[ RDMP RU-V BALIKPAPAN PROJECT ]

SUBCONTRACT NO. : RDMP-R-SC-TF-028

AFFIDAVIT OF RELEASE OF LIENS AND CLAIMS

RDMP BALIKPAPAN JO
Jl. Bongas I, Karang Jati, Balikpapan Tengah, Kota Balikpapan, Kalimantan Timur,
76123

Dear Sirs,

We here by acknowledge that we have confirmed all amounts IDR 5,342,514,187 due to us in
connection with all the Rental Works performed, and all materials, labor or services furnished by
or for us under the terms of the Subcontract for Helipad Bridge entered into between us on RDMP-
R-SC-TF-028 and any variations thereto; and in consideration of said payments we hereby waive
and release any and all liens and claims or claim or right of lien against RDMP Balikpapan JO., its
officers, directors, employees, equipment or premises arising out of or in connection with the Rental
Works performed, including but not limited to materials, labor or services furnished by us or any of
our Subcontractors, suppliers, employees or agents under the aforesaid Rental Contract or any
variations thereto.
We hereby certify that all the Rental Works, labor, materials, machinery, equipment and services
furnished by us have been fully paid for by us and that there are no amounts unpaid in favor of any
Subcontractor or supplier or any other person furnishing labor, materials or services to us and
utilized in the performance of our obligations under the aforementioned Rental contract or any
variations thereto on the basis of which any lien or claim has been or can be filed against RDMP
Balikpapan JO. for the Work done or materials, machinery or equipment furnished.
We also certify that we have fully satisfied the requirements of the labor laws and regulations of
the Country with respect to all our laborers and employees employed on the Rental Works.
In consideration of the aforementioned payments, we agree to indemnify and save harmless
RDMP Balikpapan JO., its officers, directors, and employees, form all liens and claims, arising out
of or in connection with the Rental Works, including but not limited to the labor, materials or services
furnished by us or any of our subcontractors, suppliers, employees or agents.
This letter is given in accordance with the requirements of the Agreement. All Works herein shall
have the same meaning as in the said Agreement.
Yours faithfully,

Signed :

Name :

Title : Project Manager

Duly authorized Representative of : PT Athaya Abbas Mandiri

 [ RDMP RU-V BALIKPAPAN PROJECT ]

SUBCONTRACT NO. : RDMP-R-SC-TF-028

FORM OF CONFIRMATION OF THE FINAL ACCOUNT

Project Title : RDMP RU-V Balikpapan Project

Job No. : RDMP-R-SC-TF-028
Location : Balikpapan, Indonesia
Subcontractor : PT Athaya Abbas Mandiri
Subcontract for : Helipad Bridge

Subcontract No. : RDMP-R-SC-TF-028

Subcontract Date : 01/07/2020

The Contractor and the Subcontractor hereby confirm all amounts due to the Subcontractor in
connection with all the Subcontract Works performed by the Subcontractor under this Subcontract
as follows:

(1) Final Subcontract Price as per Article 8.1.3 per Article 8.2 of
General Terms and Conditions of Subcontract and Article 3.2 IDR 5,342,514,187
of ANNEX 8_Bill of Quantities and Unit Rates

(2) Accumulated aggregate amount of change orders executed

IDR
on a lump sum basis

(3) Accumulated aggregate amount of additional or substituted

works executed on a Daywork as per Article 8.2 of General IDR
Terms and Conditions of Subcontract

(4) Settlement of claims under the Subcontract submitted by the

___________________
Subcontractor to the Contractor

(5) Settlement of claims under the Subcontract submitted by the

___________________
Contractor to the Subcontractor
 [ RDMP RU-V BALIKPAPAN PROJECT ]

SUBCONTRACT NO. : RDMP-R-SC-TF-028

Total amount due to the Subcontractor

IDR 5,342,514,187
(1) + (2) + (3)

The Subcontractor acknowledges that this confirmation of the final account is the sole and
conclusive evidence as to the value of the Subcontract Works to which the Subcontractor is entitled
under the Subcontract and waives all and any claim with respect to any further sums in connection
with the Subcontract and/or execution of the Subcontract Works.

This confirmation of the final account shall not release the Subcontractor from his guarantee
obligations in Article 17.1 of General Terms and Conditions of Subcontract of and other provisions
of the Subcontract which expressly or by their nature survive this confirmation of the final account
including but not limited to the provisions referred to in Article 15.2 of General Terms and Conditions
of Subcontract.

By

Subcontractor Authorized Representative

Date :

By

Contractor Authorized Representative

Date :

REMARKS: (Attach additional sheet, if necessary)