Baltec Pre-Qualification Survey (First

List of Contents
Daftar Isi i
Description Page
Uraian Halaman
List of Contents (Daftar Isi) .............................................................................................................................. i
Guidelines (panduan) .................................................................................................................... ...................... 1
I. General (Umum)...................................................................................................................................... 2
1.1. Company Name (Nama Perusahaan)
1.2. Operational address (Alamat Operasional)
1.3. Telecomunication (Telekomunikasi)
1.4. Number of Years in operation (Tahun Perusahaan beroperasi)
1.5. Badan Hukum dan Keuangan
II. Company Profile (Profil Perusahaan)................................................................................................. 3
2.1. Financing
2.2. Management
2.3. Manpower
2.4. Material (harap dilampirkan daftar equipment anda)
III. Line of Business (Bidang Bisnis)......................................................................................................... 5
3.1. Please Choose
3.2. Please Choose
IV. Quality Control (Kontrol Kwalitas)...................................................................................................... 7
4.1. Documentation (Dokumentasi)
4.2. Quality Assurance/ Quality Control
V. Subjected to be filled for fabricators with workshop facility only........................................ 9
5.1. Welding Equipment and personnal (peralatan & Tenaga Kerja Pengelasan)
5.2. Painting and Testing Equipment Peralatan Pengecatan dan Pengetesan)
5.3. Nondestrutive Testing Equipment & Personnel (Alat NDT & Tenaga kerja)
5.4. Miscellaneous Equipment (macam-macam peralatan)
Copy of the certificate must be given : ....................................................................................................... 12

Salinan sertifikat/ perijinan yang harus diberikan
A. Aspeck Komersial dan Legal
B. Kelengkapan dokumen Penunjang
“solutions for the power industry”
PRE-QUALIFICATION SURVEY (First Step) Page 1 of 12
Doc. No. 1000MI-930-402_1
BALTEC PRE-QUALIFICATION SURVEY
For Seller :
Manufacturer’s , Fabricator’s Commercial & Technical Survey
Head Office : Representative Office :

BALTEC Inlet and Exhaust Systems Pty.Ltd. PT. BALTEC Exhaust dan Inlet Systems Indonesia
Factory 2, 35 Gilbert Park Drive Knoxfield, KIG Blok A-16, Jl. Tridarma No. 3
Victoria, Australia 3180 Gresik 61121, Indonesia
Website: www.baltecies.com.au Website: www.baltecies.com.au
Guidelines
1. All Questioners shall have to be answered, please type or print all answers; insert word N/A (Not Available)
in the case the question is not applicable. If an additional space is required, attach additional page/sheet
reffering to the specific question number.
Semua pertanyaan pada kuesioner ini harus dijawab, mohon diisi dengan huruf cetak atau diketik, bila terdapat pertanyaan yang berlaku pada perusahaan anda
mohon cantumkan kata N/A (tidak tersedia) sebagai jawaban. Bila masih membutuhkan ruang tambahan silahkan menambahkan dengan lembar tambahan baru
dan cantumkan nomor referensi pertanyaannya.
2. Please mail (2) two completed filled document with all attachments and address to:
Mohon mengirimkan dokumen beserta lampiran-lampiran yang telah terisi dan dialamatkan ke:
PT. BALTEC Exhaust Dan Inlet Systems Indonesia, KIG Blok A-16, Jl. Tridarma No. 3 Gresik 61121, Indonesia
PT. BALTEC Exhaust Dan Inlet Systems Indonesia

KIG Blok A-16, Jl. Tridarma No. 3 Gresik 61121, Indonesia
Website: www.baltecies.com.au
Doc. No. 1000MI-930-402_1
I. General
Umum
1.1 Name of company : PT NAM LAUTAN LOGISTIK MAS

Nama Perusahaan
1.2 Operational Address : RUKO DUPAK MUTIARA F-27,JL DUPAK 63

Alamat Operational SURABAYA,JAWA TIMUR
(code post – kode post) : 60179

Other Address / Branch :
1.3 Telecommunication – Telekomunikasi:

Telephone no. : (031) 99247867
Nomor Telpon
Facsimile no. :
Nomor Faksimile
e-mail address :
1.4 Number of years in operation as:

Waktu (tahun) perusahaan operasional / aktif
a.Trading / Supplier : years
b.Contractor : years
c.Fabricator : years
d.Design/Engineering : years
e.Other, ………… : _ years (please specify)
1.5 Legal & Financing :

Badan Hukum & Keuangan
Type of company:
Jenis Perusahaan
Corporation / PT Agency/Keagenan
Representative/Perwakilan Join Venture/Join

Other(please specify)/ Lain – lain (sebutkan)
Date of established : 27-06-2019

Tanggal pendirian
Registered Address : JL HR.MUHAMMAD RUKO SURYA INTI PERMATA II BLOK B56

Alamat registrasi SURABAYA

Doc. No. 1000MI-930-402_1
(Zip code– kode post) : 60189
Registration of notary act : Notaris JUSUF PATRIANTO TJAHJONO SH,M.H

Akte notaries (oleh notaries & nomor / tahun) Akta Nomor 1 Tanggal 14 juni 2019
Government Operation Permit for Trading & Construction (no. & expired year) :
Surat Izin Usaha Perdagangan & Surat Ijin Jasa Konstruksi (no & tahun berakhir):
a. Trading : P2T/41/06.45/VII/2019
SIUP
b. Construction :
SIUJK
Tax payer Registration Number : 91.771.940.3-611.000

Nomor Pokok Wajib Pajak (NPWP)
Company classification : 52291

Klasifikasi/kelas perusahaan
Banking :
1. Acc.No
2. Acc.No
II. Company Profile

2.1. Financing
Please mention the company’s Original Capital : Rp.500.000.000
Sebutkan modal setor perusahaan
Contract Range :
Range Kontrak
2.1.1. How much the maximal contract have been awarded :
Berapa kontrak terbesar yang pernah dimenangkan
2.1.2. How much the range contract expected :

Berapa range kontrak yang diharapkan
Minimum Amount/Minimum kontrak :

Maximum Amount/Maximum kontrak :
2.1.3. Please mentioned your past 3 years sales : 1 year
Harap lampirkan penjualan 3 thn terakhir 2 year
3 year

Doc. No. 1000MI-930-402_1
2.1.4. Please attach the past 3 Years Balance Sheet (Preferably submitted to tax Directorate)
Mohon dilampirkan Neraca Rugi Laba 3 Tahun terakhir (sesuai Neraca Dikeluarkan untuk direktorat Pajak)
2.2. Management
2.2.1. Do you have International Standard Certificate ? No/Yes,ISO/ASME/
Apakah Anda punya Sertificate Standard International ?
2.2.2. Do you have safety Procedure ? please attach.

Apakah Anda punya prosedur safety ? harap dilampirkan
2.2.3. Do you have scheduling control system ? please attach.

Apakah Anda punya system untuk monitor schedule ? harap lampirkan
2.2.4. Please attach your experiences.

Harap lampirkan pengalaman – pengalaman Anda.
2.2.5. Are you the representative or agency ? please specify

Apakah Anda merupakan perwakilan / keagenan ? sebutkan.
2.2.6. Please attach Company Organization,(from level commissioner, director, Managers, Supervisors)
Mohon dilampirkan Organisasi Perusahaan (dari level Komisaris,Direktur,Manajer,Supervisi)
2.3. Manpower
2.3.1. Please attach your Curriculum Vitae (CV) of Key Person.
Harap lampirkan Curriculum Vitae (CV) untuk personel kunci
2.3.2. Manpower qualification data :

Data kualifikasi karyawan
1. SLTA : 4 person
2. Diploma/D3 : 1person
3. Graduate/S1 : 4person
4. Master : person
5. Order/specialist : person
2.3.3. Do you have training program ? if yes please attach the category of training.
Apakah Anda punya program training untuk karyawan ? harap dilampirkan Jenis trainingnya.
Not yet
2.3.4. Please specify your total present work force (including job site) : 9 person
Sebutkan jumlah total karyawan sekarang (termasuk di proyek)
2.3.5. Please fill information about any labour strikes for the past 12 month.
Harap diinformasikan pemogokan yang terjadi dalam 12 bulan terakhir.

Doc. No. 1000MI-930-402_1
Month - Bulan Reason - Alasan Month - Bulan Reason - Alasan
2.4. Material
2.4.1. Please attach your equipment list
Harap dilampirkan daftar equipment Anda
2.4.2. Do you in position to supply material/mesin ? please specify by list

Apakah Anda bersedia untuk supply material/mesin ? harap di sebutkan daftarnya
III. Line of Business / Bidang Bisnis

Please choose (tick your answer) scope of services is given by the Company :
Mohon memilih lingkup servis yang diberikan Anda
Design Engineering
Desain Perekayasan
Fabrication
Fabrikasi
Supply
Suplai
Technical Services
3.1. Please choose (tick your answer) general discipline category of service is given by the Company :
Mohon memilih kategori umum jenis jasa yang diberikan Anda
3.1.1. Mechanical work / Pekerjaan Mekanikal
Erection Work
Piping Work
Heavy Lift / Rigging Work
Tankage Work (Eng/Supp/Fab/Erect) – Type of Tank
Panckage System (Eng/Supp/Erect/Testing)

Doc. No. 1000MI-930-402_1
Panckage System (Eng/Supp/Erect/Testing) Type of system: please tick

1. Panckage Boiler Brand
2. Water Treatment System Brand
3. Cooling Water System Brand
4. Conveyor Brand
5. Ash / Coal Handling Brand
6. Other (please Specify) Brand
7. Other Mechanical Work, Please specify
3.1.2. Civil work / Pekerjaan Sipil

Steel Structure Foundation Work
Cut & Filling / compacting Concrete Structure
Pilling Work Housing/Building
HVAC/Lighting/Paging etd Finishing/Interior
Other Civil Work, please specify
3.1.3. Instruments & Electrical Work / Pekerjaan Instrument dan Electrik

Cabling High/ Low Voltage Power Generating System
Transformer/ Junction Box Instrumentation & Programming
Lightning Protection Others
3.1.4. Technical Services

Magnetic Particle Test Post Weld Heat Treatment
Penetrant Test Ultrasonic Test
Radiographic Test Other
Hardness Test
Eddy Current Test
3.1.5. Other Services

Painting Work
Chemical Cleaning
Other

Doc. No. 1000MI-930-402_1
IV. Quality Control

Kontrol Kualitas
4.1. Documentation / Record and Certification :

Dokumentasi / Pencatatan dan sertifikasi
- Do you record and maintain all activities from beginning stage up to contract completion ? Yes No
Apakah anda mengatur pencatatan seluruh aktivitas dari tahap awal sampai proyek selesai ?
- Do you maintain the document list procedure and control of change ? Yes No
Apakah ada dokumentasi mengenai daftar dokumen procedure dan control Perubahan?
- Who is responsible for document and change control ?
Siapakah yang bertanggung jawab pada dokumentasi dan control perubahan
- Does you have any National or International certificate ? if yes specify Yes No
DApakah anda memegang sertifikat tingkat national ?, Bila Ya tolong di jelaskan
o
Do you agree to be audited in your office periodically, to maintain the quality standard ? Yes No
Apakah anda setuju di audit di kantor anda secara periodic, untuk menjaga standard mutu ?
4.2. Quality Assurance / Quality Control

Kualitas jaminan mutu / control kualitas
-Who is responsible for implementation of the QA/QC program ?

Siapakah yang bertanggung jawab pada pelaksanaan kualitas jaminan mutu dan control kualitas?
-To whom does the responsible QA/QC person report ? Give title and designation !
Kepada siapa orang yang bertanggung jawab pada kualitas jaminan mutu dan control kualitas melapor?
-Has QA/QC Manager any responsibilities other than QA dan QC function ? If yes, please
specify !
Apakah pejabat penjamin kualitas mutu dan control kualitas juga memiliki tugas fungsi yang lain. Mohon dijelaskan !
-Where no QA/QC Manager or chief inspector is employed please state who carries out that
function and what their responsibilities are:
Bila ternyata tidak ada personal khusus yang ditugaskan untuk control kualitas mohon dijelaskan pihak terkait lain yang kemungkinan
menjalankan tugas tersebut dan jelaskan tanggung jawab ?
-Do you have a QA/QC Manual ? Please copy and attached !

Apakah anda memiliki manual/petunjuk mengenai kualitas jaminan mutu dan control kualitas ? bila ada mohon dilampirkan salinannya ?

Doc. No. 1000MI-930-402_1
-Do you operated a formal system for control of non confirming items? Yes No
Apakah mempunyai suatu system baku yang mengendalikan item – item tidak berkesesuaian standar baku ?
-How are non-confirming items identified?

Bagaimana item – item tidak berkesesuaian standar diidentifikasi ?
-Are corrective action for the non-confirming items issued ?

Apakah tindakan perbaikan terhadap item tidak sesuai dikerjakan/dilakukan?
-Is the QA program designed to meet any other specific QA standard ?

Apakah program kualitas jaminan mutu tersebut dirancang untuk memenuhi suatu standar kualitas dari suatu badan ? Mohon dijelaskan !
- If yes, please state / bila ya, mohon disebutkan :

Assessor council : Date assessed
:
Assessment due :
- If yes, please state / bila ya, mohon disebutkan :

Berapa hari tanggapan terhadap complain pihak klien :

Doc. No. 1000MI-930-402_1
V. Subjected to be filled for fabricators with workshop facility only.

Item – item pertanyaan berikut dikhususkan bagi perusahan jasa fabrikasi dengan fasilitas bengkel saja.
Fabrication Shop / Area

Bengkel / Area fabrikasi
Location / Address :
Lokasi / Alamat
Area covered : 1. Under Shelter/Dengan Atap m2

Luas areal lahan 2. Open Yard/Area Terbuka m2
3. Open Yard/Area Terbuka m2
Total m2
Clearance under over head crane :

Ruang bebas dibawah crane
Sand blasting/ Painting shop facility : (Yes/No) :

Fasilitas sandblast/ pengecatan (Ya, ada/tidak)
Workshop Electrical Capasity : KVA

Kapasitas Listrik di Bengkel : Volt.
: Ohm
Over Head Crane Capacities and Qty: 1. Under Shelter / Dibawah atap : Tons/ Ea
Kapasitas Over head Crane & Jumlah 2. Open Yard/ Area Terbuka : Tons/ Ea
Production Capacity : Ton/month

Kapasitas Produksi
Describe Transportation and Handling facility :

Jelaskan fasilitas transportasi :
:
:

Doc. No. 1000MI-930-402_1
5.1. Welding Equipment and Personnel:

Peralatan dan Tenaga Kerja pengelasan
Process No of Machines ASME-IX AWS Others

Shilding Metal Arc
Gas Tungsten Arc
Flux Cored Arc
Electroslag
Plasma Arc
Submerged Arc
Gas Metal Arc
Others…
5.2. Painting and Testing Equipment :

Peralatan Pengecatan dan Pengetesan
Process No of Machines Brand Type/years Remarks

Pressure blasting machine
Airless/ Conv. Spray
Profile Measurement Gauge
Surface Cleanliness Gauge
WFT gauge
DFT gauge
Adhesion Test Gauge
Other..........
5.3. Nondestructive Testing Equipment & Personnel:

Peralatan dan tenaga kerja uji pengelasan metode tak merusak
Equipment
Test Methods Level - 1 Level - 2 Level - 3 Others
Description
Welding (Inspector)
Painting (Inspector)
Liquid penetrant
Radiography Examination
Magnetic Particle
Hardness Test
Ultrasonic Test
Heating Furnace

Doc. No. 1000MI-930-402_1
5.4. Miscellaneous Equipment :

Macam-macam Peralatan
Process No of Machines Brand Brand/Years Remarks

Threads Rolling Machine
Threads Cutting Machine
Plasma Cutting Machine
Oxy Cutting Machine
Rolling Plate Machine
Bending Plate Machine
Profile Bender Machine
Lathe Machine
Drilling Machine
Shaping Machine
Milling Machine
Guillotine Shear
Hack Saw
Circular Saw
Generator
Air Compresor
Other..........
Name :
Titlle :
Date :
( )

Doc. No. 1000MI-930-402_1
Copy of the certificate must be given :

Salinan sertifikat/ perijinan yang harus diberikan
A. Aspek Komersial dan Legal

1. Akta Pendirian (Anggaran Dasar Perseroan) yang telah disesuaikan dg UU Perseroan Terbatas No.1 Th.
1995 (28 Pasal) + SK Menkeh R.I atas pendirian tersebut.
2. Akta Perubahan Pemegang Saham yang terakhir + SK Menkeh
3. Akta Perubahan Susunan Pengurus yang terakhir + SK Menkeh
4. Akta Perubahan Modal Perseroan yang terakhir + SK Menkeh
5. SIUP (Surat Ijin Usaha Perdagangan)
6. TDP (Tanda Daftar Perseroan)
7. NPWP + PKP
8. SK Domisili Perusahaan
9. SIUJK
10.Tanda anggota Asosiasi yang terkait dg bidang usahanya (misal Sertifikat KADIN)
11. SBU dari AKLI / GAPENSI
12. Foto Copy KTP Penanggung Jawab / Direktur.
13. Neraca rugi laba 3 (tiga) tahun terakhir dan Rekening Koran 3 Bulan terakhir.
14. Sertifikat Asosiasi (Kadin, Gapensi, AKI, dll)
15. API (Angka Pengenal Import), KITE (Kemudahan Import Tujuan Export).
B. Kelengkapan dokumen lainnya:

1. Copy Company Profile
2. Copy struktur organisasi
3. Copy list Pengalaman proyek yang pernah ditangani.
4. Copy List Peralatan yang dimiliki
5. Copy Procedure yang dimiliki (QA,QC,HSE, dll)
6. Copy Sertifikat yang dimiliki (ISO, HSE,dll)


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List of Contents

Copy of the certificate must be given : ....................................................................................................... 12

PRE-QUALIFICATION SURVEY (First Step) Page 1 of 12

Doc. No. 1000MI-930-402_1