APPENDIX No.

2 TO SWZ
procedure number:NPR/IH/2023/002
.................................
(place and date)

Purchaser:
Port of Gdansk Authority S.A.
st. Closed 18
80-955 Gdansk

OFFER FORM
DHASINCONTRACTORS

name (company)1

address

NIP REGON

voivodeship

contact details

e-mail address

phone no

Acting on behalf of the Contractor:

1. I am submitting an offer in a public procurement procedure conducted in the form of an
open tender on the basis ofthe Act of September 11, 2019. Public Procurement Law(i.e.
Journal of Laws of 2022, item 1710, as amended) for the implementation of the task
entitled
Construction of bottom reinforcement at Quay Przemyslowe III-1 ÷ III-6 and
replacement of the fender line at Quay Przemyslowe III-1 and III-2 at the Port of
Gdansk,
the subject of which was specified in the Terms of Reference (SWZ).

1
In the case of Contractors jointly applying for the contract, enter the data of all Contractors and the
representative - leader.

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2. I offer the performance of construction works constituting the subject of the contract
in accordance with the scope, requirements and conditions specified in the SWZ for
the price of:
Gross price 2 PLN

in zloty words

2.1. The price of the basic order:

Gross price of the basic order3 PLN

in zloty words

2.2. Price of execution of the contract under the right of option No. 14:
Gross price of the order within the law PLN
option
number
15

in zloty words

2.3. Price of execution of the contract under the right of option No. 26:
Gross lump sum price of the order PLN
in under Option 2 law7

in zloty words

3. The Contractor is obliged to complete the subject of the contract on time (without the scope
covered by the right of option No. 1 from point 8.1. letter e) of the SWZ)within 82 weeks
from the date of conclusion of the Agreement.
4. I inform that a bid bond in the amount of PLN 500,000.00filed in:

2
Addition:gross prices of the basic order (point 2.1 of the offer form), gross price of the order under the
option rightNo. 1 (item 2.2 of the Offer Form) andthe gross lump sum price of the order under the right of
option No. 2 (item 2.3 of the Tender Form).
3
In accordance with the Price Form for the basic order - Appendix No. 2A to the SWZ[row: Total gross
salary incl. VAT].
4
Option right No. 1: regarding the implementation of section III-5 with a length of 75 m between points 36e-36f
and section III-6 with a length of 82.1 m between points 36f-37, in accordance with the Draft Agreement
(Appendix 8 to the SWZ) and the OPZ constituting Appendix No. 1 to the SWZ.
5
In accordance with the Price Form for the order under the option right No. 1 - Appendix No. 2B to the
SWZ[row: Total gross salary incl. VAT].
6
Option right No. 2: regarding the change in the method of making the fender line on sections III-1 and III-2, in
accordance with the Draft Agreement (Appendix No. 8 to the ToR) and the OPZ, constituting Appendix No. 1 to
the ToR.7 In accordance with the Price Form for the order under the right of option No. 2 - Appendix No.
2B to the SWZ[row: Total gross flat-rate remuneration including VAT].

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 form of bid bond

Contractor's account
number to return the
deposit
contributed in money

5. I declare that the offer validity period is90 days from the deadline for submission of bids.
6. I declare that, with due diligence, I have read the ToR and have no objections to it, and have
obtained the necessary information necessary to prepare the offer and properly perform
the order.
7. I declare that the trade secret within the meaning of the provisions on combating unfair
competition is the following information contained in the offer:
offer page number

type of information

justification for the reservation

information as a secret
enterprises
8. I declare that in the public procurement in question, the Contractor I represent:8

□ does not intend to subcontract any part of the contract;

□ intends to entrust the performance of the following parts of the contract to the
subcontractors listed below:
lp. part of the order9 name (company) of the
subcontractor10

1.

2.

3.

4.
9. I certify that I am11:
􀀀 a micro-enterprise
􀀀a small enterprise
􀀀 medium enterprise
8
Mark the appropriate one (insert an X in the appropriate field □).
9
The scope of works should be indicated.
10
If known.
11
Mark the appropriate one (insert an X in the appropriate field □).

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 􀀀 a sole proprietorship
􀀀 a natural person who does not run a business
􀀀 different kind
10. I got acquainted with the draft terms of the contract(Appendix No. 8 to the SWZ) and, if
this offer is selected, I undertake to conclude a contract under the conditions specified
therein, at the place and time specified by the Ordering Party.
11. I declare, thatwarranty period for defects within the meaning of the regulations of the
Civil Code totals 60 monthsfrom the date of signing the Final Acceptance Protocol of the
Subject of the Agreement (last section) by the Parties to the Agreement.
12. I declare that in relation to persons whose data has been transferred to the Port of Gdansk
Authority S.A. as part of these proceedings, the information obligations provided for in
art. 14Regulation (EU) 2016/679 of the European Parliament and of the Council of 27
April 2016 on the protection of individuals with regard to the processing of personal data
and on the free movement of such data, and repealing Directive 95/46/EC(general
regulation on data protection) (Official Journal EU L 119 of 04.05.2016, p. 1, as
amended).
13. I declare that all information provided in the offer is up-to-date and truthful and has been
presented with full awareness of the consequences of misleading the Employer when
presenting information.
14. Appendices to thisoffer formwhich are part of the offer are:
1. Price formsprepared in accordance with the templates constituting Annexes 2A
and 2B to the SWZ

2. proof of payment of the deposit

3. EAT

4. Statement of the Contractor/Contractor jointly applying for the award of the

contract from Appendix No. 12 to the SWZ

5. Other - if applicable

ATTENTION!All white fields must be filled in offer form. in the fields which do not apply to
a given Contractor, put a dash.
place and date

[The document must be signed

qualified electronic signature
– in accordance with the SWZ]

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