Procurement observatory.

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| Tender submission form |
| --- |
| Public procurement entitled |
|  |
| „UPOL/FoS/DEP - Cryostat systems for Mössbauer spectroscopy“ |
|  |
|  |
|  |

Identification details of the tenderer and its representatives

Identification details of the tenderer

| Business name or full name: | Insert name |
| --- | --- |
| Registered office: | Insert registered office |
| Company ID no.: | Insert no. |
| VAT ID no.: | Insert no. or information that the tenderer is not a VAT payer |
| Entry in CR: | Insert court, section and file no. |
| The tenderer is a small or medium-sized enterprise: |  |
| Bank details: | Insert bank name |
| Bank account no.: | Insert bank no. |
| Legal representative: | Insert name, surname and position of the representative who will sign the Contract in the event of selection |
| Joint participation of tenderers in the procurement procedure[^2]: | Business name/full name, registered office, company ID no., VAT no. |
| Joint participation of tenderers in the procurement procedure[^2]: | Business name/full name, registered office, company ID no., VAT no. |
| Joint participation of tenderers in the procurement procedure[^2]: | Business name/full name, registered office, company ID no., VAT no. |

Identification details of tenderer’s representatives

| Tenderer’s contact person regarding the tender | Tenderer’s contact person regarding the tender |
| --- | --- |
| Name and surname: | Insert name and surname |
| Telephone: | Insert telephone no. including international dialing code |
| E-mail: | Insert e-mail adress |
|  |  |
| Tenderer’s person authorized to act in technical matters during performance of the Contract | Tenderer’s person authorized to act in technical matters during performance of the Contract |
| Name and surname: | Insert name and surname |
| Telephone: | Insert telephone no. including international dialing code |
| E-mail: | Insert e-mail adress |

Tenderer’s declarations

The tenderer hereby declares on its honor

**with regard to the procurement conditions**, that it

has carefully reviewed the procurement conditions of the Public procurement, including any clarifications, supplements and amendments thereto, has understood them and agrees to them,

accepts E-ZAK as the exclusive means of communication in the procurement procedure of the Public procurement,

acknowledges that, in communication carried out via E-ZAK, a data message is deemed delivered upon its receipt at the electronic address of its addressee;

**with regard to the binding commercial terms of the Public procurement**, that it accepts them in the wording provided by the Contracting authority;

**with regard to the responsible performance of the Public procurement**, that

in performing the subject of the Public procurement, it shall ensure, in respect of all employees participating in the performance of the Public procurement, compliance with labor law regulations, employment regulations and occupational health and safety regulations;

it shall impose the same obligations on its subcontractors directly participating in the performance of the Public Procurement (excluding suppliers of materials or goods in the case of resale);

**with regard to conflict of interest**, that no conditions for the existence of a conflict of interest within the meaning of Section 44 ZZVZ are met; in particular, it is not directly or indirectly influenced in the procurement procedure in relation to the Contracting authority or to entities involved in the preparation of the procurement conditions, nor does it have any special relationship with such persons (e.g. ownership, personnel or similar);

**with regard to conflict of interest within the meaning of Section 4b ZOSV**, that:

it is not a commercial company in which a public official referred to in Section 2(1)(c) ZOSV or a person controlled by such official, holds a share representing at least 25% participation in that commercial company; and

if it demonstrates fulfilment of any part of qualification through another person (subcontractor), such other person is not a commercial company in which a public official referred to in Section 2(1)(c) ZOSV or a person controlled by such official, holds a share representing at least 25% participation in that commercial company;

**with regard to international sanctions**, that

it is familiar with the applicable international sanctions, in particular Council Regulation (EU) No. 833/2014 of 31 July 2014 concerning restrictive measures in view of Russia’s actions destabilising the situation in Ukraine, as amended;

it does not offer performance subject to applicable international sanctions;

no sanctions under the applicable legislation governing the implementation of international sanctions apply to it,

if a contract for the Public procurement is concluded with it, it shall ensure for the entire duration of its performance that

the above shall also apply to all its subcontractors used in the performance of the Public procurement whose share in the subject of the Public procurement exceeds 10%;

it shall immediately replace any subcontractor meeting the above criteria if international sanctions are imposed on such subcontractor during the performance of the Public procurement.

Qualification

Basic eligibility

- The tenderer hereby declares on its honour that it is eligible to perform the Public procurement within the meaning of Section 74 ZZVZ, including the fact that:
- a) it does not have any outstanding tax arrears relating to excise duty recorded in the tax records in the Czech Republic or in the country of its registered office; and
- b) it does not have any outstanding arrears in payments of public health insurance premiums or related penalties in the Czech Republic or in the country of its registered office.

Professional eligibility

- The tenderer hereby declares on its honour that it complies with the requirement set out in Section 77(1) ZZVZ. The tenderer is able to prove this fact by submitting an extract from the Commercial Register or from a similar register, if it is entered therein.

Economic qualification

- The Contracting authority does not require the demonstration of economic qualification.

Technical qualification

The Contracting authority does not require the demonstration of technical qualification.

Evaluated criteria

The tenderer offers **a total tender price Insert ammount CZK excluding VAT**.

The Supplier offers **a P value of** **Insert ammount kW** (being the sum of the electrical power consumption, in kW, of all equipment necessary for the operation of the proposed solution during sample measurement under the reference conditions specified by the Contracting Authority in the Procurement Documentation of the Public Contract).

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| Tender submission form                                            |
| ----------------------------------------------------------------- |
| Public procurement entitled                                       |
|                                                                   |
| „UPOL/FoS/DEP - Cryostat systems for Mössbauer spectroscopy“      |
|                                                                   |
|                                                                   |
|                                                                   |

Identification details of the tenderer and its representatives

Identification details of the tenderer

| Business name or full name:                                        | Insert name                                                                                                  |
| ------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------ |
| Registered office:                                                 | Insert registered office                                                                                     |
| Company ID no.:                                                    | Insert no.                                                                                                   |
| VAT ID no.:                                                        | Insert no. or information that the tenderer is not a VAT payer                                               |
| Entry in CR:                                                       | Insert court, section and file no.                                                                           |
| The tenderer is a small or medium-sized enterprise:                |                                                                                                              |
| Bank details:                                                      | Insert bank name                                                                                             |
| Bank account no.:                                                  | Insert bank no.                                                                                              |
| Legal representative:                                              | Insert name, surname and position of the representative who will sign the Contract in the event of selection |
| Joint participation of tenderers in the procurement procedure[^2]: | Business name/full name, registered office, company ID no., VAT no.                                          |
|                                                                    | Business name/full name, registered office, company ID no., VAT no.                                          |
|                                                                    | Business name/full name, registered office, company ID no., VAT no.                                          |

Identification details of tenderer’s representatives

| Tenderer’s contact person regarding the tender                                                |                                                           |
| --------------------------------------------------------------------------------------------- | --------------------------------------------------------- |
| Name and surname:                                                                             | Insert name and surname                                   |
| Telephone:                                                                                    | Insert telephone no. including international dialing code |
| E-mail:                                                                                       | Insert e-mail adress                                      |
|                                                                                               |                                                           |
| Tenderer’s person authorized to act in technical matters during performance of the Contract   |                                                           |
| Name and surname:                                                                             | Insert name and surname                                   |
| Telephone:                                                                                    | Insert telephone no. including international dialing code |
| E-mail:                                                                                       | Insert e-mail adress                                      |

Tenderer’s declarations

The tenderer hereby declares on its honor

**with regard to the procurement conditions**, that it

has carefully reviewed the procurement conditions of the Public procurement, including any clarifications, supplements and amendments thereto, has understood them and agrees to them,

accepts E-ZAK as the exclusive means of communication in the procurement procedure of the Public procurement,

acknowledges that, in communication carried out via E-ZAK, a data message is deemed delivered upon its receipt at the electronic address of its addressee;

**with regard to the binding commercial terms of the Public procurement**, that it accepts them in the wording provided by the Contracting authority;

- 

**with regard to the responsible performance of the Public procurement**, that

in performing the subject of the Public procurement, it shall ensure, in respect of all employees participating in the performance of the Public procurement, compliance with labor law regulations, employment regulations and occupational health and safety regulations;

it shall impose the same obligations on its subcontractors directly participating in the performance of the Public Procurement (excluding suppliers of materials or goods in the case of resale);

**with regard to conflict of interest**, that no conditions for the existence of a conflict of interest within the meaning of Section 44 ZZVZ are met; in particular, it is not directly or indirectly influenced in the procurement procedure in relation to the Contracting authority or to entities involved in the preparation of the procurement conditions, nor does it have any special relationship with such persons (e.g. ownership, personnel or similar);

- 

**with regard to conflict of interest within the meaning of Section 4b ZOSV**, that:

it is not a commercial company in which a public official referred to in Section 2(1)(c) ZOSV or a person controlled by such official, holds a share representing at least 25% participation in that commercial company; and

if it demonstrates fulfilment of any part of qualification through another person (subcontractor), such other person is not a commercial company in which a public official referred to in Section 2(1)(c) ZOSV or a person controlled by such official, holds a share representing at least 25% participation in that commercial company;

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**with regard to international sanctions**, that

it is familiar with the applicable international sanctions, in particular Council Regulation (EU) No. 833/2014 of 31 July 2014 concerning restrictive measures in view of Russia’s actions destabilising the situation in Ukraine, as amended;

it does not offer performance subject to applicable international sanctions;

no sanctions under the applicable legislation governing the implementation of international sanctions apply to it,

if a contract for the Public procurement is concluded with it, it shall ensure for the entire duration of its performance that

the above shall also apply to all its subcontractors used in the performance of the Public procurement whose share in the subject of the Public procurement exceeds 10%;

it shall immediately replace any subcontractor meeting the above criteria if international sanctions are imposed on such subcontractor during the performance of the Public procurement.

Qualification

Basic eligibility

- The tenderer hereby declares on its honour that it is eligible to perform the Public procurement within the meaning of Section 74 ZZVZ, including the fact that:
- a) it does not have any outstanding tax arrears relating to excise duty recorded in the tax records in the Czech Republic or in the country of its registered office; and
- b) it does not have any outstanding arrears in payments of public health insurance premiums or related penalties in the Czech Republic or in the country of its registered office.

Professional eligibility

- The tenderer hereby declares on its honour that it complies with the requirement set out in Section 77(1) ZZVZ. The tenderer is able to prove this fact by submitting an extract from the Commercial Register or from a similar register, if it is entered therein.

Economic qualification

- The Contracting authority does not require the demonstration of economic qualification.

Technical qualification

The Contracting authority does not require the demonstration of technical qualification.

Evaluated criteria

The tenderer offers **a total tender price ****Insert ammount**** CZK excluding VAT**.

The Supplier offers **a P value of** **Insert ammount**** kW** (being the sum of the electrical power consumption, in kW, of all equipment necessary for the operation of the proposed solution during sample measurement under the reference conditions specified by the Contracting Authority in the Procurement Documentation of the Public Contract).

[^2]:  In the case of a joint participation of tenderers, the tenderer shall tick the checkbox. In the event of joint participation, all declarations made in the Tender submission form are made by the tenderer with the designated representative also on behalf of the other tenderers.