ࡱ> cH>bjbjNN4L$i$i_#2dd" " """+"+"+"8c"T"4+"5"""""#Z $<$>5@5@5@5@5@5@58[;@5!"L$##L$L$@5""""a5'''L$"""">5'L$>5''2 4"-$(Z3*5w505j3_<%Z_< 4_<" 4 L$L$'L$L$L$L$L$@5@5n&ZL$L$L$5L$L$L$L$_<L$L$L$L$L$L$L$L$L$dc : ZaBcznik nr 3 do SWZ Oznaczenie postpowania: 35/ZP/TP1/D/24 Dane Wykonawcy: Nazwa:_________________ adres:_________________ reprezentowany przez: & & & & & & & & & & & & & & (imi, nazwisko, stanowisko/podstawa do reprezentacji) OZWIADCZENIE WSTPNE WYKONAWCY skBadane na podstawie art. 125 ust. 1 ustawy z dnia 11 wrze[nia 2019 r. Prawo zamwieD publicznych (dalej jako: ustawa Pzp) Na potrzeby postpowania o udzielenie zamwienia publicznego pn. Zakup specjalistycznego sprztu medycznego w podziale na III cz[ci w ramach Programu inwestycyjnego modernizacji podmiotw leczniczych, pod nazw  SOR i pracownie diagnostyczne na miar XXI  Pabianickie Centrum Medyczne Sp. z o. o. tj. cz[ I  analizatory parametrw krytycznych; cz[ II  luminometry oraz urzdzenia do dekontaminacji; cz[ III  aparaty EKG, kardiomonitory oraz monitory TOP SOR. DOTYCZCE SPEANIANIA WARUNKW UDZIAAU W POSTPOWANIU INFORMACJA DOTYCZCA WYKONAWCY: O[wiadczam(y), |e speBniam(y) warunki udziaBu w postpowaniu okre[lone przez Zamawiajcego wSpecyfikacji Warunkw Zamwienia i ogBoszeniu ozamwieniu zamieszczonym w Biuletynie ZamwieD Publicznych. DOTYCZCE PRZESAANEK WYKLUCZENIA Z POSTPOWANIA OZWIADCZENIA DOTYCZCE WYKONAWCY: O[wiadczam(y), |e nie podlegam(y) wykluczeniu z postpowania na podstawie art. 108 ust. 1 ustawy Pzp. O[wiadczam(y), |e zachodz w stosunku do mnie podstawy wykluczenia z postpowania napodstawie art. & & & & & & .. ustawy Pzp (poda majc zastosowanie podstaw wykluczenia spo[rd wymienionych w art. 108 ust. 1 pkt1), 2) i 5) ustawy Pzp. Jednocze[nie o[wiadczam, |e w zwizku z ww. okoliczno[ci, na podstawie art. 110 ust. 2 ustawy Pzp podjBem nastpujce [rodki naprawcze: & & & & & & & & & & & & & & & & & & & & & & & & .. OZWIADCZENIE DOTYCZCE PODANYCH INFORMACJI O[wiadczam(y), |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. & & & & & .& & . (miejscowo[), dnia & & & & & & & . r. 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