ࡱ> q0bjbjzLzL8@&\&\g vvvvv84,Q<"""DDDxxx Q Q Q Q Q Q QSV Qivxxxxx QvvDD4vQxjvDvD Qx QISND@өsK,PQ0QK0W0WXSN0WvSNxxxxxxx Q QxxxQxxxx0Wxxxxxxxxx R <:DO ZAMAWIAJCEGO: Gmina Jerzmanowa ul. Lipowa 4 67-222 Jerzmanowa ZOBOWIZANIE PODMIOTU TRZECIEGO DO ODDANIA DO DYSPOZYCJI NIEZBDNYCH ZASOBW NA OKRES KORZYSTANIA Z NICH PRZY WYKONANIU ZAMWIENIA w postpowaniu o udzielenie zamwienia publicznego na zadanie pn: Utworzenie Centrum Integracji SpoBecznej w Potoczku w formule zaprojektuj i wybuduj. DziaBajc w imieniu i na rzecz: ....................................................................................................................................................................... ....................................................................................................................................................................... (PeBna nazwa podmiotu udostpniajcego zasoby) Ubiegajc si o udzielenie zamwienia publicznego O[wiadczam, stosownie do art. 118 ustawy Pzp, |e oddaj Wykonawcy: ....................................................................................................................................................................... ....................................................................................................................................................................... (nazwa i adres Wykonawcy skBadajcego ofert) do dyspozycji niezbdne zasoby na potrzeby realizacji zamwienia publicznego. Zakres naszego udziaBu przy wykonywaniu zamwienia publicznego: ....................................................................................................................................................................... ....................................................................................................................................................................... Sposb i okres udostpnienia Wykonawcy i wykorzystania ww. zasobw przez Wykonawc przy wykonywaniu zamwienia publicznego: ....................................................................................................................................................................... ....................................................................................................................................................................... O[wiadczam$ " ( 2   ʼ~o`N?N?2h#.h OJQJ^Jh? 5CJ OJQJ^JaJ #h? h? 5CJ OJQJ^JaJ h#.hp~0JOJQJ^Jh#.h0JOJQJ^Jh#.h5OJQJ^Jh#.h 0J5OJQJ^Jh#.h,0J5OJQJ^Jh#.h0J5OJQJ^Jh#.h+5OJQJ^J7h#.h+B*CJOJQJ\^JaJhnH phtH 2h#.h+5B*OJQJ\^JhnH phtH $F`"   T hB $dha$gd $dha$gd $dha$gd? $dha$gd $dha$gdKnY y7$8$H$^ygd+ fht LNb"# #"#$#~###4&6&&Z(ϴϧϙϧϧόϧϧϊϧzϧϧlh#.hNvA5OJQJ^Jh#.h 5H*OJQJ^JUh#.hGOJQJ^Jh#.h 6OJQJ^Jh#.hNvAOJQJ^Jh#.h(OJQJ^Jh#.h 5OJQJ^Jh#.h OJQJ^J h#.h CJOJQJ^JaJ#h#.h 6CJOJQJ^JaJ$`LN"#$##$4&6&&&Z(\(^(((($  &#7^7a$gds$a$gdt; $dha$gd $dha$gdNvA $dha$gd , i| w odniesieniu do warunkw udziaBu w postpowaniu dotyczcych do[wiadczenia, bdziemy realizowa usBugi, ktrych wskazane zdolno[ci dotycz. Charakter stosunku, jaki bdzie BczyB nas z Wykonawc: ....................................................................................................................................................................... ....................................................................................................................................................................... OZWIADCZENIE DOTYCZCE PODANYCH INFORMACJI: 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. & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ... & & ...& & & & & & & & & & & & & & kwalifikowany podpis elektroniczny, podpis zaufany lub podpis osobisty osoby/ osb/ upowa|nionej/ych & & & & & & & & ...& & dnia & & & & & & & .. miejscowo[ Zobowizanie podmiotu trzeciego musi by podpisane przez osob/y upowa|nion/e do reprezentowania podmiotu trzeciego zgodnie z wpisem do KRS, wpisem do CEIDG lub umow spBki albo przez osob/y posiadajc/e peBnomocnictwo, ktre Wykonawca zobowizany jest doBczy do oferty. Zgodnie z zapisami SWZ i ustawy Pzp, zobowizanie wypeBnia podmiot trzeci w przypadku, gdy Wykonawca polega na jego zasobach w celu wykazania speBniania warunkw udziaBu w postpowaniu. _____________________________________ * niepotrzebne skre[li      Znak sprawy: ZPR-I..271.4.2024 ZAACZNIK NR 6 do SWZ ___________________________________________________________________________________ PAGE  PAGE 2 Z(\(^((((((((((())*ƹuh[I7I#h#.h(6CJOJQJ^JaJ#h#.hW6CJOJQJ^JaJh#.hWOJQJ^Jh#.hmOJQJ^Jh#.hKnYOJQJ^J(h#.hqCJOJQJ^JaJnHtH(h#.hb\CJOJQJ^JaJnHtHh#.h~OJQJ^Jh#.ht;OJQJ^Jh#.hsOJQJ^Jh#.hWOK0JOJQJ^Jh#.ht;0JOJQJ^Jh#.h 0JOJQJ^J(((((((Z))**n*H+J+L+$W]^`Wa$gd? 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