1. The subject of the contract is the purchase and delivery of equipment for the needs of SPZOZ in Radzyń Podlaski described in detail in the scope and in the quantities indicated in the form - a list of technical parameters constituting Annex No. 3.1-3.3 to SWZ

Task 1 – C-arm X-ray machine

Task 2 – Laparoscope

Task 3 – Steam sterilizer

1. The subject of the contract is the purchase and delivery of equipment - medical equipment for the needs of SPZOZ in Radzyń Podlaski described in detail in the scope and in the quantities indicated in the form - a list of technical parameters constituting Annex 3.1 to the SWZ.

1. The subject of the order is the purchase and delivery of equipment - medical equipment for the needs of SPZOZ in Radzyń Podlaski described in detail in the scope and in the quantities indicated in the form of the list of technical parameters constituting Annex No. 3.2 to the SWZ.

A. A STATEMENT PURSUANT TO ARTICLE 125(1) OF THE PUBLIC PROCUREMENT LAW.

1. Declaration pursuant to Article 125(1). Declaration not to be excluded and the conditions for participation in the procedure are met, on the ESPD form, drawn up in accordance with the model standard form set out in the Commission Implementing Regulation (Single Document - Annex 2 to the ESPR)

a) In Part IV of the JAD form under the name "Qualification criteria", the Contractor may limit itself to completing section α, i.e. to submitting a general statement regarding all qualification criteria. In such a case, the Contractor does not have to fill in any of the remaining sections of Part IV of the form concerning the selection criteria, and the appropriate (evidentiary) verification of the fulfillment of specific conditions for participation in the procedure specified by the Ordering Party (selection criteria), the Ordering Party will make on the basis of relevant documents submitted by the Contractor whose offer has been evaluated the highest, at the request of the Ordering Party (Article 126 paragraph 1 of the Public Procurement Law).

b) in the case of economic operators jointly applying for the award of a contract, the single document referred to in Article 125(1) of the Public Procurement Law shall be submitted by each of these economic operators, in accordance with the template constituting Annex 3 to the SWZ. These declarations confirm the absence of grounds for exclusion and the fulfilment of the conditions for participation in the procedure to the extent that each of the contractors demonstrates compliance with the conditions for participation in the procedure.

(c) The Economic Operator shall, where relying on the capacities or situation of the entities providing the resources, also submit, together with the single document, a statement from the provider of resources confirming that there are no grounds for exclusion of that entity and, accordingly, that the conditions for participation in the procedure are met to the extent that the Economic Operator refers to its resources.

d) The Contractor shall indicate in the JEDZ form (Part III, Section D) those parts of the contract that it intends to entrust to subcontractors (if applicable) together with the Contractor's indication of the subcontractors' companies. If the Contractor does not indicate the information in the scope specified in the preceding sentence, the Ordering Party shall assess that the Contractor will perform the order in its entirety.

Instructions for completing the Single European Procurement Document (ESPD/ESPD) is published on the website of the Public Procurement Office – available at:

https://www.uzp.gov.pl/__data/assets/pdf_file/0026/45557/Jednolity-Europejski-Dokument-Zamowienia-instrukcja-2021.01.20.pdf

2. Subjective means of proof regarding the confirmation of compliance with the conditions for participation in the procedure, submitted at the request of the Ordering Party by the contractor whose offer was the highest rated (within the time limit set by the Ordering Party, not shorter than 10 days):

Not applicable

1. The subject of the order is the purchase and delivery of equipment - medical equipment for the needs of SPZOZ in Radzyń Podlaski described in detail in the scope and in the quantities indicated in the form list of technical parameters - constituting Annex No. 3.3 to the SWZ.

2. The Contracting Authority shall exclude from the Contractors' proceedings:

1) who have not demonstrated that the conditions for participation in the proceedings have been met,

referred to in Chap. VI paragraph 1 of the SWZ;

2) who have not demonstrated that they are not subject to the conditions set out in Article 108(1) of the Public Procurement Law and pursuant to Article 7(1) of the Act of 13 April 2022 on special solutions for counteracting support for aggression against Ukraine and protecting national security (Journal of Laws, item 835).

3) who have not shown that the conditions set out in Article 109(1)(1), (4-10) of the Public Procurement Law apply to them.

3. Grounds for exclusion referred to in Article 7(1) of the Act of 13 April 2022 (Journal of Laws, item 835): the Contractor, none of the consortium partners (in the case of submitting a joint offer) or any entity whose resources are invoked by the Contractor in order to meet the conditions for participation in the proceedings may not be excluded from the proceedings on the basis of any of the conditions, referred to in Article 7(1) of the Act on special solutions for counteracting the promotion of aggression against Ukraine and for the protection of national security, i.e.:

'Article 7(1). The following shall be excluded from the public procurement procedure or competition conducted on the basis of the Act of 11 September 2019 – Public Procurement Law:

(1) an economic operator and a participant in a contest included in the lists set out in Regulation 765/2006 and Regulation 269/2014 or entered on the list on the basis of a decision on entry on the list determining the application of the measure referred to in Article 1(3);

2) the contractor and the participant of the competition, whose beneficial owner within the meaning of the Act of 1 March 2018 on counteracting money laundering and terrorist financing (Journal of Laws of 2022, items 593 and 655) is a person listed in the lists specified in Regulation 765/2006 and Regulation 269/2014 or entered on the list or being such a beneficial owner from 24 February 2022, if it has been entered on the list on the basis of a decision on entry on the list determining the application of the measure referred to in point (3) of Article 1;

3) a contractor and a participant in the competition whose parent undertaking within the meaning of Article 3(1)(37) of the Accounting Act of 29 September 1994 (Journal of Laws of 2021, items 217, 2105 and 2106) is an entity listed in the lists set out in Regulation 765/2006 and Regulation 269/2014 or entered on the list or being such a parent company from 24 February 2022, in so far as he has been entered on the list on the basis of a decision on entry on the list determining the application of the measure referred to in Point (3) of Article 1.'

The contracting authority shall also inform that a person or entity subject to exclusion pursuant to Article 7(1), which during the period of such exclusion applies for the award of a public contract or participates in a public procurement procedure, is subject to a fine of up to PLN 20,000,000.00.