ࡱ> )`!bjbj.({{  $`j $h2h9   R   rT ! * 400` F   `         Nr sprawy EZP-252-38/2020 OZWIADCZENIE Nazwa i adres Wykonawcy: ....................................................................................................................................................... ....................................................................................................................................................... & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ... Zgodnie z art. 24 ust. 11 ustawy Pzp, przekazuje zamawiajcemu o[wiadczenie o przynale|no[ci lub braku przynale|no[ci do tej samej grupy kapitaBowej, o ktrej mowa w art. 24 ust. 1 pkt 23 ustawy Pzp Nawizujc do zamieszczonej w dniu & & & & & r. na stronie internetowej Zamawiajcego informacji, o ktrej mowa w art. 86 ust. 5 ustawy Pzp : o[wiadczam, |e podmiot ktry reprezentuj: nie nale|y do grupy kapitaBowej, o ktrej mowa w art. 24 ust 1 pkt 23 ustawy z dnia 29.01.2004 r.  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U. z 2019 r. poz. 1843) w zwizku z tym przedkBadam list podmiotw skBadajcych ofert w niniejszym postpowaniu, nale|cych do tej samej grupy kapitaBowej* 1) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . 2) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 3) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 4) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 5) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 6) & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .. Wraz ze zBo|eniem o[wiadczenia, Wykonawca mo|e przedstawi dowody, |e powizania z innym wykonawc nie prowadz do zakBcenia konkurencji w postpowaniu o udzielenie zamwienia. * niewBa[ciwe skre[li & & & & & & ., dnia & & & & & r. ........................................................... 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