Appendix 2 to SIWZ (Bidder s company seal) OFFER Form Awarding Entity: Polskie LNG S.A. ul. Ku Morzu 1 72-602 Świnoujście On whose behalf the proceedings are conducted by: Polskie LNG S.A. Biuro w Warszawie Al. Jerozolimskie 146 bud. B 02-305 Warszawa By submitting this offer in the Public Contract award procedure conducted in the form of an open public tender titled "Delivery of two low pressure LNG pumps and two high pressure LNG pumps" (Ref. No.: RZ/43/ZP/2018/PLNG), we, the undersigned: Bidder 1... a member/not a member** of the capital group within the meaning of Article 4(14) of the Act of 16 February 2007 on competition and consumer protection (consolidated text: Journal of Laws of 2018, item 798, hereinafter referred to as "competition law ) referred to in Article 24(1)(23) of the Public Procurement Law***. Bidder 2*... a member/not a member** of the capital group within the meaning of Article 4(14) of competition law referred to in Article 24(1)(23) of the Public Procurement Law ***. Bidder 3*... 1
a member/not a member** of the capital group within the meaning of Article 4(14) of competition law referred to in Article 24(1)(23) of the Public Procurement Law ***. Proxy* appointed to represent the Bidders jointly applying for the award of the Contract (e.g. consortium Leader):......... *to be filled in only by Bidders jointly applying for the award of the contract (civil law companies or consortia) 1. WE HEREBY SUBMIT THE OFFER in accordance with the content of the Terms of Reference. 2. WE DECLARE that we have acknowledged the provisions of the Terms of Reference and we consider ourselves bound by the said provisions and rules of the Proceedings stipulated therein and have obtained the information necessary to draw up the offer compliant with the requirements set therein. 3. WE DECLARE that we have acknowledged the draft contract constituting Annex No. 3 to the Terms of Reference and should our offer be selected, we undertake to conclude an agreement in accordance with that draft contract, on the conditions specified in the Terms of Reference, at the place and time set by the Awarding Entity. 4. WE DECLARE that to demonstrate the fulfilment of conditions referred to in Article 22(1) of the Public Procurement Law we will rely on the resources of the following entities (on the terms set in Article 22(a)(1) of the Public Procurement Law)****: Entity 1... address...... postal code town country. tax ID..., Company Registration no.... (The bidder relies on Entity 1 s technical capacity ** / professional skills ** / financial or economic standing **. Entity No. 1 will **/will not** participate in the implementation of a part of the contract). 2
Name and surname of the person (s) authorized to represent Entity 1 **:......... Basis for authorization for representation: natural person **/sole-trader**. or Name of the body authorised to represent Entity 1 **:...... Form of representation of Entity 1 **:... Data of persons acting as the body representing Entity 1 **: Entity 2... address...... postal code town country. tax ID..., Company Registration no.... (The bidder relies on Entity 2 s technical capacity ** / professional skills ** / financial or economic standing **. Entity No. 2 will **/will not** participate in the implementation of a part of the contract). Name and surname of the person (s) authorized to represent Entity 2 **:......... Basis for authorization for representation: natural person **/sole-trader**. or Name of the body authorised to represent Entity 2 **:...... Form of representation of Entity 2 **:... Data of persons acting as the body representing Entity 2 **: 5. WE OFFER to deliver the subject of the Order for the total price: A. Net price of delivery of the subject of the order... PLN VAT amount at the statutory rate as at the date of the tax obligation; the rate as at the date of the offer is... %. (A1) Gross price of delivery of the subject of the order including VAT tax at the rate as at the date of the offer... PLN. WE DECLARE that the total net price referred to above includes the delivery and services covered by the subject of the order, i.e. delivery of two low pressure LNG pumps and two high pressure LNG pumps with complete set of accessories and the supervision of the installation, operational tests, commissioning and start-up, as well as maintenance and guarantee services in 3
accordance with Appendix No. 1 to the tender specifications entitled Opis Przedmiotu Zamówienia (OPZ) Pompy niskociśnieniowe i wysokociśnieniowe (nr dokumentu O825-O1-MEC- SPC-002) according to the terms set out in Appendix 3 of the Terms of Reference (draft contract). B. WE DECLARE that for one (1) day of deferred Delivery under the Awarding Entity's Option Right, the price shall be: Net unit price... PLN Net price for delivery deferred by180 days..pln VAT amount at the statutory rate as at the date of the tax obligation; the rate as at the date of the offer is... %. (B1) Gross price for delivery deferred by180 days, including VAT amount at the rate as at the date of the offer is... PLN. Gross price for delivery deferred by180 days (B1) cannot be less than 5% of the gross price of the contract (A1). C. Total gross price (C1) amounts to (A1 + B1)... PLN. 6. WE DECLARE that the warranty period will be 24 months extended by.. months. 7. THE CONTRACT WILL BE PERFORMED BY ourselves**/with subcontractors**: a.... (subcontractor s name) for:... (scope of work to be performed by the subcontractor)** b.... (subcontractor s name) for:... (scope of work to be performed by the subcontractor). 9. WE DECLARE that with the exception of the information contained in the offer on pages from.. to.., and in the documents appended to the offer, on pages from.. to - this offer and all attachments hereto are not privileged and do not contain information constituting company secret in the meaning of the provisions of the Act on combating unfair competition**. The Contractor is obliged to prove that the privileged information constitutes company secret. Failure to indicate which information constitutes a trade secret up to the tender submission deadline will be considered as the case whereby the Bidder did not include any privileged information constituting a trade secret in the offer, and consequently the Awarding Entity will be authorised to disclose all information indicated without requesting further explanation. 10. WE DECLARE that the offer remains valid for a period of 60 days following the tender submission date. 11. WE DECLARE, that in the case of providing personal data other than directly concerning our company and in case of the absence of the application of the exclusion of the obligation to provide information as provided for in Article 13(4) or Article 14(5) of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with 4
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) (Journal of Laws UE L 119 of 04/05/2016, page 1), hereinafter "GDPR", we have fulfilled the information obligations provided for in Article 13 or Article 14 GDPR towards natural persons from whom we have obtained, directly or indirectly, personal data for the purpose of applying for contract award in a open tender procedure. 12. ANY CORRESPONDENCE regarding this Proceedings should be addressed to:. 13. THE CONTACT PERSON for the matters related with this offer is... 14. THIS OFFER contains consecutively numbered pages. 15. APPENDED TO this offer we submit the following documents: 1).. 2).. 3).. 4).. 5).. 6).. 7).. 8)..., date. (Bidder s signature) * only for bidders jointly applying for the award of the Contract ** delete as appropriate. *** If the Bidder does not indicate any answer or declares membership in a capital group, Appendix 10 to the ToR is mandatory. **** to be filled only by Bidders who rely on the resources of entities on the principles set out in Article 22(a) of the Public Procurement Law. 5