ࡱ> Qf#bjbjvv0,ee8.,Z$ ~~~~~'))))))$v8M!M~~Hn ~~' ' Q~,w=x(=`0FQQ&w MM :Oznaczenie sprawy: OKiS.271.2.2024.ESz ZaBcznik nr 3 do SWZ O[wiadczenie * Wykonawcy / * podmiotu udostpniajcego zasoby skBadane na podstawie art.125 ust. 1 ustawy z dnia11 wrze[nia 2019r. Prawo zamwieD publicznych (dalej: ustawa Pzp), dotyczce przesBanek wykluczenia z postpowania Na potrzeby postpowania o udzielenie zamwienia publicznego pn.:  Dowz dzieci/uczniw niepeBnosprawnych do szkB i placwek o[wiatowych w roku szkolnym 2024/2025 , prowadzonego przez Gmin Dbno. * OZWIADCZENIA DOTYCZCE * WYKONAWCY /* PODMIOTU UDOSTPNIAJCEGO ZASOBY: O[wiadczam, |e nie zachodz w stosunku do mnie podstawy wykluczeniu z postpowania wymienione w art. 108 ust 1 i art. 109 ust. 4-7 ustawy Pzp. O[wiadczam, |e nie zachodz w stosunku do mnie podstawy wykluczeniu z postpowania wymienione w art. 109 ust. 1 pkt 5) oraz pkt 8) ustawy Pzp. O[wiadczam, |e nie zachodz w stosunku do mnie przesBanki wykluczenia z postpowania na podstawie 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. O[wiadczam, |e zachodz w stosunku do mnie podstawy wykluczenia z postpowania wymienione w art. ustawy Pzp (poda podstaw wykluczenia). $8DL`bfhjlprx~    & ( 6 8 @ B D F R T V X d f v x ¸h] hn5>*CJ hnO5CJ hy*5CJ h(5CJh] hB5CJh] hn5CJh] h^S6CJh] h^S6CJ h 6CJ h:6CJ h]6CJh] hB6CJh] hn6CJ5z|~ H J L n p  gdDj & F dgdDj & F dgdDj $^a$gdDj $\^a$gdDj$a$gd=[ $Za$gdy*gdDjgdDj nB^ngdDj F H L P R b d | ~ j  & * l n p * , HJО{slОl h] h8Eh] h^S5h] h^S>*h] hn>*h] hn>*CJh] h^SCJ h] h^S hnO5 h]5 h5 h:5h] hB5h] hn5 h] hB h] hnh] h^S5CJh] h^S5CJh] hn5>*CJh(5>*CJ*J*,02:<LNdfhj$(  (*:<HJLf򷭣h 7 h] h8Ehih] h^S5CJh] h^S>*CJh] hn>*Uhih^S5CJhihn6h( hih8E hihnh] h^SCJh h] h^S h] hn7&(!!!{o d^gdDj $^a$gdDj $^a$gdDjgdDj $^a$gdDj$ d^a$gdDj gdDj & F   5m `gdDjgdDj $^a$gdDj & F `gdDj 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 PODWYKONAWCY NIEBDCEGO PODMIOTEM, NA KTREGO ZASOBY POWOAUJE SI WYKONAWCA: O[wiadczam, |e nastpujcy podmiot, bdcy Podwykonawc: (poda peBn nazw/firm, adres, a tak|e w zale|no[ci od podmiotu: NIP/PESEL, KRS/CEiDG), nie podlega wykluczeniu z postpowania o udzielenie zamwienia. OZWIADCZENIE DOTYCZCE PODANYCH INFORMACJI: O[wiadczam, |e wszystkie informacje podane w niniejszym o[wiadczeniu s aktualne i zgodne z prawd oraz zostaBy przedstawione z peBn [wiadomo[ci konsekwencji wprowadzenia zamawiajcego w bBd przy przedstawianiu informacji. Miejscowo[& & & & & & .. data & & & & & & .. ........................................................................... 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