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(imi, nazwisko, stanowisko/ podstawa do reprezentacji) Przystpujc do udziaBu w postpowaniu o udzielenie zamwienia publicznego prowadzonym w trybie podstawowym bez negocjacji, na zadanie inwestycyjne pn.:  Rozwj oglnodostpnej infrastruktury rekreacyjnej poprzez budow boiska do tenisa ziemnego przedkBadam: WYKAZ ROBT BUDOWLANYCH zgodnie z warunkiem okre[lonym w SWZ L.p.Rodzaj roboty budowlanej (opis)*Warto[ brutto roboty budowlanej**Data wykonania roboty budowlanej (zgodnie z zawart umow)Miejsce wykonania roboty budowlanej     $ & ( , . 8 V X b ŵwfVJ:-:h CJ\aJmHsHhnoihCJ\aJmHsHhnoih CJ\aJh)vhCJ\aJmHsH h)vhB*CJ\aJph h)vhB*CJ\aJph h)vhB*CJ\aJphh)vh DCJ\aJmHsHh)vhCJ\aJh)vhd~CJ\aJmHsHh)vhCJ\aJh)vhFHCJ\aJmHsHh;CJ\aJmHsH"jh;CJU\aJmHsH. d x z RZ $da$gdc{V $da$gdph n#gd)vgd)v$dx<a$gd[ l Tgdb d v x z  & l 2 x  F d T úúúúæ h)v5CJPJ\aJnHtH hv5CJPJ\aJnHtH&h)vh)v5CJPJ\aJnHtHhvCJ\aJh)vh[ lCJ\aJhnoih[ lCJ\aJmHsHhnoihCJ\aJmHsHhnoihCJ\aJmHsH4   "$&(*,.02468:<>@BDFHJLPRͿͱ&hwhw5CJPJ\aJnHtHh)vCJPJaJnHtHhwCJPJaJnHtHh: CJPJaJnHtH hvhvCJPJaJnHtH hw5CJPJ\aJnHtH hv5CJPJ\aJnHtH0 "$&(*,.02468:<>DXZ\^`bdfhjlnprtvxz|~վ#ht|MhwCJPJ\aJnHtH#h)vh)vCJPJ\aJnHtHh)vhwPJnHtHh)vPJnHtHhwPJnHtHh)vh)vPJnHtH&h)vhw5CJPJ\aJnHtH8*,.68:  (ƸwhhhYJ>ht|Mh5CJaJhTD5CJOJQJ^JaJhcPIhs7CJaJnHtHhcPIhc{VCJaJnHtH"hcPIhc{V5CJ\aJnHtHh 5CJ\aJhcPIh~35CJ\aJhcPIh~3CJaJhcPIhc{VCJaJhcPIhva5CJ\aJhcPIhd~5CJ\aJhcPIhcPICJaJhcPIhd~CJaJhcPIhCJaJhcPIhFHCJaJ@z$ $$Ifa$ $$If]a$ $If]]$]a$ (>@t@$x$z$|$~$$$$$$$$$$$$$$$$$$$$ѿhhOJQJ^JhCJOJQJ^JaJhRhOJQJ\^JhRh\UhRhCJ\aJ#hRhCJOJQJ\^JaJhs7hOJQJ\^Jht|MhCJ\aJht|Mh5ht|Mh5CJaJ,Podmiot, na rzecz ktrego robota budowlana zostaBa wykonana   * Wykonawca, ktry wykazuje robot budowlan, obejmujc zakres szerszy od wymaganego w celu speBnienia warunku udziaBu w postpowaniu, zobowizany jest do podania informacji, |e robota budowlana obejmowaBa swoim zakresem warunki wskazane w Rozdziale VIII ust. 2 pkt 4 SWZ. ** Wykonawca, ktry wykazuje robot budowlan, obejmujc zakres szerszy od wymaganego w celu speBnienia warunku udziaBu w postpowaniu, zobowizany jest do podania warto[ci brutto roboty budowlanej opisanej w Rozdziale VIII ust.2 pkt 4 SWZ. W przypadku Wykonawcw wsplnie ubiegajcych si o zamwienie, Wykonawcy musz wykaza, |e powy|sze warunki speBniaj wsplnie (Bcznie) lub samodzielnie lub polegajc na zasobach innych podmiotw. 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