EXAMPLE OF APPLICATION for registration SUPPLIERS OF PROCEDURES TO INVITE TO PUR

CHASE IN ECONOMY ARTS - Regional Agency for Technology and Innovation Strada Pro
v. per Casamassima, km 3 70010 Valenzano (BA)
The sottoscritto________________________________________________________________
________ _____________________________________il___________________ resident bor
n in the City of ______________________________________________________ Provinci
a____________________ Street / Piazza___________________________________________
__________n____________, acting as legal representative of _____________________
______________________________ based in_________________________________________
_____Provincia____________________ Street / Square _____________________________
__________________n________, CAP___________ CF_____________________________ PI__
______________________ Tel .___________________ Fax____________________e-mail __
__________________ REQUEST to be included in 'list of firms to invite to procure
ment of goods, services and jobs in the economy for the following categories (re
fer to the types indicated in art. 3 of the Regulation): _______________________
_____________________________________ __________________________________________
_________________________________________ and as such, under its responsibilitie
s under DPR No 445/00 and subsequent modifications and additions STATES 1. to be
entered in the Register of Companies kept by the Chamber of Commerce of _______
__________ for the following activities ___________________________ed certifies
the following
1
SIGNATURE
data (for companies based in a foreign state, or enter data or list of registrat
ion in the Official State of membership): â ¢ â ¢ â ¢ â ¢ registration number on the reg
istration form legal ________________________________ __________________________
______ ________________________________
Legal representatives (state the names, titles, dates of birth and residence) __
_____________________________________________________________________________ __
_____________________________________________________________________________ __
_____________________________________________________________________________ __
_____________________________________________________________________________
2. that the Company is not in bankruptcy, compulsory liquidation, arrangement an
d that there are no pending proceedings for the declaration of one of these situ
ations, 3. that its case is not pending in a proceeding for the application of p
reventive measures under Article. 3 of Law 27 December 1956, No 1423, or one of
the causes provided for by impeding. 10 law 31.5.65 n. 575, 4. which of themselv
es were not pronounced convictions have become final, has not been delivered bec
ame irrevocable penal sentence or sentences of punishment upon the application r
equired under Article. 444 of the CPP, for serious offenses against the State or
the Community affecting the professional conduct, which has not been issued the
sentence, with a final court for one or more offenses of participation in a cri
minal organization, corruption, fraud, money laundering, as defined by Community
legislation cited art. 45, paragraph 1, Directive 2004/18 EC, 5. that were not
uttered sentences have become final, which was made penal order became irrevocab
le nor application of the death sentences of over 2
SIGNATURE
request under Article. 444 of the CPP, for serious offenses against the State or
the Community affecting the professional conduct, which has not been issued the
sentence, with a final court for one or more offenses of participation in a cri
minal organization, corruption, fraud, money laundering, as defined by Community
legislation cited art. 45, paragraph 1, Directive 2004/18 EC in respect of thos
e stopped in the three years prior to the post of technical director or propriet
or (for sole proprietorships), partner or technical director (for partnerships)
of general partner or director technical (for a limited partnership); of Directo
rs vested with powers of representation or technical director (for any other com
pany or consortium) 1 or: acts or claims to have adopted measures for the comple
te dissociation of criminal conduct punishable as explained above, held by the o
wner or technical director (for sole proprietorships), partner or technical dire
ctor (for partnerships) of technical director or general partner (for a limited
partnership);€of Directors with powers of representation or technical director
(for any other company or consortium) 1 or: states that there are no subjects di
scontinued during the three years prior to the post of technical director or pro
prietor (for sole proprietors); membership or technical director (for partnershi
ps) of technical director or general partner (for a limited partnership); of Dir
ectors vested with powers of representation or technical director (for any other
company or consortium) 1 6. that did not violate the prohibition laid down by A
rticle trustee. Law 17 of March 19, 1990, No 55;
1
Delete the alternatives referred to in paragraph 5, not relevant
3
SIGNATURE
7. he did not commit serious offenses, duly verified, standards for safety and a
ny other obligation arising from the employment relationship resulting from data
held by the Centre 8. he did not commit a serious error in the exercise of thei
r professional activity, proven by any evidence by the contracting station 9. he
did not commit violations definitively established from obligations relating to
the payment of taxes, according to Italian law or the state where the company i
s established 10. than the year before did not make false statements about the r
equirements and relevant conditions for participation in tender procedures, resu
lting from data held by the Centre 11. he did not commit serious violations, fin
ally found the rules of social security contributions, according to Italian law
or the State where the company is established 12. (For businesses employing no m
ore than 15 employees and 15 to 35 employees who have not made new hires after J
anuary 18, 2000) a) his not being subject to the requirements of compulsory recr
uitment of Law 68/992; ( For businesses that employ more than 35 employees or 15
to 35 employees when he has a new contract after January 18, 2000) b) be in com
pliance with the rules that govern the right to work for the disabled, under Art
icle . Law 68/992 17 13. that has not been pronounced sentence for administrativ
e responsibility, borne by the Company, which includes the prohibition of bargai
ning with the government, according to D. Lgs. 231/01;
2
Delete the alternative, referred to in paragraph 12, which does not affect
4
SIGNATURE
14. that the convictions for which he has benefited not mention are the seguenti
3: _____________________________________________________________________________
__ _____________________________________________________________________________
__ _____________________________________________________________________________
__ _____________________________________________________________________________
__ Or that there are convictions for which has not benefited from menzione3 15.
to be informed in conformity with the purposes of Art. 3 D. Decree Law 196/03, t
hat personal data collected will be used, including tools, exclusively in the pr
oceedings for which this declaration is made; 16. had achieved in three years 20
03 - 2004 - 2005, categoria4 _______________________, for the following specific
turnover of Euro ___________________________________________; for category ____
_______, the following specific turnover of Euro _______________; for category _
__________, the following specific revenues that are to Euro _______________; fo
r category ___________, the following specific turnover of Euro _______________.
Signature __________________________
NB
The declaration must be accompanied by a photocopy, not authenticated, a valid d
ocument of identity of the subscriber.
3 4
Delete the alternative, referred to in paragraph 14, the interest identified for
each product category for which registration is sought on the specific total tu
rnover of the three years
5
SIGNATURE
THE DECLARATION BELOW MUST BE SIGNED AND YIELD, PENALTY IF NO ENTRY IN LIST, by
the following parties: â ¢ â ¢ â ¢ Members of partnerships, general partners of limite
d partnerships; Directors vested with powers of representation if it is other co
mpanies.
The sottoscritto________________________________________________________________
________ _____________________________________il___________________ resident bor
n in the City of ______________________________________________________ Provinci
a____________________ Street / Piazza___________________________________________
__________n____________,€acting as legal representative of ____________________
_______________________________ based in________________________________________
______Provincia____________________ Street / Square ____________________________
___________________n________, CAP____________ CF_____________________________ PI
________________________ Tel .___________________ Fax____________________e-mail
____________________ Under Articles 46 and 47 of Presidential Decree 445/00 and
subsequent amendments aware of the penalties provided by. 76 of D.P.R. For cases
of falsification of documents and false statements indicated: STATE 1) which of
themselves are not proceedings are pending for the application of preventive me
asures under Article. 3 of Law 27 December 1956, No 1423, or one of the causes p
rovided for by impeding. 10 law 31.5.65 n. 575, 2) which of themselves were not
pronounced sentences have become final, has not been issued a penal order neithe
r become irrevocable judgments on application of the sanction required under art
. 444 of the CPP, for serious offenses against the State or the 6
SIGNATURE
Communities that affect professional conduct, which has not been issued the sent
ence, with a final court for one or more offenses of participation in a criminal
organization, corruption, fraud, money laundering, as defined by Community legi
slation cited art. 45, paragraph 1 EC Directive 2004/18. Signature _____________
_____________
NB
The declaration must be accompanied by a photocopy, not authenticated, a valid d
ocument of identity of the subscriber.
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SIGNATURE