ࡱ> s>sbjbj))ACfCf&'''''(((8>( )()))))+&+ +kmmmmmm$'+++"++''))B...+R')')k.+k.."۴d)3@uǞ@,:?vWX0fz,ff'g#++.+++++n-+++++++f+++++++++ &:ZaBcznik Nr 1 nazwa, siedzib i adres Wykonawcy / Wykonawcw skBadajcych ofert: ................................................................................................................ ................................................................................................................ ................................................................................................................ NIP .......................................... , REGON .......................................... FORMULARZ OFERTOWY Przystpujc do udziaBu w postpowaniu o udzielenie zamwienia prowadzonego w trybie przetargu nieograniczonego na zadanie pn.: DOSTAWA KOAGULANTU PIX 113 do WSPOMAGANIA PROCESU OCZYSZCZANIA ZCIEKW w Miejskiej Oczyszczalni Zciekw AYNA w Olsztynie, znak PZP.262.53.2019.RGZ, OZWIADCZAMY, |e: Oferujemy wykonanie przedmiotu zamwienia, za ni|ej wymienione wynagrodzenie: cena ofertowa netto wynosi:................................(sBownie.& & & & .& & & & & & & & & & & & & & & .............................................................................................................................................................) stawka VAT: ............. % zgodnie z wycen zawart w formularzu cenowym  ZaBcznik Nr 2. Cena ofertowa okre[lona w pkt 1 zawiera wszystkie koszty zwizane z wykonaniem zamwienia, w tym koszt transportu do Zamawiajcego. Oferowany przedmiot zamwienia jest zgodny z wymaganiami Zamawiajcego okre[lonymi w SIWZ. Zamwienie bdzie realizowanie sukcesywnie w terminie 24 miesicy od daty podpisania umowy, bdz do czasu realizacji warto[ci umowy O[wiadczamy, |e preparaty posiadaj termin wa|no[ci minimum & .& & miesicy od daty dostawy do Zamawiajcego. O[wiadczamy, |e preparaty posiadaj [wiadectwa jako[ci, ktre bd doBczane przy ka|dorazowej dostawie. O[wiadczamy, |e jeste[my podatnikiem VAT, o ktrym mowa w art. 15 ustawy o VAT * (niepotrzebne skre[li). o zarejestrowanym jako podatnik VAT czynny, o zarejestrowanym jako podatnik VAT zwolniony na podstawie art. 113 ust. 1 lub 9. Akceptujemy 30-dniowy termin pBatno[ci w formie przelewu po dostarczeniu przedmiotu zamwienia i otrzymaniu faktury VAT. Za realizacj zamwienia odpowiedzialny jest p.& & & & & & & & & & & & & & & & & & & & . & & & & & & & & & & & & & & & & & & & & & .& & tel. & & & & & & & & & & & & & & & & & & & & . Uwa|am si za zwizanego niniejsz ofert przez 45 dni od ostatecznego terminu skBadania ofert. Korespondencja zwizan z niniejszym postpowaniem bdzie odbierana przez nas w sposb podany ni|ej (do wyboru przez Wykonawc): do kontaktw upowa|niona/y jest tel. ........ faks . e-mail ... ....................................... .................................................................. (data) (podpis osoby uprawnionej lub osb uprawnionych do reprezentacji Wykonawcy) ZaBcznik Nr 2 nazwa, siedzib i adres Wykonawcy / Wykonawcw skBadajcych ofert: ................................................................................................................ & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . ................................................................................................................ FORMULARZ CENOWY Wycena przedmiotu zamwienia pn.: DOSTAWA KOAGULANTU PIX 113 do WSPOMAGANIA PROCESU OCZYSZCZANIA ZCIEKW w Miejskiej Oczyszczalni Zciekw AYNA w Olsztynie, znak PZP.262.53.2019.RGZ z podaniem ceny jednostkowej netto, warto[ci netto, stawki Vat oraz ceny caBego przedmiotu zamwienia. Lp.Nazwa asortymentuIlo[ [Mg]Cena jedn. netto [zB / Mg]Warto[ netto [zB]Stawka VAT [%]1Roztwr siarczanu |elaza PIX 113 224 Razem cena ofertowa netto caBego przedmiotu zamwienia wynosi: Cena netto .......................................... zB (sBownie: & & & & & & & & ..& & & & & & & & ...& & & & & .........................................................................................................................................................................) stawka VAT: ................... % Podatek VAT w wysoko[ci & & & & & & zB ( sBownie : & & & & & & & & & & & & & & & & & & .& & & & & & & & & & & & & & & & & & & . zB ) Cena brutto &(*<BNPVblr| $ 4 R V   ! + 4 5 6 9 C s |  ƹƹƹƹƹhfh)OJQJ^Jh)OJQJ^Jh3h)OJQJ^J"heh)6<CJOJQJ^Jh)6CJOJQJ^Jheh)6CJOJQJ^JhKh)CJOJQJ^JhSCJOJQJ^JhKh)CJOJQJ^J2 5  @wf$dhx^a$gd}$ & F hdx^ha$gdw\:$dxxa$gd}$  \ p#dhxa$gd}$rdx]ra$gd}$dhxa$gd)$qdh]qa$gd)$qd]qa$gd)$a$gdr).     !  * 0 $ , f wwiwiwhShSOJQJ\^JhShE1OJQJ\^JhShOJQJ\^Jh@h)OJQJ^JhSh)5OJQJ\^JhShS5OJQJ\^Jh 73OJQJ^JhOJQJ^Jh3h)5OJQJ^Jhh)5CJOJQJ^Jh)5CJOJQJ^J%(*024@BTjnp~,0涩reZLeehh)5OJQJ^Jh)5OJQJ^Jhh)OJQJ^Jh)5CJOJQJ^JhS5CJOJQJ^Jh@5CJOJQJ^Jhh)5CJOJQJ^Jhj5CJOJQJ^Jh5CJOJQJ^JhjOJQJ^Jh@OJQJ^Jh-s'h)NHOJQJ^Jh-s'h)OJQJ^Jh@hOJQJ^J0DT^f|0np~ ,D0BFHLnĺhTh!OJQJ^Jhh)OJQJ^Jh!OJQJ^JhQ+OJQJ^JhSOJQJ^JhfeXOJQJ^JhRhhOJQJ^Jhh)5OJQJ^Jh@OJQJ^Jhh)OJQJ^Jh)OJQJ^J3R`B qqP!$ & F Vdx]^`Va$gdw\:$ & F hedhx^e`a$gdw\:$ & F Vdhx^`Va$gdw\: & F 0dhx`0gdw\: & F Vdhx^`Vgdw\:dx^`gd}dhx^`gd}RVXlz| ,0^`bf|@B涶~~~nnahT5CJOJQJ^JhThT5CJOJQJ^JhTh)5CJOJQJ^JhGCJOJQJ^JhTh 73CJOJQJ^JhGCJOJQJ\^JhTh 735CJOJQJ^JhThQ+5CJOJQJ^JhThj5CJOJQJ^JhG5CJOJQJ^JhTh!OJQJ^J$BDl  04JPPR 0JNPxxxxhhah)5CJOJQJ^Jhvh)CJOJQJ^Jh!r5CJOJQJ^Jh)5CJOJQJ^Jh5CJOJQJ^J"h15B*CJOJQJ^Jph(h{hRh5B*CJOJQJ^JphhTh5CJOJQJ^Jh5CJOJQJ^Jh5CJOJQJ^J(RVxcRc$ hdxa$gdRh$ hedx^ea$gdRh$ & F rhhdx^ha$gdw\:$ & F hhdx^ha$gdw\:$ & F hedx^e`a$gdw\:!$ & F hedhx]^e`a$gdw\:$7dx]^7a$gd} "$`dn *0JPZ^fjp嶩婩򌌌q򶶶hh)CJOJQJ^Jh)CJOJQJ^Jh )5CJOJQJ^JhRhhfeX5CJOJQJ^Jh]5CJOJQJ^Jhh)5CJOJQJ^Jh h)5CJOJQJ^Jh)5CJNHOJQJ^Jh)5CJOJQJ^Jh5CJOJQJ^J,%(<EJRV_`mnopqrzzkkbhjh)CJhjh)CJOJQJ^Jh)CJOJQJ^JhD#h)CJOJQJ^JhD#h)CJOJQJ^Jh)CJOJQJ^Jhbh)5CJOJQJ^Jh)5CJOJQJ^Jh8Th)5CJOJQJ^Jhh)5CJOJQJ^J#hh)5CJNHOJQJ^J&Vnopqr`abcdefghijklmgdDeZgdk$a$gdJgd $r]ra$gd)$rdx]ra$gdRh$ hedx^ea$gdRh$'6VXY^_`abcdefghijklmnopqrstuvwxyz{|}~Ү| hDeZhDeZh hkhkhkh]CJOJQJ^JhUkCJOJQJ^Jh hh)CJOJQJ^JaJ$hjh)CJNHOJQJ^JaJh)CJOJQJ^JaJ hjh)CJOJQJ^JaJ h)CJhjh)CJ/mnopqrstuvwxyz{|}~ $qd]qa$gd] $q]qa$gd]q]qgd}gdDeZgd~ *>  (*.>jp ˾rcVVh4qh]OJQJ^Jh4qh]CJOJQJ^Jh4qh]5CJOJQJ^Jhh]OJQJ^Jh qh]OJQJ^J"h qh]6<CJOJQJ^Jh qh]6CJOJQJ^Jh]6CJOJQJ^Jh qh]5CJOJQJ^JhS5OJQJ^Jh qh]5OJQJ^Jh r5OJQJ^J ##6#B#L#b#p######$$4&`#$/5$8$H$Ifa$gdg$$4&`#$/Ifa$gd$$4&`#$/Ifa$gdg$ 4da$gdcy$a$gd]$$@&^a$gd]$rd]ra$gd !!!!.!D!L!!!!!""" 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(data) (podpis osoby uprawnionej lub osb uprawnionych do reprezentacji Wykonawcy) ZaBcznik Nr 3 nazwa, siedzib i adres Wykonawcy / Wykonawcw skBadajcych ofert: ................................................................................................................ & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . ................................................................................................................ & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . OZWIADCZENIE o wypeBnieniu obowizkw art.14 rozporzdzenie Parlamentu Europejskiego i Rady (UE) 2016/679 zdnia 27 kwietnia 2016 r. w sprawie ochrony osb fizycznych w zwizku z przetwarzaniem danych osobowych i w sprawie swobodnego przepBywu takich danych oraz uchylenia dyrektywy 95/46/WE (oglne rozporzdzenie o ochronie danych) (Dz. Urz. UE L 119 z 04.05.2016, str. 1) Przystpujc do udziaBu w postpowaniu o udzielenie zamwienia na wykonanie zadania pn.: DOSTAWA KOAGULANTU PIX 113 do WSPOMAGANIA PROCESU OCZYSZCZANIA ZCIEKW w Miejskiej Oczyszczalni Zciekw AYNA w Olsztynie, znak PZP.262.53.2019.RGZ, O[wiadczam, |e wypeBniBem obowizki informacyjne przewidziane w art. 14 RODO wobec osb fizycznych, od ktrych dane osobowe bezpo[rednio lub po[rednio pozyskaBem i zawarBem w ofercie, w celu ubiegania si o udzielenie niniejszego zamwienia publicznego. ....................................... .................................................................. (data) (podpis osoby uprawnionej lub osb uprawnionych do reprezentacji wykonawcy) ZaBcznik Nr 4 nazwa, siedzib i adres Wykonawcy / Wykonawcw skBadajcych ofert: ................................................................................................................ ................................................................................................................ & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . OZWIADCZENIE o speBnieniu warunkw 21 i 23 Regulaminu udzielania zamwieD przez PWiK Sp. z o.o. w Olsztynie ze zmianami (ZaBcznik do UchwaBy Nr 8/07 Zarzdu PWiK Sp. z o.o. w Olsztynie z dnia 23 kwietnia 2007r., z wprowadzonymi zmianami) Przystpujc do udziaBu w postpowaniu o udzielenie zamwienia na wykonanie zadania pn.: DOSTAWA KOAGULANTU PIX 113 do WSPOMAGANIA PROCESU OCZYSZCZANIA ZCIEKW w Miejskiej Oczyszczalni Zciekw AYNA w Olsztynie, znak PZP.262.53.2019.RGZ, skBadam o[wiadczenie, |e speBniam nastpujce warunki: OZWIADCZAM, |e speBniam warunki udziaBu w postpowaniu, o ktrych mowa w 21 Regulaminu udzielania zamwieD: posiadam wiedz i do[wiadczenie oraz potencjaB techniczny, a tak|e dysponuj osobami zdolnymi do wykonania zamwienia; znajduj si w sytuacji ekonomicznej i finansowej zapewniajcej wykonanie zamwienia. OZWIADCZAM, |e brak jest podstaw do wykluczenia z powodu niespeBnienia warunkw, o ktrych mowa w 23 ust.1 i 2 Regulaminu udzielania zamwieD. ....................................... .................................................................. 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