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["Sprawa nr                                                                                                                                                                                                                                                 Załącznik nr.3/3"]
["FORMULARZ ASORTYMENTOWO-CENOWY"]
["(zamawiający zastrzega sobie prawo do zakupu mniejszych ilości towaru)"]
[null,"Nazwa asortymentu","dawka","postać leku","J.m.","Ilość","Uwagi","Cena jedn. Netto (zł)","Wart. netto (zł)","Wartość VAT","Wartość brutto (zł)"]
[1,"aqua pro injectione","500ml","inj.","szt.",10,"op.typu Ecoflac dwa równocenne porty"]
[2,"glukoza  5%","250ml","płyn do wlewów","szt.",60,"op.typu Ecoflac dwa równocenne porty"]
[3,"glukoza 5%","500ml","płyn do wlewów","szt.",20,"op.typu Ecoflac dwa równocenne porty"]
[4,"glukoza 10%","500ml","płyn do wlewów","szt.",20,"op.typu Ecoflac dwa równocenne porty"]
[5,"sterofundin ISO lub podobne","500ml","płyn do wlewów","szt.",200,"op.typu Ecoflac dwa równocenne porty"]
[6,"natrium chloratum 0,9 %","100ml","płyn do wlewów","szt.",{"v":2200,"d":"2,200"},"op.typu Ecoflac dwa równocenne porty"]
[7,"natrium chloratum 0,9%","250ml","płyn do wlewów","szt.",800,"op.typu Ecoflac dwa równocenne porty"]
[8,"natrium chloratum 0,9%","500ml","płyn do wlewów","szt.",{"v":1400,"d":"1,400"},"op.typu Ecoflac dwa równocenne porty"]
[9,"płyn Ringera ","500ml","płyn do wlewów","szt.",20,"op.typu Ecoflac dwa równocenne porty"]
[{"$nulls":6},"RAZEM"]
[]
[]
[]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]