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P R E - Q U A L I F I C A T I O N D O C U M E N T

Number : 01/PPBJ-01/DOK-PQ/XII/SAR-2014 . Date: December,22th 2014

Procurement of Medium Class Intermediate Helicopters

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Chapter I - General I - 1 CHAPTER I

GENERAL

A. This Qualification Document is arranged on the basis of Presidential Rule of Republic of Indonesia No 54 Year 2010 concerning the Implementation Guidelines on Procurement of Goods and Services for Government Bodies.

B. This Qualification Document uses terminologies, terms and abbreviations are as follows :

- Goods : any material, both tangible and intangible, moving or not moving, which can be traded, used or utilized by User;

- HPS : Owner’s Estimate;

- Partership/ Joint

Operation

(KSO) : Joint operation among the suppliers in wich each party has clear right, obligations, and responsibility stipulated in a written agreement;

- QDS : Qualification Data Sheet;

- Bid Committee : The Working Group (Procurement Service Unit) that functions to undertake Procurement of Goods and Services.

C. Qualification Document consists of: 1. General;

2. Announcement of Pre Qualification; 3. Instructions to Bidder;

4. Qualification Data Sheet (QDS); 5. Integrity Pact;

6. Qualification Forms;

7. Guidance on Qualification Form Fulfillment; 8. Partnership Agreement/ Joint Operation; 9. Qualifitaion Evaluation Pracedures.

D. This Procurement through prequalification is funded by Source of Fund listed in QDS.

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Chapter II- Announcement of Pre-Qualification II - 1 ANNOUNCEMENT OF PRE-QUALIFICATION

Number : 01/PPBJ-01/PENG-PQ/XII/SAR-2014

The National SAR Agency of Indonesia is inviting for pre-qualification of procurement as follows :

1. Procurement Package :

Name of Procurement Package : Procurement of Medium Class Intermediate Helicopters

Period of work completion until November, 30th 2015 (240 Calendar days)

2. Eligible Applicants :

This procurement package is opened for aircraft Manufacturer; 3. Invited Applicants:

1. Agusta Westland, NV 2. Airbus Helicopter, Inc. 3. Bell Helicopter Textron, Inc. 4. Sikorsky Aircraft Corporation 5. Kaman Corporation

Others applicant who are interested can submit at the address below.

4. Pre-qualification Schedule :

Registration and Pre-qualification Document Collection :

Day/Date : Monday, December 22nd ,2014 to Monday, January 5th, 2015 Time : At 07.00 a.m to 02.00 p.m (local time)

Place and Address : Bid Committee of SAR Helicopter Procurement, Basarnas Office, Lantai 6 , Jalan Angkasa Blok B 15 Kav. 2-3 Jakarta Pusat, Indonesia 10720

Submission of Applications :

Day/Date : Tuesday, December,23rd 2014 s/d Tuesday, January,6th 2015 Time : At 07.00 a.m to 02.00 p.m (local time)

Place and Address : Bid Committee of SAR Helicopter Procurement, Basarnas Office, Lantai 6 , Jalan Angkasa Blok B 15 Kav. 2-3 Jakarta Pusat, Indonesia 10720

Email for Applicants : suhardi@basarnas.go.id /cc : iqbalajo@gmail.com

Explanation of : Monday, December 22nd ,2014 to Monday, January 5th, 2015 Pre-qualification At 07.00 a.m to 02.00 p.m (local time)

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Chapter II- Announcement of Pre-Qualification II - 2 5. Registration and Pre-qualification Document Collection can be represented by other

person with the identity card and letter of assignment from the president director / leader of the company / head of branch office.

6. A person is not allowed to represent more than 1 (one) company in the registration and Pre-qualification Document collection.

7. Documents can be received in hardcopy.

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Chapter III- Instructions To Applicant III - 1 CHAPTER III

INSTRUCTIONS TO BIDDER

A. GENERAL

1. Eligible Applicants for Pre-Qualification

In case of an applicant will or is having a partnership with both national company(s), the applicant shall own Letter of Joint Operation Agreement/partnership which contains the percentage of partnerships and the companies that represent the partnership.

2. Prohibition of Corruption, Collusion and Nepotism Practices and Fraud

2.1 Applicant and all parties associated with this procurement is obliged to obey the ethics of the procurement of goods / services by avoiding and not undertaking the prohibited practices as follows :

a. to influence the member(s) of the Bid Committee in a such way whatever, either directly or indirectly to meet the Applicants’s interest contradicted to the provisions and procedures set out in the qualification document, and / or contradicted to the prevailing legislation;

b. to make conspiracy with the other participants to set the qualifications to reduce / prevent / minimize / eliminate competition and / or harm others

c. to create and/or submit the documents and/or other information that is untrue to meet the requirements in the Prequalification Document.

2.2 The Applicant(s) which according to the Bid Committee assesment is deemed proved to undertake the prohibited practices as stated in Clause 2.1 above shall be imposed by the sanctions as follows:

a. administrative sanctions, such as the elimination or cancellation of their participation in qualification process or cancellation of their qualification graduation;

b. sanction of the Black List; c. sued in civil lawsuit; and/or

d. criminally report to the relevant authorities.

2.3 The imposition of sanctions is reported by the Bid Committee to the PA/KPA

3. Prohibition of Conflict of Interest

3.1 The parties in carrying out their duties, functions and roles shall not have / perform double roles or affiliated.

3.2 Double roles as mentioned in point 3.1. above includes as follows:

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Chapter III- Instructions To Applicant III - 2

b. a management member of employees’ cooperative in a ministry / agency /

department or its subsidiaries in the state-owned enterprises that follows the Procurement of Goods and competes with other companies, are prohibited from concurrently as a member of the Bid Committee or authorized officer who determines the tender award.

3.3 Affiliation as mentioned in point 3.1. above is the linkage relationships, both among participants, between participants and Project Manager (PPK) and / or Bid Committee members that includes:

a. family relationships by marriage and descent to the second degree, both horizontally and vertikal;

b. PPK and / or members of the Bid Committee, either directly or indirectly controls

or runs participant’s company.

c. the relationship between 2 (two) either directly or indirectly controlled companies by the same party, that is more than 50% (fifty percent) of shareholders and / or one of its management members is same.

3.4 The employee in a ministry / agency / department is prohibited to become participant except they are being on leave beyond the responsibility of the ministry / agency / department.

4. One Application for Each Applicant

4.1 Each Applicant, either as single Applicant or on behalf of a member of a Joint Operation is only allowed to submit 1 (one) Application.

4.2. Each Applicant which is a member in a partnership / Joint Operation is prohibited from becoming participants either individually or as members of other partnerships / joint operation in the same work package.

B. QUALIFICATION DOCUMENT

5. Contents of the Qualification Document

Applicant shall examine and verify overall instructions, forms, and requirements in the Qualification Document. Negligence to give the information in the qualification document as required is the simply risk born by Applicant.

6. Qualification Document Language

Qualification document and all the written correspondences within use Indonesian and English languages.

7. Amendments to Qualification Document

7.1 Prior to the deadline for submission of application, the Bid Committee may amend the Qualification Document by issuing addenda.

7.2 Any addendum issued shall be a part of the Qualification Document and shall be notified to all applicants.

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Chapter III- Instructions To Applicant III - 3

8. Validity of Qualification

This qualification is only valid for the procurement package stated in LDK.

9. Application Cost

9.1 Applicant shall bear all the costs incurred to follow this qualification process.

9.2. The Bid Committee shall not be liable for any loss suffered by the Participant during the qualification process.

C. PREPARATION OF APPLICATION

10. Filling Application

10.1 Applicant shall fill out and complete the Integrity Pact and Application Forms. 10.2 The Integrity Pact and Application document shall be signed by :

a. president director / head of company

b. the endorsee of power attorney from the president director / head of the company whose endorser’s name is listed in the deed of company or its amendments;

c. The branch manager appointed by head office of the company proved by an authentic document;

d. The official who has right to represent company under the partnership agreement.

11. Form of Application Document

Application is submitted in 2 (two) copies, which consists of : 1 (one) original document and 1 (one) of its copy, and is marked with "ORIGINAL" and "COPY". If there is a discrepancy between original document and its copy, the original document is valid.

12. Integrity Pact

12.1 The Integrity pact contains a pledge to prevent and not do and will report the occurrence of collusion, corruption, and nepotism (KKN) practices during the process of procurement of goods.

12.2 The Integrity pact is inserted into the Application Document and becomes a part of the Application Document.

D. SUBMISSION OF APPLICATION

13. Submission of Application

13.1 Application document is inserted into a sealed envelope and marked outside with

“APPLICATION DOCUMENT”, name of the Procurement Package, name and address

of the Applicant, and submitted to the Bid Committee at the address specified in LDK. 13.3 Applicant submits Application Document directly by hand to the Bid Committee in

line with the schedule specified in LDK.

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Chapter III- Instructions To Applicant III - 4

13.4 In case of Application Document is submitted by mail/courier, the sealed envelope is inserted into the outer envelope bearing the name of the procurement package and the address of the bid committee.

14. Late Application

14.1 Every application received by the Bid Committee beyond the deadline for submission of applications will be rejected and sent back to the Applicant in a sealed envelope (not opened) accompanied by evidence of receipt.

14.2 To the late application submitted by mail / courier, the Bid Committee will open the outer cover to find out the name and address of applicant, and then notify the concerned applicants to take back the application accompanied by evidence of receipt. 14.3 In case of application document is submitted by mail / courier, all risks of delay and

destruction of documents shall be the risks of applicant.

15. Confidentiality of Evaluation Process

The information relating to the evaluation on applications shall not be disclosed to Applicants or to any other parties until the results of Qualification is announced. 16. Evaluation of Application

16.1 Evaluation of applications is carried out by using a knockout evaluation method. 16.2 Integrity pact shall has been completed, signed, and attached in Application

Document.

16.3 The procedures of application evaluation is conducted in accordance with Chapter VIII of this Qualification Document.

16.4 If the applicants passed the qualification evaluation is less than 3 (three), then the bidding fails.

17. Clarification on Application

17.1 Clarification on qualification for the qualified applicants shall be undertaken after evaluation of applications is accomplished.

17.2 Clarification on applications is conducted by verifying original document or endorsed documents with its copy.

17.3 if necessary, the Bid Committee clarify and / or verify the documents to the issuer. 17.4 If the results of application clarification find false data, the applicant shall be failed or

eliminated and included in the Black List.

E. QUALIFICATION RESULTS

18. Determination of Qualification Results

18.1 All the qualified Applicants shall be included into bidder shortlist by the Bid Committee.

18.2 if the qualified applicants is less than 3 (three) applicants, the bidding shall be failed. 19. Notification of Qualification Results

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Chapter III- Instructions To Applicant III - 5

20. Objection

20.1 Applicant may raise written objection to the Bid Committee on the qualification results not later than 5 (five) working days following the notification of qualification results attached with evidence of fraud, with cc to the PPK, PA/KPA and internal control unit. 20.2 Objection may only be submitted if accompanied by the evidences of procedures

manipulation, including:

a. manipulation to the provisions and procedures stipulated in Presidential Regulation No 54 Year 2010 and has been specified in the Qualification Document;

b. certain manipulations that prevent a fair competition among Applicants, and/or c. abuse of authority by the Bid Committee and/or by other autorized officials.

20.3 The bid committee shall provide written response on all objections arising not later than 5 (five) working days following the objection received.

20.4 If the objection is sustained, the bid committee shall fail the tender.

20.5 The objection submitted not to the bid committee or submitted beyond objection period, it should be considered as a complaint and shall be responded.

20.6 There is no appeal objection in the qualification process.

21. Re-qualification

21.1 If the qualified applicants are less than 3 (three) applicants, the Bid Committee shall re-announce the qualification to invite new applicants other than the qualified applicants. The qualified Applicants are not necessary to re-evaluated, unless there is an amendment in qualification document.

21.2 In case of upon re-qualification is conducted but the qualified Applicants is still less than 3 (three), the Bid Committee shall proceed the tender process.

22. Invitation to the Qualified Applicants

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Chapter IV – Qualification Data Sheet IV - 1

CHAPTER IV

QUALIFICATION DATA SHEET

A. The Scope of Qualification Name of the Bid Committee : Pokja ULP Badan SAR Nasional The Bid Committee’s address :

Jl. Angkasa Blok B-15, Kav. 2-3, Lantai 6 (Ditsarpras), Kemayoran, Jakarta Pusat, Indonesia 10720

The name of Work Package :

Procurement of Medium Class Intermediate Helicopter.

Period of work completion until November, 30th 2015 (240 Calendar days)

B. Source of Funds

This procurement is funded by the National SAR Agency of Indonesia Budget for Fiscal Year 2015.

C. Submission of Applications

Date : Monday, December 22nd ,2014 to Monday, January 5th, 2015

Time : At 08.00 a.m to 02.00 p.m (local time)

Place : Jl. Angkasa Blok B-15, Kav. 2-3, Lantai 6 (Ditsarpras), Kemayoran, Jakarta Pusat, Indonesia 10720

Email : suhardi@basarnas.go.id /cc : iqbalajo@gmail.com

D. Qualification Requirements

The Applicant shall meet the following requirements:

a) The Integrity Pact signed by the President Director of the Company or by the Endorsee;

b) Applicants must be aircraft Manufacturer;

c) Company Deed and its amendments, if any, and shall be endorsed by the Indonesian Embassy in the country of origin;

d) Company Profile which describes: - Brief company profile,

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Chapter V – Integrity Pact II - 1

CHAPTER V INTEGRITY PACT

[Example of an Integrity Pact for Single Applicant]

INTEGRITY PACT

I am, the Undersigned :

Name : __________[ the name of authorized representative of business

entities]

Identity Number : __________ [Fill with the identity number]

Position : __________

Acting for and on behalf of

: _____________ [fill with the company name]

for the Work Procurement of 1 (one) SAR Helicopter Package (Phase 1) at National SAR Agency of Indonesia, hereby certify that I :

1. will not commit nepotism,corruption and collution practices;

2. will report to the Inspectorate of the National SAR Agency of Indonesia and/or LKPP when we find nepotism,corruption and collution practices during the bidding process;

3. will follow the procurement process in a clean, transparent and professional way to provide the best performance accordance with the provisions of the prevailing legislation and regulations;

4. If I violate the things that I have stated in this Integrity Pact, I'm willing to bear the administrative penalties, sanction to be included in the Black List, compensation and criminal claims in accordance with the provisions of the prevailing legislation and regulations.

__________[place], __[date] __________[month] 20____[year]

[Company]

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Chapter V – Integrity Pact II - 2

[Example of an Integrity Pact with Joint Operation Applicant]

INTEGRITY PACT

We, the Undersigned :

1. Name : __________[ name of authorized representative of business

entities]

Identity Number : __________ [Fill with the identity number]

Position : __________

Acting for and on behalf of

: _____________ [fill with the company name]

2. Name : __________[ name of authorized representative of business

entities]

Identity Number : __________ [Fill with the identity number]

Position : __________

Acting for and on behalf of

: _____________ [fill with the company name]

3. ...[and so on, filled in accordance with the number of partnership member]

for the Work Procurement of 1 (one) SAR Helicopter Package (Phase 1) at National SAR Agency of Indonesia, hereby certify that I :

1. will not commit nepotism,corruption and collution practices;

2. will report to the Inspectorate of the National SAR Agency of Indonesia and/or LKPP when we find nepotism,corruption and collution practices during the bid process;

3. will follow the procurement process in a clean, transparent and professional way to provide the best performance accordance with the provisions of the prevailing legislation and regulations;

4. If I violate the things that I have stated in this Integrity Pact, I'm willing to bear the administrative penalties, sanctioned the inclusion of the Black List, compensation and criminal claims in accordance with the provisions of the prevailing legislation and regulations.

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Chapter VI - Qualification Forms VI - 1 CHAPTER VI

QUALIFICATION FORMS

QUALIFICATION FORM

I am, the Undersigned :

Name : . . . Position : . . . Acting for : Company . . . and on behalf of

Address : . . . No. Telephone/Fax : . . . Email : . . .

hereby declare that:

1. I legally have the capacity to sign a contract according to the letter ... ... ... ... ... ... ... ... (according to deed of company / amendment / power of attorney, stated clearly the establishment number / amendment / power of attorney and the date);

2. I am not as a government employee of Indonesian ministry / agency / department / institution [for government employee of Indonesian ministry / agency / department / institution dependents who is on leave outside the ministry / agency / department / institution is written as follows: "I am a government employee of Indonesian ministry / agency / department / institution is dependents on leave outside the ministry / agency / department / institution”];

3. I'm not serving a criminal penalty;

4. I am not and will not be involved in a conflict of interest with the parties concerned, directly or indirectly in this procurement process;

5. The business entities that I represent is not included in the Black List, not under court supervision, not bankrupt or being legally discontinued operation;

6. one and / or all of the management entity that I represent are not included in the Black List;

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Chapter VI - Qualification Forms VI - 2

Business License Issuer : ………..

C. Legal Basis of Company Deed

1. Company Deed

a. Certificate Number :

b. Date :

c. Name of Public Notary : 2. Last Amendment Certificate

a. Certificate Number :

b. Date :

c. Name of Public Notary :

D. Company Administrators

1. Commissioners

NO. Name Identity Number Position in the company Head

Office

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Chapter VI - Qualification Forms VI - 3 2. Directors / Legally Liable Persons / Corporate Administrators

NO. Name Indentity Number Position in the company

E. Financial Data

1. Shareholder Structure

NO. Name Identity

Number

Address Percentage

2. Taxes

1. Number of Tax Payers Subject (NPWP)

:

2. Evidence of Corporate Annual Income Tax Payment in the last year Number/Date

:

3. Monthly Report of Corporate Income Tax/State Income Tax (PPh/PPN) in the last three months Number/ Date

:

4. [Fiscal Statement (instead of number 2 and 3)]

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Chapter VI - Qualification Forms VI - 4 F. The last Corporate Balance Sheet by 31 December ...

(in thousands IDR)

ASSETS LIABILITIES

I Current Assets : Rp. ………. IV Liabilities

Cash : Rp. ………. Account Payable : Rp. ……….

Bank : Rp. ………. Tax Payable : Rp. ……….

Receivables *) : Rp. ………. Others Liabilities : Rp. ……….

Supplies : Rp. ………. Total Liability (d) Rp. ……….

Works in Progress : Rp. ……….

Total (a) Rp.

………. V Long Term Liability (e)

Rp……….. Rp……...

II Fixed Assets : Rp. ………. Rp………

Equipments and machines

: Rp. ……….

Inventory : Rp. ……….

Buildings : Rp. ……….

Total (b) Rp.

………. VI Net Asset (a+b+c) (d+e) –

Rp... Rp...

II I

Others Assets (c) Rp.

………. Total : :

Rp…….. Rp.

………. Total Rp. ……….

*) Short term receivables (in the period up to six months) : Rp………

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Chapter VI - Qualification Forms

*) Attached with a copy of Contract as a written evidence

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Chapter VII - Instructions To Fill Up Application VII - 1 CHAPTER VII

INSTRUCTIONS TO FILL UP APPLICATION

A. Administration Data

1. Fill with the Name of applicant’s company.

2. Select the status of a business entity (Head Office/Branch).

3. Fill with the address, telephone numbers, fax numbers and email of the applicant’s company that can be contacted.

4. Fill with address, telephone numbers, fax numbers and email of head office that can be contacted, if the applicant is a branch office.

B. Bussiness License

1. Fill with the type of business license, number and date of publication. 2. Fill with validity period of license.

3. Fill with the name of the business license issuing agencies

C. Legal Basis of Company Deed

1. Fill with with a number, date and name of the public notary who issues Company Deed. 2. Fill with with a number, date and name of the public notary who issues Last Amendment

Certificate.

D. Company Administrators

1. Fill with name, ID number and positions in Company, if the company is Limited. 2. Fill with name, ID number and positions in Company.

E. Financial Data

1. Fill with name, ID number, and shareholder / partner in addresses and the percentage ownership of shares / partner in.

2. Taxes :

a. Fill with Number of Tax Payers Subject (NPWP)

b. Fill with the number and date of last year's tax report in evidence of annual report. c. Fill with the number and date of the monthly report evidence (for the last three

months)

Fulfillment of the requirements of the last year tax liability with submission the annual tax reports and monthly reports can be replaced Certificate of Fiscal (SKF) issued by the tax office.

F. The last Corporate Balance Sheet

[Filled with financial data compiled by the Financial Accounting Standards issued by the Indonesian Institute of Accountants]

G. Corporate Experience Data

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Chapter VIII Qualification Evaluation Procedures VIII - 1 CHAPTER VIII

QUALIFICATION EVALUATION PROCEDURES

A. Application documents will be evaluated shall meet the following requirements : 1. Application form is signed by :

a. the president director/head of the company;

b. the endorsee of the president director / head of the company whose his/her

endorser’s name is listed in the company deed or its amendments;

c. the Branch manager appointed by head office of the company proved by an authentic document; or

d. the officials who has the right to represent company under the partnership agreement.

2. have a business license in accordance with prevailing legislation

3. Submitted a written statement / acknowledgment that the company is not being under court supervision, not bankrupt, not being discontinued operations, and / or the directors who act for and on behalf of companies is not being serve criminal penalties.

4. one and / or all of the management and the company are not included in the Black List;

5. Have Tax Payers Subject Number (NPWP) and already paid the taxes liabilities for the last year proven by the copies of receipt of the last Corporate Annual Income Tax (SPT), and have a monthly report of Income Tax PPh article 21, PPh article 23 (if any), PPh article 25/article 29 and VAT (for Taxable) for at least 3 (three) months of the year. Participants can replace this requirement by submitting the Certificate of Fiscal (SKF);

6. obtain at least 1 (one) job as a supplier in the last 4 (four) years, both in government and private sector, including subcontract experience.

7. has the capability to appropriate Sub Field of Procurement.

8. In case of the applicant will make partnership :

a. applicant shall have a partnership/joint operation agreements that shows the percentage of share and companies that represent partnership.

b. the requirement evaluation number 1 up to 7 is carried out for each joint operation applicant.

9. the partnership/joint operation agreement as stated in point 8.a shall be made in front of

a public notary, in the form of notary certificate.

B. The Bid Committee shall examine and compare the data entry requirements with the

applicant’s application, in terms of :

1. completeness of Application Documents; and

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Chapter VIII Qualification Evaluation Procedures VIII - 2 C. If there is unclear or missing data, the Bid Committee may request applicant to make

clarification in writing, but shall not change the substances of the application.

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