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["Załącznik nr 3/1.3              "]
["nr sprawy ZP.12.PN.2017"]
["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)","VAT %","VAT (zł)","Wartość brutto (zł)"]
[1,"dziurawiec ziele",null,"zioła fix","op.",1,"do 3g w torebce"]
[2,"glukoza",null,"substancja","op.",3,"op a 1 kg"]
[3,"krople miętowe",null,"krople doustne","op.",4]
[4,"krople żołądkowe",null,"krople doustne","op.",20]
[5,"len nasiona mielone odtł.",null,"zioła mielone","op.",10,"op.po 200g"]
[6,"melisa liść",null,"zioła fix","op.",2,"do 3g w torebce"]
[7,"mięta pieprzowa liść",null,"zioła fix","op.",36,"do 3g w torebce"]
[8,"neospasmina",null,"syrop","op.",45,"op.po 1,25kg"]
[9,"normosan",null,"zioła fix","op.",4,"do 3g w torebce"]
[10,"rumianek koszyczek",null,"zioła fix","op.",12,"do 3g w torebce"]
[11,"szałwia liść",null,"zioła fix","op.",1,"do 3g w torebce"]
[12,"neospasmina",null,"syrop","op.",2,"op.150 g."]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]