KEMENTERIAN PEKERJAAN UMUM DAN PERUMAHAN RAKYAT

DIREKTORAT JENDERAL SUMBER DAYA AIR

BALAI BESAR WILAYAH SUNGAI POMPENGAN JENEBERANG
UNIT LAYANAN PENGADAAN (ULP) PROVINSI SULAWESI SELATAN
KELOMPOK KERJA (POKJA) SATUAN KERJA OPERASI DAN PEMELIHARAAN SDA POMPENGAN JENEBERANG
Jl. Batara Bira No.8 Km.16 Baddoka, Makassar 90234 Telp/Fax. (0411) 512323 email: pokja.op.bbwspj@gmail.com

PREQUALIFICATION DOCUMENT FOR

PROCUREMENT OF

PJE-CS-07
PENYIAPAN DAN PENETAPAN IZIN OPERASI
BENDUNGAN PONRE-PONRE, KALOLA,
SALOMEKKO DAN BILI-BILI

(PREPARATION AND LEGALIZATION OF OPERATION PERMIT OF

PONRE- PONRE, KALOLA, SALOMEKKO AND BILI-BILI DAMS)

CONSULTANT SERVICES

Loan IBRD No. 8711 – ID

Loan AIIB No. 000010-IDN
 TABLE OF CONTENTS

CHAP. I SCHEDULE ..................................................................................... 1

CHAP.II GENERAL INFORMATION ............................................................... 2

A. Definition ..................................................................................... 2
B. Source of Funds ......................................................................... 2
C. Service Provider ......................................................................... 2
D. Validity of Expression of Interest ................................................. 2
E. Confidentiality ............................................................................. 2
F. Cost of Expression of Interest ..................................................... 2

CHAP. III ASSESSMENT METHOD OF EXPRESSION OF INTEREST .......... 3

A. General ....................................................................................... 3
B. Assessment of Expression of Interest ......................................... 3

CHAP.IV SHORTLIST SELECTION AND ANNOUNCEMENT......................... 4

A. General ....................................................................................... 4
B. Ownership of Expression of Interest Document .......................... 4

CHAP.V ATTACHMENT OF EXPRESSION OF INTEREST FORM FOR

CONSULTING SERVICES
 CHAPTER - I

SCHEDULE

Interested Consultant Firm shall fulfill the activities specified in the following schedule:

No. Activity Date Time

23.59 WIB
1. Request Expression of Interest Notice October 01, 2018
(GMT + 7)

23.59 WIB
2. Document Acquirement (online) Oct 01- Oct 18, 2018
(GMT +7)

23.59 WIB
3. Document Acquirement Limit
October 18, 2018 (GMT +7)

09.59 WIB
4. Document Submission Limit
October 19, 2018 (GMT+7)

10.00 WIB
5. Opening of Submitted Document October 19, 2018 (GMT +7)
 CHAPTER - II

GENERAL INFORMATION

A. Definition

The following words, sentences and abbreviations have the meaning as mentioned
unless otherwise specified:
1. The Government is the Government of Republic of Indonesia;
2. Budget User is the Minister of Public Works and Housing;
3. Authorized Budget User is The Head of Satuan Kerja Operasi dan Pemeliharaan
SDA Pompengan Jeneberang;
4. Owner of the work is The Commitment Maker Official of Satuan Operasi dan
Pemeliharaan SDA Pompengan Jeneberang;
5. Consulting Firm/Company is a business entity whose activities provide services
(“consultant”);
6. Procurement Committee (POKJA) is a team appointed by the Authorized Budget
User to carry out the procurement process;
7. Prequalification Document is a document which prepared by the Procurement
Committee (POKJA) and legalized by the Authorized Budget User as guideline in
the process of preparing and submitting prequalification data by the consultant.

B. Source of Funds
The source of the fund to be used for financing this work comes from the World Bank
Loan for Reconstruction and Development (IBRD) Loan No. 8711-ID and Asian
Infrastructure Investment Bank Loan No. 000010-IDN

C. Service Provider
This prequalification is open to all consulting service providers who have the
competence and business ability to complete the work as specified in the terms of
reference.
The Consultant shall be deemed to have passed the prequalification if meets the
stipulated requirements.

D. Validity of Expression of Interest

The Expression of Interest only valid for PJE-CS-07: Penyiapan dan Penetapan
Izin Operasi Bendungan Ponre-Ponre, Kalola, Salomekko dan Bili-Bili (Preparation
and Legalization of Operation Permit of Ponre- Ponre, Kalola, Salomekko and Bili-Bili
Dams).

E. Confidentiality
All documents and information received from prequalification participants are kept
confidential and used for proper prequalification.

F. Cost of Expression of Interest

All costs incurred by the participant in relation with this prequalification process are the
responsibility of the prequalification participant
 CHAPTER – III

ASSESSMENT METHOD OF EXPRESSION OF INTEREST

A. General

1. Assessment of Expression of Interest (prequalification documents) shall be carried

out by the procurement committee (POKJA) based on data and information stated
in the submitted prequalification document by the participants.

2. If it is necessary, the committee may ask the participants to complete the data, if
not met then it will become the risk of participants.

3. If the data / information that is submitted is not correct and there is forgery, the
participant is dropped and included in the blacklist of the Government for 2 (two)
years, and subject to civil and criminal sanction in accordance with the applicable
regulations.

B. Assessment of Expression of Interest

The assessment of the prequalification document shall be made to the fulfillment of the
requirements as set forth in this prequalification document.

Selection Method is based on Quality and Cost Based Selection (QCBS) set out in the
Consultant Guidelines (paragraph 1.9 of the W orld Bank’s Guidelines: selection and
employment of consultant under IBRD loans and IDA Credits & Grants by World Bank
Borrowers [July 2014])
 CHAPTER – 4

SHORTLIST SELECTION AND ANNOUNCEMENT

A. General

The procurement committee shall notify in writing the results of the prequalification and
the names of the prequalification participants who pass and are included in the Short
List of Consultants who are invited to participate in the general selection.

B. Ownership of Expression of Interest Document

The prequalification documents submitted to the committee shall belong to the

committee and shall not be returned to prequalification participants whether listed or
not listed in shortlist.
 CHAPTER – 5

ATTACHMENT OF EXPRESSION OF INTEREST FORM FOR

CONSULTING SERVICES

PJE-CS-07

PENYIAPAN DAN PENETAPAN IZIN OPERASI

BENDUNGAN PONRE-PONRE, KALOLA,
SALOMEKKO DAN BILI-BILI

(PREPARATION AND LEGALIZATION OF OPERATION PERMIT

OF PONRE- PONRE, KALOLA, SALOMEKKO
AND BILI-BILI DAMS)
 ATTACHMENT
Form 1

COMPANY LETTERHEAD

EXPRESSION OF INTEREST STATEMENT LETTER

TO FOLLOW THE PROCUREMENT OF CONSULTING SERVICES

The undersigned below:

Name : ..........................................................................
Position : ..........................................................................
Acting for/on behalf of : (Consulting Firm’s Name).................................
Address : ..........................................................................
Telephone/Fax : ………………………………………………………
Email : ……………………………………………………..

Declare that after knowing the procurement to be carried out by the Satuan Kerja Operasi dan
Pemeliharaan Sumber Daya Air Pompengan Jeneberang of Fiscal Year 2018, hereby declare the
interest to follow the process of procurement of consultancy services "PJE-CS-07 : Penyiapan
dan Penetapan Izin Operasi Bendungan Ponre-Ponre, Kalola, Salomekko dan Bili-Bili (Preparation
and Legalization of Operation Permit of Ponre- Ponre, Kalola, Salomekko and Bili-Bili Dams) " to
finish.

Thus I make this statement with full awareness and responsibility.

. . . . . . . . . . . . (date). . . . . . . . . . .
(Consulting Firm’s Name)
Seal and Stamp
(signed)

( Name )
( Position )
 ATTACHMENT
Form 2

Prequalification Assessment From

Procurement of Consulting Services

PJE-CS-07 : Penyiapan dan Penetapan Izin Operasi

Bendungan Ponre-Ponre, Kalola, Salomekko dan Bili-Bili
(Preparation and Legalization of Operation Permit of Ponre- Ponre, Kalola, Salomekko
and Bili-Bili Dams)

Satuan Kerja Operasi dan Pemeliharaan Sumber Daya Air

Pompengan Jeneberang
Ministry of Public W orks and Housing
Fiscal Year 2018

The undersigned below :

Name : ..........................................................................
Position : ..........................................................................
Acting for/on behalf of : (Consulting Firm’s Name)....................................
Address : ..........................................................................
Telephone/Fax : ………………………………………………………
Email : ……………………………………………………..

Certify that :

1. By law having the capacity to sign a contract based on …………………………………

2. The firm/company is not being declared bankrupt or its business activities are not being
terminated or not undergoing criminal sanctions or under the supervision of the court.
3. I have never been convicted on the basis of a court decision for actions relating to my
professional conduct.
4. The firm/company data is as follows:

a. Administration
1. Name of the Firm/Company :
2. Status of the Firm/Company : Central Branch
3. Address :
Telephone :
Fax :
E-mail :
4. Central Office Address : .................................................
Telephone :
Fax :
E-mail :
 b. Business Permit

Business Permit (…..........................) : No. ...................... Date .......................

Validity of Business Permit : ……………..(date)................................
Issued by : ……………………….............................

c. Legal Standing of Firm/Company

1.
Certificate of Incorporation (CoI)
Certificate Number :
:
Date
:
Issued by
2.
Latest Amendment of CoI
Certificate Number
Number
:
Issued by :
:

d. Firm/Company Management
1. Commissioner
No. Name ID Number Position in the Firm/Company

2. Board of Directors
No. Name ID Number Position in the Firm/Company

e. Financial Information
1. Share Ownership Structure
No. Name ID Number Address Percentage

2. Tax Information
1. Tax payer ID number
:
2. Receipt of latest Tax Repayment
:
Receipt Number /Date
3. :
VAT for the last three months
Number/Date

f. Personnel Data
Experts
Date of Position in the Professional
No Name Education Experience Certificate
birth Project expertise
1 2 3 4 5 6 7 8

g. Firm’s/Company’s Experience Data for the last 10 (ten) years

Users Contract Completed by date of
Name of
No Field Location
Project Address/ Number Contract
Name Contract Final Handover
Telephone & Date Value
1 2 3 4 5 6 7 8 9 10

h. Firm’s/Company’s Ongoing Project

Users Contract Latest progress
Name of
No Field Location
Project Address/ Number Contract
Name Date Percentage (%)
Telephone & Date Value
1 2 3 4 5 6 7 8 9 10
Herewith I make this statement in truth and full of responsibility. If in the future, data /
documents that I submitted is not true and there is forgery, then I am willing to be imposed
an administrative sanction which is included in the blacklist of the Government for a period
of 2 (two) years, and civil and criminal sanctions in accordance with the applicable
regulations.

. . . . . . . .(date)……. . . . .
(Firm/Company name)
...........................................

Seal and Stamp

( Name )
Position