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Nazwa Wykonawcy ................................................................ Adres Wykonawcy ............................................................... Wykaz osb skierowanych przez wykonawc do realizacji zamwienia (rozdziaB VI pkt 2 ppkt 4 lit. b SWZ) oraz informacja o podstawie do dysponowania tymi osobami w postpowaniu pn.  Modernizacja drg oraz modernizacja i budowa chodnikw na terenie Gminy Borek Wlkp. - etap I. L.p.Zakres wykonywanych czynno[ci / Imi i nazwiskoOpis posiadanych kwalifikacji zawodowych (data uzyskania uprawnieD, nr, opis uprawnieD)Podstawa do dysponowania osob1.2.3.4.  UWAGA!!! WYPEANIONY DOKUMENT NALE{Y PODPISA KWALIFIKOWANYM PODPISEM ELEKTRONICZNYM, PODPISEM ZAUFANYM LUB PODPISEM OSOBISTYM Zamawiajcy zaleca zapisanie dokumentu w formacie PDF.  Nale|y precyzyjnie okre[li podstaw do dysponowania wskazan osoba, tj. np. pracownik wBasny (umowa o prac), umowa zlecenie, umowa o dzieBo, czy jest to pracownik oddany do dyspozycji przez inny podmiot. 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