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\f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 { \rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14293675 \chftnsepc \par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3679007 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 { \rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14293675 \chftnsep \par }}{\*\aftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3679007 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 { \rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14293675 \chftnsepc \par }}\ltrpar \sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid8748775\sftnbj\saftnnar {\footerr \ltrpar \pard\plain \ltrpar\s24\qr \li0\ri0\widctlpar \tqc\tx4536\tqr\tx9072\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675\charrsid3407962 PAGE \\* MERGEFORMAT}}{\fldrslt {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\lang1024\langfe1024\noproof\insrsid15025085 1}}}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675\charrsid3407962 \par }\pard \ltrpar\s24\ql \li0\ri0\widctlpar\tqc\tx4536\tqr\tx9072\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14293675 \par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}} {\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8 \pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar\ql \li5664\ri0\sl360\slmult1 \widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin5664\itap0\pararsid1592828 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 Za\'b3\'b9cznik nr 1 do formularza oferty \par }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid12146859 Znak sprawy: ZP/220/}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15025085 95}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid13310683\charrsid12146859 /1}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid2453762\charrsid12146859 9}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid12146859 \par }\pard \ltrpar\ql \li4956\ri-851\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-851\lin4956\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 Zamawiaj\'b9cy: \par Samodzielny}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 Publiczny Szpital Kliniczny Nr 2 \par PUM w Szczecinie \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 Al. Powsta\'f1c\'f3w Wlkp. 72}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15871249\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 70-111 Szczecin \par }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 Wykonawca: \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\ql \li0\ri-1\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1592828\charrsid1920648 (pe\'b3na nazwa/firma, adres oraz }{ \rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 w zale\'bfno\'9cci od podmiotu: NIP/PESEL, KRS/CEiDG) \par }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\ul\insrsid15619077\charrsid1920648 reprezentowany przez: \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85. \par }\pard \ltrpar\ql \li0\ri-1\sl360\slmult1\widctlpar\tx9638\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 (imi\'ea, nazwisko, stanowisko/}{ \rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid3167296\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 podstawa do}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid3167296\charrsid1920648 r}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 eprezentacji) \par }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qc \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid1592828\charrsid1920648 O\'8cWIADCZENIE WYKONAWCY }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid1592828\charrsid1920648 DOTYCZ\'a5CE PRZES\'a3ANEK WYKLUCZENIA Z POST\'caPOWANIA}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid275205 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\tx284\tx1080\wrapdefault\aspalpha\aspnum\faroman\adjustright\rin0\lin0\itap0\pararsid13393229\contextualspace {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 Na potrzeby post\'eapowania o udzielenie zam\'f3wienia publicznego pn. }{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \f38\fs18\cf1\insrsid12274243\charrsid1920648 dostaw}{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \f38\fs18\cf1\insrsid275205\charrsid1920648 a}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid275205\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15562319 jednorazowego sprz\'eatu medycznego}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15025085 oraz czy\'9cciwa przemys\'b3owego w roli }{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15562319 dla }{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15562319\charrsid14051689 SPSK-}{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15562319 2 }{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15562319\charrsid3480579 w Szczecinie}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15562319 }{\rtlch\fcs1 \ab\af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3407962\charrsid1920648 (}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 nazwa post\'eapowania}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1592828\charrsid1920648 )} {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 ,}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 prowadzonego przez SPSK-2}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15562319 w}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 Szczecinie }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 (oznaczenie zamawiaj\'b9cego),}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid2453762 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid275205 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid2453762 o\'9cwiadczam, co nast\'eapuje: \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 \par }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 \cbpat17 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid6162127 I. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'8cWIADCZENIA DOTYCZ\'a5CE WYKONAWCY: \par }\pard\plain \ltrpar\s15\qj \li720\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid1592828\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \b\f38\fs18\lang1045\langfe1033\langfenp1033\insrsid15619077\charrsid1920648 \hich\af38\dbch\af0\loch\f38 1.\tab}}\pard \ltrpar\s15\qj \fi-284\li284\ri0\sl360\slmult1 \widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin284\itap0\pararsid1592828\contextualspace {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'9cwiadczam, \'bfe nie podlegam wykluczeniu z post\'ea powania}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 na podstawie art. 24 ust 1 pkt 12-23 ustawy Pzp}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16729093\charrsid1920648 (Dz.U.201}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675 9}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16729093\charrsid1920648 .}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675 1843}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16729093\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675 t.j. z dnia 2019}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3407962\charrsid1920648 .}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid14293675 09.16)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 . \par }\pard\plain \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang1045\langfe1033\cgrid\langnp1045\langfenp1033 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1920648 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \'85\'85\'85\'85\'85.\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid3167296\charrsid1920648 (miejscowo\'9c\'e6), }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 dnia \'85\'85\'85\'85\'85\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 r.}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid3167296\charrsid1920648 \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid3167296\charrsid1920648 (podpis) \par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \b\f38\fs18\lang1045\langfe1033\langfenp1033\insrsid15025085\charrsid15025085 \hich\af38\dbch\af0\loch\f38 2.\tab}}\pard \ltrpar\qj \fi-284\li284\ri0\sl360\slmult1 \widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin284\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15025085\charrsid15025085 \par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \b\f38\fs18\lang1045\langfe1033\langfenp1033\insrsid15619077\charrsid1920648 \hich\af38\dbch\af0\loch\f38 3.\tab}}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'9cwiadczam, \'bfe zachodz\'b9 w stosunku do mnie podstawy wykluczenia z post\'eapowania}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 na podstawie}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16729093\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 art. \'85\'85\'85\'85. ustawy Pzp }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 (poda\'e6 maj\'b9c\'b9 zastosowanie podstaw\'ea wykluczenia spo\'9cr\'f3d wymienionych}{ \rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1592828\charrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 w art. 24 ust. 1 pkt 13-14, 16-20 lub art. 24 ust. 5 ustawy Pzp).}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 \par }\pard \ltrpar\qj \li284\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin284\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 Jednocze\'9cnie o\'9cwiadczam, \'bfe w zwi \'b9zku z ww. okoliczno\'9cci\'b9, na podstawie art. 24 ust. 8 ustawy Pzp podj\'b9\'b3em nast\'eapuj\'b9ce \'9crodki naprawcze: \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16521872\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{ \rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1920648 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \'85\'85\'85\'85\'85.\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1920648\charrsid1920648 (miejscowo\'9c\'e6), }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 dnia \'85\'85\'85\'85\'85\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 r.}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1920648\charrsid1920648 (podpis)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid13393229 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15025085 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 \cbpat17 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid6162127 II. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'8cWIADCZENIE DOTYCZ\'a5CE PODMIOTU, NA KT\'d3REGO ZASOBY POWO\'a3UJE SI\'ca WYKONAWCA: \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2453762 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\i\f38\fs18\cf6\insrsid2453762\charrsid1920648 Wype\'b3ni\'e6 tylko w przypadku powo \'b3ywania si\'ea na zasoby innych podmiot\'f3w.}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\i\f38\fs18\cf6\insrsid2453762 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\i\f38\fs18\cf6\insrsid2453762\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 O\'9cwiadczam, \'bfe w stosunku do nast\'eapuj \'b9cego/ych podmiotu/t\'f3w, }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\ul\insrsid15619077\charrsid1920648 na kt\'f3rego/ych zasoby}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\ul\insrsid16477966 powo\'b3uje si\'ea w niniejszym }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\ul\insrsid15619077\charrsid1920648 post\'eapowaniu}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 ,\~tj.:}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\ul\insrsid1592828\charrsid16477966 \par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 \'85\'85 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 (poda\'e6 pe\'b3n\'b9 nazw\'ea/firm\'ea, adres, a tak\'bfe w zale\'bfno\'9cci od podmiotu: NIP/PESEL, KRS/CEiDG)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1592828\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1592828\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 nie zachodz\'b9 podstawy wykluczenia z post\'eapowania o udzielenie zam\'f3wienia. \par \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \'85\'85\'85\'85\'85.\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1920648\charrsid1920648 (miejscowo\'9c\'e6), }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 dnia \'85\'85\'85\'85\'85\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 r.}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid1920648 \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid1920648\charrsid1920648 (podpis)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid10756653\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 \cbpat17 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid6162127 III. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'8cWIADCZENIE DOTYCZ\'a5CE PODWYKONAWCY NIEB\'caD\'a5CEGO PODMIOTEM, NA KT\'d3REGO ZASOBY POWO\'a3UJE SI\'ca WYKONAWCA: \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 O\'9cwiadczam, \'bfe w stosunku do nast\'eapuj\'b9cego/ych podmiotu/t\'f3w, b\'ead\'b9cego/ych podwykonawc\'b9/ami: }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16475019\charrsid1920648 \par \par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16475019 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..\'85.\'85\'85}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16475019\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85 ..}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid15619077\charrsid1920648 (poda\'e6 pe\'b3n\'b9 nazw\'ea/firm\'ea, adres, a tak\'bfe w zale\'bfno\'9cci od podmiotu: NIP/PESEL, KRS/CEiDG)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 ,}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16475019\charrsid1920648 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1592828 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid16475019\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 nie zachodz\'b9 podstawy wykluczenia z post\'eapowania o udzielenie zam\'f3wienia. \par \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 \'85\'85\'85\'85\'85.\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid2453762\charrsid1920648 (miejscowo\'9c\'e6), }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 dnia \'85\'85\'85\'85\'85\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762 r.}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762 }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762 \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid2453762\charrsid1920648 (podpis)}{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid2453762 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid6162127 \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid6162127 \cbpat17 { \rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid6162127 IV. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 O\'8cWIADCZENIE DOTYCZ\'a5CE PODANYCH INFORMACJI: \par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid6162127 {\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \b\f38\fs18\insrsid15619077\charrsid6162127 O\'9cwiadczam, \'bfe wszystkie informacje podane w powy\'bfszych o\'9cwiadczeniach s\'b9 aktualne \line i zgodne z prawd\'b9 oraz zosta\'b3y przedstawione z pe\'b3n\'b9 \'9c wiadomo\'9cci\'b9 konsekwencji wprowadzenia zamawiaj\'b9cego w b\'b3\'b9d przy przedstawianiu informacji. \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid15619077\charrsid1920648 \par }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 \'85\'85\'85\'85\'85.\'85\'85. }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \i\f38\fs18\insrsid2453762\charrsid1920648 (miejscowo\'9c\'e6), }{\rtlch\fcs1 \af38\afs18 \ltrch\fcs0 \f38\fs18\insrsid2453762\charrsid1920648 dnia \'85\'85\'85\'85\'85\'85\'85. }{\rtlch\fcs1 \af38\afs18 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