| Note: this form has to be filled out and submitted with the Request to Participate / Tender by: each entity, whose capacities the Candidate/Tenderer or consortium relies on to prove his/its ability due to para 47 German Procurement Ordinance. |
| 1. Name of the Candidate / Tenderer / Consortium who plans to occupy the capacities |
| 1. in the Tender Procedure |
| 1. Specifications and declarations of the committing entity: | |
| Name of the entity: | |
| Street, No.: | |
| Postcode, City: | |
| Country: |
| I/We commit myself/ourselves towards the contracting authority to provide the necessary capacities of my/our entity to the abovementioned Candidate / Tenderer / consortium in the event of the contract award with the service area(s) as follows: |
| Description of the (partial) services: |
| Only in the event of an economic and financial reliance on the capacities of other entities: I/we commit myself/ourselves towards the contracting authority in the event of the contract award to the abovementioned Candidate / Tenderer / consortium to be jointly liable with the latter for the execution of the contract to the extent that I/we have made my/our means available. |
Furthermore we declare,
- that no reasons exist for an exclusion pursuant to para 123 sec. 1 and para 123 sec. 1 Gesetz gegen Wettbewerbsbeschränkungen (German Act against Restraints on Competition) and
- that there are no violations of the penal and penalty provisions stated in para 263, 264, 266 a, 298 Strafgesetzbuch (German Penal Code), para 370 Abgabenordnung (German Fiscal Code) and para 8 sec. 1 No. 2, 10 to 11, 21 Schwarzarbeitsbekämpfungsgesetz (German Act to Combat Clandestine Employment) or of para 404 sec. 1 respectively sec. 2 Nr. 3 Sozialgesetzbuch III (German Third Book of the Social Code – Employment Promotion) or of paras 15, 15a, 16 sec. 1 No. 1, 1c, 1d, 1f or No. 2 Arbeitnehmerüberlassungsgesetz (German Temporary Employment Act) or of paras 19, 21 sec. 1 respectively sec. 2 Mindestlohngesetz (German Act on Minimum Wages) or of paras 21, 23 sec. 1 respectively sec. 2 Arbeitnehmer-Entsendegesetz (German Employee Secondment Act) by our entity or by a person whose conduct our entity is accountable.
| Place, date | Name(s) of the Signatory(s), (digital/manual) Signature |
(Please multiply form if need be)