ࡱ> RUOPQ=&bjbj..A4LhLh @( ........8., /,.7/7/(_/_/_/222egggggg$LZE.2%2%2^22.._/_/4442X._/.R_/e42e44Fpq."E_/$2XQ0Տp33EE@>.2242222232222222222222222 c ,:OZWIADCZENIE WYKONAWCY O NIEPODLEGANIU WYKLUCZENIU ORAZ O SPEANIANIU WARUNKW UDZIAAU W POSTPOWANIU SkBadane na podstawie art. 125 ust. 1 ustawy z dnia 11 wrze[nia 2019 r. Prawo zamwieD publicznych (dalej jako: ustawa Pzp) Nazwa (firma) / Imi i nazwisko oraz adres Wykonawcy: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . Reprezentowany przez: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . (Imi i nazwisko, stanowisko / podstawa do reprezentacji) W zwizku z ubieganiem si o udzielenie zamwienia publicznego w ramach postpowania pn.  Zakup autobusu szkolnego dla Gminy MaBa Wie[ (znak postpowania: RGK.271.9.2023), skBadam niniejsze o[wiadczenie: O[wiadczam, |e nie podlegam wykluczeniu z postpowania na podstawie art. 108 ust 1 ustawy Pzp O[wiadczam, |e nie podlegam wykluczeniu z postpowania na podstawie art. 109 ust. 1 pkt 4 i 7 ustawy Pzp. (je|eli dotyczy) O[wiadczam, |e zachodz w stosunku do mnie podstawy wykluczenia z postpowania na podstawie art. & & & & & ustawy Pzp (poda majc zastosowanie podstaw wykluczenia spo[rd wymienionych w art. 108 ust. 1 pkt 1, 2 lub 5 oraz art. 109 ust 1 pkt 4 lub 7 ustawy Pzp). Jednocze[nie o[wiadczam, |e w zwizku z ww. okoliczno[ci, na podstawie art. 110 ust. 2 ustawy Pzp podjBem nastpujce [rodki naprawcze: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .. O[wiadczam, |e nie jestem umieszczony na listach i nie podlegam wykluczeniu z niniejszego postpowania o udzielenie zamwienia, na podstawie obowizujcych prfh` b 6 8   f h P  & ( 0 2 4 6 v x z 468BLɻhRPJnH tH hJPJnH tH h5PJnH tH hh5PJnH tH hPJnH tH  hMhMCJPJaJnH tH hMhMPJnH tH hMhM5PJnH tH =hb 8  h x z 68 N$ed ^ea$gdR$ & Fed ^ea$gdM$ p# d a$gdMd gdM $d a$gdM $d a$gdM  .BrBLN$2:X@ZRxZPR  * 2 @ Z ʻ󫫫hMhM5PJ\nH tH h}\YhRPJnH tH UhRhRPJnH tH hMhM6PJnH tH hRhRPJnH tH hMhMPJnH tH CNR."2"###$}^gdM$ & Fed ^ea$gdM$ p# hd ^ha$gdM$hd ^ha$gdM$ & Fd a$gdM$hd ^ha$gdR$ & Fd a$gdR $d a$gdM$ed ^ea$gdM zepisw okre[lonych w 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 (Dz.U. z 2022 r. poz. 835) O[wiadczam, |e speBniam warunki udziaBu w postpowaniu okre[lone przez Zamawiajcego w Specyfikacji Warunkw Zamwienia w nastpujcym zakresie: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ... & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ... O[wiadczam/my, |e dokument, o ktrym mowa w Rozdziale 10 ust. 3 pkt 3.2 SWZ (tj.: odpis lub informacja z Krajowego Rejestru Sdowego lub z Centralnej Ewidencji i Informacji o DziaBalno[ci Gospodarczej), jest dostpny w formie elektronicznej pod nastpujcym adresem internetowym oglnodostpnej, bezpBatnej bazy danych*): 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. 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 * niewBa[ciwe skre[li      Strona PAGE21 z NUMPAGES32 RGK.271.9.2023 ZaBcznik nr 3 do SWZ Z !!","."0"2"Z"#####$$Z$$$$$\%^%r%t%v%x%z%|%~%%%%%%%%%%%%%%%%%%%%%%%%%%%%jhngUnH tH jh~=hUh!<h^4h=7jh=7U hMhMhhMmHsHhMmHsHhMhvhMhM5hMhM56PJnH tH hMhMPJnH tH 8$$$^%t%v%x%z%|%~%%%%%%%%%%%%%%gdjo!^gdMgdM d @&]gdM$ ad a$gdM Bd gdM%%%%%%%%%%%*&,&.&0&2&4&6&8&:&X&Z& ^gdO{gd!$a$!  p#aEgd $da$gd2Vgdjo%%%%%%%%%&&&&&& &"&&&(&*&,&.&0&2&4&6&8&:&J&L&N&T&V&X&Z&f&t&v&z&&&&&ѾѾѺ{{u{{o h!<CJ hMCJ hCJ hO{CJ hJCJhWh!<CJhWhWCJ h^4CJ hMCJhYgh:h:CJaJh#Hhq\5\mHnHu h#H5\jh#H5U\h#HmHsHh^4h!< h2Vh!<jhngUnH tH *Z&&&&&gdM ^gd2V&& hMhM?0P&P :p:. 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