ࡱ> 36012o\bjbj[i[i9\9\ 8l\8FXXL r!4!EEEEEEE$TH KNEE! "!!EE'''!jE'!E''98>WP@,"=sEF08F>XK,"XK(>>8XK>!!'!!!!!EE$!!!8F!!!!XK!!!!!!!!!R j: O Z W I A D C Z E N I E Nazwa i adres podmiotuDotyczy postpowania: Nazwa nadana zamwieniu przez zamawiajcego: Budowa budynku mieszkalnego kontenerowego na dz. nr ewid. 2005 w Trzcianie Numer referencyjny nadany sprawie przez zamawiajcego: RGI.271.25.2024 ZaBcznik nr 3 do SWZ  OZWIADCZENIE PODMIOTU 1. Informacje na temat podmiotu na zasoby ktrego wykonawca powoBuje si w celu wykazania speBnienia warunkw udziaBu w postpowaniu: Podmiot reprezentowany jest przez:Imi i nazwisko:Stanowisko/podstawa do reprezentacji: 2. O[wiadczenia: W imieniu reprezentowanego przeze mnie podmiotu, niniejszym  zgodnie z wymogami art. 125 ust. 5 ustawy z dnia 11 wrze[nia 2019 r. - Prawo zamwieD publicznych zwanej dalej w skrcie  ustaw o[wiadczam, |e: podmiot ten (odpowiednie zaznaczy - w puste pole wpisa znak  X ): jako podmiot udostpniajcy zasoby speBnia wszystkie warunki udziaBu w postpowaniu, o ktrych mowa w rozdz. VIII Specyfikacji Warunkw Zamwienia (SWZ) jako podmiot udostpniajcy zasoby speBnia warunki udziaBu w postpowaniu w zakresie jak ni|ejProsz wskaza zakres, w jakim podmiot udostpniajcy zasoby speBnia warunki udziaBu w postpowaniu (w puste pole nale|y wpisa odpowiednio: pkt: 1; 1  jedna robota; 2; 2  jedna osoba)Lp.:Zakres:pkt1rozdz. VIIISWZ2rozdz. VIIISWZ oraz |e (odpowiednie zaznaczy - w puste pole wpisa znak  X ): podmiot ten nie podlega wykluczeniu z postpowania na podstawie art. 108 ust. 1 ustawy wykonawca ten nie podlega wykluczeniu z postpowania na podstawie art. 109 ust. 1 pkt 4, 5, 6, 7 ustawy podmiot ten nie podlega wykluczeniu z postpowania na podstawie 7 ust. 1 ustawy z dnia 13 kwietnia 2022 r. o szczeglnych rozwizaniach w zakresie przeciwdziaBania wspieraniu agresji na Ukrain oraz sBu|cych ochronie bezpieczeDstwa narodowego w stosunku do podmiotu24<FHXhjlnp˻yg\SH@H4h h]G5OJQJhzfOJQJhU|h]GOJQJhrB5OJQJhrBhrBOJQJ"h+&h6CJOJQJ\aJh 6CJOJQJ\aJ"h+&h8^6CJOJQJ\aJh8^6CJOJQJ\aJ"h+&h+&6CJOJQJ\aJh.Lh6CJOJQJaJ$h.LhCJ$OJQJaJ$mHsHh.LhCJ$OJQJaJ$$h.LhCJOJQJaJmHsH468:6kd$$IfF40M#`e t 6`0644 lap ytrB$&`#$/IfgdrB$$&`#$/Ifa$gdrB$$&`#$/Ifa$gdrB:<jlnJ7$$&`#$/Ifa$gdrBkd$$IfF40M# e t 6`0644 lap ytrB$$&`#$/Ifa$gd+&$$&`#$/Ifa$gdrBnp lY$$&`#$/Ifa$gdn0$$&`#$/Ifa$gdi}$$&`#$/Ifa$gd]Glkd|$$IfF#$ 6`064 FaytrB     6 8 : ŷwhVKVh?/hh{'5CJOJQJaJhh5OJQJhR]5OJQJ^J#hmW5hR]5CJOJQJ^JaJhR]5CJOJQJ^JaJhrB5OJQJhrBhrBOJQJhR]h]G5OJQJhE~~5OJQJ^Jhi}5OJQJ^JhR]OJQJ^Jh h]G5OJQJ^Jhi}hi}OJQJ]^Jh">hi}OJQJ]^Jh|Uhg5OJQJ\^Jh|Uh]G5OJQJ^J 8 : F H J }xc$$&`#$/Ifa$gd5@gd\$a$gd gd $a$gdlkd#$$IfF#$ 6`064 FaytrB: < @ h v x z B D F H J X ƹƭƛ~seWNB7h h5@OJQJh h5@OJQJ]h\5OJQJh h\5OJQJ\h h5@5OJQJ\h 5OJQJ\h5CJOJQJaJhh 5CJOJQJaJhd(5OJQJhZ}5OJQJh h 5OJQJh h OJQJ^Jh 5OJQJhVhJ5OJQJhVh{'5OJQJhVhy5OJQJhVh]p"5OJQJ {{$$&`#$/Ifa$gd5@nkd$$IfF## 6`0#64 Fayt5@   nYY$$&`#$/Ifa$gd5@kdY$$IfFJ0C # s  6` 0#64 Fap yt5@     . 0 2 ~ *.VXnȼ~sksc[scSh24OJQJhE~~OJQJh+&OJQJhUNOJQJhhOJQJhOJQJh;OJQJh8eh24OJQJh OJQJh24h24CJOJQJaJhVh'5OJQJhVhJ5OJQJhh'CJOJQJaJhzhz<h h5@OJQJh h5@OJQJ]h5@5OJQJ  . 0 ni__QQQ $]a$gd24 $a$gd'gdzkd)$$IfFJ0C # s  6` 0#64 Fap yt5@,DNPRTVXZ\^`<DȼȼȼȼȰިtttlt镠tdYhEh5OJQJh5OJQJh58OJQJhEhEOJQJh85h5OJQJh h OJQJh85hEOJQJhEOJQJhOJQJh*h246OJQJhl~h246OJQJh246OJQJh246CJOJQJaJh8eh24OJQJh OJQJhX!h24CJOJQJaJ"\^`$$If]a$gd $$If]^a$gd  $]a$gdE$ & F ]^`a$gdZxjP@$$If]a$gd $ s$If]^a$gd  $]a$gdEkd$$IfF0" t0644 lapyt85.X\hj$t>FJ̳̾̾~pb~SKKhE~~OJQJhEhE56OJQJ]h1#h1#6OJQJ]h1#h6OJQJ]h1#hUN6OJQJ]h1#hE6OJQJ]h56OJQJ]h h 6OJQJ]h 6OJQJ]h5h56OJQJ]hEhE6OJQJ]hEhEOJQJh5OJQJhEh5OJQJh OJQJZ\m$$If]a$gdkd$$IfF0" t0!644 layt n$$If]a$gd\j$$If]a$gd+&lkd$$IfF"! t0!644 layt5nnnn$$If]a$gd\j~kd($$IfF40" t0!644 layt+&*$$If]a$gd\jkd$$IfF4m\O"I J J  t(0!644 lap(yt85 "*,04kd$$IfFt\O"I J J t0!644 lap(yt5$$If]a$gd\j0HJRT4kd $$IfFl\O"I J J t0!644 lap(yt5$$If]a$gd\jJLTVdf~<>ѹ|qfOfGhE~~OJQJ,h85hE~~CJOJPJQJ^JaJnH tH h85hE~~OJQJh585OJQJ^J,h85hCJOJPJQJ^JaJnH tH h OJQJh85hOJQJhZ}h OJQJh24OJQJh*h246OJQJhl~h246OJQJh246OJQJhphh24OJQJh\jOJQJhEh5OJQJhZ}OJQJTV-kdo $$IfF0" t0644 lapyt85$$If]a$gd85$$If]a$gd85$ & F ]^`a$gdZ} $]a$gdE`bdFkdL $$IfF0" t0644 lapytX$$If]a$gdX$$If]a$gdX $]a$gd58^bdfLNPRnNNNNNNNNNǰǙLj}rjh[M[M[MBrhD >6OJQJ^Jh85h:6OJQJ^Jh85h:OJQJ^JUh OJQJh85h:OJQJhn05OJQJ^J!h0qh58B* OJQJ^Jph `-h58h58OJPJQJ^Jeh@r@,h58h58CJOJPJQJ^JaJnH tH h58h58OJQJ^Jh58h58OJQJhE~~5OJQJ^Jh85hE~~OJQJh(hE~~OJQJdfNPRT>$7]^7`a$gd24kd) $$IfF0" t0644 lapyt|U$$If]a$gd|U$$If]a$gd|URTPO&P(P*P,PQkd $$IfF4/0"` t0644 lapyt85$$If]a$gd85$$If]a$gd85 zachodz podstawy wykluczenia z postpowania na podstawie art. 108 ust. 1 pkt & & & & .* ustawy, a w pozostaBym zakresie podmiot nie podlega wykluczeniu z postpowania *poda majc zastosowanie podstaw wykluczenia spo[rd wymienionych w art. 108 ust. 1 pkt 1, 2 i 5 ustawyjednocze[nie o[wiadczam, |e w zwizku z ww. okoliczno[ci, na podstawie art. 110 ust. 2 ustawy jak wy|ej podmiot podjB nastpujce czynno[ci:Opis/ dowody podjtych czynno[ci do wykazania rzetelno[ci podmiotu  w stosunku do wykonawcy zachodz podstawy wykluczenia z postpowania na podstawie art. 109 ust. 1 pkt & & & & .* ustawy jak wy|ej, a w pozostaBym zakresie wykonawca nie podlega wykluczeniu z postpowania *poda majc zastosowanie podstaw wykluczenia spo[rd wymienionych w art. art. 109 ust. 1 pkt 4, 5, 6, 7jednocze[nie o[wiadczam, |e w zwizku z ww. okoliczno[ciami, na podstawie art. 110 ust. 2 ustawy podjBem nastpujce czynno[ci:Opis/ dowody podjtych czynno[ci do wykazania rzetelno[ci wykonawcy  O[wiadczam, |e wszystkie informacje podane w powy|szych o[wiadczeniach s aktualne i zgodne z prawd oraz zostaBy przedstawione z peBn [wiadomo[ci konsekwencji wprowadzenia zamawiajcego w bBd przy przedstawianiu informacji. Miejscowo[ i data: ...................................................................................................................................... [kwalifikowany podpis elektroniczny, podpis zaufany lub podpis osobisty osoby (osb uprawnionej(ych) do skBadania o[wiadczeD woli w zakresie praw i obowizkw majtkowych podmiotu]     O[wiadczenie  znak sprawy: RGI.271.25.2024 str.  PAGE \* MERGEFORMAT 3 z  NUMPAGES \* MERGEFORMAT 3Gmina Zwilcza, 36-072 Zwilcza 168 GMINA ZWILCZA str.  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