ANNEX B)	

EXPRESSION OF INTEREST
FOR
The commitment of the supply of scientific instrumentation aimed to the realization of a system for analysis of materials by laser ablation, laser ionization and time of flight mass spectrometry.

TO 
INAF- Astrophysical Observatory of Catania			
Via Santa Sofia n.78
95123 - Catania
ITALY
		
Certified mailbox: inafoacatania@pcert.postecert.it

I undersigned   ______________________________________________________________________________________________
born in ________________________ (       ) on __/___/____ resident in ____________________________________________________________________________________________________________________street/square ________________________________________________________________________________________________
as legal representative or special prosecutor of __________________________________________________
___________________________________________________________________________________________________________________,

having viewed the public notice of INAF- Astrophysical Observatory of Catania for the manifestation of interest for the "Commitment of the supply of scientific instrumentation aimed to the realization of a system for analysis of materials by laser ablation, laser ionization and time of flight mass spectrometry", being aware of the criminal  liability in case of fraudulent claims and use of falsified documents on the basis and for the effects of the articles 46, 47 and 76 of the Decree of the President of the Republic no. 445/2000 and its modifications and integrations,

EXPRESS MY INTEREST
to participate in the possible and future negotiated procedure, without prior publication of a call for tenders, to be activated according to article 63, subsection 3, letter a) of the Legislative Decree no. 50/2016 and its modifications and integrations, for the commitment of the "Supply of scientific instrumentation aimed to the realization of a system for analysis of materials by laser ablation, laser ionization and time of flight mass spectrometry" relating to the Lot no. _________ (specify which Lot you are interested to)

For this purpose, 
I DECLARE

To submit my application as:

Individual economic operator: (Indicate the name and designation of the Company/Entity)_______________________________________________________________________________________________________________________________________________________________________________________________________________
otherwise
Temporary grouping of companies: (Indicate the name of the group leader and members)__________________________________________________________________________________________________________________________________________________________________________________________________________________________
otherwise
Other(specify)____________________________________________________________________________________________________________________________________________________________________________________________________________________

that the Entity represented:

a)	is enrolled to the C.C.I.A.A. (Chamber of Commerce, Industry, Crafts and Agriculture) Register of _________________________________________ registration no _______________________ Fiscal Code _____________________________ and VAT number________________________ for activities associated with the above mentioned supply; 

otherwise

b)	is enrolled to a professional or commercial register as requested in its home country;
c)	has not committed any finally ascertained violation of obligations related to the payment of taxes and levies;
d)	Position regards to I.N.P.S. (National Social Security Institute):
number ____________________________________________________________________________________________,
competent I.N.P.S. headquauarter___________________________________________________________,
e)	Position regards to I.N.A.I.L. (National Institute of Workplace Injury Insurance):
Company Code____________________________________________________________________________________________,
P.A.T. (Territorial Insurance Position) _______________________________________________________________,
competent I.N.A.I.L. headquarter________________________________________________________________________,
(N.B.: The declarations listed in points d) and e) must not be made by economic operators not based in Italy).

I ALSO DECLARE

a)	Not to be in any of the conditions provided by article 80 of the Legislative Decree no. 50/2016 and its modifications and integrations, which may be grounds for exclusion from participation in a procurement procedure;
b)	Not having been convicted of crimes involving incapacity to engage with the Italian Public Administration, in accordance with article 32 quater of the Criminal Code;
c)	To possess the economical capabilities required in the notice;
d)	To possess the technical and professional capabilities required in the notice.

The undersigned agrees, in accordance with the Legislative Decree no. 196/2003 and its modifications and integrations, to the processing of the personal data for the purpose of the procedure in question.

The undersigned indicates the following references for any communication relative to the present procedure:

Address: _________________________________________Telephone number: _______________________________
Certified mailbox: ________________________________________________________________________________________

Attachments:

•	Copy of a valid identity document;
•	Copy of the Special Proxy (where necessary).

	SIGNATURE

___________________________________