Annex 1 – to Request for Tender no.04 /06/2017/CD20 dated 30.06.2017
FORM OF TENDER
(template)
I.
Name and address of tenderer and its registration details, including NIP (tax ID):
…………………………………
…………………………………
…………………………………
II.
Name, phone number and e-mail of the contact person:
…………………………………………
………………………………………..
………………………………………..
III.
Information about quality system in Tenderer’s facility
IV.
The date of commencement of work from the moment of signing agreement [in
days] – not later than October 1 2017:
V.
Time of completion of analysis (from analysis of first sample till final report deliver,
in days):
VI.
Date of payment:
1
Status of the methods (considered in evaluation criteria)
Method
Qualified/validated for
Rituximab [Yes/No]
In-house method [Yes/No]
If No, Name and Address of the cooperating
company
FcGRI/CD64
FcGRIIa/CD32a (H)
FcGRIIa/CD32a (R)
FcGRIIb/CD32b
FcGRIIIa/CD16a
(V)
FcGRIIIa/CD16a (F)
FcGRIIIb/CD16b
FcRn
VII.
a.
I agree to:
Place the following point to the contract:
“In case of any error occurring that may affect final results, the Performer is obligated to find
optimal solution that will provide satisfactory results (meeting the initial arrangements in
paragraph ________ of the contract). Samples repetition should be carried out without
additional quotation within initial timelines.”
b. Allow a delegated person from Contracting Entity to audit if Tenderer’s facilities and
stuff adhere to highest quality standards (particularly the issue of quality assurance
system) before cooperation starts.
VIII.
Validity of tenders
I declare that following tender is valid for 90 days from the deadline for submission of tenders.
2
Place and date: ………………………..
…..………………………………………………………………….…..
Signature of Tenderer or Tenderer's authorised representative
and company seal (if Tenderer is an entity that runs business activity)
3
ANNEX 2 – to Request for Tender no. 04/06/2017/CD20 dated 30.06.2017
STATEMENT ON THE ABSENCE OF PERSONAL OR CAPITAL LINKS
I, the undersigned …………………………………………………………………………………………………………….....,
[name and surname of Tenderer or its authorised representative], declare that
…………………………………. [name of tenderer] has / I have no personal or capital links with
Contracting Entity.
Capital or personal links are understood as mutual ties between Contracting Entity or persons
authorised to bind Contracting Entity or persons who act on behalf of Contracting Entity in
connection with preparing and conducting the procedure for selection of a contractor, and
the contractor, which are in particular the following:
1.
participation in a partnership as a partner of a civil law partnership or general
partnership,
2.
holding at least 10% of shares,
2.
serving as a member of a supervisory body or a managing body, acting as a registered
representative (prokurent) or an attorney,
3.
being a spouse, a relative by lineal consanguinity or affinity, by collateral consanguinity
to the 2nd degree or affinity to the 2nd degree, or a person linked by way of adoption, custody
or legal guardianship.
Place and date: ……………………….
…..………………………………………………………………….…..
Signature of Tenderer or Tenderer's authorised representative
and company seal (if Tenderer is an entity that runs business activity)
4
ANNEX 3 – to Request for Tender no. 04/06/2017/CD20 dated 30.06.2017
Attribute
Method/Analysis
Number of
repetitions
Number of samples
Netto price for
analysis of one
repetition
Netto price for
analysis of all
samples
Netto price for
whole analytical
panel
Brutto price for
whole analytical
panel
Blok analityczny
FcGRI/CD64
FcGRIIa/CD32a (H)
FcGRIIa/CD32a (R)
FcGRIIb/CD32b
FcGRIIIa/CD16a (V)
FcGRIIIa/CD16a (F)
FcGRIIIb/CD16b
FcRn
SPR
3
1717
…..………………………………………………………………….…..
Signature of Tenderer or Tenderer's authorised representative
and company seal (if Tenderer is an entity that runs business activity)
5
ANNEX 4 – to Request for Tender no. 04/06/2017/CD20 dated 30.06.2017
STATEMENT ON FULFILLING THE FORMAL REQUIREMENTS FOR PARTICIPATION IN THE
PROCEDURE
I, the undersigned …………………………………………………………………………………………………………….....,
[name and surname of Tenderer or its authorised representative], declare that
…………………………………. [name of tenderer]
a. have/ has the appropriate knowledge and experience to perform the contract
in the highest standards
b. have/ has a financial situation that guarantees the performance of the whole order
Place and date: ………………………..
…..………………………………………………………………….…..
Signature of Tenderer or Tenderer's authorised representative
and company seal (if Tenderer is an entity that runs business activity)