AMENDMENT NO. 4 TO THE CONTRACT (Dated April 21, 2015) FOR NON-CONSULTING SERVICES TIME BASED REGIONAL OVERSIGHT MANAGEMENT SERVICES (ROMS) 6 IBRD Loan 8259-ID BETWEEN Directorate of Water Supply Development Directorate General of Human Settlements Ministry of Public Works and Public Housing AND PT. Kogas Driyap Konsultan in Joint Venture With : PT. Perentjana Djaja Contract Number : KU.08.08/Kontrak/Pamsimas/175/VIII/2013 Dated : August 27, 2013
SUMMARY OF CONTRACT 1. Loan No. : Loan IBRD8259 ID (Third Water Supply and Sanitation for Low Income Communities-WSLIC3/ PAMSIMAS II) 2. Name of Service Providers : PT. KogasDriyapKonsultan In Joint Venture with : PT. PerentjanaDjaja 3. Contract No. and Date : : KU.08.08/Kontrak/Pamsimas/175/VIII/2013 Date: August 27, 2013 Amendment No. 1 : Dated : Nov 25, 2013 Amendment No. 2 : Dated : May 30, 2014 Amendment No. 3 : Dated : November 27, 2014 Amendment No. 4 : Dated : April 21, 2015 4. Domicile/Address of : Jl. Jatipadang Raya No. 41 Pasar Minggu, Service Providers Jakarta Selatan, 12540 5. Value of Contract : Original Contract : IDR 37,303,950,000 (Include VAT 10% APBN Portion) Amendment No. 1 : IDR 36,505,201,500 (Include VAT 10% APBN Portion) Amendment No. 2 : IDR 40,065,450,060 (Include VAT 10% APBN Portion) Amendment No. 3 : IDR 44,553,693,599 (Include VAT 10% APBN Portion) Amendment No. 4 : IDR 44,553,693,599 (Include VAT 10% APBN Portion) 6. Brief Description of Services : Provision of advisory services for the Provincial Project Management Unit and District Project Management Unit in the daily operation, management and implementation of Community- Based Water Supply Project (PAMSIMAS II) in the Provinces of Gorontalo, Central Sulawesi, North Sulawesi, Maluku and North Maluku. 7. Percentage Eligible for : IBRD Financing Original Contract : 80 % Net of VAT Amendment No. 1 : 80 % Net of VAT Amendment No. 2 : 80 % Net of VAT Amendment No. 3 : 80 % Net of VAT Amendment No. 4 : 80 % Net of VAT
8. Percentage Eligible for : APBN-RM Financing Original Contract : 20 % Net of VAT Amendment No. 1 : 20 % Net of VAT Amendment No. 2 : 20 % Net of VAT Amendment No. 3 : 20 % Net of VAT Amendment No. 4 : 20 % Net of VAT 9. Percentage Eligible for : APBN-RM Financing (Non Sharing) Original Contract : Nil Amendment No. 1 : Nil Amendment No. 2 : 100 % Net of VAT Amendment No. 3 : 100 % Net of VAT Amendment No. 4 : 100 % Net of VAT 10. Amount Eligible for : IBRD Financing Original Contract : IDR 29,258,000,000 (Net of VAT) Amendment No. 1 : IDR 28,355,120,000 (Net of VAT) Amendment No. 2 : IDR 28,355,120,000 (Net of VAT) Amendment No. 3 : IDR 31,605,703,168 (Net of VAT) Amendment No. 4 : IDR 31,605,703,168 (Net of VAT) 11. Amount Eligible for : APBN-RM Financing Original Contract : IDR 7,314,500,000 (Net of VAT) IDR 731,450,040 (VAT 10%) Amendment No. 1 : IDR 7,088,780,000 (Net of VAT) IDR 708,878,600 (VAT 10%) Amendment No. 2 : IDR 7,088,780,000 (Net of VAT) IDR 708,878,600 (VAT 10%) Amendment No. 3 : IDR 7,901,425,792 (Net of VAT) IDR 790,142,579 (VAT 10%) Amendment No. 4 : IDR 7,901,425,792 (Net of VAT) IDR 790,142,579 (VAT 10%) 12. Amount Eligible for : TF Financing Original Contract : Nil Amendment No. 1 : IDR 352,423,500 (Net of VAT)
Table of Contents Section I FORM OF CONTRACT Section II GENERAL CONDITIONS OF CONTRACT ( No Change ) Section III SPECIAL CONDITIONS OF CONTRACT ( Amended ) APPENDIX A DESCRIPTION OF SERVICES ( No Change ) APPENDIX B PERSONNEL AND STAFFING SCHEDULE ( No Change ) APPENDIX C SUMMARY OF COST ESTIMATE ( No Change ) APPENDIX D REMUNERATION AND REIMBURSABLE COST ESTIMATE ( No Change ) APPENDIX E ADVANCE PAYMENT GUARANTEE ( No. Change ) APPENDIX F PERFORMANCE BANK GUARANTEE ( No Change )
Section I FORM OF CONTRACT
AMENDMENT No. 4 TO THE CONTRACT Dated April 21, 2015 REGIONAL OVERSIGHT MANAGEMENT SERVICES (ROMS) 6 IBRD Loan 8259-ID Contract Number : KU.08.08/Kontrak/Pamsimas/175/VIII/2013 Dated : August 27, 2013 This Contract Amendment No. 4 (hereinafter called Amendment No. 4 ) is made on Tuesday, 21 of the month of April 2015 between, on the one hand, Directorate of Water Supply Development, Directorate General of Human Settlements, Ministry of Public Works and Public Housing, Government of Indonesia, (hereinafter called the Employer ) and, on the other hand, a Joint Venture PT. Kogas Driyap Konsultan consisting of the following entities, each member of which will be jointly and severally liable to the Employer for all the Service Provider s obligations under this Contract, namely, PT. Perentjana Djaja (hereinafter called the Service Provider ). WHEREAS (a) decree of Minister of Public Works and Public Housing, number 137/KPTS/M/2015 dated March 17, 2015; (b) the Employer had officially requested the Service Provider to submit the draft contract Amendment No. 4, with letter No. UM.01.01/Pamsimas/IV/..., dated April 20, 2015; (c) the Service Provider submit the Contract Amendment No. 4. NOW THEREFORE the parties hereto hereby agree as follows: The following documents attached hereto shall be deemed to form an integral part of this Contract: 1. The General Conditions of Contract (including Attachment 1 Bank Policy Corrupt and Fraudulent Practices); No Change 2. The Special Conditions of Contract ; Amended 3. Appendices: (a) Appendix A : Description of Services; No Change (b) Appendix B : Personnel, Staffing Schedule; No Change (c) Appendix C : Summary Cost Estimates; No Change (d) Appendix D : Remuneration and Reimbursable Cost Estimates; No Change (e) Appendix E : Advance Payments Guarantee; No Change (f) Appendix F : Performance Bank Guarantee; No Change
Section II GENERAL CONDITIONS OF CONTRACT (No Change)
Section III SPECIAL CONDITIONS OF CONTRACT (Amended)
Special Conditions of Contract Number of Amendments of, and Supplements to, Clauses in the General GC Clause Conditions of Contract 1.1(e) The contract name is Regional Oversight Management Services (ROMS) 6 1.1(h) Currently written as : The Employer is Pejabat Pembuat Komitmen, Kegiatan Wilayah II, Satuan Kerja Pembinaan Pamsimas Direktorat Jenderal Cipta Karya Kementerian Pekerjaan Umum To be amended as : The Employer is Pejabat Pembuat Komitmen, Pembinaan Pelaksanaan Wilayah II, Satuan Kerja Pengembangan Air Minum Berbasis Masyarakat Direktorat Jenderal Cipta Karya Kementerian Pekerjaan Umum dan Perumahan Rakyat 1.4 Currently written as : The addresses are: Employer: Pejabat Pembuat Komitmen, Kegiatan Wilayah II, Satuan Kerja Pembinaan Pamsimas Direktorat Jenderal Cipta Karya, Kementerian Pekerjaan Umum Attention: Diah Suryaningtyas,SIP,MM Address: Jl. PAM Baru I No. 1 Pejompongan, Jakarta Pusat 10210 Telephone : 021-5742254 Service Provider: PT. Kogas Driyap Konsultan in Joint Venture with PT. Perentjana Djaya Attention: Address: Email: To be amended as : The addresses are: Employer: Yenni Siti Rostiani Jl. Jatipadang Raya No. 41 Pasar Minggu, Jakarta Selatan 12540 Telephone : 021-7817707 kogas@centrin.net.id Pejabat Pembuat Komitmen, Pembinaan Pelaksanaan Wilayah II, Satuan Kerja Pengembangan Air Minum Berbasis Masyarakat Direktorat Jenderal Cipta Karya,
Number of GC Clause Amendments of, and Supplements to, Clauses in the General Conditions of Contract Kementerian Pekerjaan Umum dan Perumahan Rakyat Attention: Diah Suryaningtyas,SIP,MM Address: Jl. PAM Baru I No. 1 Pejompongan, Jakarta Pusat 10210 Telephone : 021-5742254 Service Provider: PT. Kogas Driyap Konsultan in Joint Venture with PT. Perentjana Djaya Attention: Address: Email: 1.6 Currently written as : Yenni Siti Rostiani Jl. Jatipadang Raya No. 41 Pasar Minggu, Jakarta Selatan 12540 Telephone : 021-7817707 kogas@centrin.net.id The Authorized Representatives are: For the Employer : Diah Suryaningtyas,SIP,MM Pejabat Pembuat Komitmen, Kegiatan Wilayah II, Satuan Kerja Pembinaan Pamsimas Direktorat Jenderal Cipta Karya Kementerian Pekerjaan Umum For the Service Provider : Yenni Siti Rostiani President Director PT. Kogas Driyap Konsultan To be amended as : The Authorized Representatives are: For the Employer : Diah Suryaningtyas,SIP,MM Pejabat Pembuat Komitmen, Pembinaan Pelaksanaan Wilayah II, Satuan Kerja Pengembangan Air Minum Berbasis Masyarakat Direktorat Jenderal Cipta Karya Kementerian Pekerjaan Umum dan Perumahan Rakyat For the Service Provider : Yenni Siti Rostiani President Director PT. Kogas Driyap Konsultan
APPENDIX A TERMS OF REFERENCE (No Change)
APPENDIX B PERSONNEL AND STAFFING SCHEDULE (No Change)
APPENDIX C SUMMARY OF COST ESTIMATE (No Change)
APPENDIX D REMUNERATION AND REIMBURSABLE COST ESTIMATE (No Change)
APPENDIX E ADVANCE PAYMENT GUARENTEE (No Change)
APPENDIX F PERFORMANCE BANK GUARANTEE (No Change)