Lampiran Surat Pesanan (SP)

Nomor : 900/4176099/SP/APBD/RSUD/2016
Tanggal : 18 April 2016

NO. NAMA DAN JENIS BARANG MERK/TYPE DIMENSION (mm)

L D

A RECEIVING AREA

S/S Load Transfer Trolley (Service Trolley 3 Tiers) MMP/Custom 890 600

Floor Scale 150 Kg NAGATA/150 W

S/S Work Table W/Undershelf and Aplash Back MMP/Q97101120 1200 750

S/S Double Sink Table W/Splas Back MMP/Q9104120 1200 750

Mix Faucet Deck KLARCO/9144000

Grease Trap LOKAL/IGT 30 328 428

B PREPARATION AREA

S/S Pot Sink W/Splash Back MMP/Q91100060 600 750

S/S Mix Faucet Deck KLARCO/9144000

Grease Trap LOCAL/IGT 30 400 300

Undercounter Chiller 2 Doors W/Bs MASTERCOOL/GN 2100 TN 1530 750

S/S Work Table W/Undershelf and Splash Back MMP/Q97101150 1500 750

S/S Pot Sink W/O Splash Back MMP/Q91100060 600 750

S/S Mix Faucet Deck KLARCO/9144000

Grease Trap LOCAL/IGT 30 400 300

S/S Work Table W/Undershelf W/O Splash Back MMP/Q97100120 1200 750

Undercounter Chiller 2 Doors W/O Bs MASTERCOOL/GN 2100 TN 1530 750

C HOT COOKING

S/S Sauce Table For Kwali-90 (Filler Table) MMP/CUSTOM 400 900

Gas Kwali Range 2 Wok MASTERCHEF/MGKH 15-75N 1500 750

Grease Trap LOCAL/IGT 30 328 428

S/S Sauce Table For Meritus Series (Filler Table) MMP/CUSTOM 400 750

S/S Exhaust Hood Island Type Left/Right MMP/9681200+4*9930030+2*9930031 2000 2200

S/S Exhaust Hood Island Type Left/Right MMP/9681180+3*9930030+2*9930031 1800 2200

Gas Fryer Economic 40 LBS DEAN/SR42G

 Gas Fry Top MASTERCHEF/LDFT24 610 745

Gas Char Broiler MASTERCHEF/LDCB24 660 748

Gas Range 6 Burner MASTERCHEF/LDHP6 915 745

S/S Exhaust Hood Wall Type For Joint MMP/9669220+4*9930030+2*9930031 2200 1000

S/S Exhaust Hood Wall Type For Joint MMP/9669240+4*9930030+2*9930031 2400 1000

Gas Rice Cooker 3 Deck RINNAI/RRA 156 700 700

60 Ltr Gas Boiling Pan ELECTROLUX/E7BSGHDNF0 - 371089 800 730

S/S Sauce Table For Meritus Series (Filler Table) MMP/CUSTOM 300 750

60 Ltr Gas Tilting Bratt Pan ELECTROLUX/371181 (371104) 800 730

S/S Gas Stock Pot Stove MASTERCHEF/SLSP 500 500

D POT WASH AREA

S/S Soiled Table W/Scrap Hole and Splash Back MMP/9171122+9707013 1200 750

S/S Solid Wall Shelf MMP/9200120 1200 300

S/S Double Sink Table W/Splash Back MMP/Q9104120 1200 750

S/S Mix Faucet Deck KLARCO/9144000

Grease Trap LOCAL/IGT 30 328 428

S/S Pot Sink W/Splash Back MMP/Q91100120 1200 750

S/S Mix Faucet Deck KLARCO/9144000

Grease Trap LOCAL/IGT 30 328 428

Shelving Rack 4 Tires OLYMPIC/J1836C 1200 500

E PASTRY & BAKERY AREA

Shelving Rack 4 Tiers OLYMPIC/J1836C 900 500

Refri Chiller Cab 2 (Upright Chiller 1 Section) MASTERCOOL/GN 650 TN M 740 830

Refri Chiller Cab 2 (Upright Chiller 1 Section) MASTERCOOL/GN 650 TN M 740 830

Planetary Mixer SINMAG/SM 201 456 530

S/S Table Top W/O Splash Back (Filler Plate) MMP 700 750

S/S Solid Wall Shelf 2 Tiers MMP/2*9200120 1200 300

S/S Work Table W/Undershelf and Aplash Back MMP/Q97101120 1200 750

Stand Mixer KITCHEN AID/5K45SSEWH

Digital Scale NAGATA/LCS 12

S/S Work Table W/Undershelf And Splash Back MMP/Q97101060 600 750
 Flat Top Induction DIPO INDUCTION/TCK26E 327 390

Gas Deck Oven (Double Deck) SINMAG/MB-822+SM-10F 1436 1152

S/S Condensate Hood MMP/Q911651101+911650000 1800 1500

S/S Dough Work Table (Marble Top) MMP/Q97103160+9711620 1600 800

Bakery Flour Bin CAMBRO/IBS27+SCP64CW 475 640

Hand Wash Sink DSS/SS 1018/KA/SD 430 392

S/S Bakery Cooling Rack (Exclaude Bakery MMP/CUSTOM 430 392

Pan)/Baking Rack Trolley

F DISHWASING AREA

S/S Sorting Rack MMP/Q9170061 1500 600

S/S Soiled Table With Splashback MMP/Q9171082 750 1500

Dishwasher 2 Sink Square Legs W/Splashback MMP/Q9200120 1200 750

S/S Mix Faucet Deck KLARCO/9144000

Pre Rinse KLARCO/9145000

Grease Trap LOCAL/IGT 30 328 428

Hood Type Dishwasher ZANUSSI/ZHT7 620 745

Dish & Cutlery Rack CAMBRO/PR314 + FR258 620 745

Condensate Hood Wall Type MMP/911650000 1000 1000

S/S Diswasher Table With Splashback MMP/Q97103090 900 750

S/S Solid Wall Shelf For Basket Rack 45 Degree MMP/CUSTOM 550 510

Camshelving 36" OLYMPIC/J1836C 1200 500

Camshelving 36" OLYMPIC/J1836C 1200 500

G ADDITIONAL

Blender Mixer HALLDE/VCB 32

Juicer SANTOS/N 50

Toaster ROWLETT REGENT/4ATS

BIA

Yang menerima pesanan,

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PT. SADYAMANUNGGAL TEHNIK Direktur Ru
Selaku Penyedia Barang Selaku Pejabat Pengg

HERRY SAFARI drg. D

DIREKTUR NIP
 Rumus harga satuan sebelum Pajak
Harga Pasar (hasil Survai) X 10

11
SATUAN KUANTI HARGA
ENSION (mm) JUMLAH
TAS SATUAN
H

27,406,698

920 Unit 1 4,105,263 4,105,263

Unit 1 6,956,938 6,956,938

850/950 Unit 2 3,540,670 7,081,340

850/950 Unit 1 6,717,703 6,717,703

Unit 1 1,531,100 1,531,100

49410
338 Unit 1 1,014,354 1,014,354

68,736,838

850/950 Unit 1 4,746,411 4,746,411

Unit 1 1,531,100 1,531,100

220 Unit 1 1,014,354 1,014,354

850/950 Unit 1 21,320,574 21,320,574

850/950 Unit 1 4,057,416 4,057,416

850 Unit 2 3,961,722 7,923,444

Unit 2 1,531,100 3,062,200

220 Unit 1 1,014,354 1,014,354

850 Unit 1 3,454,545 3,454,545

850 Unit 1 20,612,440 20,612,440

530,430,620

750/1200 Unit 2 3,291,866 6,583,732

810/440 Unit 2 47,023,923 94,047,846

338 Unit 2 1,014,354 2,028,708

850/867 Unit 2 2,066,986 4,133,972

600 Unit 1 22,784,689 22,784,689

600 Unit 1 21,071,770 21,071,770

Unit 1 19,933,014 19,933,014

 460 Unit 1 19,349,282 19,349,282

463 Unit 1 19,349,282 19,349,282

382 Unit 1 23,119,617 23,119,617

600 Unit 1 15,779,904 15,779,904

600 Unit 1 17,052,632 17,052,632

1340 Unit 1 77,253,589 77,253,589

850 Unit 1 80,928,230 80,928,230

850/867 Unit 2 1,961,722 3,923,444

850 Unit 1 89,980,861 89,980,861

450 Unit 2 6,555,024 13,110,048

31,693,778

850/950 Unit 1 4,114,833 4,114,833

150/190 Unit 3 1,062,201 3,186,603

850/950 Unit 1 6,717,703 6,717,703

Unit 1 1,531,100 1,531,100

338 Unit 1 1,014,354 1,014,354

850/950 Unit 1 5,722,488 5,722,488

Unit 1 1,531,100 1,531,100

338 Unit 1 1,014,354 1,014,354

1545 Unit 3 2,287,081 6,861,243

272,153,109

1545 Unit 1 2,287,081 2,287,081

2010 Unit 1 20,842,105 20,842,105

2010 Unit 1 20,842,105 20,842,105

802 Unit 1 20,956,938 20,956,938

750 150
105 Unit 1 2,507,177 2,507,177

150/190 Unit 1 2,143,541 2,143,541

850/950 Unit 1 3,540,670 3,540,670

Unit 1 5,224,880 5,224,880

Unit 1 4,842,105 4,842,105

850/950 Unit 1 2,555,024 2,555,024

 105 Unit 1 16,334,928 16,334,928

1319 Unit 1 126,641,148 126,641,148

600 Unit 1 12,411,483 12,411,483

850/870 Unit 1 7,712,919 7,712,919

715 Unit 2 4,325,359 8,650,718

420 Unit 1 9,110,048 9,110,048

420 Unit 1 5,550,239 5,550,239

91,894,738

650 Unit 1 2,822,967 2,822,967

Unit 1 3,923,445 3,923,445

870/970 Unit 1 8,220,096 8,220,096

Unit 1 1,531,100 1,531,100

Unit 1 4,832,536 4,832,536

338 Unit 1 1,014,354 1,014,354

1500 Unit 1 36,593,301 36,593,301

1500 Set 1 555,024 555,024

600 Unit 1 4,526,316 4,526,316

870/970 Unit 1 2,880,383 2,880,383

510 Unit 1 3,330,144 3,330,144

1545 Unit 2 5,004,785 10,009,570

1545 Unit 2 5,827,751 11,655,502

34,526,316

Unit 1 16,583,732 16,583,732

Unit 1 14,631,579 14,631,579

Unit 1 3,311,005 3,311,005

JUMLAH 1,056,842,097
BIAYA MATERIAL & PENGIRIMAN 80,000,000
JUMLAH 1,136,842,097
PAJAK PPN 10% 113,684,210
TOTAL 1,250,526,307
DIBULATKAN 1,250,500,000

Yang memesan,
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Direktur Rumah Sakit Umum Daerah Banten
Selaku Pejabat Pengguna Anggaran/Pejabat Pembuat Komitmen

drg. DWI HESTI HENDARTI, M.Kes

NIP. 19610209 198911 2 001