ࡱ>  cbjbjNN4~$i~$ih LL********85+ ,t*},},},},},-:-- nppppppxp]* .-- . .p**},},4111 .*},*},n1 .n11j},O0(bZ0Z\%0%8%*l) . .1 . . . . .pp1j . . . . . . .% . . . . . . . . .Lc ):ZaBcznik nr 1 do SWZ ZAMAWIAJCY: Gmina Zwiebodzin ul. Rynkowa 2 66-200 Zwiebodzin FORMULARZ OFERTOWY w postpowaniu o udzielenie zamwienia publicznego pn. Zwiadczenie usBug dowozu i odwozu uczniw do i ze szkB podstawowych na terenie Gminy Zwiebodzin w roku szkolnym 2024/2025  nr sprawy: ZP.271.20.2024 Nazwa Wykonawcy: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .& & & & & ...& & & & & & & & & .& ..& & ........ Adres Wykonawcy: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .& & & & & ...& & & & & & & & & .& ..& & ........ Wojewdztwo: & & & & & & & & ..& & . Numer NIP: & & & & & & & & & & & ...& . Numer REGON: & & & & & & & & & & & & Numer KRS/CEiDG: & & & & & ..& & & & & & ..& & (oglnodostpna i bezpBatna baza danych umo|liwiajca dostp do danych Krajowego Rejestru Sdowego, Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej lub innego wBa[ciwego rejestru znajduje si pod adresem internetowym: & & & & & & & & & & & & & .& & & & ..) Numer telefonu: & & & & ..& & & & & ...& ..& Adres e-mail: & & & & & & & & & ...& & ..& & & Rodzaj Wykonawcy: % mikroprzedsibiorstwo (przedsibiorstwo, ktre zatrudnia mniej ni| 10 osb i ktrego roczny obrt lub roczna suma bilansowa nie przekracza 2 milionw euro) % maBe przedsibiorstwo (przedsibiorstwo, ktre zatrudnia mniej ni| 50 osb i ktrego roczny obrt lub roczna suma bilansowa nie przekracza 10 milionw euro) % [rednie przedsibiorstwo (przedsibiorstwa, ktre nie s mikroprzedsibiorstwami ani maBymi przedsibiorstwami i ktre zatrudniaj mniej ni| 250 osb i ktrych roczny obrt nie przekracza 50 milionw euro lub roczna suma bilansowa nie przekracza 43 milionw) % jednoosobowa dziaBalno[ gospodarcza % osoba fizyczna nieprowadzca dziaBalno[ci gospodarczej % inny rodzaj (wBa[ciwe zaznaczy) UpeBnomocniony przedstawiciel: & & & & & & & & & & & & & & & & .................................................................. UWAGA: W przypadku gdy ofert skBadaj Wykonawcy wsplnie ubiegajcy si o zamwienie powy|sze informacje nale|y poda dla ka|dego z tych Wykonawcw oraz wskaza peBnomocnika (lidera) do reprezentowania ich w postpowaniu o udzielenie niniejszego zamwienia Przystpujc do postpowania o udzielenie zamwienia publicznego  nr sprawy: ZP.271.20.2024, prowadzonego w trybie podstawowym pn. Zwiadczenie usBug dowozu i odwozu uczniw do i ze szkB podstawowych na terenie Gminy Zwiebodzin w roku szkolnym 2024/2025, oferuj wykonanie przedmiotu zamwienia zgodnie z wymogami Specyfikacji Warunkw Zamwienia, zwanej dalej  SWZ , za cen brutto w wysoko[ci: ......................................................... zB*, w tym nale|ny .& .% podatek VAT, zgodnie z poni|sz tabel cenow: TABELA CENOWA: Lp.OdlegBo[ w kilometrachCena brutto biletu miesicznegoLiczba doje|d|ajcych uczniwWarto[ brutto (kol. 3 x kol. 4)Warto[ brutto ogBem w przeliczeniu na 10 miesicy (kol. 5 x 10 m-cy)1234561.0-94642.10-2561RAZEM:525 Zobowizuj si do podstawienia pojazdu zastpczego w sytuacjach awaryjnych w czasie do: .................. minut* * Cena oferty (pkt 1) i Czas podstawienia pojazdu zastpczego w sytuacjach awaryjnych (pkt 2) podlegajce ocenie O[wiadczam, |e zapoznaBem si ze SWZ wraz z wprowadzonymi do niej zmianami (w przypadku wprowadzenia ich przez Zamawiajcego), nie wnosz do niej |adnych zastrze|eD oraz zdobyBem konieczne informacje, potrzebne do wBa[ciwego przygotowania oferty. O[wiadczam, |e speBniam wszystkie wymagania zawarte w SWZ. O[wiadczam, |e uwa|am si za zwizanego niniejsz ofert przez czas wskazany w SWZ. Zobowizuj si do wykonania przedmiotu zamwienia w terminie od dnia 2 wrze[nia 2024 r. do dnia 27 czerwca 2025 r. O[wiadczam, |e w celu wykazania speBniania warunku udziaBu w postpowaniu polegam na zdolno[ciach technicznych lub zawodowych nw. Podmiotu udostpniajcego te zasoby: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ..& & & & & & & & .& & & & & & ...& & & & .......(nazwa (firma) Podmiotu udostpniajcego zasoby, adres, NIP, KRS/CEiDG - oglnodostpna i bezpBatna baza danych umo|liwiajca dostp do danych Krajowego Rejestru Sdowego, Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej lub innego wBa[ciwego rejestru znajduje si pod adresem internetowym: & & & & & & & & & & & & & & & & & & & & & ..), na potwierdzenie speBniania warunku okre[lonego w pkt 1.4. lit. & ROZDZIAAU VI. 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(nazwa (firma) Podmiotu udostpniajcego zasoby, adres, NIP, KRS/CEiDG - oglnodostpna i bezpBatna baza danych umo|liwiajca dostp do danych Krajowego Rejestru Sdowego, Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej lub innego wBa[ciwego rejestru znajduje si pod adresem internetowym: & & & & & & & & & & & & & & & & & & & & & ..), na potwierdzenie speBniania warunku okre[lonego w pkt 1.4. lit. & ROZDZIAAU VI. SWZ (nale|y poda odpowiedni nr warunku). O[wiadczam, |e podmioty, spo[rd ww., na zdolno[ciach ktrych polegam w zakresie wyksztaBcenia, kwalifikacji zawodowych lub do[wiadczenia zrealizuj usBugi w ramach niniejszego przedmiotu zamwienia. O[wiadczam, |e nie wpisanie w pkt 7 podmiotu udostpniajcego zasoby oznacza, |e nie polegam na zdolno[ciach technicznych lub zawodowych innych podmiotw. O[wiadczam, |e zamwienie wykonam przy udziale nw. Podwykonawcy: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ....& ...& & & & & .............................& & ..& & . (nazwa (firma) Podwykonawcy, adres, NIP, KRS/CEiDG - oglnodostpna i bezpBatna baza danych umo|liwiajca dostp do danych Krajowego Rejestru Sdowego, Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej lub innego wBa[ciwego rejestru znajduje si pod adresem internetowym: & & & & & & & & & & & & & & & & & & & & ..), ktremu powierz wykonanie nastpujcej cz[ci zamwienia: .......................................................................................................................................................................................... & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ....& ...& & & & & ........& & & & & & ...& ..& & . (nazwa (firma) Podwykonawcy, adres, NIP, KRS/CEiDG - oglnodostpna i bezpBatna baza danych umo|liwiajca dostp do danych Krajowego Rejestru Sdowego, Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej lub innego wBa[ciwego rejestru znajduje si pod adresem internetowym: & & & & & & & & & & & & & & & & & & & & ..), ktremu powierz wykonanie nastpujcej cz[ci zamwienia: .......................................................................................................................................................................................... O[wiadczam, |e nie wpisanie w pkt 8 podwykonawcw oznacza, |e zamwienie wykonam bez udziaBu podwykonawcw. Wynagrodzenie prosz przekazywa na konto nr: & & & ...............................................................................& & .& ..& & . W przypadku wyboru mojej oferty, osob odpowiedzialn do kontaktw zZamawiajcym bdzie: & & & & & .........................& .....& .....& & , tel. & & & & ..& ....& ..& & .., e-mail: .............................................................. . O[wiadczam, |e zawarte w SWZ: Wzr umowy, stanowicy zaBcznik nr 8 do SWZ oraz Wzr umowy powierzenia danych osobowych do przetwarzania, stanowicy zaBcznik nr 9 do SWZ zostaBy przeze mnie zaakceptowane i zobowizuj si w przypadku wyboru mojej oferty do zawarcia ww. umw na warunkach w nich okre[lonych, w miejscu i terminie wyznaczonym przez Zamawiajcego. O[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 sio udzielenie zamwienia publicznego w niniejszym postpowaniu*. 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). * Skre[li 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.      .&LbNbPfRfggiiiiva d*$G$^gdYN & F d*$G$^`gd7N$ Sl]l^a$gd8d d*$G$^gd8d $^a$gd8d d*$G$gd8d $7^7a$gdYN$ & F-7^7`a$gd8d bXccc(eVeXeZe\eeeeeeٱ٠xZ@&@2hQ h|5CJOJPJQJ\^JaJnHtH2hQ h7N5CJOJPJQJ\^JaJnHtH;hQ h7N5B*CJOJPJQJ\^JaJnHphtH,hQ h7NCJOJPJQJ^JaJnHtH hQ h7NCJOJQJ^JaJ hQ h7NCJOJQJ^JaJ,hQ h7N56CJOJQJ\]^JaJ h8d6CJOJQJ]^JaJ&hQ h7N6CJOJQJ]^JaJ#hQ h7N6CJOJQJ^JaJ eeeffLfNfPfRffdgfgжzmXA)A/h8dh8d>*CJOJPJQJ^JaJnHtH,h8dh8dCJOJPJQJ^JaJnHtH(h8dh7NCJ OJQJ^JaJ mHsHh9h8dOJQJ^J h8d6CJOJQJ]^JaJ&hrIh8d6CJOJQJ]^JaJ,h8d5CJOJPJQJ\^JaJnHtH2hQ h7N5CJOJPJQJ\^JaJnHtH,hQ h7NCJOJPJQJ^JaJnHtH/hQ h7N5CJOJPJQJ^JaJnHtH fgzg|gggggiiiiiiiiл禕rcSc@+(hQ hYNCJOJQJ^JaJmHsH$hQ h7NCJOJQJ^JmHsHhQ h7N5CJOJQJ^JhQ h7NCJOJQJ^J(h8dh8dCJOJQJ^JaJmHsHh8dCJOJQJ^JaJ h8dh8dCJOJQJ^JaJ(h8dh8dCJ OJQJ^JaJ mHsH)hZ5CJOJPJQJ^JaJnHtH,h8dh8dCJOJPJQJ^JaJnHtH/h8dh8d5CJOJPJQJ^JaJnHtHijj,jDjFjj~llllmnznnnnnoo$o&owwfUDffw hQ hYNCJOJQJ^JaJ hQ h!CJOJQJ^JaJ hQ hYNCJOJQJ^JaJhCJOJQJ^JaJ hQ h7NCJOJQJ^JaJ,hQ h7N56CJOJQJ\]^JaJ&hQ h7N6CJOJQJ]^JaJ#hQ h7N6CJOJQJ^JaJhQ CJOJQJ^JaJh8dCJOJQJ^JaJ hQ h7NCJOJQJ^JaJinn|s~sXtZtpuruFww[ & F d*$G$^`gdB d*$G$gd  & F d*$G$^`gdf$ Sl]l^a$gd8d$5$7$8$9DH$a$gdYN$75$7$8$9DH$^7a$gdYN$ & F.75$7$8$9DH$^7`a$gdYN &oo^qqqqrrVs|s~s6t8tRtXtZt(uٱpbpUD5hQ hgCJOJQJ^J hQ h8dCJOJQJ^JaJhTh8dOJQJ^Jh8dCJOJQJ^JaJ h8dh8dCJOJQJ^JaJ h8dheGCJ OJQJ^JaJ hCJOJQJ^JaJ hQ hYNCJOJQJ^JaJ hQ hYNCJOJQJ^JaJ,hQ hYN56CJOJQJ\]^JaJ&hQ hYN6CJOJQJ]^JaJ#hQ hYN6CJOJQJ^JaJ(uLujunupuru$v&vw6w@wDwFwHwwwrxxz zƳp_K_K_6)hQ h'B*CJOJQJ^JaJph&hfhf5CJOJQJ\^JaJ hfhfCJOJQJ^JaJ(hBh ^CJOJQJ^JaJmHsH$hBhBCJOJQJ^JmHsHhBCJOJQJ^JhBhBCJOJQJ^J$hghBCJOJQJ^JmHsH$hfhfCJOJQJ^JmHsHhfCJOJQJ^JhQ hgCJOJQJ^JhQ CJOJQJ^JFwHwz z(|*|~~w $a$gdJ? $a$gda@$7s^7`sa$gdFT $^a$gd0:$5$7$8$9DH$a$gdW$ & F5$7$8$9DH$^`a$gd0:$ & F *$1$^`a$gdf^gdg zzzH{&|(|*|2|:}<}P~R~~~HIJ}}kYG8hQ huCJOJQJaJ#hQ hu6CJOJQJ^JaJ#hQ hu6CJ OJQJ^JaJ #hQ hy 6CJOJQJ^JaJhQ 6CJOJQJ^JaJ#hQ hW6CJOJQJ^JaJ&hQ hW6CJH*OJQJ^JaJ#hQ hW6CJOJQJ^JaJ hQ h~CJOJQJ^JaJ+hQ hWCJH*OJQJ^JaJmHsH(hQ hWCJOJQJ^JaJmHsH ϾhK>hhWh1!j; h {h1CJU^JaJhGhqmhGCJOJQJaJ h#Yh#Yh.vjh.vUhyhJ?OJQJ  $a$gdJ?  p#n#gd1$a$gd*RX$a$gd#Y dgd}21h:p1. 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