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["Załącznik nr 3/3               "]
["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)","Wartość VAT","Wartość \nbrutto \nw zł.","Wartość brutto (zł)"]
[1,"aqua pro injectione","500ml","inj.","flakon",10,"op.typu Kabi Pac"]
[2,"glukoza  5%","250ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[3,"glukoza 5%","500ml","płyn do wlewów","flakon",60,"op.typu Kabi Pac"]
[4,"glukoza 5% + natrium chloratum 0,9% (2:1) ","500ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[5,"glukoza 10%","500ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[6,"glukoza 10%","250ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[7,"natrium chloratum 0,9 %","100ml","płyn do wlewów","flakon",{"v":1760,"d":"1,760"},"op.typu Kabi Pac"]
[8,"natrium chloratum 0,9%","250ml","płyn do wlewów","flakon",840,"op.typu Kabi Pac"]
[9,"natrium chloratum 0,9%","500ml","płyn do wlewów","flakon",{"v":1280,"d":"1,280"},"op.typu Kabi Pac"]
[10,"płyn fizjologiczny wieloelektrolitowy ","500ml","płyn do wlewów","flakon",100,"op.typu Kabi Pac"]
[11,"płyn Ringera ","500ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[12,"płyn pediatryczny wyrównawczy ","250ml","płyn do wlewów","flakon",10,"op.typu Kabi Pac"]
[13,"glukoza 5% + natrium chloratum 0,9% (2:1) ","250ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[14,"płyn fizjologiczny wieloelektrolitowy ","250ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[15,"płyn Ringera ","250ml","płyn do wlewów","flakon",20,"op.typu Kabi Pac"]
[16,"glukoza 5%","100ml","płyn do wlewów","flakon",200,"op.typu Kabi Pac"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]