Professional Documents
Culture Documents
Attachment 4. Direct Appointment
Attachment 4. Direct Appointment
Attachment 4. Direct Appointment
Waiver
Please check the applicable box that explains your reasons for the requested waiver of competitive bidding or for requesting a single/sole
source.
A sole source justification exists if the goods or services required to satisfy are only available from one
Sole Source supplier
An emergency justification may exist if the goods or services are required to: correct or prevent an
emergency health, environmental, or safety hazard; provide for the completion of special or time
Emergency sensitive events; or enable the emergency repair or emergency replacement of existing equipment
essential for daily operations
Sponsor The vendor and items/services requested are specified in the proposal and listed in the award
Designated
agreement. Attach copies of the proposal and award budgets.
Vendor and Item
Address Jl.Raya Pasir Madang Km 7 Desa Sipayung Kec. Sukajaya Kode Pos 16660
(Local Currency)
Package/others
No. Item Name Item Specification Qty. Unit Price/Unit Total
Qty. Unit
Waiver
Please check the applicable box that explains your reasons for the requested waiver of competitive bidding or for req
single/sole source.
A sole source justification exists if the goods or services required to satisfy are only
Sole Source
from one supplier
An emergency justification may exist if the goods or services are required to: correc
an emergency health, environmental, or safety hazard; provide for the completion o
Emergency
X time sensitive events; or enable the emergency repair or emergency replacement o
equipment essential for daily operations
Sponsor
The vendor and items/services requested are specified in the proposal and listed in
Designated
agreement. Attach copies of the proposal and award budgets.
Vendor and Item
Package/others
No. Item Name Item Specification QTY Unit
QTY Unit
idding
GA
E1-27 Surabaya
458
RIYANI
Price/Unit Total
50,000 5,000,000
Rp 5,000,000
Rp -
Rp 500,000 Rp 500,000
Rp 100,000
Rp 5,600,000
BANK TRANSFER, 7 DAYS AFTER
RECEIVING THE INVOICE
AVAILABLE UPON REQUEST/MAR
1, 2021 TO SURABAYA CDP
DELIVERY
OFFICE