Annex 1 Wyższa Szkoła Ekonomii i Innowacji w Lublinie The University of Economics and Innovation in Lublin 20-209 Lublin, ul. Projektowa 4 tel. (81)749-17-70, fax. (81) 749-32-13 NIP [Tax Identification Number]: 712-265-26-93 REGON [Polish National Business Registry Number]: 432260703 Proposal s template With regard to the request for a proposal concerning provision of the service consisting in development of the training materials and providing training in English within the project Międzynarodowy program kształcenia w języku angielskim na kierunku Pielęgniarstwo I stopnia w Wyższej Szkole Ekonomii i Innowacji w Lublinie [International teaching at the bachelor degree program in Nursing offered by the University of Economics and Innovation WSEI in Lublin]. Tenderer s data Name and surname Phone E-mail Address Personal Identification Number NIP [Tax Identification Number] (only with regard to persons engaged in their own business activity)
In order to submit the proposal, please fill in the table with the amount required regarding the chosen module/s respectively. No. Module Prise for one teaching hour lectures workshops classes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. General module Information Technologies Polish language for foreigners International nursing Humanities module Intercultural communication International health problems Preventive nursing Physical Education Basic science I Basic science II Basic medical science III Basic medical science IV Law, organization, management and Public Health Social science in nursing I Social science in nursing II
17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. English language Nursing basics Health promotion and dietetics Basic health and Physical examination Research in Nursing/Occupational Health and Safety/The right to protection of Intellectual property Optional course: Hospitalacquired Infections / Mental Health Promotion / Sign Language Internal Diseases and Internal Medicine Nursing Paediatrics and paediatric nursing I Surgery and surgical nursing Obstetrics, gynaecology and gynaecological nursing Psychiatry and psychiatric nursing Anaesthesiology and Nursing in life-threatening conditions Rehabilitation and care of the disabled Neurology and neurological nursing 31. Geriatrics and geriatric nursing 32. Palliative care
33. Basics of medical rescue Hereby I declare that: 1. the proposal is valid for the period of 120 days starting from the day of its submission, 2. I express my consent to the payment conditions stipulated in the request for a proposal, 3. I declare that I have read the description of the subject of the request for a proposal and I do not raise any objections to it, 4. I fulfil all conditions determined by the contracting party, 5. the information provided in the proposal is up-to-date and truthful, 6. I commit myself to conclude a contract in the place and time determined by the contracting party, 7. The prise of the proposal includes all costs necessary to provide the service to the contracting party, 8. there are no personal or financial links between me as a tenderer and the contracting party. Financial and personal links are defined as mutual links between the Beneficiary or persons authorised to bind the contracting party, or persons that manage the activities aimed at the preparation and implementation of tenders selection procedure on behalf of the contracting party, and a tenderer, consisting in: a) serving a partner in a civil-law partnership or a regular partnership, b) holding at least 10% of stocks, unless no lower amount has been determined by the law or stipulated in the programme guidelines, c) serving as a member of a supervisory body, a proxy or a plenipotentiary, d) marriage, first-degree family relationship or affinity, collateral family relationship or affinity, care or custody. 9. If the contract is awarded to me, my professional engagement in implementation of all projects co-financed from the ESIF and the Social Fund, as well as activities financed from other sources, including own-contribution and the contribution of other entities, will in total not exceed 276 hours a month. 10. Herewith I attach following documents: a) a detailed track record taking into account the information indispensable to evaluate the proposal, including a document certifying the teaching experience,
b) copies of higher education certificates such as a higher education diploma, c) copies of the certificates and other documents demonstrating the competences acquired that are related to the thematic areas of the modules and/or academic degree diploma/s. Such documents are attached in order to fulfil the criteria enabling to gain additional points during the evaluation process. 11. I would like to express my consent to processing of my personal data for the purpose of recruitment (in accordance with the Personal Data Protection Act of 29.08.1997 (Dz. U. [Journal of Laws] from 2016, item 922)...... Date, tenderer s legible signature (Name and surname)