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DENGAN ANGKA
1 579,172,000
2 609,654,700
3 Err:509
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DENGAN ANGKA
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TERBILANG
LIMA RATUS TUJUH PULUH SEMBILAN JUTA SERATUS TUJUH PULUH DUA RI 9
ENAM RATUS SEMBILAN JUTA ENAM RATUS LIMA PULUH EMPAT RIBU TUJU 9
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RUPIAH 1
RUPIAH 1 RUPIAH 1
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RUPIAH 1 RUPIAH 1
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RUPIAH 1
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RUPIAH 1
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TERBILANG
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RUPIAH 1
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SATU
SEBELAS
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579 LIMA RAT TUJUH PUSEMBILA 172 SERATUS TUJUH PU
609 ENAM RA SEMBILA 654 ENAM RA LIMA PUL
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2 3 4 5 6 7 8 9
DUA TIGA EMPAT LIMA ENAM TUJUH DELAPAN SEMBILAN
DUA BELATIGA BEL EMPAT BELIMA BEL ENAM BE TUJUH BEDELAPAN SEMBILAN BELAS
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RUPIAH
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RUPIAH
RUPIAH
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RUPIAH
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DUA 000 LIMA RAT LIMA RAT SERATUS
EMPAT 700 TUJUH RA ENAM RA ENAM RA ENAM RA
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SERATUS
ENAM RA TUJUH RATUJUH RA
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PT. MULTI STRUCTURE
r u c u r e e r e c o n
SERVICE O
Nomor : 031/MS/RSU-IDI/V/2015
Divii : BUILDIN!
Pro"e# : RSUD $r% &u'ir M()*u$
No*or N%P%+%PPT. MULTI STRUCTURE
No% 0,%-0,%.,,.%-%0/%000
+i*( ./ Lt% 0 J1% Let2en$% S% P(r*(n
3(v% . S1i4i% P(1*er()
P)one : 0,5-///.006 7(8 : 0,5-//5.
J(#(rt( B(r(t D3IJA3ARTA
No URAIAN PEKERAAN SAT
1 P!". I#$%&'&$ P!m&&m K!*&"&r I#$%&'&$ +,r% S%! P'
, Pi4( B1(c# Stee1 Sc) 0(% Di(%/; *
'% Di(%; *
'% Di(% ,; *
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c% Di( ; *
$% Di( , ,; *
e% Di( ,; *
7ittin< $(n Acceorie 1
- He($ S4rin#1er ')
!(te ?(1ve Di(%-; ')
5 !(te ?(1ve Di( ,; ')
/ OriCce P1(te Di( ,; ')
. A1(r* S>itc) Di(%-; ')
,0 M(teri(1 B(ntu Tetin< @o**iionin< Di(% /; 1
3 INSTALASI +DRANT ANUNAN UTAMA LANTAI 2
, Pi4( B1(c# Stee1 Sc) 0(% Di(%-; *
'% Di(% ,; *
c% Di( ; *
$% Di( , ,; *
e% Di( ,; * 7ittin< $(n Acceorie 1
- He($ S4rin#1er ')
- Jika tidak ada konfrmasi dalam watu 3 (tiga) hari, maka harga dianggap sah
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De*i#i(n Service Or$er SOF ini $i'u(t untu# $i4er
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RDER (SO)
3e4($( t)6
CV. PROTECTINDO
U4 ANDI PRANOTO
Te14 0412 631 23607(8
3ur R4
VOLUME+ARA TOTAL
KETERANANSATUAN ( R7. )
5%00 -90600%0 0-699.6/00%0
%00 ,6,00%0 /,690600%0
%00 ,,9600%0 56600%0
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--%00 .06500%0 6-/6500%0
%00 5/6,00%0 6/00600%0
-9%00 -6,00%0 .6/.,6900%0
,%00 ,/60006000%0 ,/60006000%0
.0%00 /.6500%0 6.56000%0
,%00 ,6,56000%0 ,6,56000%0
,%00 506000%0 506000%0
,%00 06500%0 06500%0
,%00 06506000%0 06506000%0
,%00 056000%0 056000%0
,%00 6-06000%0 6-06000%0
,%00 .6,006000%0 .6,006000%0
0%00 ,5/6000%0 -6,06000%0
,/%00 ,,9600%0 ,690.600%0
./%00 .06500%0 56-56000%0
5.%00 5/6,00%0 -6,9.6.00%0
,9%00 -6,00%0 /6.600%0
,%00 96..56000%0 96..56000%0
%00 /.6500%0 6-56000%0
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J(#(rt( 6 ,5 Mei 0,5
PT. MULTI STRUKTUR
ER;AN SAMSUL A+RI
Pro2ect M(n(
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PT. MULTI STRUCTURE
S t r u c t u r e O f P e r f e c t i o n
BERITA ACARA PEMERIKSAAN
1. MANGKU. PS :
2. ANDI PRANOTO :
Kedua belah pihak telah mengadakan pemeriksaan pekerjaan berdasarkan pada :
1 SO Nomor : 031/MS/RSU!"!/#/$01%$ &anggal Kontrak : 1% Mei $01%
3 'khir Kontrak : $0 September $01%
ada hari ini+ Senin tanggal "ua uluh &ujuh bulan 5uli tahun "ua Ribu 6ima belas+ kami 4an
diba.ah ini :
Selaku Site Manager ro4ek emb- RSU dr- 7ubir'2eh &imur dalam hal ini bertindak untuk dan ata
STRUCTURE 4ang berkedudukan di 5l- 6et- 5end-
5akarta 11(10+ selanjutn4a disebut sebagai PIHA
Selaku SubKontraktor 4ang bertindak untuk dan 4ang berkedudukan di 5ln- &gk- "ihaji 6r- K
6amdingin Ke2amatan Kuta 'lam - '2eh+ selanj
K"U'
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ANDI PRANOTO MAN
SubKontraktor Site
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bertanda tangan
Mahmud!di+ Kab-nama PT. MULTI
S- arman Ka8- ,)+
PERTAMA
atas naman4a sendiriu2hik udiman "esa
utn4a disebut !'K
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KU. PS
anager
PT. MULTI STRUCTURE
t r u c t u r e e r e c t o n
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____________________________________________________________ PT. MULTI STRUCTURE Proyek Pemb. RSUD-Aceh Timur
t r u c t u r e e r e c t o n
OPNAME PRESTASIOPNAME 3E : 0,
N(*( No% Pro"e# : 0-,MSRSUIDI?0,5
Lo#(i Pro"e# : J1n% Me$(n B(n$( Ace) I$i 3('u4(ten Ace) Ti*ur No% SO : 0-,MSRSUIDI?0,5
N(*( Pe#er2((n : PEKERAAN ;IRE ALARM
Lo#(i Pe#er2((n : !e$un< RSU Dr% &u'ir M()*u$ I$i Ace) Ti*ur
No URAIAN PEKERAAN
SESUAI SPK
VOLUME +ARA UMLA+
SAT UMLA+ SATUAN ( R7. )
1 P!". I#$%&'&$ P!m&&m K!*&"&r I#$%&'&$ +,r% S%! P'
,Pi4( B1(c# Stee1 Sc) 0
(% Di(%/; * 5%00 -90600%00 0-699.6/00%00
'% Di(%; * %00 ,6,00%00 /,690600%00
7ittin< $(n Acceorie 1 ,%00 KKK 565006000%00
-Out$oor H"$r(nt Bo8 unit %00 ,6/06000%00 ,69/06000%00
7ire Hoe 65; 8 -0 *tr unit %00 ,6/06000%00 ,69/06000%00
5Hoe R(c# 65; unit %00 056000%00 -606000%00
/No==1e 65; unit %00 056000%00 -606000%00
.H"$r(nt Pi11(r >(" unit %00 -6,506000%00 56006000%00!(te ?(1ve unit ,,%00 ,6906000%00 06.906000%00
9S>in< @)ec# ?(1ve unit %00 6.006000%00 56006000%00
,0!(te ?(1ve unit -%00 6/06000%00 ,6.06000%00
,,Se(*ee @onection unit %00 69.6500%00 69956000%00
,M(teri(1 B(ntu Tetin< @o**iionin< 1 ,%00 KKK -60006000%00
2 INSTALASI +DRANT ANUNAN UTAMA LANTAI 1
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2 INSTALASI +DRANT ANUNAN UTAMA LANTAI 1
,Pi4( B1(c# Stee1 Sc) 0
(% Di(%-; * --%00 ,5/6000%00 56,6000%00
'% Di(% ,; * %00 ,,9600%00 56600%00
c% Di( ; * --%00 .06500%00 6-/6500%00
$% Di( , ,; * %00 5/6,00%00 6/00600%00
e% Di( ,; * -9%00 -6,00%00 .6/.,6900%00
7ittin< $(n Acceorie 1 ,%00 KKK ,/60006000%00
-He($ S4rin#1er ') .0%00 /.6500%00 6.56000%00
!(te ?(1ve ') ,%00 ,6,56000%00 ,6,56000%00
5!(te ?(1ve ') ,%00 506000%00 506000%00
/OriCce P1(te ') ,%00 06500%00 06500%00
.A1(r* S>itc) ') ,%00 6-06000%00 6-06000%00
,0M(teri(1 B(ntu Tetin< @o**iionin< 1 ,%00 .6,006000%00 .6,006000%00
3 INSTALASI +DRANT ANUNAN UTAMA LANTAI 2
,Pi4( B1(c# Stee1 Sc) 0
(% Di(%-; * 0%00 ,5/6000%00 -6,06000%00
'% Di(% ,; * ,/%00 ,,9600%00 ,690.600%00
c% Di( ; * ./%00 .06500%00 56-56000%00
$% Di( , ,; * 5.%00 5/6,00%00 -6,9.6.00%00e% Di( ,; * ,9%00 -6,00%00 /6.600%00
7ittin< $(n Acceorie 1 ,%00 96..56000%00 96..56000%00
-He($ S4rin#1er ') %00 /.6500%00 6-56000%00
!(te ?(1ve ') ,%00 ,6,56000%00 ,6,56000%00
5!(te ?(1ve ') ,%00 506000%00 506000%00
/OriCce P1(te ') ,%00 06500%00 06500%00
.Si
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6 6 6 6
9Air ?ent B(11 ?(1ve ') ,%00 ,6556000%00 ,6556000%00
,0M(teri(1 B(ntu Tetin< @o**iionin< 1 ,%00 56.56000%00 56.56000%00
TOTAL SPK
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ERA
OPNAME VOLUME PEKERAAN UMLA+ SISA
MINU MINU S/D MINU OPNAME S/D VOLUME KETERANAN
LALU INI INI MINU INI SPK
5%00 5%00 0-699.6/00%00
%00 %00 /,690600%00
,%00 ,%00 565006000%00
%00 %00 ,69/06000%00
%00 %00 ,69/06000%00
%00 %00 -606000%00
%00 %00 -606000%00
%00 %00 56006000%00 ,,%00 ,,%00 06.906000%00
%00 %00 56006000%00
-%00 -%00 ,6.06000%00
%00 %00 69956000%00
,%00 ,%00 -60006000%00
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--%00 --%00 56,6000%00
%00 %00 56600%00
--%00 --%00 6-/6500%00
%00 %00 6/00600%00
-9%00 -9%00 .6/.,6900%00
,%00 ,%00 ,/60006000%00
.0%00 .0%00 6.56000%00
,%00 ,%00 ,6,56000%00
,%00 ,%00 506000%00
,%00 ,%00 06500%00
,%00 ,%00 06506000%00
,%00 ,%00 056000%00
,%00 ,%00 6-06000%00 ,%00 ,%00 .6,006000%00
0%00 0%00 -6,06000%00
,/%00 ,/%00 ,690.600%00
./%00 ./%00 56-56000%00
5.%00 5.%00 -6,9.6.00%00 ,9%00 ,9%00 /6.600%00
,%00 ,%00 96..56000%00
%00 %00 6-56000%00
,%00 ,%00 ,6,56000%00
,%00 ,%00 506000%00
,%00 ,%00 06500%00
,%00 ,%00 056000%00
,%00 ,%00 6-06000%00
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,%00 ,%00 ,6556000%00
,%00 ,%00 56.56000%00
TOTAL A F
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S t r u c t u r e O f P e r f e c t i o n
BERITA ACARA PEMBAYARAN
SAMSU :
ANDI PRANOTO :
KM'5U'N KR5''
NO- UR'!'N S/" R!O" 6'6U R!O" !N!9Rp- 9Rp-
1- restasi ekerjaan )0*+)%(+,00-00
ada hari ini+ Senin tanggal "ua uluh &ujuh bulan 5uli tahun "ua Ribu 6ima belas+ k
diba.ah ini :
Selaku Keuangan ro4ek emb- RSU dr- 7ubir
&imur dalam hal ini bertindak untuk dan atas nama
4ang berkedudukan di 5l- 6et- 5end- S- arman
selanjutn4a disebut sebagai !'K R&'M'
Selaku SubKontraktor 4ang bertindak untuk dan
berkedudukan di 5ln- &gk- "ihaji 6r- Keu2hik
Ke2amatan Kuta 'lam - '2eh+ selanjutn4a disebut
erdasarkan erita '2ara emeriksaan 9terlampir dan sesuai Surat erjanjian dan S
Mei $01%+ maka !'K K"U' berhak menerima pemba4aran dengan rin2ian sebagai be
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ANDI PRANOTO SA
SubKontraktor Keu
"isetujui Oleh+
PT. MULTI STRUCTURE
ro4ek embangunan RSU dr- 7U!R M'MU" '2eh &imur
ERAN SYAMSUL BAHRI
/roje2t Manager
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S/" R!O" !N!9Rp-
)0*+)%(+,00-00
mi 4ang bertanda tangan
ahmud !di+ Kab- '2eh
&- MU6&! S&RU=&UR
Ka8- ,)+ 5akarta 11(10+
tas naman4a sendiri 4ang
udiman "esa 6amdingin
!'K K"U'
r8i2e Order0+ tanggal 1%
rikut:
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SU
ngan
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______________________________________________________ PT. MULTI STRUCTURE Proyek Pemb. RSUD-Aceh Timur
Sudah Terima Dari : T. MULTI STRUCTURE
Terbilang :
Untuk Pembayaran : Mandor Borong
Lokasi : 031/MS/RSU!D!/"/#01$
%omor &ontrak : 031/MS/RSU!D!/"/#01$
Tagihan : !
'umlah : R() $*+,1*#,000)00
!di -.eh Timur 01 -gustus #01$
Lokasi : !# RSU Dr. =*r M&m - I A! T ang Menerima
ANDI PRANOTO
SubKontraktor
LIMA RATUS TUJUH PULUH SEMBILAN JUTA SERATUS TUJUH PULUH DUA
RIBU RUPIAH
K > ! & ' N S !
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______________________________________________________ PT. MULTI STRUCTURE Proyek Pemb. RSUD-Aceh Timur
