ '?- '% '0

-'&% -'$ '*$- 0+ '0+ ++ '0&-%$ $ %%$ &'&'0+$-$'% '0+ '&/'*+ '0+& ,0 '0* ' $'0

'0+ -%/$#0$ -%0<&':%0 '*'$- *+<*+.

4. C'?' &'+ %%$ - & $'&+06KSO +/'0+$

$' ................... [nama wakil peserta ang diberi kuasa] *& $'%%$:

-'/+ '&+&+6+0'$%0 %& '0%- ..................[nama peserta 1]

/'0-0$ '0-'%% '0%*+-) 0+ .............[nama peserta 2] .......................

[nama peserta 3] .....................[dan seterusna] -'%/% ' -%/--+

-'&% $''% *& -'&% #$%&' : $ + +.

5. P'0+ ++ $ /'0*$% -'$ * ++.

@. P'0+ ++ -'0 ##&+- &'+ /* +$ /'0*$% *+ /+* -'*'$-+ +$

+&'$ #*' '0%- $'&+06KSO.

7. P'0+ ++ +/% *& 0$ .............. (....................) : &-+<&-+

&'&%:+ $'$% %$%& : -&.

DENGAN KESEPAKATAN INI -'&% # $'&+06KSO &'&/%/%$

+ .............. 0+ ............... * ........... /%* ............. % ......................

P':'+ 1 P':'+ 2 P':'+ 3

(.............................) (............................) (............................)

-''0%-:

(...............................)

D+-$ #*' NOTARIS)

(...............................)

) sebelum menandatangani dokumen%dokumen atas nama kemitraan harus

mendapatkan persetu&uan tertulis dari anggota kemitraan'KS(!



) dapat disahkan setelah kemitraan ditun&uk sebagai pelaksana peker&aan dengan

ketentuan prosentase kemitraan dan perusahaan ang mewakili kemitraan tersebut

tidak berubah!

BAB >I. PAKTA INTEGRITAS

[)ontoh Pakta *ntegritas +adan saha -anpa Kemitraan]

PAKTA INTEGRITAS

S: : /'0 + /? ++8

N& 8 .................... [nama wakil sah badan usaha]

J/ 8 ....................

B'0+$ %%$ 8 PT6"V6F+0&6K#'0-+6K'&+0.................... - & 8 …………………………………[ pilih ang sesuai dan .antumkan

nama ]

*& 0$ ' .................... .................... [isi sesuai dengan

Satuan Ker&a di lingkungan Kementerian P] ' ++ &':$ /?8

1. +$ $ &'*$%$ 0$'$ K#0%-+ K#*%-+ N'#+-&' (KKN);

2. $ &'*#0$ $' +$ : /'0?+/6/'0?' /+* &''%+

++$-+ KKN *& 0#-'- ' ++;

3. $ &'+$%+ 0#-'- ' -'0 /'0-+ 0-0 0#,'-+#*

%%$ &'&/'0+$ -+* $'0 '0/+$ -'-%+ $''% '0%0 '0%<

%;

4. /+* &'*0 *<* : +:$ *& PAKTA INTEGRITAS ++

/'0-'+ &''0+& -$-+ &++-0+, &''0+& -$-+ '%& *&

D,0 >+& +% -'0 '0 6% +*#0$ -'0 +.

.................... [tempat] ............[tanggal] .................... [bulan] 2... [tahun]

[/ama Penedia]

[tanda tangan]

[nama lengkap]



[)ontoh Pakta *ntegritas +adan saha Dengan Kemitraan]

PAKTA INTEGRITAS

K&+ : /'0 + /? ++8

1. N& 8 .................... [nama wakil sah badan usaha]

J/ 8 ....................

B'0+$ %%$ 8 PT6"V6F+0&6K#'0-+6K'&+0.....................................

- & 8 ..................................... [pilih ang sesuai dan .antumkan

nama]

2. N& 8 .................... [nama wakil sah badan usaha]

J/ 8 ....................

B'0+$ %%$ 8 PT6"V6F+0&6K#'0-+6K'&+0.....................................


nama]

3. ......[dan seterusna, diisi sesuai dengan &umlah anggota kemitraan]

*& 0$ ' .................... .................... [isi sesuai dengan

Satuan Ker&a di lingkungan Kementerian P] ' ++ &':$ /?8

1. +$ $ &'*$%$ 0$'$ K#0%-+ K#*%-+ N'#+-&' (KKN);

2. $ &'*#0$ $' +$ : /'0?+/6/'0?' /+* &''%+

++$-+ KKN *& 0#-'- ' ++;

3. $ &'+$%+ 0#-'- ' -'0 /'0-+ 0-0 0#,'-+#*

%%$ &'&/'0+$ -+* $'0 '0/+$ -'-%+ $''% '0%0 '0%<%;

4. /+* &'*0 *<* : +:$ *& PAKTA INTEGRITAS ++

/'0-'+ &''0+& -$-+ &++-0+, &''0+& -$-+ '%& *&

D,0 >+& +% -'0 '0 6% +*#0$ -'0 +.

.................... [tempat] ............[tanggal] .................... [bulan] 2... [tahun]

[/ama Penedia]

[tanda tangan]

[nama lengkap]

[/ama Penedia]

[tanda tangan]

[nama lengkap]

[/ama Penedia]

[tanda tangan]

[nama lengkap]



BAB >II. FORMULIR ISIAN KUALIFIKASI

S: : /'0 + /? ++8

N& 8 .................... [nama wakil sah badan usaha]

J/ 8 ....................

B'0+$ %%$ 8 PT6"V6F+0&6K#'0-+6K'&+0.....................................


nama]

A*& 8 ...................................

T'*'#6FH 8 .....................................

E&+* 8 ......................................

&':$ ' -'-%%: /?8

1. -: -'0 %$%& &'&%:+ $-+- &'+ $#0$

/'0-0$ S%0 .................... [sesuai akte pendirian'perubahanna'surat

kuasa, disebutkan se.ara &elas nomor dan tanggal akte pendirian'perubahan'surat kuasa! Jika Kemitraan maka Surat dimaksud

adalah Per&an&ian Kemitraan!] ;

2. -: /%$ -'/+ '?+ K6L6D6I [bagi pegawai K'0'D'* ang sedang .uti

diluar tanggungan K'0'D'* ditulis sebagai berikut Saa merupakan pegawai

K'0'D'* ang sedang .uti diluar tanggungan K'0'D'*] ;

3. -: +$ -' &'*+ -$-+ +;

4. -: +$ -' +$ $ '0*+/ '0' $''+ '

0 +$ : '0$+ *-% &%% +$ *-% *& 0#-'-

' ++;

5. / %- : -: ?$+*+ +$ &-%$ *& D,0 >+& +$ *&

'?- '+* +$ +*+ $'+ %-: +$ -'

+'+$;

@. -* -% 6% -'&% '%0%- / %- : -: ?$+*+ +$

&-%$ *& D,0 >+&

7. < -:6/ %- : -: ?$+*+ * -'/+ /'0+$%8



A. Daa A*m,n,#ra#,

1.N& (PT6"V6F+0&6K#'0-+6K'&+0) 8

………………………………………

2. S%-8

P%- "/

K'&+0

3.

A*& 8 …………………………………..N#.T'* 8 …………………………………..N#. FH 8 ………………………………….E&+*

8……………………………………

4.

A*&8

…………………………………..N#.T'* 8 …………………………………..N#. FH 8 ……………………………………E&+*

8……………………………………

B. I@,n U#a-a

1. S%0 I+ U- ............ 8 N#. ………………. T* ……………

2. M- /'0*$% ++ %- 8 …………………………

3. I--+ '&/'0+ ++%-

8 …………………………

<. I@,n La,nn4a (a2a$,la *,2"r#4araan)

1. S%0 I+ U- ............ 8 N#. ………………. T* ……………

2. M- /'0*$% ++ %- 8 …………………………

3. I--+ '&/'0+ ++%-

8 …………………………



D. Lan*a#an H''m P"n*,r,an Ba*an U#a-a1K"m,raan

1. A$' P'+0+ PT6"V6F+0&6K#'0-+6K'&+0

. N#. A$' 8 ………………………../. T* 8 ………………………... N& N#0+- 8 ………………………..

2. A$' P'0%/ T'0$+0

. N#. A$' 8 …………………………

/. T* 8 …………………………. N& N#0+- 8 …………………………

E. P"ng'r'#

. Kom,#ar,# 'n' P"r#"roan T"r$aa# (PT)

No. Nama No. KTPJa$aan *alam Ba*an

U#a-a

%. D,r"#,1P"ng'r'# Ba*an U#a-a1K"m,raan


U#a-a

5. Kom,#ar,# Ba*an U#a-a


U#a-a



F. Daa K"'angan

. S'#'nan K"2"m,l,an Sa-am ('n' PT)1S'#'nan P"#"ro ('n'<>1F,rma)1S'#'nan K"m,raan

No. Nama No. KTP Alama Pr"#"na#"

%. Pa+a

. N#&#0 P#$#$ C+/ P$ 8 ……………………/. B%$+ L#0 P$ T%

'0$+0

8 N#. ………………………..T* …………………..

. B%$+ L#0 /%* (+

/%* '0$+0)

8

1) PP P-* 21 8 N#. ………………………..T* …………………..

2) PP P-* 23 (/+*

0-$-+)

8 N#. ………………………..T* …………………..

3) PP P-* 256P-* 29 8 N#. ………………………..

T* …………………..4) PPN 8 N#. ………………………..

T* …………………..

G. Daa P"r#onal,a (T"naga a-l, "a2 $a*an '#a-a1"m,raan)

No. NamaTgl1$ln1T-n

La-,r T,nga

P"n*,*,an

Ja$aan*alam

2""r+aan

P"ngalamanK"r+a (a-'n)

Pro6"#,1K"a-l,an

Ta-'nS"r,6,a1I+a@a-

% 5 7 ! 0 9

H. Daa P"ngalaman P"r'#a-aan & (#"2'l'-) a-'n "ra-,r

No.NamaPa"

P""r+aan

B,*ang1S'$

B,*angP""r+aan

Loa#,

P"m$"r,T'ga#1P"+a$a

P"m$'a Kom,m"nKonra

Tanggal S"l"#a,M"n'r'

NamaAlama1T"l"2on

No 1Tanggal

N,la, KonraBA

S"ra-T"r,ma

1 2 3 4 5 @ 7 9 1



I. Daa P""r+aan 4ang #"*ang *,la#anaan

No.NamaPa"

P""r+aan

B,*ang1S'$B,*ang

P""r+aan

Loa#,

P"m$"r,T'ga#1P"+a$a

P"m$'aKom,m"n

Konra

Tanggal S"l"#a,

M"n'r'

NamaAlama1T"l"2on

No 1Tanggal

N,la,Konra

(r"nana)

Pr"#a#,K"r+a ()

1 2 3 4 5 @ 7 9 1

J. Daa Fa#,l,a#1P"ralaan1P"rl"nga2an 4ang m"n*''ng[.antumkan &ika disaratkan oleh Panitia Pengadaan]

N#.J'+-

F-+*+-6P'0*6P'0*'$

J%&*

K-+-%

output -

++

M'0$+'

T%'&/%

K#+-+()

L#$-+S'$0

B%$+K''&+*+$)

1 2 3 4 5 @ 7 9

) B%$+</%$+ -%0 $''&+*+$ 0%- +%%$$ ?$% +'0*%$

D'&+$+ '0: ++ -: /% ' -'/'0: '% 0- %

?/. J+$ +$'&%+ 0+ +'&%+ /? 6#$%&' : -: -&+$

+$ /'0 % '&*-% &$ -: / %- : -: ?$+*+

/'0-'+ +$'$ -$-+ /'0% -$-+ &++-0+, -$-+ '%&

*& D,0 >+& % -'0 '0 6% '*#0 -'0 +

$' +$ /'0?' -'-%+ ' $''% '0%<%.

.................... [tempat] ....... [tanggal]

................ [bulan] 2 ..... [tahun]

PT6"V6F+0&6K#'0-+6K'&+0

.................... [pilih ang sesuai dan

.antumkan nama]

[rekatkan meterai p 4!555,% dan tanda

tangan]

(nama lengkap wakil sah badan

usaha'kemitraan)

[&abatan pada badan usaha'kemitraan



BAB >III. PETUNJUK PENGISIAN FORMULIR ISIANKUALIFIKASI

A. A*m,n,#ra#,2. D++-+ ' & / %- '-'06$'&+0.

3. P+*+ -%- / %- (P%-6"/6K'&+0). U%$ : /%$

P%-6"/6K'&+0 0 &'+-+ -%- P%-.

4. D++-+ ' *& #&#0 '*'# #&#0 ,$-+&+*+ e%mail /

%- '-'06$'&+0 : +%/%+.

5. D++-+ ' *& #&#0 '*'# #&#0 ,$-+&+*+ e%mail $#0

%- : +%/%+ : ++-+ /+* '-'0 /'0-%- $#0

/.

B. I@,n U#a-a

A0 -'/'*%& &'+-+ +-+$ ++ %- +&$-% * : +&+*+$+

#*' / %- : &'+$%+ $%*+,+$-+.

1. D++-+ ' '+- -%0 ++ %- #&#0 * ''0/+:.

2. D++-+ ' &- /'0*$% ++ %-.

3. D++-+ ' & +--+ ''0/+ -%0 ++ %-.

<. I@,n la,nn4a (a2a$,la *,2"r#4araan)

A0 -'/'*%& &'+-+ +-+$ ++ *+: +&$-% * : +&+*+$+

#*' / %- : &'+$%+ $%*+,+$-+.1. D++-+ ' '+- -%0 ++ #&#0 * ''0/+:.

2. D++-+ ' &- /'0*$% ++.

3. D++-+ ' & +--+ ''0/+ -%0 ++.

D. Lan*a#an H''m P"n*,r,an Ba*an U#a-a1K"m,raan

1. D++-+ ' #&#0 * & N#0+- ''0/+ $' '+0+

/ %-6$'&+0.

2. D++-+ ' #&#0 * & N#0+- ''0/+ $' '0%/

'0$+0 / %-6$'&+0 /+* .

E. P"ng'r'#

1. D++-+ ' & #&#0 KTP / *& / %- /+*

/'0/'%$ P'0-'0# T'0/-.

2. D++-+ ' & #&#0 KTP / *& / %-6$'&+0.

3. D++-+ ' & #&#0 KTP / *& / %-.

F. Daa K"'angan

1. D++-+ ' & #&#0 KTP *& '&+*+$ -&6'-'0#6#

$'&+0 '0-'-' $''&+*+$ -&6'-'0#6$'&+0.

2. P$

. D++-+ NPCP / %-.

/. D++-+ #&#0 * /%$+ L#0 P$ T% '0$+0 /'0% SPT

T%.

. D++-+ #&#0 * /%$+ *#0 /%* (+ /%* '0$+0)

/'0% SPT M-8



1) PP P-* 21.

2) PP P-* 23.

3) PP P-* 256P-* 29.

4) PPN.

P'0-:0 '&'% $'?+/ $ % '0$+0 ' ':&+

SPT T% SPT M- ++ #*' P':'+ B06J- '

':&+ S%0 K''0 F+-$* (SKF) : +$'*%0$ #*' K#0

P'*: P$

G. Daa P"r#onal,a

1. D++-+ #&#0 %0%.

2. D++-+ ' & ' *+ ' : +&+*+$+ #*' /

%-6$'&+0.

3. D++-+ *6/%*6% *+0.

4. D++-+ +$ '++$ :+% -0 % - -0.5. D++-+ / *& '$'0 : '0 +*$-$.

@. D++-+ *& '*& $'0 *& -% %.

7. D++-+ 0#,'-+6$'*+ -'-%+ ' -'0+,+$ $'*+ : +&+*+$+.

. D++-+ % ''0/+ -'0+,+$6+ 0+ -'+ ' *+ ' :

+'0*%$.

H. Daa P"ngalaman P"r'#a-aan

1. D++-+ #&#0 %0%.

2. D++-+ ' & $' '$'0 : '0 +*$-$.

3. D++-+ /+6-%//+ '$'0 : +'0-:0$.4. D++-+ *#$-+ '& '*$- '$'0.

5. D++-+ #&#06* $#0$.

@. D++-+ +*+ $#0$.

7. D++-+ * -'*'-+ $' '$'0 &'%0% $#0$.

. D++-+ * /'0+ 0 -'0 '0+& %%$ &-+<&-+ $'

'$'0 -'*& 1 (-'%*%) % '0$+0.

I. Daa P""r+aan 4ang #"*ang D,la#anaan

1. D++-+ #&#0 %0%.

2. D++-+ ' & $' '$'0.

3. D++-+ /+6-%//+ '$'0.

4. D++-+ *#$-+ '& '*$- '$'0.

5. D++-+ & I--+ 0+ P'&/'0+ T%-6P'/ P'&/% K#&+&'.

@. D++-+ *&6'*'# I--+ 0+ P'&/'0+ T%-6P'/ P'&/%

K#&+&'.

7. D++-+ #&#06* $#0$.

. D++-+ +*+ $#0$.

9. D++-+ '0-'-' 0#0'- &'%0% $#0$.

1.D++-+ '0-'-' 0'--+ $'0 '0$+0.

J. Daa Fa#,l,a#1P"ralaan1P"rl"nga2an

1. D++-+ #&#0 %0%.

2. D++-+ ' '+- ,-+*+-6'0*6'0*'$.

3. D++-+ %&*.

4. D++-+ $-+- % output : ++ - ++.



5. D++-+ &'0'$ +'.

@. D++-+ % '&/%.

7. D++-+ $#+-+ (*& '0-'-')

. D++-+ *#$-+ $'/'0 - ++.

9. D++-+ /%$+ $''&+*+$ (&+*+$ -'+0+6-'? /'*+6-'?) 0+ &-+&-+

,-+*+-6'0*6 '0*'$. B%$+ -%0 $''&+*+$ 0%-

+%%$$ ?$% P'&/%$+ K%*+,+$-+.



BAB IC. TATA <ARA E>ALUASI KUALIFIKASI

A. S'/'*%& +*$%$ E=*%-+ K%*+,+$-+ &$ P++ P' &''*++

$ P$ I'0+- '* ++. A/+* P$ I'0+- +$++ &$ +$ +*$%$ '=*%-+ *'/+ *%. E=*%-+ K%*+,+$-+

+*$%$ /'0-0$ F#0&%*+0 I-+ K%*+,+$-+ : '0+0+ 0+8

1. '+*+ P'0-:0 K%*+,+$-+ : +*$%$ ' S+-'& G%%0;

2. '=*%-+ P'0-:0 T'$+- K%*+,+$-+ : +*$%$ ' S+-'& N+*+

%%$ &'-+*$ "*# D,0 P''$.

B. P'+*+ P'0-:0 K%*+,+$-+ 0%- &'&'%+ '0-:0 -'/+ /'0+$%8

1. F#0&%*+0 +-+ $%*+,+$-+ ++ #*'8

. +0'$%0 %&6+&+ '0%-;

/. ''0+& $%- 0+ +0'$%0 %&6+&+ '0%- : &

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