OFFER FORM
Contractor’s corporate stamp
LOTOS Petrobaltic S.A.
Stary Dwór 9
80-958 Gdańsk, Poland
TENDER
Unit price
Description
Quantity
Item
Name of the
manufacturer,
model,
country of
origin
Units
1. Further to an announcement concerning a contract award procedure under an open tendering
procedure for the delivery of drill/casing pipes*, we shall offer to execute the said contract in
accordance with the detailed terms and conditions of the contract for the price of:
1.
Drill pipes*
meters 3000
2.
Casing pipes*
meters 2000
Net Value
VAT
VAT
rate
Value
(%)
Gross Value
TOTAL
Say (total): ..................................................................................................................................................
.....................................................................................................................................................................
2. Contract performance date*:
3.
4.
5.
6.
7.
8.
drill pipes:
from ........... to ...............
casing pipes: from ........... to .............. .
We recognise ourselves as obliged to maintain the tender for a period of 30 days as from
the tender submission date.
We represent that we have become acquainted with the Specification of Essential Terms of
the Contract and attachments thereto, including the subject of contract and the provisions of
the Material Provisions of the Contract that shall be incorporated into the contents of a future
agreement, we accept them and do not make any reservations to them.
We hereby inform that we shall /shall not** assign part of the contract to be performed by
a Sub-Contractor, i.e.; .............................................................................................................................. .
We hereby advise that information included in the tender, contained on pages from ......... to
.........*** constitute the company’s secret within the meaning of the provisions of the Unfair
Competition Act and as such may not be made generally available.
We undertake to sign a contract pursuant to the terms and conditions included in the SIWZ at
the venue and time indicated by the Awarding Entity.
Attachments to the Tender Form that form an integral part thereof:
a) Attachment 1 – the Contractor’s Statement on Satisfaction of the Conditions for Participation in
the Contract Award Procedure.
b) Attachment 2 – Material Provision of the Contract.
* Delete as applicable – no deletion shall mean submission of a tender for both parts of the contract
** Delete as applicable
*** Mandatory field, if does not apply, please put in “nie dotyczy” [does not apply]
..........................................................
Place, date
..................................................................................................
(signatures of person/s indicated in the document, authorised to transact
business, represent the Contractor, make or receive statements of intent on its
behalf)
Attachment 1 to the Offer Form
.................................., ...........................
(place)
(date)
[Contractor’s corporate stamp]
LOTOS Petrobaltic S.A.
ul. Stary Dwór 9
80-958 Gdańsk, Poland
STATEMENT OF THE CONTRACTOR
ON FULFILMENT OF THE CONDITIONS FOR PARTICIPATION IN THE CONTRACT
AWARD PROCEDURE
Acting on behalf of: ......................................................................................................................................................................................................
...........................................................................................................................................................................................................................................................
............................................................................................................................................................................................. [give the Contractor’s name]
(“Contractor”) and being duly authorised to represent it, I/we hereby represent that
the Contractor satisfies the conditions for participation in the contract award procedure for:
...........................................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................................
......................................................................................................................................................................................................
[described the contract]
(“Contract”) listed in Art. 22.1 of the Act on Public Procurement Law of 29 January 2004 (“Act”)
concerning:
1. authorisations to perform activities: ..................... ..............................................................................................................................
.................................................................................................................. ..............................................................................................................................
.................................................................................................................. ................................................................
[describe operations]
2. knowledge and experience, having appropriate technical potential and personnel capable of
performing a contract
3. economic and financial standing.
Furthermore, I/we represent that the Contractor is not subject to exclusion from the contract
award procedure pursuant to Art. 24.1 and 24.2 of the said Act on Public Procurement Law.
...........................................................................................................
(signatures of person/s indicated in the document,
authorised to transact business, represent the
Contractor, make or receive statements of intent on
its behalf)