No.

Deskripsi Alat

Peralatan Puskesmas Rawat Inap

1 Branchard
Merk Type Specifications Material Construction Finishing Dimension Accessories Description : Stainless Steel : SS Pipe SS Pipe & Mattress : Polished : 200 x 65 x 80 cm : 4" wheel, tying rope & stainless infusion hanger : To move a Patient : Blessmed - Local : BP 035 SS STD

Patient Bed 1 Crank

Merk Type Specifications Back-raise, Fixed-height Torque Release Handle Detachable Head/Foot Board 125 dia. Caster Less maintenance crank mechanism Two kinds of width, user-selectable Sleep Surface = width of mattress Width (mm) : 91 cm type (a) 910 (b) 1040 Height up to (mm) : 91 cm type (c) 550 (d) 948 Dimension : : Paramount - Local : PA-11210

Bed Side Cabinet

Merk Type Specifications Steel body and door Plastic top surface drawer and pull-out table : Paramount - Local : PF-1100

Towel rails Plastic shelves 40 mm dia caster 454W x 469D x 930H mm

Standard Infus
Merk Type Specifications Stainless pipe rod Dimensions (mm) : 1030 - 1775 L : Paramount - Local : KC-56

Instrument/Medicine Cabinet
Merk Type Specifications Material Construction Finishing Dimension Accessories Description : Stainless steel & Glass : SS Plate, SS Pipe & Glass : Polished : 70 x 40 x 170 cm (180 cm with leg) : Glass rack & standard door lock : To keep medicine : Blessmed - Local : BP 0211 ASS

Instrument Trolley / Meja Instrument

Merk Type Specifications Material Construction Finishing Dimension Accessories Description : Stainless Steel : SS Pipe & Glass : Polished : 60 x 43 x 80 cm : 2" wheel : Nursing Trolley : Blessmed - Local : BP 019 SS

Infant Incubator
Merk Type Specifications Note Material Construction Bed Inclination Finishing : With Skin Control : Mild Steel & Acrylic : MS Plate, MS Pipe, MS Pipe & Acrylic : By Crank : Powder Coating : Blessmed - Local : BP 032 Servo

Dimension Power Supply Temp. Control & Alarm Temp. Fluctuation Skin Control Air Circulation Humidity Control Mattress Size Max. Load Weight Accessories Description

: 93 x 42 x 135 cm : 300 watt, 220 Volt AC, 50 Hz : 27C - 37C, alarm indicator with busser will work at 38C : 1C : Available : By Fan : By Higrometer : 65 x 36 cm : 7 Kg : 65 Kg : 4" wheel, Mattress, Safety Oxygen Supply Equipment & Powder Cord : To Maintain a Certain Baby's Body Temperature

Sterilisator
Merk Type Specifications Voltage Powder Consumption Chamber Capacity Setting Timer Size Weight : 230V - 50Hz : 1500 watt : 7 litre : 1 - 30 minutes : 44 x 22 x 23 cm : 6 Kg : Blessmed - Local : SS-31

Jackson Rees Pediatric

Merk Type Specifications Alat ini digunakan untuk breathing system yang open. Biasa digunakan untuk operasi pasien dengan BB sampai dengan 20 Kg, tapi terkadang untuk kasus-kasus ttt dapat digunakan untuk dewasa. : Altera - Turkey : ---

10

Jackson Rees Adult

Merk Type Specifications Alat ini digunakan untuk breathing system yang open. Biasa digunakan untuk operasi pasien dengan BB sampai dengan 20 Kg, tapi terkadang untuk kasus-kasus ttt dapat digunakan untuk dewasa. : Altera - Turkey : ---

11

Gynecology Chair
Merk : Blessmed - Local

Type Specifications Movement Material Construction Finishing Dimension Accessories Description

: BP 027 STD SS : Backrest only : Stainless Steel : SS Pipe & Mattress : Polished : 100 x 65 x 80 cm : Basin & Twin Leg Support : To Examine a Gynaecolog Patient

12

Sphygmomanometer
Merk Type Specifications Internal graduated glass scale with inside diameter of 3.5 mm and a clear reading scale. Manual Operator On/Off mercurial tap Range : 0-300 mmHg Air release at closed tap max 4mm/Hg/Minute : Blessmed - Local : MSP-1001

13

Stethoscope
Merk Type Specifications Weight Material : 200 g : Silicon, stainless steel, plastic : Blessmed - Local : STE-3006

14

Emergency Kit
Merk Type Consisting of : Operating Scissors, 14cm, straight, s-s Lister Scissors, 18cm, Supercut Stitch Scissor, 14cm Iris Scissors, 12cm, str, s-s Adult Silicone Resuscitator Mercurial Sphygmomanometer Stainless stethoscope :1 :1 :1 :1 :1 :1 :1 : Blessmed - Local : Various

15

Tromol Kasa / Kain Steril

Merk Type Specifications : Local : ---

Material Ukuran

: Stainless steel : Sedang

16

Spine Board / Long Board

Merk Type Technical Index Product size Net Weight Load Bearing Gross Weight : (L x W x H) 175 x 45 x 6 cm : 9 Kg : < 159 Kg : 12 Kg : My Life - China : ---

17

Minor Surgery
Merk Type Consisting of : Scalpel Handle 3# Scalpel Handle 4# 14 cm Dressing Forceps 14 cm Tissue Forceps, 1x2 teeth Operating Scissors, 14 cm straight, s-s Operating Scissors, 14 cm curved, s-s Operating Scissors, 14 cm straight, s-b Operating Scissors, 14 cm curved, s-b Needle Holders, 14cm, Mayo-Hegar Needle Holders, 14cm, Crile-Wood 12.5cm Mosquito Forceps, cvd 12.5cm Mosquito Forceps, str 14cm Forceps, cvd, full serrated 14cm Forceps, str, full serrated :1 :1 :2 :2 :1 :1 :1 :1 :1 :1 :2 :2 :4 :4 : Blessmed - Local : Various

18

Suction Pump
Merk Type Specifications Max. Vacuum Pressure Max. Suction Capacity : -80kPa (-60.8cmHg) : Normal Mode 24 L/min. (Pump Capacity 30 L/min. at Air) Power Saving Mode 18 L/min. at Air. (Pump Capacity 20 L/min. at Air) Suction Bottle Capacity 3 Electric Powers Charging Time Continuous Running Time : 1,400ml (Polycarbonate) : AC mains - 220V, DC 12V 2A (Car Battery), & Built-in Battery. : About 3-4 hours : About 6 hours (In AC 100V-240V) : Sharp - Japan : Minic-DC

PUMP Dimension &Weight Safety Bottle

: Double Headed, Diaphragm : H296 x W375 x D150mm, About 5.5kg : Liquid or mist overflow prevention from entering the motor unit

Standard Accessories Patient tube Tubing between bottle or housing Bottle Rubber Bottle Cover Sub (f) assembly Suction inlet with nozzle Bottle holder sub assembly Suction Bottle 1.4 L Safety Bottle Rubber Ring for safety bottle Filter for safety bottle Catheter Holder Battery Charger Cigar Lighter Card

19

Tabung Oksigen 1m3 + Regulator, Trolley, Nasal

Merk Type Specifications Measurement Oxygen Trolley : Material Construction Finishing Accessories Dimension Description Oxygen Inhale : Flow Range Pressure Gauge Max. Pressure Water Level : 1-15/min 20C : 0-250 kgf/cm (0-3500) lbf/in : 14.700 Kpa : 50 ml : Mild Steel : Ms Pipe : Powder Coating : 90 cm Height : 3" wheel : To move an oxygen tank : 1m3 : Blessmed - Local : ---

20

Sphygmomanometer Mobile Stand

Merk Type Specifications : Blessmed - Local : MSP-1003

Features Material Weight

: Velcro cuff (2 tubes), Storage compartment, - securing mercury for safety during transport, Scale angled back for easy reading. locking mechanism : Plastic, silicon, rubber, iron, mercury : 2,2 kg

21

Examination Lamp (LED Mobile)

Merk Type Specifications Illuminance Color Temperature Power Supply Voltage Spot Diameter Temperature Rise Rated Voltage of Bulb Brightness Adjustment Pole : 30,000 Lux 0.5m / 10,000 Lux 1m : 3,000 - 4,500K : AC 220V + 10%, 50 Hz + 1 Hz : 100 mm : 2C : Super Bright LED Iminotron 3,3V / 3 Watt : Absolute adjustment : Adjust up and down : Blessmed - Local : YD 01

22

Examination Table
Merk Type Specifications Back raise and Hi-Lo adjustment Two Table Tops with Polyurethane Foam Mattress covered with vinyl leather Steel Frame (Powder Coated) Fixed Steel Pipe Board (Chrome Plated) 1985 (L) x 750 (W) x 550 ~ 870 (H) mm : Paramount - Local : PK-1122

23

Kursi Roda
Merk Type Specifications Material Construction Finishing Accessories Description : Mild steel, can be folded : Ms Pipe & Synthetic Leather : Chromed : Rubber wheel : To Move Patient with Disability : Blessmed - Local : BP 052

24

Antidecubitus Matras
Merk Type Specifications Mattress Model : Block shape : Blessmed - Local : WM-33

Voltage Frequency Consumed Power Charged Pressure Noise

: AC ~ 220V 10% : 50Hz l Hz : 15 Watt : 10 Kpa : < 50 dB

25

Stretcher
Merk Type Specifications Back raise and Hi-Lo adjustment Two Table Tops with Polyurethane Foam Mattress covered with vinyl leather Steel Frame (Powder Coated) Fixed Steel Pipe Board (Chrome Plated) 150mm dia. TENTE central locking casters. Dimension : Base - Length - Width - Height Overall - Length - Width - Height : 2175 mm : 900 mm : 894 ~ 1278 mm : 1985 mm : 750 mm : 575 ~ 894 mm : Paramount - Local : PK-2100

26

Food Trolley
Merk Type Specifications Material Construction Finishing Dimension Power Supply Description : Stainless Steel : SS Plate & SS Pipe : Polished : 93 x 60 x 80 cm : 3" wheel : To Deliver the patient meals : Blessmed - Local : BP-01703

27

Bahan Habis Pakai : a). Kertas ECG

Merk Type Specifications Size : 50 mm x 30 m : Blessmed - Local : ---

Packaging

: Roll

b). Kertas USG

Merk Type Specifications Size Packaging : 50 mm x 30 m : Roll : Blessmed - Local : ---

c). Jelly ECG

Merk Type Specifications Conductivity Gel : Hypoallergenic, Water Soluble : Blessmed - Local : Bless Gel

d). Jelly USG

Merk Type Specifications Conductivity Gel : Hypoallergenic, Water Soluble : Blessmed - Local : Bless Gel

28

Dapur Set
Merk Type : Local : Various

Terdiri dari :
a). Piring Merk b). Piring Ceper Merk c). Mangkok Kecil Merk d). Mangkok Besar Merk e). Mangkok Sayur Merk f). Sendok : Akuila - Local 20 : Akuila - Local 10 : Akuila - Local 10 : Akuila - Local 10 : Akuila - Local 10 10

Merk g). Garpu Merk h). Gelas Merk i). Nampan Merk j). Wadah Sambel Merk

: Abert - Local 20 : Abert - Local 10 : Libi - Local 10 : Jiushitray - Local 10 : Akuila - Local

Total Penawaran Harga

Kondisi Penawaran Harga

- Harga - Franco - Pembayaran - Garansi - Masa Penawaran - Pengiriman : : : : : :

Qty

H a r g a (Rp.) Satuan Jumlah

10 1

set

Rp

393,394,150 9,010,300

Rp

3,933,941,500 9,010,300

unit Rp

unit Rp

18,545,500

18,545,500

unit Rp

5,043,100

5,043,100

unit Rp

1,296,300

1,296,300

unit Rp

18,565,800

18,565,800

unit Rp

3,413,300

3,413,300

unit Rp

90,100,100

90,100,100

unit Rp

4,573,300

4,573,300

unit Rp

910,600

910,600

unit Rp

910,600

910,600

unit Rp

14,334,700

14,334,700

unit Rp

519,100

519,100

unit Rp

446,600

446,600

unit Rp

5,597,000

5,597,000

unit Rp

2,124,250

2,124,250

unit Rp

3,475,650

3,475,650

unit Rp

15,699,150

15,699,150

unit Rp

23,607,450

23,607,450

uilt-in Battery.

ing the motor unit

unit Rp

2,457,750

2,457,750

unit Rp

2,047,400

2,047,400

unit Rp

9,555,500

9,555,500

unit Rp

17,292,700

17,292,700

unit Rp

4,982,200

4,982,200

unit Rp

2,594,050

2,594,050

unit Rp

30,261,500

30,261,500

unit Rp

12,013,250

12,013,250

Set 146,000

1,460,000

10 buah Rp

1 pack Rp

3,138,000

3,138,000

10 buah Rp

105,000

1,050,000

10 buah Rp

105,000

1,050,000

set

Rp

87,319,000

87,319,000

lusin

lusin

lusin

lusin

lusin

set

set

lusin

lusin

lusin

3,933,941,500

awaran Harga
sudah termasuk PPN 10%. di tempat. 40% saat penempatan SPK, 60% setelah penyerahan barang. 1 (satu) tahun. 2 (dua) bulan. as soon as possible.

LAPORAN KEGIATAN PROYEK

Nama Paket Pekerjaan : Bidang / Sub Bidang Pekerjaan : Alkes Pemberi Tugas : Dinkes Jember No. Kontrak : .. Tanggal Serah Terima : . Alamat :

PENUNJUKKAN | PEMILIHAN | LELANG

Peralatan Puskesmas Rawat Inap

Tanggal Kontrak : ... Pelaksanaan ( hari )

Dasar Pengenaan Pajak (DPP) Pajak Pertambahan Nilai (PPN 10%) Pajak Penghasilan (PPh 1,5 %)
Jumlah Pajak yang dibayar Nilai BKF {Kontrak - (PPN + PPH)}

0.909

10.0% 1.5%

########### Rp 4,104,863,636 ########### Rp 410,486,364 61,572,955 ########### Rp

Rp

472,059,318

1. 2. 3. 4.

Pembelian Barang / Harga Pokok Realisasi Ongkos Kirim Pembelian Jasa Instalasi
Pengesetan+O. Kirim

Rp

250,000

Sub Total
BIAYA FEE :

Rp

250,000

1. 2. Fee Bendahara, SP2D,KPKN (0,3 % - 0,4 %)0.3%

3. Fee Lembaga atau PPA 10.0%

Rp 4,043,290,682 Rp 4,043,290,682 Rp 4,043,290,682 Rp 4,043,290,682 Rp 4,043,290,682 Rp 4,043,290,682 Rp 4,043,290,682

Rp Rp Rp Rp Rp Rp Rp

12,129,872 404,329,068 40,432,907 40,432,907 60,649,360 20,216,453 101,082,267

4. 5. 6. 7. 8.

Fee Pimpinan Proyek (PPTK) Fee Pejabat Pembuat Komitmen Fee Panitia Pengadaan ( 5 Org) Fee Panitia Perima Barang ( 3 Org) Fee Bendera

1.0% 1.0%
1.5%

0.5% 2.5%
16.8%

Sub Total
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Jasa Pembuatan Penawaran & Pra
Jasa Pembedelan Kontrak

BIAYA ADMINISTRASI (untuk 1 atau beberapa perusahaan) :

Materai Kontrak Jasa Pembuatan Kontrak Referensi Bank Jaminan Penawaran Jaminan Pelaksanaan Jaminan Pemeliharaan Jaminan Uang Muka Pembukaan Rekening

10

Rp Rp Rp Rp. Rp. Rp. Rp. Rp. Rp. Rp

500,000 Rp 500,000 Rp 6,000 Rp Rp. Rp. Rp. Rp. Rp. Rp. Rp.

500,000 500,000 60,000

Sub Total

BIAYA LAIN-LAIN :

1. 2. 3. 4. 5.

Biaya Entertaint, Lobby,Koran Biaya Operasional Pengesetan

Rp Rp Rp. Rp. - Rp Rp. Rp.

Biaya Komunikasi Sumbangan Sewa Fungsi Kantor Biaya Bunga Bank ( ,,,,% per bulan)

Sub Total
Belanja Barang / HPP : 1 Peralatan Puskesmas Rawat Inap 2 PEMBELIAN BARANG / BELANJA / HPP : Profit Pekerjaan (Dihitung per pekerjaan) #NAME? Catatan / Analisa : ( Min ) Pendapatan < Pengeluaran 10 Rp 273,385,000 Rp 2,733,850,000 Rp -

Rp 2,733,850,000

UNJUKKAN | PEMILIHAN | LELANG Lokasi :

| TERKONDISI

Tanggal Mulai Lobi : Telpon : Nilai Penawaran : Terbayar Tanggal : Pagu 5% Rp 4,515,350,000 HPS

Nilai Kontrak ############ 3% Rp 4,753,000,000 Rp147,000,000 Rp 237,650,000

Rp

4,043,290,682

Rp 4,043,040,682

Rp

679,272,835

Rp

3,363,767,847

Rp

1,060,000

Rp

3,362,707,847

Rp

Rp

3,362,707,847

Rp Rp

628,857,847 628,857,847