ࡱ> ^`YZ[\]5@0(Lbjbj22+GXXjjjjkkk2k:::8rtt2k/xfffffDDD///////$E5R76/QkD@DD6/jjff/hhhDj8fkf/hD/hhzJ 6kkD$fZ `bK:r./0/L1818D$2k2kjjjjD$018kt&hDDD6/6/2k2kւdd2k2kւZaBcznik nr 3 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o przynale|no[ci lub braku przynale|no[ci do tej samej grupy kapitaBowej w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: ZAKUP SPRZTU DO TELEREHABILITACJI KARDIOLOGICZNEJ (REHABILITACJI HYBRYDOWEJ) WRAZ Z OPROGRAMOWANIEM  SYSTEMEM TELEMEDYCZNYM . (Nr sprawy: D10.251.56.C.2019) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e Wykonawca, ktrego reprezentuj(my)*: % Nie przynale|y do tej samej grupy kapitaBowej, wrozumieniu ustawy z dnia 16 lutego 2007 r. o ochronie konkurencji i konsumentw (t.j. Dz. U. Nr 50 poz. 331 z pzn. zm.) z innymi Wykonawcami, wskazanymi w informacji zamieszczonej przez Zamawiajcego na podstawie art. 86 ust. 5 ustawy Pzp na jego stronie internetowej % Przynale|y do tej samej grupy kapitaBowej, wrozumieniu ustawy z dnia 16 lutego 2007 r. o ochronie konkurencji i konsumentw (t.j. Dz. U. Nr 50 poz. 331 z pzn. zm.) z innymi Wykonawcami (podanymi przez nas ni|ej), wskazanymi w informacji zamieszczonej przez Zamawiajcego na podstawie art. 86 ust. 5 ustawy Pzp na jego stronie internetowej ......................................... ......................................... ......................................... & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 4 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o braku podstaw do wykluczenia dot. braku wyroku lub decyzji w sprawie zalegania z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: ZAKUP SPRZTU DO TELEREHABILITACJI KARDIOLOGICZNEJ (REHABILITACJI HYBRYDOWEJ) WRAZ Z OPROGRAMOWANIEM  SYSTEMEM TELEMEDYCZNYM . (Nr sprawy: D10.251.56.C.2019) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e wobec Wykonawcy, ktrego reprezentuj(my)*: % Nie zostaB wydany prawomocny wyrok sdu lub ostateczna decyzja administracyjna o zaleganiu z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne % ZostaB wydany prawomocny wyrok sdu lub ostateczna decyzja administracyjna o zaleganiu z uiszczaniem podatkw, opBat lub skBadek na ubezpieczenia spoBeczne lub zdrowotne, ale dokonano pBatno[ci tych nale|no[ci wraz z ewentualnymi odsetkami lub grzywnami lub zawar d f r d f nR@1@h!n5CJOJQJ^JaJ#hjhj5CJOJQJ^JaJ6htht5;B*CJOJPJQJ\^JaJph hthtCJOJQJ^JaJ*htht5CJOJPJQJ\^JaJ*htht5CJOJPJQJ\^JaJ*htht5CJOJPJQJ\^JaJ-htht@B*CJOJQJ^JaJph hthtCJOJQJ^JaJ,htht5>*CJOJQJ\]^JaJ  " f h j $da$gd!n$d*$7$8$H$a$gdol$d*$7$8$H$a$gd!n$a$gdt $*$7$a$gdt$d*$7$a$gdtgdt $da$gdt $da$gdtFH"L&Lf h j l  ͸xXC2 hthtCJOJQJ^JaJ)hthtB*CJOJQJ^JaJph?htht5B*CJKHOJPJQJ\^JaJnHphtH)hthtB*CJOJQJ^JaJph&h!n5;>*CJOJQJ\^JaJ,htht5;>*CJOJQJ\^JaJ)htht5;CJOJQJ\^JaJ?holhj5B*CJKHOJPJQJ\^JaJnHphtH#hjhol5CJOJQJ^JaJ   n|FH & Fgdtgdt $a$gdt $7$a$gdt $a$gdt&dPgdt$ -DM a$gdt Z 0DFѾwdNwdN<3hthtCJ#hthtCJOJQJ\^JaJ*htht5CJOJPJQJ\^JaJ$hthtCJOJPJQJ^JaJ#htht5CJOJQJ^JaJ#htht5CJOJQJ^JaJ#htht5CJOJQJ^JaJ hthtCJOJQJ^JaJ$htht0J\CJOJQJ^JaJ-htht@B*CJOJQJ^JaJph-htht@B*CJOJQJ^JaJphHJLNPRTVXZx$&Vtvx$d*$7$8$H$a$gd!n$a$gd!n $*$7$a$gdt $da$gdt $a$gdtgdtFLXZv"TVZlV@.#htht5CJOJQJ^JaJ*htht5CJOJPJQJ\^JaJ*htht5CJOJPJQJ\^JaJ*htht5CJOJPJQJ\^JaJ-htht@B*CJOJQJ^JaJph hthtCJOJQJ^JaJ,htht5>*CJOJQJ\]^JaJ,hthI}5>*CJOJQJ\]^JaJ&hI}5>*CJOJQJ\]^JaJ&ht5>*CJOJQJ\]^JaJ rtrvxzǶdO8$8&h!n5;>*CJOJQJ\^JaJ,hth!n5;>*CJOJQJ\^JaJ)hth!n5;CJOJQJ\^JaJ?holh!n5B*CJKHOJPJQJ\^JaJnHphtHh!n5CJOJQJ^JaJ#hjh!n5CJOJQJ^JaJ h!nhjCJOJQJ^JaJ hthtCJOJQJ^JaJ#htht5CJOJQJ^JaJ#htht5CJOJQJ^JaJ'htht5CJOJPJQJ^JaJ x ,.6667 $a$gdt$ 7$a$gdt $7$a$gdt $a$gdt&dPgdt$ -DM a$gdt$da$gdt$da$gd!n .vRӾlZHZ4'htht5CJOJPJQJ^JaJ#htht5CJOJQJ^JaJ#htht5CJOJQJ^JaJ$htht0J\CJOJQJ^JaJ-htht@B*CJOJQJ^JaJph-htht@B*CJOJQJ^JaJph hthtCJOJQJ^JaJ)hthtB*CJOJQJ^JaJph,htht5;>*CJOJQJ\^JaJ)hth!nB*CJOJQJ^JaJph RT&jtv&66666|8888ǵ~gS?&hj5>*CJOJQJ\]^JaJ&ht5>*CJOJQJ\]^JaJ,htht5>*CJOJQJ\]^JaJ hthtCJOJQJ^JaJ htht0J\CJOJQJaJ$htht0J\CJOJQJ^JaJU#htht5CJOJQJ^JaJ#htht5CJOJQJ^JaJ'htht5CJOJPJQJ^JaJ$hthtCJOJPJQJ^JaJto wi|ce porozumienie w sprawie spBat tych nale|no[ci, co potwierdzaj zaBczone do niniejszego o[wiadczenia dokumenty** & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 5 .................................................. (piecz adresowa firmy Wykonawcy) O Z W I A D C Z E N I E o braku podstaw do wykluczenia dot. braku orzeczenia tytuBem [rodka zapobiegawczego zakazu ubiegania si o zamwienia publiczne w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie przetargu nieograniczonego pn.: ZAKUP SPRZTU DO TELEREHABILITACJI KARDIOLOGICZNEJ (REHABILITACJI HYBRYDOWEJ) WRAZ Z OPROGRAMOWANIEM  SYSTEMEM TELEMEDYCZNYM . (Nr sprawy: D10.251.56.C.2019) Bdc przedstawicielem(lami) Wykonawcy: (nazwa firmy) o[wiadczam(my), |e wobec Wykonawcy, ktrego reprezentuj(my) brak jest orzeczenia tytuBem [rodka zapobiegawczego zakazu ubiegania si o zamwienia publiczne. & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) ZaBcznik nr 7 NR SPRAWY: D10.251.56.C.2019 .................................................. (piecz adresowa firmy Wykonawcy) WYKAZ USAUG wykonanych, w okresie ostatnich 3 lat, przed upBywem terminu skBadania ofert, a je|eli okres prowadzenia dziaBalno[ci jest krtszy - w tym okresie Lp.Przedmiot dostawyWarto[ brutto usBugi (PLN)Nazwa i adres podmiotu, na rzecz, ktrego usBuga byBa lub jest wykonywanaData wykonania   UWAGA: Do wykazu nale|y zaBczy dowody potwierdzajce, |e wskazane powy|ej usBugi zostaBy wykonane nale|ycie lub s wykonywane nale|ycie. & ..& & & & & .& & & & & & ..................................................................... (miejscowo[ i data) (piecz i podpis upowa|nionego przedstawiciela Wykonawcy) * Zaznaczy wBa[ciwe * Zaznaczy wBa[ciwe ** Nale|y przedstawi Zamawiajcemu dokumenty potwierdzajce dokonanie pBatno[ci tych nale|no[ci wraz z ewentualnymi odsetkami lub grzywnami lub zawarcie wi|cego porozumienia w sprawie spBat tych nale|no[ci       COPERNICUS Podmiot Leczniczy Sp. z o.o. ul. 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