@ Telkomsel \V/ervanco BERITA ACARA SERAH TERIMA LAPANGAN Pekerjaan ~ Regional Sumbagteng (“Pekerjaan”) - 5 Site Site Name Site 1D Pada hari ini AES Tanggal oe Foe. Bulan. 2EL..., Tahun Due Ribu ‘Dua Puluh Empat, telah dilakukan serah terima atas pekerjaan : Pengadaan Genset 2023 — Regional Sumbagteng (“Pekerjaan”) — 5 Site (M100005157 / 4200038857). Antara: Pihak I PT. Telekomunikasi Selular Nama Mochammad Salman Jabatan —_: Enginer Network Oprations and Productivity Batam Pihak II PT. Infrastruktur Telekomunikasi Indonesia Nama awanto Jabatan —: TO Tanjung Pinang Pihak IIT PT. Verdanco Indonesia Nama: FEBRI Jabatan Engineer Adapun Pekerjaan Pengadaan Genset 2023 - Regional Sumbagteng (“Pekerjaan”) ~ 5 Site telah diserah terimakan oleh Pihak III kepada Pihak II cian Pihak I, setelah pekerjaan tersebut selesai dilaksankan oleh Pihak III dengan balk. Demikian Serah Terima Lapangan ini dibuat dengan sebenar-benarnya, untuk dapat digunakan sebagaimana mestinya. PT. Infrastruktur PT. Telekomunikasi Selular Telekomunikasi Indonesia _PT. Verdancq Indonesia Mochammad Salman Pawanto FEBRI@ Telkomsel \/eroanco BERITA ACARA UJI TERIMA LAPANGAN Pekerjaan _: Pengadaan Genset 2023 ~ Regional Sumbagteng ("Pekerjaan”) ~5 Site SiteName — :JAGO Site ID Tanggal ..2.S....., Bulan... Z0AT. Dua Puluh Empat, kami yang bertandatangan dibawah ini : Tahun Dua Ribu 1. Nama ‘Mochammad Salman Jabatan Enginer Network Oprations and Productivity Batam Dalam hal ini bertindak untuk dan atas nama PT. Telekomunikasi Selular, 2. Nama : Pawanto Jabatan TO Tanjung Pinang Dalam hal ini bertindak untuk dan atas nama PT. Infrastruktur Telekomunikasi Indonesia dan 3. Nama Indarto Jabatan _: Engineer Dalam hal ini bertindak untuk dan atas nama PT. Verdanco Indonesia Berdasarkan Kontrak/PONo ——_ : M100005157 / 4200038857 Tanggal +: 30 Agustus 2023 PT. Telekomunikasi Selular, PT. Infrastruktur Telekomunikasi Indonesia dan PT. Verdanco Indonesia telah melaksanakan Uji Terima terhadap Pekerjaan dengan hasil: Baik dan Pekerjaan Telah Diselesaikan 100% Demikian Uji Terima Lapangan ini dibuat dengan sebenar-benarnya, untuk dapat digunakan sebagaiman mestinya. PT. Infrastruktur PT. Telekomunikasi Selular Telekomunikasi Indonesia _PT. Verdanco Indonesia Mochammad Salman Pawanto FEBRI@ Telkomsel \/enoanco TANDATI Yang bertandatangan dibawah ini : Nama : Jabatan Perusahaan Pada hari ini ZAK... , Tanggal uc: Tahun Dua Ribu Dua Puluh Empat, berdasarkan Kontrak No.M100005157 / PO No. 4200038857 tertanggal 30 ‘Agustus 2023, telah cilakukan serah terima barang untuk site : : PT Telekomunikasi Selular Site ID + RAIOSS: Site Name SADANU NOP Name Pounnto Dengan rincian sebagai Berkut [Ne __Nama Barang Jumiah | Satuan [4 Teenset sitent20KVA z Ta) unit 2 Manual Book Genset 20 KVA 1 | Pes 3_| SOP Maintenance Genset 20 KVA 1_| Pes ‘| Kunei Genset 20 kVA 4 | Pes 5 | Panel ATS AMF 25 kVA | Pes 6 | Material Support: T ~ Kabel Power NYFGDY 4x10mm? 10 Meter ~__Kabel Kontrol NYYHY 8x2,5mm? | 5 Meter Bahwa untuk barang-barang yang telah disebutkan diatas untuk site tersebut telah diserah terimakan dengan keadaan baik dan dapat berfungsi Demikian tanda terima ini kami buat dengan sebenarnya dan sebagai bukti sah serta dapat digunakan sebagaimana mestinya Yang menerima, Yang menyerahkan, PT. Telekomunikasi Selular PT. Verdanco Indonesia@ Telkomsel \/eroanco GENSET TION Inspection Genset 20 KVA Installation Date rae" fore | Site 1D TPIsi9 Project Pengadaan Genset 2023 | Site Name JAGO Region Sumbagteng EQUIPMENT DATA A. Generating Set = Manufacture Voltage 230/400 volt ~ Model WPG22-1L Phase 3 Phase = Output 20KVA “Speed 1500 rpm * current 22.9 Ampere = Frequency SoHertz = Rating Continue: 20KVA ~ Serial Number 8. Alternator = Manufacture type ‘Hee. Levey soma = Model Yee. -heo- SerialNumber: By Be Palen 0-7.) Cle O648 004, = Manufacture: “Type Zardovin - Model YmobGges/g — ~SerialNumber : BIW Ya sase, Battery / accumulator - Manufacture: = Voltage VAS ol ~ Type : Batley karg — -Current je Ampere 2 SSUAL CHECK No scratch / Damage on the genset body / Fuel tank No oli / Water leakage - Genset is clean from oli / water ~The oli level is above the minimum standard operation ~ Genset position / placement based on layout ~ Genset housing / cage is in good condition 3. INSTALLATION Genset is installed correctly on the center line of foundation + Genset base frame is fixed to the foundation + Fuel tank is installed properly Fuel tank is equipped with low fuel level control 4. CABLING: + Cable size type Power NYFGBY / NYY 42..x..@ mm? Control 6 ¥ 45 mm Grounding = All cables are laid under the floor and covered with conduit = Cable scone is applied in each cable end ~All cable are connected properly on the terminatior bar : OK / NOTOR Ok / NOTOK Ok / NOFOK ok / NeTeK OK / NETOK Ok / NOTOK Ok / NETOR Ok / WOHeK@ Telkomsel \/eroanco ~ Label is applied in each cable 2 OK / NDFOK 5. DISPLAY METER ~ AC voltage : 2 OK | NORSK + Frequency 2 OK / NOTOK = Output voltage (shown by voltmeter on the front panel of genset): OK / NOTEK RN 2AQ vac 220 VAC # 5% SN ery vac 220 VAC # 5% TN 921 vac 220 VAC + 5% RS Wor vac 380 VAC # 5% RT 293 vac 380 VAC £ 5% st : vac 380 VAC # 5% Freq ees He SO-1 6. TESTALARM MODUL GENSET ~ Modul Manufacture : Type DSE C130 tA 11) Model : Serial Number: = Under speed fal : OK / NOTOK = Over speed fal 2 OK / NOFOK = Low oli pressure alarm : OK / NORSK ~ Higt temperature alarm. 2 OK / NOTOK = Emergency stop genset function : OK / NOTOK 7. NOTES Reviewed & Approved by, Prepared by, PT Telekomunikasi Selular PT Verdanco Inonesia Name Name : FeBAy Title Title Date: Date fees - £02@ Telkomsel \/eroanco EKSISTING Inspection = Asset Ex Swap Date 7 ps - 5-90 Site 1D 2 TPI5I9 Project: Pengadaan Genset 2023 SiteName __:_JAGO Region: _Sumbagteng A. DATASET, ~ Part Name 2 Genset 7 ~ Brand 1 PGkleins Type + Serial Number : = Quantity - Condition + Damaged DATAASSET 2. = Part Name Panel ATS - Brand ~ Type + Serial Number + = Quantity, sot - Condition : Damaged C. DATAASSET3 Part Name - Brand Type - Serial Number Quantity : ~ Condition Good / Damaged D. NOTES Reviewed & Approved by, Prepared by, PT Telekomuni PT Verdanco Indonesia Name Name: FEGL/ Title Title Date Date aS. Se Zo2H@ Telkomsel \/eroanco PANEL ATS INSTALLATION Inspection : Panel ATS AMF installation Date. aF-S —foty | | site1o 2 TPIS19 Project Pengadaan Genset 2023 SiteName___:_JAGO Region 2 Sumbagteng J 1 VOLTAGE & 2. Phase ~ Phase (380 V tolerance 5%) -U- = Yop Ok / NOTORE - U-B= 393 Ok / NOFOKE - 2-B = 368 OK / NOFOKE Phase — Netral (220 V tolerance 5%) - U-N= 27S OK / NOTOKE - B-N= USO Ok / NOTOKE - BN = 22F Ok / NOT-OKE ‘Amperes with load (A) - us ot OK / NOT OKE - 226.9 Ok / NOTOKE ea =0760 2 OK / NOTOKE 2. AMEPANEL ~ Installed separate with genset : YES / NO = Dimension 850x500x300mm 2 OK / NOFOKE = Non corrosive 2 OK / YOFOKE 3. TOUCH BUTTON ‘The AMF panel shall be aquipped with touch / push button for the following functions : Test operation : YES / WO ~ Stop genset 2 YES / NO ~ Start genset : YES / WO = Autometic operation YES / NO = Manual operation : YES / NO = On/off contactor from AC main supply 2 YES / NO = On/off contactor from genset YES / 80. ~ Emergency stop : YES / NO 4. INDICATOR = Alarm start (genset) falure Yes / WO = Over speed / crank alarm YES / N8 ~ Low battery to start genset voltage : YES / Ne 5. OPERATION TEST = Main supply failure : OK / NOTORE ~ Phase failure 2 OK / NOTORE - Main AC supply restore OK / METOKE 6. ALARM ~ Allalarm shall consist of dry contact, : OK / NOTORE@ Telkomsel \V/ervanco 7. CONTROL SUPPLY ~The AME control voltage is same as the battery to start genset OK / NOFOKE 8. BATTERY CHARGER ~ Rating capacity ok / MOTOKE + Compact and easy for replacement. OK / NOTOKE 9. TIMERAND COUNTER > Start delay 1 OK / NOFOKE = Start attempt OK / NOFOKE = Crank duration Ok / NOFOKE = Re-crank duration 2 OK / NOTOKE = Engine supervisory delay Ok / NOFOKE - ATStransfer time : OK / NOFOKE Engine cooling down OK / NOFOKE ~ Engine auto shutdown OK / NOTOKE 10. we RM-UP = Able to operate the engine for weekly warm-up OK / NOTOKE = The duration is adjustable 2 OK / NOT OKE 11, EMERGENCY STOP ~ Equipped with an emergency stop : OK / NOTOKE 12, TECHNOLOGY All controller shall electronic, easy to operate and maintenance, : OK / NOTOKE diagnostic and trouble shooting with high reliability ~The core element of AMF control shall be easily replaced : OK / NOFOKE~ 13. NOTES Reviewed & Approved by, Prepared by, PT Telekorunikasi Selular PT Verdanco Indonesia Name: Name: Fade’ Title Title Date: Date BS-5-p024@ Telkomsel \/ervanco A TANCE TEST Inspection Installation Documentation Date £9 _f-2oeww site 1D P1519 Project: Pengadaan Genset 2023, SiteName : IAGO Region ‘Sumbagteng@ Telkomsel \V/eroanco\/eroanco @ Telkomsel@ Telkomsel \/ervanco 2. Panel ATS Ex Swap@ Telkomsel re :DANCO ACCEPTANCE TEST Inspection: Asset ExSwap Documentation Date T 2e- $= Zeta, site 1D 2 TPIS19 Project: Pengadaan Genset 2023 | siteName: JAGO_ i Region ‘Sumbagteng J 1. Genset Ex swap