ࡱ> iIbjbjEf\\pppp}~v~v~v~~~~8~|>T~3555555$DY9v~pp"Y&~&~,,,&~&~83,3,,?@^~PANzD0z(v~h,YYppR |: ZaBcznik nr 3 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o przynale|no[ci lub braku przynale|no[ci do tej samej grupy kapitaBowej w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: DOSTAWA ARTYKUAW HIGIENICZNYCH ORAZ ZRODKW CZYSTOZCI. (Nr sprawy: D10.251.20.C.2020) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e Wykonawca, ktrego reprezentuj(my)*: % Nie przynale|y do tej samej grupy kapitaBowej, wrozumieniu ustawy z dnia 16 lutego 2007 r. o ochronie konkurencji i konsumentw (t.j. Dz. U. Nr 50 poz. 331 z pzn. zm.) z innymi Wykonawcami, wskazanymi w informacji zamieszczonej przez Zamawiajcego na podstawie art. 86 ust. 5 ustawy Pzp na jego stronie internetowej % Przynale|y do tej samej grupy kapitaBowej, wrozumieniu ustawy z dnia 16 lutego 2007 r. o ochronie konkurencji i konsumentw (t.j. Dz. U. Nr 50 poz. 331 z pzn. zm.) z innymi Wykonawcami (podanymi przez nas ni|ej), wskazanymi w informacji zamieszczonej przez Zamawiajcego na podstawie art. 86 ust. 5 ustawy Pzp na jego stronie internetowej ......................................... ......................................... ......................................... ...) & ....................................... & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 4 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o braku podstaw do wykluczenia dot. braku wyroku lub decyzji w sprawie zalegania z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: DOSTAWA ARTYKUAW HIGIENICZNYCH ORAZ ZRODKW CZYSTOZCI. (Nr sprawy: D10.251.20.C.2020) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e wobec Wykonawcy, ktrego reprezentuj(my)*: % Nie zostaB wydany prawomocny wyrok sdu lub ostateczna decyzja administracyjna o zaleganiu z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne % ZostaB wydany prawomocny wyrok sdu lub ostateczna decyzja administracyjna o zaleganiu z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne, ale dokonano pBatno[ci tych nale|no[ci wraz z ewentualnymi odsetkami lub grzywnami lub zawarto wi|ce porozumienie w sprawie spBat tych nale|no[ci, co potwierdzaj zaBczone do niniejszego o[wiadczenia dokumenty** & ..& & & & & .& & & & & & .................................................................  R \ b d f Ķ|i[M40hU5;B*CJOJPJQJ\^JaJphh CJOJQJ^JaJhSCJOJQJ^JaJ$hU5CJOJPJQJ\^JaJ$hU5CJOJPJQJ\^JaJ$h}q5CJOJPJQJ\^JaJ'hU@B*CJOJQJ^JaJphhUCJOJQJ^JaJ&hU5>*CJOJQJ\]^JaJ&h55>*CJOJQJ\]^JaJ&h5>*CJOJQJ\]^JaJ " f   h j &dP$ -DM a$$da$gdJl$dh^a$gdd $a$ $*$7$a$ $d*$7$a$$da$$da$$a$gdIf      ˶wcL8!,h hU5;>*CJOJQJ\^JaJ&hT.65;>*CJOJQJ\^JaJ,h hn5;>*CJOJQJ\^JaJ&hd 5;>*CJOJQJ\^JaJ&h f-5;>*CJOJQJ\^JaJ&h+5;>*CJOJQJ\^JaJ,h hLd5;>*CJOJQJ\^JaJ)h h 5;CJOJQJ\^JaJ.hNhd 5;@KHOJPJQJ^JaJ8hNhd 5B*KHOJPJQJ^JaJnHphtH    f  " ͻufWH8%W$hU5CJOJPJQJ\^JaJhUCJOJPJQJ^JaJhU5CJOJQJ^JaJhU5CJOJQJ^JaJhU5CJOJQJ^JaJhU0J\CJOJQJ^JaJ'hU@B*CJOJQJ^JaJph'hU@B*CJOJQJ^JaJphhUCJOJQJ^JaJ#hUB*CJOJQJ^JaJph9hnq5B*CJKHOJPJQJ\^JaJnHphtH)h hUB*CJOJQJ^JaJphj l 02.P<$da$$a$gds & Fgd H$a$$7$a$$a$ &dP4.2:;vbN;$h}q5CJOJPJQJ\^JaJ'hU@B*CJOJQJ^JaJph&hU5>*CJOJQJ\]^JaJ&hC5>*CJOJQJ\]^JaJ&h5>*CJOJQJ\]^JaJhUhCJOJQJ^JaJhUCJOJQJ^JaJhUCJOJQJ\^JaJ$hU5CJOJPJQJ\^JaJhUCJOJPJQJ^JaJhU5CJOJQJ^JaJbdf8<>@\^$7$a$$a$ &dP$ -DM a$ $da$$da$gdT.6$dh^a$gdd $a$ $*$7$a$`f468;lT?(,h hT.65;>*CJOJQJ\^JaJ)h hT.65;CJOJQJ\^JaJ.hNhd 5;@KHOJPJQJ^JaJ8hNhd 5B*KHOJPJQJ^JaJnHphtH0hU5;B*CJOJPJQJ\^JaJphh=MCJOJQJ^JaJhUCJOJQJ^JaJhU5CJOJQJ^JaJ!hU5CJOJPJQJ^JaJhU5CJOJQJ^JaJ$hU5CJOJPJQJ\^JaJ :^xdP@x1hU5CJOJQJ^JaJhU0J\CJOJQJ^JaJ'hU@B*CJOJQJ^JaJph'hU@B*CJOJQJ^JaJphhUCJOJQJ^JaJ#hUB*CJOJQJ^JaJph&hU5;>*CJOJQJ\^JaJ)h hT.6B*CJOJQJ^JaJph,h hT.65;>*CJOJQJ\^JaJ&hd 5;>*CJOJQJ\^JaJ&hT.65;>*CJOJQJ\^JaJBDNPR 4444444`55555566 $*$7$a$ $d*$7$a$$da$$da$ $a$gdn$a$ $ 7$a$@DFVFHJLPR4444444^5mYEYm&h5>*CJOJQJ\]^JaJ&hk5>*CJOJQJ\]^JaJ&hU5>*CJOJQJ\]^JaJUhCJOJQJ^JaJhUCJOJQJ^JaJ hnhn0J\CJOJQJaJhU0J\CJOJQJ^JaJhUCJOJPJQJ^JaJ!hU5CJOJPJQJ^JaJhU5CJOJQJ^JaJhU5CJOJQJ^JaJ.... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 5 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o braku podstaw do wykluczenia dot. braku orzeczenia tytuBem [rodka zapobiegawczego zakazu ubiegania si o zamwienia publiczne w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: DOSTAWA ARTYKUAW HIGIENICZNYCH ORAZ ZRODKW CZYSTOZCI. (Nr sprawy: D10.251.20.C.2020) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e wobec Wykonawcy, ktrego reprezentuj(my) brak jest orzeczenia tytuBem [rodka zapobiegawczego zakazu ubiegania si o zamwienia publiczne. & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 7 & & & & & & & & .& & & & & & & & & & (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E - zBo|y na wezwanie Zamawiajcego- Przystpujc do udziaBu w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego na: DOSTAWA ARTYKUAW HIGIENICZNYCH ORAZ ZRODKW CZYSTOZCI. (Nr sprawy: D10.251.20.C.2020) reprezentujc: (nazwa firmy) jako upowa|niony/upowa|nieni w imieniu Wykonawcy o[wiadczam/o[wiadczamy, |e: Oferowane wyroby speBniaj wymogi dopuszczenia do obrotu i u|ywania i s zgodne z ustaw z dnia 20 maja 2010 r. o wyrobach medycznych (t.j. Dz.U. z 2017 r. poz. 211, z pzn. zm.). & & & & & & & ........................................................ (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) * Zaznaczy wBa[ciwe * Zaznaczy wBa[ciwe ** Nale|y przedstawi Zamawiajcemu dokumenty potwierdzajce dokonanie pBatno[ci tych nale|no[ci wraz z ewentualnymi odsetkami lub grzywnami lub zawarcie wi|cego porozumienia w sprawie spBat tych nale|no[ci       COPERNICUS Podmiot Leczniczy Sp. z o.o. ul. Nowe Ogrody 1-6, 80-803 GdaDsk Centrala telefoniczna: 58 76 40 100 Sekretariat Biura Zarzdu: 58 76 40 340, 58 76 40 142, fax 58 30 21 416www.copernicus.gda.pl sekretariat.kopernik@copernicus.gda.pl NIP: 583-316-22-78, REGON: 221964385, KRS: 0000478705 Sd Rejonowy GdaDsk-PBnoc w GdaDsku KapitaB zakBadowy 271.848.000,00 PLN wpBacony w caBo[ci Rachunek bankowy: 72 1440 1101 0000 0000 1099 1064  PAGE 4 ^5555$6666l777"8$8Ŷzl^lA).hNhd 5;@KHOJPJQJ^JaJ8hNhd 5B*KHOJPJQJ^JaJnHphtHhSCJOJQJ^JaJhUCJOJQJ^JaJhU5CJOJQJ^JaJ-hU5B*CJOJPJQJ\^JaJph*hU5B*CJOJPJQJ^JaJphhU5CJOJQJ^JaJ$hU5CJOJPJQJ\^JaJ$hU5CJOJPJQJ\^JaJ'hU@B*CJOJQJ^JaJph 677$8d8f88888::::xx$a$ -D1$M $dh7$a$ $dha$dh&dP$ dh-DM a$$ -DM a$$da$gdT.6$dh^a$gdd $a$ $8&8,8N8R8V8\8`8b8d8f8889N9ӿӿӖrdP<'hU@B*CJOJQJ^JaJph'hU@B*CJOJQJ^JaJphhUCJOJQJ^JaJ#hUB*CJOJQJ^JaJph#hUB*CJOJQJ^JaJph)h hT.6B*CJOJQJ^JaJph&hd 5;>*CJOJQJ\^JaJ&hT.65;>*CJOJQJ\^JaJ,h hT.65;>*CJOJQJ\^JaJ)h hT.65;CJOJQJ\^JaJN9:::;;;;;;;;L<V<<ӿu`\J<+ hk5CJOJQJ\^JaJhkCJOJQJ^JaJ#hkB*CJOJQJ^JaJphhk)hk5B*CJOJQJ\^JaJph#hk5>*CJOJQJ\^JaJh/NCJOJQJ^JaJhCJOJQJ^JaJhkCJOJQJ^JaJhUCJOJQJ^JaJ'hU@B*CJOJQJ^JaJph-hU5B*CJOJPJQJ\^JaJph*hU5B*CJOJPJQJ^JaJph::: :(::;;;;;;;;;;;;;<P<R<gdk-DM gdk-D1$7$M gdk $a$gdkgd$a$R<T<V<<<<==>p>>>>>>>>&dPgdk$da$gdT.6$dh^a$gdd $|]|a$gdk$da$gdk$dha$gdk $a$gdkgdk<<<<===>n>p>r>x>±cK6,h hT.65;>*CJOJQJ\^JaJ)h hT.65;CJOJQJ\^JaJ.hNhd 5;@KHOJPJQJ^JaJ8hNhd 5B*KHOJPJQJ^JaJnHphtHh/N5>*OJQJ\^Jhk5>*OJQJ\^J)hkhk5>*CJOJQJ\^JaJ hkhkCJOJQJ^JaJ)hkhkB*CJOJQJ^JaJph/hkhk6B*CJOJQJ]^JaJph hk6CJOJQJ]^JaJ x>>>>>>>>>>>>>??@(@@}oaM}8)hkhkB*CJOJQJ^JaJph&hkhk5CJOJQJ\^JaJhkCJOJQJ^JaJhkCJOJQJ^JaJ hkhkCJOJQJ^JaJhkOJQJ^J&hk56CJOJQJ\]^JaJ)h hT.6B*CJOJQJ^JaJph,h hT.65;>*CJOJQJ\^JaJ&hd 5;>*CJOJQJ\^JaJ&hT.65;>*CJOJQJ\^JaJ>???AAAAAAVBPChCjClCgd-D1$M gdk\^\`gdk $a$gdk|$ d] a$gdk $a$gdk$-DM a$gdk-DM gdkgdk@@@AAANChCjClCpCCCCCCCCùxg]YH>]YHhn0JSOJQJ hnhn0JSCJOJQJaJhUhUOJQJ^J h27h270JSCJOJQJaJhkCJOJQJ^JaJ0hk5>*@B*CJOJQJ\^JaJphhkCJOJQJ^JaJhkOJQJ^JaJhkOJQJ^J hkhkCJOJQJ^JaJ$hkhk@CJOJQJ^JaJ0hkhkB*CJOJPJQJ\^JaJphlCCCbEdEhEjEnEpEtEvEzE|EEEEEFfFFFtGG v$$Ifa$gd>{ v$Ifgd>{vxxgd1uxxgdK/uxxgdu2d~d~CC`EbEdEfEjElEpErEvExE|E~EEEEEPHlHnHtHIIfIlInIpImiWIjhU0J`CJUaJ#hUB*CJ^JaJmHphvqqsHh>{)hmk h>{B*CJ^JaJmHphvqqsH(hC'h>{B*CJ\aJmHphsH hC'h>{B*CJ\aJph#h>{B*CJ^JaJmHphvqqsH hUCJjh1Uh'yZjhu2Ujh)Uh)hUhUOJQJ]^J hnhUCJOJQJ^JaJG,HHIIhIjIlInIIIIIIIygdgd1vgd1vvh]hZkd $$If<05&Q'44 laPp v$$Ifa$gd>{pI|I~IIIIIIhkCJOJQJ^JaJh)hUhd 0J`CJaJmHnHujhU0J`CJUaJhU0J`CJaJC&P 0p1X/R :p'<0. 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