ࡱ> Uhbjbjnnaa0!0!0!0!0!D!D!D!8|!\!D!dl"":"""Juu,uGIIIIII$6Bm0!voovvm0!0!""L.|.|.|vZ0!"0!"G.|vG.|.|Ċ" wpwg340d{xpwzx(x0!3vv.|vvvvvmmyDvvvdvvvvxvvvvvvvvvV :ZaBcznik nr 3 do SWZ Wykonawca: Nazwa wykonawcy/wykonawcw skBadajcych ofert wspln: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ...& & & & .. ........................................................................................................................................................ Adres wykonawcy:.......................................................................................................................... Nr telefonu: ......................................................................... Adres e-mail: ...................................................................... NIP: ............................................................... REGON: Numer rachunku bankowego do zwrotu wadium: & & & & & & & & & & & & Uwaga: w przypadku Wykonawcw skBadajcych ofert wspln nale|y wskaza wszystkich Wykonawcw wystpujcych wsplnie FORMULARZ OFERTOWY DziaBajc w imieniu Wykonawcy: & & & & & & & ...& & & & & & & & & & & & & & & ., w odpowiedzi na ogBoszenie o zamwieniu w postpowaniu prowadzonym w trybie przetargu nieograniczonego na:  Dostaw samochodu osobowego typu furgon wraz z zabudow biurow oraz wyposa|eniem , w ramach realizacji Projektu pn.  Strenghtening the detection methods, leading to effective eradication of cross-border crime, targeted in financial loss of the European Union ( Wzmocnienie metod wykrywczych, prowadzcych do skutecznego zwalczania przestpczo[ci transgranicznej, wymierzonej w finance Unii Europejskiej ), finansowanego z Programu Unii Europejskiej Hercule III, nr postpowania: 52/S/21, oferuj wykonanie przedmiotu zamwienia za cen brutto: & & & & & & & & & & & & & & & & & & .. zB (sBownie: & & & & & & & & ..& & & & & & & & & & & & & & & & & & & & & ), i zgodnie z poni|szym wyliczeniem i zestawieniem: L.p.Przedmiot zamwieniaCena netto w PLNStawka podatku VATCena brutto w PLN 1.Producent, marka pojazdu bazowego: .......................................................... Model, typ, wersja, wariant: .......................................................... O[wiadczam, |e oferowany pojazd: L.p.Kryterium oceny ofert Oferowana warto[1.Posiada wspBczynnik masy pojazdu bazowego gotowego do jazdy do maksymalnej mocy netto silnika2.Posiada pojemno[ silnika  3.Zu|ywa energi rozumian jako zu|ycie paliwa w cyklu mieszanym w 1/100 km 4.Emituje dwutlenek wgla w cyklu mieszanym w g/km 5.Emituje zanieczyszczenia: tlenkw azotu, czstek staBych oraz wglowodorw w mg/km  O[wiadczam, |e oferuj udzielenie gwarancji: na podzespoBy mechaniczne, elektryczne i elektroniczne pojazdu bazowego, na ktrym wykonano zabudow na okres & & & & & . miesicy (min. 36 miesicy z limitem min. 100.000 km przebiegu), na powBok lakiernicz na okres & & & & .. miesicy (min. 36 miesicy), na perforacj elementw nadwozia na okres & & & & miesicy (min. 36 miesicy), na caBo[ zabudowy i wyposa|enia pojazdu po zabudowie na okres & & .& miesicy (min. 24 miesice), na uprzywilejowanie pojazdu na okres & & & & . miesicy (min. 60 miesicy), na instalacj i sprzt Bczno[ci radiowej na okres & & ..& miesicy (min. 36 miesicy). UWAGA: w przypadku niewskazania okresw gwarancji, Zamawiajcy przyjmie, |e Wykonawca oferuje okresy minimalne. Wykonawca jest*: ( mikroprzedsibiorstwem ( maBym przedsibiorstwem ( [rednim przedsibiorstwem ( jednoosobowa dziaBalno[ gospodarcza (osoba fizyczna nieprowadzca dziaBalno[ci gospodarczej ( inny rodzaj *(zaznaczy wBa[ciwy kwadrat, je|eli ma zastosowanie) O[wiadczenie Wykonawcw wsplnie ubiegajcych si o udzielenie zamwienia (art. 117 ust. 4 Pzp): O[wiadczamy, |e: Wykonawca & & & & & & & & & & & & & & & & . (nazwa i adres) zrealizuje nastpujce dostawy & & & & & & & .& & & & & & & & & & & & & & & & & & & & & & & & & , Wykonawca & & & & & & & & & & & & & & & & . (nazwa i adres) zrealizuje nastpujce dostawy & & & & & & & .& & & & & & & & & & & & & & & & & & & & & & & & & O[wiadczam, |e wybr oferty Wykonawcy nie bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego w zakresie podatku VAT. O[wiadczam, |e w przedmiotowym postpowaniu zamierzam zleci podwykonawcy/-om wykonanie cz[ci zamwienia: TAK  FORMCHECKBOX  NIE  FORMCHECKBOX  (Uwaga: W przypadku niewypeBnienia tego pkt Zamawiajcy przyjmie, |e wykonawca nie bdzie zlecaB wykonania cz[ci przedmiotu zamwienia podwykonawcy/-om). 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