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fac simile di Domanda - Comune di Montoggio

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__________________________________________________________________________<br />

sede nel <strong>Comune</strong> <strong>di</strong> ____________________________________Provincia______________<br />

via/piazza__________________________________________________________________<br />

con co<strong>di</strong>ce fiscale numero_____________________________________________________<br />

e partita IVA numero _________________________________________________________<br />

telefono _____________________fax _____________________ e-mail_________________<br />

con espresso riferimento alla Ditta che rappresenta,<br />

CHIEDE<br />

<strong>di</strong> partecipare alla procedura aperta in<strong>di</strong>cata in oggetto come:<br />

(in<strong>di</strong>care con una crocetta la voce che interessa)<br />

impresa singola<br />

capogruppo <strong>di</strong> una associazione temporanea <strong>di</strong> imprese costituita dalle seguenti imprese:<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

mandante <strong>di</strong> una associazione temporanea <strong>di</strong> imprese costituita dalle seguenti imprese:<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

partecipante GEIE costituito dalle seguenti imprese:<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

__________________________________________________________________________<br />

consorzio stabile costituito dalle seguenti imprese:<br />

__________________________________________________________________________<br />

__________________________________________________________________________

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