Annex No. 1 to the Inquiry No. 2/2016
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Date, Place
Supplier Name
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Supplier Address
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Identification Number ……………………………………………………………...
REGON*
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KRS**
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E-mail Address
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Phone Number:
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* Only for Polish Suppliers
**If applicable
CELLPEUTICS Sp. z o.o.
ul. Duńska 9
54-424 Wrocław
tel: +48 603 820 820
e-mail: [email protected]
FORM SHEET
PROCEDURE FOR PUBLIC PROCUREMENT
INQUIRY NO 2/2016
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In response to a call for tenders to delivery of device and material for cell isolation, we offer fulfillment
of the order in accordance with the requirements set in the proposal request No. 2/2016.
A project co-financed under the Measure 1.2 „Innowacyjne przedsiębiorstwa”;
Sub-measure 1.2.1 „Innowacyjne przedsiębiorstwa– konkurs horyzontalny”;
Scheme 1.2 A Wsparcie dla przedsiębiorstw chcących rozpocząć lub rozwinąć działalność B+R
of the Regional Operational Programme for the Voivodship of Lower Silesia for the period 2014-2020.
Price without VAT:
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VAT*:
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Final Price:
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Validity of the offer (the minimum period
during which the Supplier will guarantee the
offer)
Payment Conditions:
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Term of delivery - Task No.1 (in day):
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Term of delivery - Task No.2 (in month):
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* If applicable
Specification of the quotation:
A set of devices for the isolation and cultivation of rare cells necessary for research specified in the
Task No.1
Price for isolation and cultivation device of
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rare cells by size-based separation method –
1 200 pcs.
Price for immunomagnetic separation method
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/ device – 15 ml
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Price without VAT:
VAT*:
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Final Price:
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* If applicable
A set of devices for the isolation and cultivation of rare cells necessary for research specified in the
Task No.2
Price for device for isolation and cultivation
of rare cells by size-based method – 600
pcs.
Price for immunomagnetic separation
method device – 5 ml
Price without VAT:
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Final Price:
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2
VAT*:
Strona
* If applicable
A project co-financed under the Measure 1.2 „Innowacyjne przedsiębiorstwa”;
Sub-measure 1.2.1 „Innowacyjne przedsiębiorstwa– konkurs horyzontalny”;
Scheme 1.2 A Wsparcie dla przedsiębiorstw chcących rozpocząć lub rozwinąć działalność B+R
of the Regional Operational Programme for the Voivodship of Lower Silesia for the period 2014-2020.
On behalf of the Supplier I declare that the total cost of the offer was estimated taking into account all
the requirements and components of the terms of reference, and for the price offers all fees and
indirect costs associated with the performance of the contract and the execution of delivery.
The offer was made on... numbered pages.
Annexes to this offer are:
1. STATEMENT ON FULFILLMENT OF THE CONDITIONS ON PARTICIPATION IN THE PROCEEDINGS.
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date and signature / authorized representative of the Supplier /
A project co-financed under the Measure 1.2 „Innowacyjne przedsiębiorstwa”;
Sub-measure 1.2.1 „Innowacyjne przedsiębiorstwa– konkurs horyzontalny”;
Scheme 1.2 A Wsparcie dla przedsiębiorstw chcących rozpocząć lub rozwinąć działalność B+R
of the Regional Operational Programme for the Voivodship of Lower Silesia for the period 2014-2020.