ࡱ> bd_`abQbjbj.X}}t >>>>>RRRRnDR/+++++++$0X3l?+>?+>>.%%%>>+%+%%:C)) f wR;#)+.0/) 3;#3))3>*%?+?+%/3  :ZaBcznik nr 2 do SIWZ FORMULARZ OFERTY I. Wykonawca: 1 Nazwa i adres .............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. NIP........................................... REGON..................................... Telefon....................................... Fax............................................. www........................................... E-mail......................................... wojewdztwo............................ nr KRS lub innego dokumentu:....................................... 2. Firmy zagraniczne podaj informacj, czy maj siedzib w Polsce, czy poza granicami: ............................................................................................................................................................................................................................................................................................................................................................................................................ 3. Stanowisko oraz imi i nazwisko osoby upowa|nionej do zawarcia umowy: ............................................................................................................................................................................................................................................................................................................................................................................................................ 4. O[wiadczamy, ze jeste[my zwizani niniejsz ofert przez okres 60 dni, liczc od daty skBadania ofert. 5. O[wiadczamy, |e gwarantujemy niezmienno[ cen przez okres trwania umowy. II. Przedmiot zamwienia: Nazwa zamwienia do ktrego Wykonawca przystpuje: Grupa 1...................................................................................................................................................................... Grupa 2...................................................................................................................................................................... Grupa 3...................................................................................................................................................................... Grupa 4...................................................................................................................................................................... Grupa 5...................................................................................................................................................................... Grupa 6...................................................................................................................................................................... Grupa 7...................................................................................................................................................................... Grupa 8...................................................................................................................................................................... Grupa 9.. Grupa 10.................................................................................................................................................................... Grupa 11.................................................................................................................................................................... Grupa 12.................................................................................................................................................................... Grupa 13.................................................................................................................................................................... Grupa 14.................................................................................................................................................................... Grupa 15.................................................................................................................................................................... Grupa 16.................................................................................................................................................................... Grupa 17.................................................................................................................................................................... Grupa 18.................................................................................................................................................................... Grupa 19.................................................................................................................................................................... Grupa 20.................................................................................................................................................................... Grupa 21.................................................................................................................................................................... Grupa 22.................................................................................................................................................................... Grupa 23.................................................................................................................................................................... Grupa 24.................................................................................................................................................................... Grupa 25.................................................................................................................................................................... Grupa 26.................................................................................................................................................................... Grupa 27.................................................................................................................................................................... Grupa 28.................................................................................................................................................................... Grupa 29.................................................................................................................................................................... Grupa 30.................................................................................................................................................................... Grupa 31.................................................................................................................................................................... Grupa 32.................................................................................................................................................................... Grupa 33.................................................................................................................................................................... Grupa 34.................................................................................................................................................................... Grupa 35.................................................................................................................................................................... Grupa 36.................................................................................................................................................................... Grupa 37.................................................................................................................................................................... Grupa 38.................................................................................................................................................................... Grupa 39.................................................................................................................................................................... Grupa 40.................................................................................................................................................................... Grupa 41.................................................................................................................................................................... Grupa 42.................................................................................................................................................................... Grupa 43.................................................................................................................................................................... Grupa 44.................................................................................................................................................................... Grupa 45.................................................................................................................................................................... Grupa 46.................................................................................................................................................................... Grupa 47.................................................................................................................................................................... Grupa 48.................................................................................................................................................................... Grupa 49.................................................................................................................................................................... Grupa 50.................................................................................................................................................................... Grupa 51.................................................................................................................................................................... Grupa 52.................................................................................................................................................................... Grupa 53.................................................................................................................................................................... Grupa 54.................................................................................................................................................................... Grupa 55.................................................................................................................................................................... Grupa 56.................................................................................................................................................................... Grupa 57.................................................................................................................................................................... Grupa 58.................................................................................................................................................................... Grupa 59.................................................................................................................................................................... Grupa 60.................................................................................................................................................................... Grupa 61.................................................................................................................................................................... Grupa 62.................................................................................................................................................................... Grupa 63.................................................................................................................................................................... Grupa 64.................................................................................................................................................................... Grupa 65.................................................................................................................................................................... Grupa 66.................................................................................................................................................................... Grupa 67.................................................................................................................................................................... Grupa 68.................................................................................................................................................................... Grupa 69.................................................................................................................................................................... Grupa 70.................................................................................................................................................................... Grupa 71.................................................................................................................................................................... Grupa 72.................................................................................................................................................................... Grupa 73.................................................................................................................................................................... Grupa 74.................................................................................................................................................................... Grupa 75.................................................................................................................................................................... Grupa 76.................................................................................................................................................................... Grupa 77.................................................................................................................................................................... Grupa 78.................................................................................................................................................................... Grupa 79.................................................................................................................................................................... Grupa 80.................................................................................................................................................................... Grupa 81.................................................................................................................................................................... Grupa 82.................................................................................................................................................................... Grupa 83.................................................................................................................................................................... Grupa 84.................................................................................................................................................................... III. Cena: 1. Cena grupa 1: 1. Cena grupa 2: 1. Cena grupa 3: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 4: 1. Cena grupa 5: 1. Cena grupa 6: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 7: 1. Cena grupa 8: 1. Cena grupa 9: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 10: 1. Cena grupa 11: 1. Cena grupa 12: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 13: 1. Cena grupa 14: 1. Cena grupa 15: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 16: 1. Cena grupa 17: 1. Cena grupa 18: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 19: 1. Cena grupa 20: 1. Cena grupa 21: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 22: 1. Cena grupa 23: 1. Cena grupa 24: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 25: 1. Cena grupa 26: 1. Cena grupa 27: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 28: 1. Cena grupa 29: 1. Cena grupa 30: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 31: 1. Cena grupa 32: 1. Cena grupa 33: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 34: 1. Cena grupa 35: 1. Cena grupa 36: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 37: 1. Cena grupa 38: 1. Cena grupa 39: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 40: 1. Cena grupa 41: 1. Cena grupa 42: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 43: 1. Cena grupa 44: 1. Cena grupa 45: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 46: 1. Cena grupa 47: 1. Cena grupa 48: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 49: 1. Cena grupa 50: 1. Cena grupa 51: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 52: 1. Cena grupa 53: 1. Cena grupa 54: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 55: 1. Cena grupa 56: 1. Cena grupa 57: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 58: 1. Cena grupa 59: 1. Cena grupa 60: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 61: 1. Cena grupa 62: 1. Cena grupa 63: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 64: 1. Cena grupa 65: 1. Cena grupa 66: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 67: 1. Cena grupa 68: 1. Cena grupa 69: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 70: 1. Cena grupa 71: 1. Cena grupa 72: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 73: 1. Cena grupa 74: 1. Cena grupa 75: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 76: 1. Cena grupa 77: 1. Cena grupa 78: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 79: 1. Cena grupa 80: 1. Cena grupa 81: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... 1. Cena grupa 82: 1. Cena grupa 83: 1. Cena grupa 84: a) netto............................................... a) netto............................................... a) netto......................................... b) brutto............................................. b) brutto............................................. b) brutto................................... c) warto[ VAT................................ c) warto[ VAT................................ c) warto[ VAT............................... IV. Termin pBatno[ci  pBatno[ przelewem w terminie - dni ( RozdziaB VIII pkt. 4 SIWZ ): Grupa 1...................................................................................................................................................................... Grupa 2...................................................................................................................................................................... Grupa 3...................................................................................................................................................................... Grupa 4...................................................................................................................................................................... Grupa 5...................................................................................................................................................................... Grupa 6...................................................................................................................................................................... Grupa 7...................................................................................................................................................................... Grupa 8...................................................................................................................................................................... Grupa 9.. Grupa 10.................................................................................................................................................................... Grupa 11.................................................................................................................................................................... Grupa 12.................................................................................................................................................................... Grupa 13.................................................................................................................................................................... Grupa 14.................................................................................................................................................................... Grupa 15.................................................................................................................................................................... Grupa 16.................................................................................................................................................................... Grupa 17.................................................................................................................................................................... Grupa 18.................................................................................................................................................................... Grupa 19.................................................................................................................................................................... Grupa 20.................................................................................................................................................................... Grupa 21.................................................................................................................................................................... Grupa 22.................................................................................................................................................................... Grupa 23.................................................................................................................................................................... Grupa 24.................................................................................................................................................................... Grupa 25.................................................................................................................................................................... Grupa 26.................................................................................................................................................................... Grupa 27.................................................................................................................................................................... Grupa 28.................................................................................................................................................................... Grupa 29.................................................................................................................................................................... Grupa 30.................................................................................................................................................................... Grupa 31.................................................................................................................................................................... Grupa 32.................................................................................................................................................................... Grupa 33.................................................................................................................................................................... Grupa 34.................................................................................................................................................................... Grupa 35.................................................................................................................................................................... Grupa 36.................................................................................................................................................................... Grupa 37.................................................................................................................................................................... Grupa 38.................................................................................................................................................................... Grupa 39.................................................................................................................................................................... Grupa 40.................................................................................................................................................................... Grupa 41.................................................................................................................................................................... Grupa 42.................................................................................................................................................................... Grupa 43.................................................................................................................................................................... Grupa 44.................................................................................................................................................................... Grupa 45.................................................................................................................................................................... Grupa 46.................................................................................................................................................................... Grupa 47.................................................................................................................................................................... Grupa 48.................................................................................................................................................................... Grupa 49.................................................................................................................................................................... Grupa 50.................................................................................................................................................................... Grupa 51.................................................................................................................................................................... Grupa 52.................................................................................................................................................................... Grupa 53.................................................................................................................................................................... Grupa 54.................................................................................................................................................................... Grupa 55.................................................................................................................................................................... Grupa 56.................................................................................................................................................................... Grupa 57.................................................................................................................................................................... Grupa 58.................................................................................................................................................................... Grupa 59.................................................................................................................................................................... Grupa 60.................................................................................................................................................................... Grupa 61.................................................................................................................................................................... Grupa 62.................................................................................................................................................................... Grupa 63.................................................................................................................................................................... Grupa 64.................................................................................................................................................................... Grupa 65.................................................................................................................................................................... Grupa 66.................................................................................................................................................................... Grupa 67.................................................................................................................................................................... Grupa 68.................................................................................................................................................................... Grupa 69.................................................................................................................................................................... Grupa 70.................................................................................................................................................................... Grupa 71.................................................................................................................................................................... Grupa 72.................................................................................................................................................................... Grupa 73.................................................................................................................................................................... Grupa 74.................................................................................................................................................................... Grupa 75.................................................................................................................................................................... Grupa 76.................................................................................................................................................................... Grupa 77.................................................................................................................................................................... Grupa 78.................................................................................................................................................................... Grupa 79.................................................................................................................................................................... Grupa 80.................................................................................................................................................................... Grupa 81.................................................................................................................................................................... Grupa 82.................................................................................................................................................................... Grupa 83.................................................................................................................................................................... Grupa 84.................................................................................................................................................................... V. Termin wykonania caBo[ci przedmiotu umowy - ( RozdziaB VI pkt. 1 SIWZ ): Grupa 1...................................................................................................................................................................... Grupa 2...................................................................................................................................................................... Grupa 3...................................................................................................................................................................... Grupa 4...................................................................................................................................................................... Grupa 5...................................................................................................................................................................... Grupa 6...................................................................................................................................................................... Grupa 7...................................................................................................................................................................... Grupa 8...................................................................................................................................................................... Grupa 9.. Grupa 10.................................................................................................................................................................... Grupa 11.................................................................................................................................................................... Grupa 12.................................................................................................................................................................... Grupa 13.................................................................................................................................................................... Grupa 14.................................................................................................................................................................... Grupa 15.................................................................................................................................................................... Grupa 16.................................................................................................................................................................... Grupa 17.................................................................................................................................................................... Grupa 18.................................................................................................................................................................... Grupa 19.................................................................................................................................................................... Grupa 20.................................................................................................................................................................... Grupa 21.................................................................................................................................................................... Grupa 22.................................................................................................................................................................... Grupa 23.................................................................................................................................................................... Grupa 24.................................................................................................................................................................... Grupa 25.................................................................................................................................................................... Grupa 26.................................................................................................................................................................... Grupa 27.................................................................................................................................................................... Grupa 28.................................................................................................................................................................... Grupa 29.................................................................................................................................................................... Grupa 30.................................................................................................................................................................... Grupa 31.................................................................................................................................................................... Grupa 32.................................................................................................................................................................... Grupa 33.................................................................................................................................................................... Grupa 34.................................................................................................................................................................... Grupa 35.................................................................................................................................................................... Grupa 36.................................................................................................................................................................... Grupa 37.................................................................................................................................................................... Grupa 38.................................................................................................................................................................... Grupa 39.................................................................................................................................................................... Grupa 40.................................................................................................................................................................... Grupa 41.................................................................................................................................................................... Grupa 42.................................................................................................................................................................... Grupa 43.................................................................................................................................................................... Grupa 44.................................................................................................................................................................... Grupa 45.................................................................................................................................................................... Grupa 46.................................................................................................................................................................... Grupa 47.................................................................................................................................................................... Grupa 48.................................................................................................................................................................... Grupa 49.................................................................................................................................................................... Grupa 50.................................................................................................................................................................... Grupa 51.................................................................................................................................................................... Grupa 52.................................................................................................................................................................... Grupa 53.................................................................................................................................................................... Grupa 54.................................................................................................................................................................... Grupa 55.................................................................................................................................................................... Grupa 56.................................................................................................................................................................... Grupa 57.................................................................................................................................................................... Grupa 58.................................................................................................................................................................... Grupa 59.................................................................................................................................................................... Grupa 60.................................................................................................................................................................... Grupa 61.................................................................................................................................................................... Grupa 62.................................................................................................................................................................... Grupa 63.................................................................................................................................................................... Grupa 64.................................................................................................................................................................... Grupa 65.................................................................................................................................................................... Grupa 66.................................................................................................................................................................... Grupa 67.................................................................................................................................................................... Grupa 68.................................................................................................................................................................... Grupa 69.................................................................................................................................................................... Grupa 70.................................................................................................................................................................... Grupa 71.................................................................................................................................................................... Grupa 72.................................................................................................................................................................... Grupa 73.................................................................................................................................................................... Grupa 74.................................................................................................................................................................... Grupa 75.................................................................................................................................................................... Grupa 76.................................................................................................................................................................... Grupa 77.................................................................................................................................................................... Grupa 78.................................................................................................................................................................... Grupa 79.................................................................................................................................................................... Grupa 80.................................................................................................................................................................... Grupa 81.................................................................................................................................................................... Grupa 82.................................................................................................................................................................... Grupa 83.................................................................................................................................................................... Grupa 84.................................................................................................................................................................... VI. Termin wykonania ( realizacji ) bie|cego zamwienia - dni roboczych( RozdziaB VI pkt. 5 SIWZ ): Grupa 50.................................................................................................................................................................... Grupa 65.................................................................................................................................................................... Grupa 66.................................................................................................................................................................... Grupa 68.................................................................................................................................................................... Grupa 70.................................................................................................................................................................... Grupa 77.................................................................................................................................................................... Grupa 78.................................................................................................................................................................... Grupa 79.................................................................................................................................................................... VII. UzupeBnienie depozytu w terminie, dni roboczych ( RozdziaB VI pkt. 4 SIWZ ): Grupa 1...................................................................................................................................................................... Grupa 2...................................................................................................................................................................... Grupa 3...................................................................................................................................................................... Grupa 4...................................................................................................................................................................... Grupa 5...................................................................................................................................................................... Grupa 6...................................................................................................................................................................... Grupa 7...................................................................................................................................................................... Grupa 8...................................................................................................................................................................... Grupa 9.. Grupa 10.................................................................................................................................................................... Grupa 11.................................................................................................................................................................... Grupa 12.................................................................................................................................................................... Grupa 13.................................................................................................................................................................... Grupa 14.................................................................................................................................................................... Grupa 15.................................................................................................................................................................... Grupa 16.................................................................................................................................................................... Grupa 17.................................................................................................................................................................... Grupa 18.................................................................................................................................................................... Grupa 19.................................................................................................................................................................... Grupa 20.................................................................................................................................................................... Grupa 21.................................................................................................................................................................... Grupa 22.................................................................................................................................................................... Grupa 23.................................................................................................................................................................... Grupa 24.................................................................................................................................................................... Grupa 25.................................................................................................................................................................... Grupa 26.................................................................................................................................................................... Grupa 27.................................................................................................................................................................... Grupa 28.................................................................................................................................................................... Grupa 29.................................................................................................................................................................... Grupa 30.................................................................................................................................................................... Grupa 31.................................................................................................................................................................... Grupa 32.................................................................................................................................................................... Grupa 33.................................................................................................................................................................... Grupa 34.................................................................................................................................................................... Grupa 35.................................................................................................................................................................... Grupa 36.................................................................................................................................................................... Grupa 37.................................................................................................................................................................... Grupa 38.................................................................................................................................................................... Grupa 39.................................................................................................................................................................... Grupa 40.................................................................................................................................................................... Grupa 41.................................................................................................................................................................... Grupa 42.................................................................................................................................................................... Grupa 43.................................................................................................................................................................... Grupa 44.................................................................................................................................................................... Grupa 45.................................................................................................................................................................... Grupa 46.................................................................................................................................................................... Grupa 47.................................................................................................................................................................... Grupa 48.................................................................................................................................................................... Grupa 49.................................................................................................................................................................... Grupa 51.................................................................................................................................................................... Grupa 52.................................................................................................................................................................... Grupa 53.................................................................................................................................................................... Grupa 54.................................................................................................................................................................... Grupa 55.................................................................................................................................................................... Grupa 56.................................................................................................................................................................... Grupa 57.................................................................................................................................................................... Grupa 58.................................................................................................................................................................... Grupa 59.................................................................................................................................................................... Grupa 60.................................................................................................................................................................... Grupa 61.................................................................................................................................................................... Grupa 62.................................................................................................................................................................... Grupa 63.................................................................................................................................................................... Grupa 64.................................................................................................................................................................... Grupa 67.................................................................................................................................................................... Grupa 69.................................................................................................................................................................... Grupa 71.................................................................................................................................................................... Grupa 72.................................................................................................................................................................... Grupa 73.................................................................................................................................................................... Grupa 74.................................................................................................................................................................... Grupa 75.................................................................................................................................................................... Grupa 76.................................................................................................................................................................... Grupa 80.................................................................................................................................................................... Grupa 81.................................................................................................................................................................... Grupa 82.................................................................................................................................................................... Grupa 83.................................................................................................................................................................... Grupa 84.................................................................................................................................................................... VIII. ZaBatwienie reklamacji jako[ciowej w terminie, dni roboczych ( RozdziaB VI pkt. 6 SIWZ ): Grupa 1...................................................................................................................................................................... Grupa 2...................................................................................................................................................................... Grupa 3...................................................................................................................................................................... Grupa 4...................................................................................................................................................................... Grupa 5...................................................................................................................................................................... Grupa 6...................................................................................................................................................................... Grupa 7...................................................................................................................................................................... Grupa 8...................................................................................................................................................................... Grupa 9.. Grupa 10.................................................................................................................................................................... Grupa 11.................................................................................................................................................................... Grupa 12.................................................................................................................................................................... Grupa 13.................................................................................................................................................................... Grupa 14.................................................................................................................................................................... Grupa 15.................................................................................................................................................................... Grupa 16.................................................................................................................................................................... Grupa 17.................................................................................................................................................................... Grupa 18.................................................................................................................................................................... Grupa 19.................................................................................................................................................................... Grupa 20.................................................................................................................................................................... Grupa 21.................................................................................................................................................................... Grupa 22.................................................................................................................................................................... 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Grupa 84.................................................................................................................................................................... IX. Warto[ ksigowa przedmiotu u|ywania (oddanego w u|ywanie) - ( RozdziaB V pkt. 8 SIWZ ): Grupa 33& & & & & & & & & & zB brutto Grupa 51& & & & & & & & & & zB brutto Grupa 69& & & & & & & & & & zB brutto Grupa 75& & & & & & & & & & zB brutto X. Informacja dotyczca podwykonawcw: 1.O[wiadczam, |e przy wykonywaniu przedmiotowego zamwienia bd korzystaB z podwykonawcw. W zawizku z powy|szym przedstawiam informacje dotyczce powierzonej cz[ci zamwienia i podaj nazw podwykonawcw: L.p.Nazwa podwykonawcy( podmiotu )Opis zakresu i rodzaj powierzonej cz[ci, ktr wykona podwykonawca 2. O[wiadczam, |e w celu wykazania speBniania warunkw udziaBu w postpowaniu korzystam z zasobw na zasadach okre[lonych w art. 22a ust. 1 ustawy Prawo zamwieD publicznych. W zawizku z powy|szym przedstawiam informacje o podwykonawcach na zasoby, ktrych si powoBuj. L.p.Nazwa podwykonawcy( podmiotu ) XI. Informacja dotyczca obowizku podatkowego: O[wiadczam, |e wybr naszej oferty bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego zgodnie z przepisami o podatku od towarw i usBug. Jednoczenie wskazuje poni|ej nazw (rodzaj) towaru, ktrego dostawa bdzie prowadzi do jego powstania, oraz wskazuje ich warto[ bez kwoty podatku. UWAGA Pozostawienie poni|szej tabeli bez wypeBnienia oznacza, |e oferta Wykonawcy nie bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego. Nazwa (rodzaj) towaru (zgodnie z zaBcznikiem nr 2 /i /lub 2a do SIWZ), ktrego dostawa bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowegoWarto[ towaru ( cena peBnego zakresu ilo[ciowego ), ktrego dostawa bdzie prowadzi do powstania obowizku podatkowego w PLN netto XII. O[wiadczenie wykonawcy  RODO: 6=DKRY` gn$ ^`a$gd)*$1$gd)DL5KS<RZXYa`h  QgoXnv#tu}!"*|ȭȭh)CJPJ^JaJh8h)CJPJ^JaJh8h)5CJPJ\^Jh8h)5>*CJh)5>*CJh8h)CJaJh)CJaJDu"|)07>ELSZ$ ^`a$gd)*$1$gd)|()1m08t7?=>FDEMKLT=S[YZbȹۭȹȹۭȹȹȹh)CJPJ^JaJh8h)CJPJ^JaJh8h)CJaJh)CJaJh8h)5CJPJ\^Jh8h)5>*CJh)5>*CJBZ0j   l %$  TjM $l&`#$/Ifa$gd "`$a$gd "`gdlgdn*$1$gd)>.0jzĹݭvvnbbL+h 56@B*OJQJ\]^JphhnhlCJ\aJhlCJaJhnCJ\aJhnhnCJ\aJhwCJ\aJhlCJ\aJhnCJaJhwCJaJhnhn5CJaJhl5>*CJ_Hhnhn5>*CJ_Hhl5>*CJaJhnhn5>*CJaJh)5>*CJaJh- 5CJaJ$ Źi[J>3+3h "`CJaJh "`h.PCJaJh "`h.PCJ]aJ h "`h.PB*CJ]aJphh "`B*CJ]aJph-h "`h.P56@B*CJ\]aJph(h "`h.P56>*@B*\]phh "`h "`5>*CJh "`ha-5>*CJh "`hy5>*CJhDhy5>*CJhDhe5>*CJhDhD5>*CJhUR5>*CJ1hehl56@B*OJQJ\]^Jph     j l n t v | ~             ƻƝymdXLh "`hyCJ]aJh "`h?"CJ]aJh "`CJ]aJh "`ha-CJ]aJhlCJ]aJh "`h?"5CJh "`hH+5CJ h "`h3Rh "`h.P6CJaJh "`ha-CJaJ h "`h.Ph "`h.PCJaJ h "`ha-h "`h.P5CJ\aJh "`h.P5CJaJhh "`h.P5CJaJh "`hwCJaJl n p ?%$  TjM $l&`#$/Ifa$gd "`kd$$IflF#7*  t 6`l06    44 lapyt.Pp r t v x z /kd$$IflF#7* t 6`l06    44 lapyt "`%$  TjM $l&`#$/Ifa$gd "`z | ~    /kd$$IflF#7* t 6`l06    44 lapyt "`%$  TjM $l&`#$/Ifa$gd "`       TA??::*$1$$ dh^ `a$gd.Pkd$$IflF#7* t 6`l06    44 lapyt "`        %$  TjM $l&`#$/Ifa$gd "`$a$gdw$a$gd?"*$1$                     " $ ʾyoe^ULCh- 5>*CJhl5>*CJh/) 5>*CJ h35CJh "`h?"5CJh "`h?"5CJ h "`h?"h "`h?"6CJaJ h "`ha-h "`ha-CJaJh "`hyCJaJ h "`hyh "`hy5CJaJhh "`hy5CJaJh "`h?"CJaJh "`hyCJaJh "`h?"@CJ\]aJh "`hy@CJ\]aJ    ]88%$  TjM $l&`#$/Ifa$gd "`kd$$Ifl0 7S  t 6`l0644 lapyty    lGG%$  TjM $l&`#$/Ifa$gd "`kd$$Ifl0 7S t 6`l0644 lapyty    lGG%$  TjM $l&`#$/Ifa$gd "`kd`$$Ifl0 7S t 6`l0644 lapyty        lYTTLLD*$1$gd3*$1$gd?"gd?"$ dh^ `a$gd?"kd"$$Ifl0 7S t 6`l0644 lapyty  " $  Xb $$Ifa$gd3$a$gd3gd3 $ & ( *     Bbdhjnptvx|ǿyhhXM>h- 5>*B*CJaJphh/) 5>*CJaJh5h35mHnHsHtH h5h3aJmHnHsHtHh3CJaJmHnHsHtH$h5h3CJaJmHnHsHtH h3aJh35CJaJh- 5CJaJh h3CJaJh3CJaJ"h356>*@B*\]phh35>*CJhDhD5>*CJh)5>*CJhUR5>*CJbdfhicc$Ifkd$$Ifl0o FF  t0o 644 lBalpyt3hjln$Ifxkd$$Ifl0o  t0o 644 lalyt3nprt$Ifxkd{$$Ifl0o  t0o 644 lalyt3tvxz|~ H>HXHyyyyyyyna $[$a$gd/) $dha$gd/) $a$gd/) gd/) xkd& $$Ifl0o  t0o 644 lalyt3 |~FFFF^GHH H H>HXH^HJJJϾϯo^S>^(hY h/) B*CJH*aJmHphsHhY h/) CJaJ hY h/) B*CJH*aJph#hY h/) 5>*B*CJaJph hY h/) B*CJH*aJphhY h/) CJaJ#hY h/) 5B*CJH*aJphhY h/) B*CJaJphUh/) 5>*B*CJaJph#hY h/) 5>*B*CJaJphh- 5>*B*CJaJphhl5>*B*CJaJphO[wiadczam, |e wypeBniBem obowizki informacyjne przewidziane w art. 13 lub art. 14 RODO1) wobec osb fizycznych, od ktrych dane osobowe bezpo[rednio lub po[rednio pozyskaBem w celu ubiegania si o udzielenie zamwienia publicznego w niniejszym postpowaniu2) ________________________ Wyja[nienia: 1) rozporzdzenie Parlamentu Europejskiego i Rady (UE) 2016/679 zdnia 27 kwietnia 2016 r. w sprawie ochrony osb fizycznych w zwizku z przetwarzaniem danych osobowych i w sprawie swobodnego przepBywu takich danych oraz uchylenia dyrektywy 95/46/WE (oglne rozporzdzenie o ochronie danych) (Dz. Urz. UE L 119 z 04.05.2016, str. 1). 2) W przypadku gdy wykonawca nie przekazuje danych osobowych innych ni| bezpo[rednio jego dotyczcych lub zachodzi wyBczenie stosowania obowizku informacyjnego, stosownie do art. 13 ust. 4 lub art. 14 ust. 5 RODO tre[ci o[wiadczenia wykonawca nie skBada (usunicie tre[ci o[wiadczenia np. przez jego wykre[lenie). Pouczenie: Formularz oferty stanowi integraln cz[ Specyfikacji, jego wypeBnienie stanowi warunek formalny stawiany oferentom. Formularz musi by wypeBniony czytelnie w jzyku polskim i podpisany przez osob uprawnion. 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