ࡱ> psmnocmbjbjNN7|$i$iBN#^#n#n#n####8#|6$#a$$$$$0&F& R&k`m`m`m`m`m`m`cfZm`Qn#Z&0&0&Z&Z&m`n#n#$$H`)))Z&n#$n#$k`)Z&k`))#P4#U$jc0'"WR4W``0aR g4'H gh#U#UX gn#{V Z&Z&)Z&Z&Z&Z&Z&m`m`|(Z&Z&Z&aZ&Z&Z&Z& gZ&Z&Z&Z&Z&Z&Z&Z&Z&d ":Wykonawca: & & & & & & & & & & & & & & & & & & & & & & & & & & & & (peBna nazwa/firma, adres, w zale|no[ci od podmiotu: NIP/PESEL, KRS/CEiDG) reprezentowany przez: & & & & & & & & & & & & & & & & & & & & & & & & & & & & (imi, nazwisko, stanowisko/podstawa do reprezentacji) Zamawiajcy: Wojewdzka Stacja Sanitarno-Epidemiologiczna ul. Kazimierza JagielloDczyka 8B 66-400 Gorzw Wlkp. FORMULARZ OFERTOWY Nawizujc do ogBoszenia o zamwieniu w postepowaniu o udzielenie zamwienia publicznego na dostaw sprztu laboratoryjnego skBadamy nastpujc ofert: Dane Wykonawcy: Nazwa (firma): & & & & & & & & & & .. Siedziba: & & & & & & & & & & .. Numer telefonu Numer fax & & & & & & & & & & & & . E-mail & & & & & & & & & & & & . Numer REGON Numer NIP& & & & & & & & & & & & . (w przypadku skBadania oferty przez podmioty wystpujce wsplnie prosz poda nazwy(firmy) i adresy wszystkich wsplnikw spBki cywilnej lub czBonkw konsorcjum) CZZ I - dostawa chromatografu gazowego dwukanaBowego ze spektrometrem mas typu potrjny kwadrupol (GC/MS/MS) Warto[ oferty: Oferujemy wykonanie przedmiotu zamwienia w peBnym zakresie rzeczowym i na warunkach okre[lonych w SWZ za cen oraz z uwzgldnieniem nastpujcych warto[ci: 1.Warto[ netto (w PLN)& & & & & & & & zB2.Warto[ brutto (w PLN)& & & & & & & & zB3.Okres gwarancji (wymg formalny 24 miesice)& & & & & & & & m-cy4.Nazwa urzdzenia (producent, typ i model) & & .& & & & & & & & & & & & & & & & & & & &  CZZ II - dostawa zestawu do analizy wstrzykowo-przepBywowej FIA Warto[ oferty: Oferujemy wykonanie przedmiotu zamwienia w peBnym zakresie rzeczowym i na warunkach okre[lonych w SWZ za cen oraz z uwzgldnieniem nastpujcych warto[ci: 1.Warto[ netto (w PLN)& & & & & & & & zB2.Warto[ brutto (w PLN)& & & & & & & & zB3.Okres gwarancji (wymg formalny - 12 miesicy)& & & & & & & & m-cy4.Nazwa urzdzenia (producent, typ i model) & & .& & & & & & & & & & & & & & & & & & & & UWAGA! W przypadku skBadania oferty tylko na 1 cz[ postpowania Wykonawca usunie tabel dotyczc cz[ci na ktr nie skBada oferty. Zamawiajcy wymaga, aby zamwienie zostaBo zrealizowane najpzniej do dnia 17 grudnia 2024 r. O[wiadczam, |e podmiot, ktry reprezentuj, to: (wBa[ciwe zaznaczy  X ) mikroprzedsibiorstwo*[ ] Tak [ ] Nie maBe przedsibiorstwo*[ ] Tak [ ] Nie [rednie przedsibiorstwo*[ ] Tak [ ] Nie jednoosobowa dziaBalno[ gospodarcza[ ] Tak [ ] Nie *w rozumieniu Ustawy z dnia 6 marca 2018 r. Prawo Przedsibiorcw O[wiadczenie: O[wiadczamy, |e: Zapoznali[my si z SWZ wraz z zaBcznikami i uznajemy si za zwizanych ich zapisami. Akceptujemy warunki realizacji zamwienia okre[lone przez Zamawiajcego w SWZ. Uwa|amy si za zwizanych niniejsz ofert na czas wskazany w dokumentacji przetargowej (SWZ). O[wiadczam, |e oferta nie zawiera/ zawiera (wBa[ciwe podkre[li) informacji stanowicych tajemnic przedsibiorstwa w rozumieniu ustawy z dnia 16 kwietnia 1993 r. o zwalczaniu nieuczciwej konkurencji. 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