ࡱ> +Wbjbj² IШDhШDh99999MMMMM7G4uuuuu   JFLFLFLFLFLFLF$kI!LBpF9& "& & pF99uu[F!!!& R9u9uJF!& JF!!@xzDuGx :B$6FG07G^BcLx FcLHzDzD\cL9D`& & !& & & & & pFpF F& & & 7G& & & & cL& & & & & & & & & c :GMINA ZRODA WIELKOPOLSKA Numer postpowania: IiZ.271.9.2022 ZaBcznik nr 1 do SWZ FORMULARZ OFERTOWY Wykonawca/Wykonawcy: peBna nazwa/firma:  Adres:  NIP lub REGON: w zale|no[ci od podmiotu KRS/CEiDG:UWAGA: w przypadku skBadania oferty przez podmioty wystpujce wsplnie powy|sze dane nale|y poda dla wszystkich wsplnikw spBki cywilnej lub czBonkw konsorcjum Reprezentowany/reprezentowani przez: imi:  nazwisko: podstawa doreprezentacji: Dane do kontaktu zwizane z postpowaniemtel.: e-mail: W odpowiedzi na ogBoszenie w postpowaniu o udzielenie zamwienia publicznego prowadzonego w trybie art. 275 pkt 1 ustawy p.z.p. pn.: Budowa sieci kanalizacji sanitarnej w ul. Za Strzelnic w Zrodzie Wielkopolskiej skBadam/y niniejsz ofert: C E N A O F E R T O W A: & & & & & & & & & & & & & . zB brutto w tym VAT ..& % SBownie zBotych:& & & & & & & & & & & & & & & & & & & & & & & & .& & & & & & & & & & & & & & & & & . OKRES RKOJMI I GWARANCJI: & & & & & . miesicy Zgodnie z zapisami i na warunkach okre[lonych w Rozdziale XX SWZ: nale|y wpisa licz miesicy okresu rkojmi i gwarancji (36 m-cy, lub 48 m-cy lub 60 m-cy)  Oferujemy wykonanie zamwienia w terminie zgodnym z SWZ. O[wiadczamy, |e zapoznali[my si ze SWZ i nie wnosimy do niej zastrze|eD oraz zdobyli[my wszystkie informacje niezbdne do przygotowania oferty. O[wiadczamy, |e uwa|amy si za zwizanych niniejsz ofert przez czas wykazany w SWZ. Akceptujemy postanowienia zawarte we wzorze umowy stanowicym zaBcznik nr 7 do SWZ i w przypadku wyboru naszej oferty zobowizujemy si do zawarcia umowy na warunkach w miejscu i terminie okre[lonym przez Zamawiajcego. O[wiadczamy, |e dokumenty zaBczone do oferty opisuj stan prawny i faktyczny, aktualny na dzieD skBadania oferty. O[wiadczamy, |e oferta: ZAWIERA / NIE ZAWIERA (niepotrzebne skre[li) informacj stanowice tajemnice przedsibiorstwa w rozumieniu przepisw o zwalczaniu nieuczciwej konkurencji. OZWIADCZAMY, |e w celu speBnienia warunkw udziaBu w postpowaniu (opisane w Rozdziale VIII SWZ) polegamy na zdolno[ciach innych podmiotw (je[li dotyczy): Nazwa i adres podmiotu Zasoby oddane do dyspozycji Wykonawcy OZWIADCZAMY, |e zamierzamy (niepot 246\^npxz| " 0 2 ^ ` ŴtcccUUh6/hlq5PJ^J_H !h6/hp?56PJ\^J_H h6/6PJ^J_H hVb6PJ^J_H h6/h+6PJ^J_H h6/hp?6PJ^J_H h8(5PJ\]^J_H !h6/hM5PJ\]^J_H h6/hPJ]^J_H h8(PJ]^J_H &hAhA5CJOJQJ\^JaJjhAUmHnHu462 ` 0 kd$If]kgdmkd$If]kgdc dgdm$Ld^La$gdm pd]pgdM p#gdAgdA ` r v     $ , . 0 2 8 @ z չիސyyy,h6/h'6B*CJOJQJ^JaJph4h6/hCr6B*CJOJQJ^JaJmHphsHj8h8(6PJU^Jjh8(6PJU^Jjh8(6PJU^Jh8(6PJ^Jh6/h8(6PJ^Jh8(5PJ^Jh6/h8(5PJ^J-0 2 | ~ ~pbP?$d$Ifa$gdckd$If]kgdc d]gd8( d]gdn=$ p#r^ra$gd)Gpkd$$IfF## t0644 lap ytcz | ~ " $ & ( 4 @ J z | ƸƪƢpbbpSbh8(PJ\^J_H mHsHh8(PJ^J_H mHsH h8(6PJ]^J_H mHsHh8(6]^Jh8(6\]^Jh8(CJ^JaJnHtHh8(PJ^Jjh8(6PJU^JjZh8(6PJU^Jh8(6PJ^Jh8(5PJ\^Jh?x5PJ\^J4h6/h'6B*CJOJQJ^JaJmHphsH $ & ( | r``NFdh$If]FgdcUd$If]Ugdchkd$$Ifl~#F# t0644 lBaytckd$If]kgdckd$If]kgdm rrd$Ifgdckd,$$Ifl40~#`YF t0644 lBaytc  rR;;;d$-DIfM gd}$ & F"d$7$If^"`a$gdDm$ d]gdn=kd$$Ifl40~#BF t0644 lBaytc    @ F L R n   RVX~ ó喀jjjj+hqh L5CJPJ^J_H aJnHtH+hqh|e5CJPJ^J_H aJnHtHh8(hlq5CJ\^JaJh715B*\^Jphh%fh%f5B*\^JphhDh%f5B*\^Jphh%fh"^Jh%fhM^Jh%fhlqPJ^J_H h6/h8(5PJ\^J% &(*,.02468:<>BFHLXZflnrtvxz~Ϲϣϣϣϊqq1hqh|e6CJPJ\]^J_H aJnHtH1hqh L6CJPJ\]^J_H aJnHtH+hqh$5CJPJ^J_H aJnHtH+hqhVb5CJPJ^J_H aJnHtH+hqh L5CJPJ^J_H aJnHtH4hqh L5B*CJPJ^J_H aJnHphtH,梋y#hqh|e5PJ^J_H nHtH,hqhlqB*PJ\^J_H nHphtH)h}h L6PJ\]^J_H nHtH1hqh L6CJPJ\]^J_H aJnHtH+hq6CJPJ\]^J_H aJnHtH1hqh|e6CJPJ\]^J_H aJnHtH&fw[[= 7d$-DIfM gd8(K$ 7d$-DIfM gd}pkd$IfK$L$F2%-% t0644 lap yt|ed$-DIfM gd}K$ .68<BDFHJNPTVdfj2@DFVZ\bdhjntvz~ӻ'hqh8(6CJOJPJQJ_H aJ/hqh8(6CJOJPJQJ_H aJnHtH+hqh8(5CJPJ^J_H aJnHtH+hqh L5CJPJ^J_H aJnHtH=  $&.04N\dhj:< "$.2>df~Ⱥ#hnChlq6PJ^J_H nHtH hnCh"PJ^J_H nHtH hnChlqPJ^J_H nHtHh8(PJ^J_H nHtHhnChlqPJ^J_H #h}h L5PJ^J_H nHtH/hqh L5CJOJPJQJ_H aJnHtH2s+Gkd$$Ifl#& t&644 laVp ytPN 7d$-DIfM gd8(pkd$IfK$L$F2%-% t0644 lap yt}<*WW,$ & F ""d$-DIfM ]"^"`a$gdL+ & F """d$-DIfM ]"^"`gd .$ & F """d$-DIfM ]"^"`a$gdL!$""d$-DIfM ]"^"a$gd8(~$6  ",0d~&(<>ɸɸ#hnCh5PJ^J_H nHtH#hnChz#5PJ^J_H nHtH hnChz#PJ^J_H nHtH hnChlqPJ^J_H nHtH#hnChlq6PJ^J_H nHtH#hnCh6PJ^J_H nHtH#hnCh6PJ^J_H nHtH1  *Dt&(*,.HXZ߳{{{{u h8(^JhnChhI5PJ^JhnChhI^JnHtHhy|hhI6PJ]^J hnChy|PJ^J_H nHtH hy|hhIPJ^J_H nHtHhnChbyk6]^JhnChbyk^J hVb^JhnChhI^JhnChhI5^JhlqPJ^J_H nHtH(*,Z=kd$IfK$L$l0" %FFT t0#644 lBapytNK$dh$Ifa$gdNKK$!$""d$-DIfM ]"^"a$gdy|bkd$IfK$L$l0" %T t0#644 lapytNK$dh$Ifa$gdNKK$&Fuf=)$ & F ""d$-DIfM ]"`a$gdb w$d$Ifa$gdhIkdN$IfK$L$ls0" %T t0#644 lapytNKFF F"F$F&F(F8FFFFFFFFFFFGG G$G(G*G`GbGdGlGGGGG̽xlxxxxxX&hy|h6PJ]^J_H nHtHhy|hRin6]^Jhy|hhI6]^Jhy|hy|^Jhy|h^Jhy|hhI^J hy|^J hhI^JhnCh^JhnChhI^Jhm6PJ^J_H nHtHhb w6PJ^J_H nHtHU#hnChb w6PJ^J_H nHtH hnChb wPJ^J_H nHtH"rzebne skre[li*): wykona przedmiot zamwienia bez udziaBu podwykonawcw (samodzielnie)*, powierzy podwykonawcom nastpujcy zakres zamwienia*: Nazwa i adres podwykonawcy (o ile jest znany na etapie skBadania oferty) zakres powierzonych prac  O[wiadczam, |e wypeBniBem/wypeBnili[my 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 si o udzielenie zamwienia publicznego w niniejszym postpowaniu.** Do oferty doBczono nastpujce dokumenty: O[wiadczenie o braku podstaw do wykluczenia oraz speBnianiu warunkw udziaBu w postpowaniu (zaB. Nr 2 do SWZ), PeBnomocnictwo (je[li dotyczy), Inne dokumenty (je[li dotyczy) UWAGA: formularz ofertowy musi zosta podpisany elektronicznie przez osob(y) upowa|nion(e) do reprezentowania Wykonawcy(w) za pomoc kwalifikowanego podpisu elektronicznego lub podpisu zaufanego lub podpisu osobistego (poprzez e-dowd). PozostaBe dane Wykonawcy wymagane wyBcznie do celw statystycznych Wykonawca jest (odpowiednie zaznaczy): % mikroprzedsibiorstwem (zatrudniajcym mniej ni| 10 osb i roczny obrt lub roczna suma bilansowa nie przekracza 2 milionw euro), % maBym przedsibiorstwem (zatrudniajcym mniej ni| 50 osb i roczny obrt lub roczna suma bilansowa nie przekracza 10 milionw euro), % [rednim przedsibiorstwem (zatrudniajcym mniej ni| 250 osb i roczny obrt nie przekracza 50 mln euro lub roczna suma bilansowa nie przekracza 43 mln euro). % inne 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. 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