ࡱ>  Z]QRSTUVWXYibjbj22PjPjN<& & $P7I('''[[[#L[[[[[''41"1"1"[''1"[1"1",'zu}+ 4( l0Iڒ %AH%0n%(D51"[[[ [[[I[[[[%[[[[[[[[[& c :ZaBcznik nr 1 do SWZ FORMULARZ OFERTY do zamwienia publicznego pn. Dostawa zasilaczy awaryjnych UPS, dyskw do macierzy oraz routera w ramach projektu  Cyberbezpieczny Samorzd" L.p.Nazwa(y) Wykonawcy(w)Adres(y) Wykonawcy(w)REGON NIP1. 2.  OSOBA/Y UMOCOWANA/E DO REPREZENTOWANIA WYKONAWCY/W: Imi i nazwiskoAdres poczty elektronicznejNr telefonuDokument, z ktrego wynika prawo do reprezentowania Wykonawcy (KRS, CEiDG, inny wBa[ciwy rejestr, peBnomocnictwo lub inny dokument potwierdzajcy umocowanie) UWAGA: Wskazany dokument nale|y doBczy do oferty lub wskaza adres oglnodostpnej i bezpBatnej bazy danych umo|liwiajcej dostp do tego dokumentuOferuj/emy zrealizowanie przedmiotu zamwienia, zgodnie z wymogami okre[lonymi wSWZ: Dostawa zasilaczy awaryjnych UPS, dyskw do macierzy oraz routera w ramach projektu  Cyberbezpieczny Samorzd", zgodnie z wymogami okre[lonymi w SWZ * za cen ryczaBtow brutto: ........................... zB, w tym stawka podatku VAT & & % Lp.Przedmiot dostawyCena jednostkowa brutto (zB)Liczba szt. Okres, na jaki zostaje udzielona gwarancja (wyra|ony w miesicach)***Kwota ogBem brutto (zB)Kol. 1Kol. 2Kol. 3Kol. 4Kol. 5Kol. 6 = Kol. 3 x Kol. 4 1Zasilacze awaryjne UPS do stacji roboczych  typ 1 (pkt II.1 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 78 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 24 miesice2Zasilacze awaryjne UPS do serwera  typ 2 (pkt II.2 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 4 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 36 miesicy, 24 miesice na baterie3Zasilacze awaryjne UPS do serwera  typ 3 (pkt II.3 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 4 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 36 miesicy, 24 miesice na baterie4Zasilacze awaryjne UPS do serwera  typ 4 (pkt II.4 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 4 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 36 miesicy, 24 miesice na baterie5Urzdzenie zabezpieczajce - Router (pkt II.5 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 1 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 24 miesice 6Dyski do macierzy (pkt II.6 OPZ) Producent: & & & & & & & & & & ** Model: & & & & & & & & & & ** (** wypeBnia Wykonawca) 4 & & & & & & .. (nale|y wskaza liczb miesicy) Uwaga: Minimalna gwarancja wymagana w OPZ przez Zamawiajcego to 60 miesicy7RAZEM CENA RYCZAATOWA BRUTTO [zB] (suma poz. 1, 2, 3, 4, 5 i 6) Je|eli Wykonawca wska|e okres gwarancji krtszy ni| minimalny okres gwarancji wymagany w OPZ przez Zamawiajcego  oferta takiego Wykonawcy zostanie odrzucona, jako niezgodna z warunkami zamwienia. Je|eli Wykonawca wska|e okres gwarancji dBu|szy ni| minimalny okres gwarancji wymagany w OPZ przez Zamawiajcego  przyjmuje si, |e Wykonawca udzieliB gwarancji na okres wskazany w ofercie. O[wiadczam/y, |e w cenie oferty zostaBy uwzgldnione wszystkie koszty niezbdne do wykonania przedmiotu zamwienia z nale|yt staranno[ci i zgodnie zwymaganiami okre[lonymi przez Zamawiajcego. Informuj/emy, |e (zaznaczy wBa[ciwe): - wybr oferty nie bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego. - wybr oferty bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego: w odniesieniu do nastpujcych towarw lub usBug (w zale|no[ci od przedmiotu zamwienia): .........................................................; warto[ towaru lub usBug (w zale|no[ci od przedmiotu zamwienia) powodujca obowizek podatkowy u Zamawiajcego: netto.................................................. zB; stawka podatku od ww. towarw i usBug, ktra zgodnie z wiedz&*,LNf h 繣y^L:L(#hX3h#$@5CJOJQJ^JaJ#hX3h)5CJOJQJ^JaJ#hX3h2U5CJOJQJ^JaJ5hX3h!@B*CJOJQJ^JaJnHphtH8hX3h!5B*CJOJQJ^JaJnHphsHtHhX3hd"OJQJ^J+hX3h!5CJOJQJ^JaJnHtH+hX3hFC5CJOJQJ^JaJnHtH/hX3h!95CJOJQJ^JaJnHsHtH/hX3h!5CJOJQJ^JaJnHsHtH ,Nh r $ $G$If^`a$gdA$$ $G$If^`a$gd=` $$G$Ifa$gd=` $ xa$gd8$ G$a$gd0h$$ xa$gd0hh p r t       p]$hX3h,JCJOJQJ^JnHtH hX3hA$OJQJ^JnHtH#hX3hA$OJQJ\^JnHtH+hX3hA$CJOJQJ\^JaJnHtHhX3hA$OJQJ^J(hX3hA$CJOJQJ^JaJnHtH$hX3hq*CJOJQJ^JnHtHhX3hA$CJOJQJ^J$hX3hA$CJOJQJ^JnHtH 7) $G$Ifgd=` $$G$Ifa$gd=`kd$$If4r7 B#7 j  `````2#44 FaFf4p2yteN Bkd7$$If4 r7 B#7 j #44 FaFf4p2yt#$@ $G$Ifgd=` $Ifgd=`     $Ifgd=` $G$Ifgd=` $$G$Ifa$gd=`   z VN:// $G$Ifgd=`$ hh^h`a$gd=`$a$gd=`kd0$$If4r7 B#7 j #44 FaFf4p2yt#$@   2 6 D p v z wbS:0hX3h!CJOJQJ^JaJmHnHsHtHhX3h!CJOJQJ^J(hX3hFCCJOJQJ^JaJnHtH+hX3h!CJOJQJ\^JaJnHtHhX3h!OJQJ^J(hX3h!CJOJQJ^JaJnHtH#hX3h]n 5CJOJQJ^JaJ#hX3h!5CJOJQJ^JaJ+hX3hE5CJOJQJ^JaJnHtH+hX3h!5CJOJQJ^JaJnHtH $G$Ifgd=` $G$Ifgd,Jfkd)$$If0#  ` #44 FaFpyteN &fkd$$Ifm0#  ` #44 FaFpyteN $G$Ifgd=`fkd$$If0#  ` #44 FaFpyteN    r 0 2 @ v ókSk;k.hX3hs5>*CJOJQJ^JaJnHtH.hX3hq*5>*CJOJQJ^JaJnHtH.hX3h;:5>*CJOJQJ^JaJnHtH.hX3hL5>*CJOJQJ^JaJnHtH.hX3hnQ45>*CJOJQJ^JaJnHtHhX3h;:6CJ$OJQJ^JhX3hL6CJOJQJ^JhX3hLCJOJQJ^JhX3hsCJOJQJ^JhX3h;:CJOJQJ^J 2 ^ ` b >sdPP$ hxx^ha$gd;$ & F3xxa$gdLK7fkd`$$IfB0#  ` #44 FaFpyto $G$Ifgd=` $$Ifa$gd]n $$G$Ifa$gd=` \ ^ ` b иvdR=((hX3h ,KCJOJQJ^JaJnHtH(hX3h;:CJOJQJ^JaJnHtH#hX3hs5CJOJQJ^JaJ#hX3hsCJOJQJ\^JaJ(hX3hSCJOJQJ^JaJnHtH(hX3h!CJOJQJ^JaJnHtH.hX3h$X5>*CJOJQJ^JaJnHtH.hX3h{5>*CJOJQJ^JaJnHtH.hX3h]n 5>*CJOJQJ^JaJnHtH.hX3h!95>*CJOJQJ^JaJnHtH   `xjR:R".hX3hC~5CJOJQJ\^JaJnHtH.hX3h)5CJOJQJ\^JaJnHtH.hX3h rU5CJOJQJ\^JaJnHtH.hX3h-5CJOJQJ\^JaJnHtH.hX3h5CJOJQJ\^JaJnHtH#hX3hd"5CJOJQJ^JaJ(hX3hSCJOJQJ^JaJnHtH(hX3h;:CJOJQJ^JaJnHtH(hX3h ,KCJOJQJ^JaJnHtH(hX3h#$@CJOJQJ^JaJnHtH 8:<>DNdrtçiSi=i'i+hX3h 5CJOJQJ^JaJnHtH+hX3hLZhv46LfhvӿwgggggXXXXXXhX3hjiOJPJQJ^JhX3hji5OJPJQJ^J#hX3hji5CJOJPJQJ^J!hji6CJOJPJQJ^JaJ'hX3hji6CJOJPJQJ^JaJ hX3hjiCJOJQJ^JaJ'hX3hji5CJOJPJQJ^JaJ+hX3h!5CJOJQJ^JaJnHtH+hjihji5CJOJQJ^JaJnHtH &Vp.0>LZhv$$*$Ifa$gd%6Tm$Ff $$*$Ifa$gdi5m$Ffy$$*$Ifa$gdyLm$$$*$If^a$gd!m$$$*$Ifa$gd!m$$ $*$Ifa$gd!m$46Lfhv$&x$*$Ifgdkm$$$*$Ifa$gd!m$ $*$Ifgdyym$ $*$IfgdjT#m$ $*$Ifgdi5m$$&:<Rln|(*੓t੓a$hji5CJOJPJQJ\^JaJ#hX3hji5CJOJPJQJ^JhX3hjiOJQJ^J*hX3hji5CJOJPJQJ\^JaJ$hX3hjiCJOJPJQJ^JaJ'hX3hji6CJOJPJQJ^JaJhX3hji5OJPJQJ^JhX3hjiOJPJQJ^JhX3hji6OJPJQJ^J&kd $$Iflֈ7 >#7O t0#44 lalp<ytji:<Rln|(* $*$IfgdwPm$ $*$Ifgd-lm$$$*$Ifa$gd-lm$Pnp\^&(*,00248:<Nuu*hX3hji5CJOJPJQJ\^JaJ$hX3hjiCJOJPJQJ^JaJ'hX3hji6CJOJPJQJ^JaJhX3hji6OJPJQJ^JhX3hji5OJPJQJ^J#hX3hji5CJOJPJQJ^JhX3hjiOJQJ^JhX3hjiOJPJQJ^J.kd,$$Iflֈ7 >#7O t0#44 lalp<ytjiPnp\^(* $*$IfgdwPm$ $*$Ifgdm$ $*$Ifgd-lm$$$*$Ifa$gd-lm$*,kd=$$Iflֈ7 >#7O t0#44 lalp<ytji,00248:<N\^ $*$IfgdwPm$ $*$Ifgdm$ $*$Ifgd-lm$$$*$Ifa$gd-lm$NZ\^`bd &(XZ\`bdfhj|BX\^`dɳܦt܄ɳܦhX3hji6OJPJQJ^JhX3hji5OJPJQJ^J#hX3hji5CJOJPJQJ^JhX3hjiOJQJ^J*hX3hji5CJOJPJQJ\^JaJ$hX3hjiCJOJPJQJ^JaJhX3hjiOJPJQJ^J'hX3hji6CJOJPJQJ^JaJ-^`kdN$$Iflֈ7 >#7O t0#44 lalp<ytji`d &(XZ\`bdfhj| $*$IfgdwPm$ $Ifgdcz $*$Ifgdm$ $*$Ifgd-lm$$$*$Ifa$gd-lm$\^ $*$Ifgd-lm$ $Ifgd ^`kdm$$Iflֈ7 >#7O t0#44 lalp<ytji`d68:>@BT24 $*$IfgdwPm$ $*$Ifgdm$ $*$Ifgd-lm$$$*$Ifa$gd-lm$68:>@BT02468:~ P !uuuZIII hX3hXOJQJ^JnHtH4hX3h#$@6B*CJOJQJ^JaJnHphtH#hX3hji5CJOJPJQJ^JhX3hjiOJQJ^J*hX3hji5CJOJPJQJ\^JaJ$hX3hjiCJOJPJQJ^JaJ'hX3hji6CJOJPJQJ^JaJhX3hji5OJPJQJ^JhX3hji6OJPJQJ^JhX3hjiOJPJQJ^J46kd~$$Iflֈ7 >#7O t0#44 lalp<ytji6:~.kd$$IflF7>#7 t0#    44 lalpytji $*$Ifgd-l $$*$Ifa$gd-l$$*$Ifa$gd-lm$$$*$Ifa$gd-lm$P !Z##Z$%,&'tuvvh $x^a$gda $ & F4xa$gdLK7 $ & F4a$gdLK7 $^a$gd; $^a$gda$ & F3xxa$gdLK7$ dxx]^a$gd rU$ dxx]^a$gdr*$ ]^a$gd' !!0"P""""""Z#t######$ӾөӔj]E+E2hX3h;56CJOJPJQJ^JaJnHtH/hX3h;6CJOJPJQJ^JaJnHtHhX3h!OJQJ^J(hX3hLCJOJQJ^JaJnHtH(hX3haCJOJQJ^JaJnHtH(hX3h#$@CJOJQJ^JaJnHtH(hX3h]n CJOJQJ^JaJnHtH(hX3ho CJOJQJ^JaJnHtH(hX3h!CJOJQJ^JaJnHtH-hX3huB@B*OJQJ^JnHphtH$$X$Z$x$$%,&'(ttttuuu盂iP71hX3h#$@56CJOJQJ\^JaJnHtH1hX3ha56CJOJQJ\^JaJnHtH1hX3h!56CJOJQJ\^JaJnHtH1hX3h;l56CJOJQJ\^JaJnHtH/hX3hz6CJOJPJQJ^JaJnHtHU2hX3h;56CJOJPJQJ^JaJnHtH/hX3ha6CJOJPJQJ^JaJnHtH/hX3h;6CJOJPJQJ^JaJnHtH Wykonawcy bdzie miaBa zastosowanie wynosi: .....................%; W przypadku, gdy Wykonawca nie zaznaczy wBa[ciwego przyjmuje si, |e wybr oferty nie bdzie prowadzi do powstania u Zamawiajcego obowizku podatkowego. SkBadam/y niniejsz ofert we wBasnym imieniu*/jako Wykonawcy wsplnie ubiegajcy si oudzielenie zamwienia.* Jestem/[my zwizany/i ofert przez okres wskazany w SWZ. ZapoznaBem/li[my si z tre[ci SWZ i przyjmuj/emy ten dokument bez zastrze|eD. O[wiadczam/y, |e zobowizuj/emy si, w przypadku wyboru mojej/naszej oferty, do zawarcia umowy zgodnej z ofert, na warunkach okre[lonych w SWZ w miejscu i terminie wyznaczonym przez Zamawiajcego. O[wiadczam/y, |e zobowizuj/emy si do wykonania zamwienia w terminie okre[lonym w SWZ. O[wiadczam/y, |e otrzymaBem/li[my konieczne informacje do przygotowania oferty. Zamierzam/y powierzy podwykonawcom wykonanie nastpujcych cz[ci zamwienia*: Cz[ zamwienia, ktrej wykonanie Wykonawca zamierza powierzy podwykonawcyNazwa ewentualnego podwykonawcy, je|eli jest ju| znany  {adna z informacji zawarta w ofercie nie stanowi tajemnicy przedsibiorstwa* / Informacje zawarte w pliku oznaczonym jako & & & & & & & & .............. stanowi tajemnic przedsibiorstwa*: Uzasadnienie, |e zastrze|one informacje stanowi tajemnic przedsibiorstwa:* & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ....... O[wiadczam/y, |e jestem/[my (nale|y zaznaczy wBa[ciwe): mikroprzedsibiorstwem, maBym przedsibiorstwem, [rednim przedsibiorstwem, osob prowadzc jednoosobow dziaBalno[ci gospodarcz, osob fizyczn nieprowadzc dziaBalno[ci gospodarczej, inny rodzaj. Mikroprzedsibiorstwo: przedsibiorstwo, ktre zatrudnia mniej ni| 10 osb i ktrego roczny obrt lub roczna suma bilansowa nie przekracza 2 milionw EUR. MaBe przedsibiorstwo: przedsibiorstwo, ktre zatrudnia mniej ni| 50 osb i ktrego roczny obrt lub roczna suma bilansowa nie przekracza 10 milionw EUR. Zrednie przedsibiorstwa: przedsibiorstwa, ktre nie s mikroprzedsibiorstwami ani maBymi przedsibiorstwami i ktre zatrudniaj mniej ni| 250 osb i ktrych roczny obrt nie przekracza 50 milionw EUR lub roczna suma bilansowa nie przekracza 43 milionw EUR. W przypadku Wykonawcw wsplnie ubiegajcych si zamwienie nale|y uwzgldni kategori przedsibiorstwa lidera konsorcjum. O[wiadczam/y |e wypeBniBem/li[my obowizki informacyjne przewidziane w art. 13 lub art. 14 RODO wobec osb fizycznych, od ktrych dane osobowe bezpo[rednio lub po[rednio pozyskaBem/li[my w celu ubiegania si o udzielenie zamwienia publicznego w niniejszym postpowaniu.** Do oferty doBczam/y: ................................................................................................. ................................................................................................. ................................................................................................. * niepotrzebne skre[li ** w przypadku, gdy Wykonawca nie przekazuje danych osobowych innych ni| bezpo[rednio jego dotyczcych lub zachodzi wyBczenie stosowania obowizku informacyjnego, stosownie do art. 13 ust. 4 lub art. 14 ust. 5 RODO tre[ci o[wiadczenia Wykonawca nieskBada (np. wykre[la je). Uwaga! WypeBniony formularz nale|y opatrzy kwalifikowanym podpisem elektronicznym lub podpisem zaufanym lub podpisem osobistym      PAGE \* MERGEFORMAT17  Projekt/program: Projekt jest realizowany w ramach FUNDUSZY EUROPEJSKICH NA ROZWJ CYFROWY 2021-2027 (FERC) Priorytet II: Zaawansowane usBugi cyfrowe, DziaBanie 2.2.  Wzmocnienie krajowego systemu cyberbezpieczeDstwa.  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