ࡱ> i:bjbj...LDbDbX,J,JWWWWWWWW8XT\X4WaXXXXXkY Y Y3a5a5a5a5a5a5a$efhlYa9WYkYkYYYYaWWXXa[[[YjWXWX3a[Y3a[[VA`@`X !ISY Z`*aa0a` h Zh`hW`h[YYYYaYa[YYYaYYYYhYYYYYYYYY,JV V: ZAACZNIK NR 3a DO SWZ NR ZSP1.0812.22.2022 WYKONAWCA: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & OZWIADCZENIE WYKONAWCY O NIEPODLEGANIU WYKLUCZENIA ORAZ SPEANIENIU WARUNKW O KTRYM MOWA W ART. 125 UST. 1 USTAWY Z DNIA 11 WRZEZNIA 2019 R. PRAWO ZAMWIEC PUBLICZNYCH  Na potrzeby postpowania o udzielenie zamwienia publicznego, na dostaw sprztu i pomocy dydaktycznych do pracowni szkolnych w zwizku z realizacj projektu pn. ,, Kosmiczna wiedza II  kursy i szkolenia w ZSP Nr 1 w BeBchatowie" wspBfinansowanego ze [rodkw Europejskiego Funduszu SpoBecznego w ramach Regionalnego Programu Operacyjnego Wojewdztwa Adzkiego na lata 2014-2020 o[wiadczam, co nastpuje: DOTYCZCE SPEANIANIA WARUNKW UDZIAAU W POSTPOWANIU O[wiadczam, |e speBniam warunki udziaBu w postpowaniu okre[lone przez Zamawiajcego Specyfikacji Warunkw Zamwienia zwanej dalej SWZ. PRZESAANEK WYKLUCZENIA Z POSTPOWANIA O[wiadczam, |e nie podlegam wykluczeniu z postpowania na podstawie art. 108 ust. 1 pkt 1-6 oraz art. 109 ust. 1 pkt 4, 5, 7 ustawy p.z.p. O[wiadczam, |e nie podlegam wykluczeniu z postpowania na podstawie art. 7 ust. 1 ustawy z dnia 13 kwietnia 2022 r. o szczeglnych rozwizaniach w zakresie przeciwdziaBania wspieraniu agresji na Ukrain oraz sBu|cych ochronie bezpieczeDstwa narodowego." INFORMACJA NA TEMAT PODWYKONAWCW NIEBDCYCH PODMIOTAMI UDOSTPNIAJCYMI ZASOBY (je|eli dotyczy) Informuje, |e podwykonawca niebdcy podmiotem udostpniajcym zasoby nie podlega wykluczenia na podstawie: art. 108 ust. 1 pkt 1-6 oraz art. 109 ust. 1 pkt 4, 5, 7 ustawy p.z.p Informuje, |e podwykonawca niebdcy podmiotem udostpniajcym zasoby nie podlega wykluczeniu na podstawie art. 7 ust. 1 ustawy z dnia 13 kwietnia 2022 r. o szczeglnych rozwizaniach w zakresie przeciwdziaBania wspieraniu agresji na Ukrain oraz sBu|cych ochronie bezpieczeDstwa narodowego." 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. & & & & & & & & & & dn. & & & & & & 2022 r. (miejsce i data zBo|enia o[wiadczenia)   6 8 V X v x ʳʛneTeEeEeEeEehT$hm B*KH^Jph!hT$hm B*KHPJ^JphhT$hm ^J.hT$hq%F5B*CJKH\]^JaJph(h55B*CJKH\]^JaJph.hT$hm 5B*CJKH\]^JaJph,h<Z5B*KHOJPJQJ\]^Jph,hm 5B*KHOJPJQJ\]^Jph;hm 56B*CJKHOJPJQJ\]^J_H9aJph 8 X x z |  =kd$$Ifz%%44 Fap $$9DIfa$$$9DG$Ifa$ A9D]A9D 9D`x z |   P T  Z \ ^ ǾǾǾǾǩpcpQBQBQph>p5>*KHPJ^J_H9"hT$hm 5>*KHPJ^J_H9h9}>*KHPJ^J_H9hT$hm >*KHPJ^J_H9%hT$hm B*KHPJ^J_H9ph+hT$hm 5B*KHPJ\^J_H9ph)hT$hm 56B*KH\]^JphhT$hm ^J#hT$hm 5B*KH\^Jph&hT$hm 5>*B*KH\^Jph#hT$hm 6B*KH]^Jph prb$ d 9Da$]$ d x^a$gd>p$ d x9Da$ & Fd 1$9D^`$ d 9Da$ $d x7$a$ & Fd1$7$9D^` $d1$9Da$ $9D`a$ np~ҼҭҜ|p|^OF6h>ph>p6B*]^Jphh>ph>p^Jhm 6B*KH]^Jph#hT$hm 6B*KH]^Jphh9}B*KH^JphhT$hm B*KH^Jph!hT$hm 5>*\^JnHtH!hT$hm B*KHPJ^JphhT$hm PJ^JnHtH*hT$hm 5>*B*\^JnHphtHhT$hm ^J,hT$hm @B*KHPJ\^J_H9phh>p>*KHPJ^J_H9df^`,.0ؽخؓzp_N_?ϮhT$h0B*KH^Jph!hT$h0@B*KH^Jph!hT$hm @B*KH^Jphh>ph>p6^Jh>ph>p^Jh>ph>p6B*]^Jphh>p6B*KH]^Jphh9}B*KH^JphhT$hm B*KH^Jph#hT$h06B*KH]^JphhT$hm ^J#hT$hm 6B*KH]^Jph)hT$hm 56B*KH\]^Jph`.04p*6,,,8-p$ rd 9D^ra$ Bd 1$9D$,9D^`,a$$,9D^`,a$gd<Z$9D^a$gdq%F $9Da$gdq%F$9Da$ $d x9Da$$ d x9Da$gd>p 0HJP`fhnp*`*r******Ͳ{yhWWNhT$hm ^J hT$h<Z6B*KH^Jph hT$hq%F6B*KH^JphU'hT$hm 6B*KHPJ]^JphhT$hm CJ^JaJ+hT$hm 6B*CJKH]^JaJphhT$h<ZB*KH^JphhaFB*KH^JphhT$hm B*KH^Jph$hT$hm 6B*KHPJ^Jph hT$hm 6B*KH^Jph & & & & .& & & & & & & & & .& & & & & & & ..& & & & & & & & ..& (podpis Wykonawcy lub osb upowa|nionych do wystpowania w imieniu Wykonawcy) INFORMACJA NA TEMAT PODMIOTW, NA KTRYCH ZASOBY WYKONAWCA SI POWOAUJE (je|eli dotyczy) OZWIADCZENIEO SPEANIEU WARUNKW O[wiadczam, |e w zakresie w jakim udostpniam zasoby, speBniam warunki udziaBu w postpowaniu okre[lone w SWZ. OZWIADCZENIE O NIEPODLEGANIU WYKLUCZENIU Informuje, |e jako podmiot udostepniajcy zasoby nie podlegam wykluczeniu z postpowania na podstawie art. 108 ust. 1 pkt 1-6 oraz art. 109 ust. 1 pkt 4, 5, 7 ustawy p.z.p. 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. & & & & & & & & & & dn. & & & & & & 2022 r. (miejsce i data zBo|enia o[wiadczenia) & & & & & & & & & & .& & & & & & & & & .& & & & & & & ..& & & (podpis Wykonawcy lub osb upowa|nionych do wystpowania w imieniu Wykonawcy) Dokument nale|y podpisa kwalifikowanym podpisem elektronicznym lub podpisem zaufanym lub podpisem osobistym przez osob lub osoby umocowane do zBo|enia podpisu w imieniu Wykonawcy      projekt pn.  Kosmiczna wiedza II - kursy i szkolenia w ZSP Nr 1 w BeBchatowie wspBfinansowany ze [rodkw Europejskiego Funduszu SpoBecznego w ramach Regionalnego Programu Operacyjnego Wojewdztwa Adzkiego na lata 2014-2020 BIURO PROJEKTU ZespB ds. Strategii i Rozwoju Powiatu Starostwo Powiatowe w BeBchatowie ul. 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