ࡱ> |yz{ 4Bbjbj&z&zEVDPgDPgrr333GGG8dDG''''='''JLLLLLL$7pi3'"''p'=''8'J'J@h' "ȱXND60C(hh3'''pp''''''''''''''''rc ~: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.: Zakup aparatury medycznej dla Szpitala Copernicus PL Sp. z o.o. (Nr sprawy: D10.251.93.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.: Zakup aparatury medycznej dla Szpitala Copernicus PL Sp. z o.o. (Nr sprawy: D10.251.93.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  N X ^ ` b n]A6hRZ hU5;B*CJOJPJQJ\^JaJph hRZ h CJOJQJ^JaJ hRZ hSCJOJQJ^JaJ*hRZ hU5CJOJPJQJ\^JaJ*hRZ hU5CJOJPJQJ\^JaJ*hRZ h}q5CJOJPJQJ\^JaJ-hRZ hU@B*CJOJQJ^JaJph hRZ hUCJOJQJ^JaJ,hRZ hU5>*CJOJQJ\]^JaJ b " r t v &dP$ -DM a$$ -DM a$gd(C$d*$7$8$H$a$gd(C$a$ $*$7$a$ $d*$7$a$$da$ $da$gdib l    " p r t v ҼvaPPPPP9-hRZ hU@B*CJOJQJ^JaJph hRZ hUCJOJQJ^JaJ)hRZ hUB*CJOJQJ^JaJph?hRZ h(C5B*CJKHOJPJQJ\^JaJnHphtH%hnq56>*CJOJQJ\]^J%h\56>*CJOJQJ\]^J+h ~h(C56>*CJOJQJ\]^J/h ~h(C56>*CJOJQJ\]^JaJ)h\56>*CJOJQJ\]^JaJv  :<8Z$&(*,.0N$a$gds & Fgd H$a$$7$a$$a$     , >8:<8ͼs]]]]ss]KK#hRZ hUCJOJQJ\^JaJ*hRZ hU5CJOJPJQJ\^JaJ$hRZ hUCJOJPJQJ^JaJ#hRZ hU5CJOJQJ^JaJ#hRZ hU5CJOJQJ^JaJ#hRZ hU5CJOJQJ^JaJ hRZ hUCJOJQJ^JaJ4jh0Jh@B*CJOJQJU^JaJph-hRZ hU@B*CJOJQJ^JaJphZ"$&(*,.0LNӼ}}fO88-hRZ hU@B*CJOJQJ^JaJph,hRZ hU5>*CJOJQJ\]^JaJ,hRZ h(C5>*CJOJQJ\]^JaJ&h(C5>*CJOJQJ\]^JaJ&ho@5>*CJOJQJ\]^JaJ,hRZ hC5>*CJOJQJ\]^JaJ,hRZ h5>*CJOJQJ\]^JaJhRZ hUOJQJ hRZ hUCJOJQJ^JaJ hRZ hCJOJQJ^JaJN,tvxJ  \^` &dP$ -DM a$ $da$$ -DM a$gd(C$d*$7$8$H$a$gd\$a$ $*$7$a$$da$*,0rtvxFHJT꾾uduH3)h\56>*CJOJQJ\]^JaJ6hRZ hU5;B*CJOJPJQJ\^JaJph hRZ h=MCJOJQJ^JaJ hRZ hUCJOJQJ^JaJ#hRZ hU5CJOJQJ^JaJ'hRZ hU5CJOJPJQJ^JaJ#hRZ hU5CJOJQJ^JaJ*hRZ hU5CJOJPJQJ\^JaJ*hRZ h}q5CJOJPJQJ\^JaJ*hRZ hU5CJOJPJQJ\^JaJT  Z\^`|~ѾѫnnnnnW@-hRZ hU@B*CJOJQJ^JaJph-hRZ hU@B*CJOJQJ^JaJph hRZ hUCJOJQJ^JaJ)hRZ hUB*CJOJQJ^JaJph,hRZ hU5;>*CJOJQJ\^JaJ%h(C56>*CJOJQJ\]^J%h\56>*CJOJQJ\]^J+h ~h(C56>*CJOJQJ\]^J/h ~h\56>*CJOJQJ\]^JaJ`|~`b33^4(5*5,5.50525456585V556$da$$da$dgdW$a$ $ 7$a$$7$a$$a$^`bdt2x233334^4&5ѿn]L]]] hRZ hCJOJQJ^JaJ hRZ hUCJOJQJ^JaJ+jhi0JhCJOJPJQJU^JaJU$hRZ hUCJOJPJQJ^JaJ'hRZ hU5CJOJPJQJ^JaJ#hRZ hU5CJOJQJ^JaJ#hRZ hU5CJOJQJ^JaJ'h@B*CJOJQJ^JaJph4jhi0Jh@B*CJOJQJU^JaJphdokonano 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 & ..& & & & & .& & & & & & ..................................................................... (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.: Zakup aparatury medycznej dla Szpitala Copernicus PL Sp. z o.o. (Nr sprawy: D10.251.93.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)  Zaznacz wBa[ciwe  Zaznacz 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. 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