Appendix 1 to the Request for Tenders -NS/WK/WSPA/2016
Contractor Tender form
…………………………………………………………………………………………………………………………………………………………………….
Name and surname of the Contractor / Company name
…………………………………………………………………………………………………………………………………………………………………….
Address of the Contractor:
…………………………………………………………………………………………………………………………………………………………………….
Correspondence address:
…………………………………………………………………………………………………………………………………………………………………….
Telephone number:
…………………………………………………………………………………………………………………………………………………………………….
E-mail address:
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NIP (if applicable)
…………………………………………………………………………………………………………………………………………………………………….
PESEL (if applicable)
The offer is addressed to the Ordering Party:
WYŻSZA SZKOŁA PRZEDSIĘBIORCZOŚCI I ADMINISTRACJI W LUBLINIE
ul. Bursaki 12
20-150 Lublin
Project „WySPA KOMPETENCJI”
In response to the request to conduct conversation lessons in English with 55 people in dimension 5 hours with
1 person, I submit e following offer to:
1) PART I (to be filled in if the Contractor submits the tender for Part I)
Offered gross price1
for conducting 1 hour (45 minutes) of conversations in English:
……..…………..………………………………………………………………………………………..………
PLN,
(in
words:
………………………………………………………………………………………………………………….………………….. gross),
2)
1
PART II (to be filled in if the Contractor submits the tender for Part II)
Gross price for one hour of the service includes all applicable taxes, charges and costs. Tenderer being a natural person who does not perform business
economic activities, must include in the offer price all the costs of national insurance (ZUS) and income tax required to be borne by the Ordering Party.
Offered gross price1
for conducting 1 hour (45 minutes) of conversations in English:
……..…………..………………………………………………………………………………………..………
PLN,
(in
words:
………………………………………………………………………………………………………………….………………….. gross),
3) PART III (to be filled in if the Contractor submits the tender for Part III)
Offered gross price1
for conducting 1 hour (45 minutes) of conversations in English:
……..…………..………………………………………………………………………………………..………
PLN,
(in
words:
………………………………………………………………………………………………………………….………………….. gross),
I hereby agree to perform the ordered tasks between 12 December 2016 and 28 February 2017; in
accordance with the schedule submitted by the Ordering Party.
1. Signing the following tender I also state that:
a) I entirely accept and fulfil all the conditions for participation in the proceedings;
b) I have read and understood the contents of this inquiry and I bring to it no objections, I also accept the
conditions contained therein;
c) Services will be implemented in accordance with the conditions set out in the inquiry;
d) The offer price is a flat rate and it contains all the costs of execution of the order, including in particular
(depending on the status of the Contractor) any taxes, health insurance contributions, pension contributions
and other contributions under the law, including the costs derived from wages as well as the costs of transport,
accommodation, meals etc.
e) In the event that my offer is chosen as the most advantageous one I undertake to conclude the agreement in
the place and time specified by the Ordering Party;
f) I consent to the processing of my personal data for the purposes of the present proceedings.
g) Any documents attached to this offer are consistent with the original.
2. I include the following documents to the offer:
a) List of persons appointed by the Contractor to perform the contract - Appendix 2
b) Statement of the lack of personal connections and financial links with the Ordering Party - Appendix 3
c) Statement of compliance with the conditions for participation in the proceedings - Appendix 4
d) documents proving the citizenship of a country where mother tongue or official language is English
(refers to persons appointed by the Contractor to perform the contract)
e) documents proving the experience of persons appointed by the Contractor to perform the contract
Aware of liability for making false statements I inform that the data contained in the tender bid and in the
attachments are true.
………......................................
Place and Date
.............................................
(legible signature of the Contractor)
Appendix 2 to Request for tenders - NS/WK/WSPA/2016
List of persons appointed by the Contractor for the implementation of the order
Applies to PART I (to be filled in if the Contractor submits the tender for Part I)
No.
Person appointed by the Contractor for
the performance of the order
Entity to which the service was
provided
Time the service was
provided
Number of hours of carried
out conversations
Time the service was
provided
Number of hours of carried
out conversations
Time the service was
provided
Number of hours of carried
out conversations
Applies to PART II (to be filled in if the Contractor submits the tender for Part II)
No.
Person appointed by the Contractor for
the performance of the order
Entity to which the service was
provided
Applies to PART III (to be filled in if the Contractor submits the tender for Part III)
No.
Person appointed by the Contractor for
the performance of the order
Entity to which the service was
provided
..................................................................................
(date, legible signature of the Contractor)
*Please add as many lines as needed.
Appendix 4 to the Request for Tenders -NS/WK/WSPA/2016
Contractor’s declaration
I, the undersigned, ………………………………….…………………………………………… ……….……………………………….. hereby
(Contractor’s data)
declare what follows:
1.
2.
3.
4.
5.
6.
7.
I declare that I fulfil the conditions for the participation in proceedings related to the service of carrying
out of individual conversations in English - NS / WK / WSPA / 2016, including possessing the knowledge
and experience and the necessary technical and personnel resources to perform the contract.
I declare that I accept all the provisions of inquiry NS / WK / WSPA / 2016
and I assure that I:
a) will implement the contract with due diligence and punctuality,
b) am ready to change the dates of implementation of the contract in case of force majeure or for
reasons beyond the control of the Ordering Party
c) will negotiate the terms of cooperation at every stage of the proceedings,
d) guarantee the validity of the offer for 30 days from the date of its submission,
I declare that I have read and understood the contract and I do not have any objections to it.
I declare that the persons appointed to perform the tasks will be fully available within the executed
order.
The Contractor shall ensure that the total working hours of the Party engaged in the implementation of
this project and all projects financed by the Structural Funds and the Cohesion Fund and activities
funded from other sources, including funds and other entities, does not exceed and will not exceed
throughout the period of the implementation of the agreement 276 hours per month. The limit of
professional involvement referred to above applies to all forms of professional engagement
I declare that I am / am not * employed in the institutions participating in the implementation of the
Operational Programme on the basis of employment. In the case of employment in the above
institutions I declare that there is no conflict of interest or a double financing.
I hereby consent to the processing of my personal data included in the tender for the proceedings
concerning the inquiry NS / WK / WSPA / 2016 project "WySPA KOMPETENCJI", according to the Act of
29 August 1997 on the Protection of Personal Data (Journal of Laws 2016, item. 922)
…………………………………………….
place, date
……………………………….…………………………
legible signature of the Contractor
Appendix 3 to the Request for Tenders -NS/WK/WSPA/2016
CONTRACTOR’S DECLARATION
I hereby declare that (name)……………………..…............................................................................
(name and surname / company name)
is not subject to exclusion from bidding on the contract within the Project „WySPA KOMPETENCJI”
due
to
personal
connections
or
financial
links
with
WYŻSZA
SZKOŁA
PRZEDSIĘBIORCZOŚCI
I ADMINISTRACJI W LUBLINIE, persons authorised to incur liabilities on its behalf, and those responsible on its
behalf to perform activities related to the preparation and the procedure for selecting the supplier or
contractor; there are no affiliations between ……………….............................................................................
................................................................................
/me
and
WYŻSZA
SZKOŁA
PRZEDSIĘBIORCZOŚCI
I
ADMINISTRACJI W LUBLINIE or any persons abovementioned, and especially there are no affiliations of the
following kind:
a) participation in a company as a partner in private partnership or partnership,
b) the possession of at least 10% of shares or stocks,
c) being a member of the supervisory or management body, representative or proxy,
d) being married, in consanguinity or affinity in a straight line, the second degree of kinship
or affinity of the second degree in the collateral line or by adoption, guardianship or
custody,
…………………………………………
place, date
…………………………………….……………………
legible signature of the contractor