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[null,"Usuwanie wyrobów zawierających azbest z terenu Gminy ",null,null,null,null,"GMINA",null,null,null,null,null,1]
[]
[null,"Rodzaj robót",null,"Masa odpadów zawierających azbest [Mg]",null,"Koszt kwalifikowany\nzadania [zł]1\n","Termin zakończenia zadania do","Planowane nakłady finansowe [zł]"]
[]
[]
[]
[null,null,null,null,null,null,null,"dotacja\nWFOŚiGW\n","dotacja\nNFOŚiGW\n","netto/brutto\n","środki własne jst/inne"]
[]
[]
[null,"1.",null,"2.",null,"3.","4.","5.","6.","7.","8.",null,1]
[null,"Unieszkodliwianie wyrobów zawierających azbest (demontaż, zbieranie, transport)",null,{"$f":"H12/350","v":0},null,{"$f":"ROUND(H12/Pomocnicz!K10,2)","v":{"$error":"#N/A"}},"2022-09-30",{"$f":"H12-I11","v":0},{"$f":"ROUNDDOWN((0.6*H12)/0.85,2)","v":0},{"$f":"IF($M$10=1,\"brutto\",\"netto\")","v":"brutto"},{"$f":"F11-H12","v":{"$error":"#N/A"}}]
[null,null,null,null,null,null,null,null,null,{"$f":"IF($M$10=1,\"brutto\",\"netto\")","v":"brutto"}]
[null,"1 koszt jednostkowy 350 [zł/Mg]"]
[]
[null,"Oświadczenie o podatku VAT"]
[null,"Wnioskowana kwota dotacji - brutto"]
[null,"Oświadczamy, że w przypadku niniejszego zadania podatek VAT stanowi  koszt ponoszony na jego realizację i  nie przysługuje  prawo jego odliczenia/odzyskania  zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2021.685 t.j.)"]
[null,"Wnioskowana kwota dotacji - netto"]
[null,"Oświadczamy, że w przypadku niniejszego zadania podatek VAT nie stanowi kosztu ponoszonego na jego realizację i przysługuje prawo jego odliczenia/odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług \n(Dz.U.2021.685 t.j.)"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"W-AZBEST"]
[]
[]
[null,null," WNIOSEK  O  DOTACJĘ\nw ramach programu priorytetowego NFOŚiGW pod nazwą \n „Ogólnopolski program finansowania usuwania wyrobów zawierających azbest”\n"]
[null,null,"Data rejestracji ..............................................."]
[null,null,"Wpisano do rejestru pod nr ............................"]
[]
[null,null,"CZĘŚĆ I.  DANE DOTYCZĄCE WNIOSKODAWCY:"]
[null,null,"1.Dane Wnioskodawcy"]
[null,null,"Nazwa "]
[]
[null,null,"Adres"]
[]
[]
[null,null,"Numer telefonu"]
[]
[]
[]
[null,null,"Adres e-mail"]
[]
[null,null,"2. Numery:"]
[null,null," N I P :",null,null,null,null,null,null,null,null,null,null,null,null,null,"REGON:"]
[]
[]
[null,null,"3. Osoba prowadząca sprawę:"]
[null,null,"Imię i nazwisko"]
[]
[null,null,"Numer telefonu"]
[]
[null,null,"Adres e-mail"]
[]
[null,null,"4.  Rachunek bankowy Wnioskodawcy, na który należy przekazać dotację:"]
[null,null,"Numer konta bankowego"]
[]
[null,null,{"$f":"CONCATENATE(MID(C34,1,2),\" \",MID(C34,3,4),\" \",MID(C34,7,4),\" \",MID(C34,11,4),\" \",MID(C34,15,4),\" \",MID(C34,19,4),\" \",MID(C34,23,4))","v":"      "}]
[null,null,"Nazwa banku"]
[]
[]
[null,null,"5.  Czy wnioskodawca prowadzi działalność gospodarczą"]
[]
[null,null,"6. Wartość wskaźnika G dochodów podatkowych na jednego mieszkańca w gminie, o których mowa  w ustawie z dnia 13 listopada 2003 r. o dochodach jednostek samorządu terytorialnego (t.j. Dz.U z 2018 r. poz. 1530 z póź. zm.)  na rok 2021 wynosi: "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Pomocnicz!J10","v":"Wskaźnik G \n na 2021 r."}]
[]
[null,null,"CZĘŚĆ II. WNIOSEK "]
[null,null,"1. Wnioskujemy o przyznanie dotacji na rok 2022 r. w kwocie: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!H12","v":0}]
[null,null,"  słownie: ",null,null,{"$f":"Słownie(S45)","v":"zero złotych "}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"    "]
[null,null,"2. Koszt  kwalifikowany zadania :",null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!F11","v":{"$error":"#N/A"}}]
[]
[null,null,"  słownie: ",null,null,{"$f":"Słownie(M48)","v":{"$error":"#VALUE!"}}]
[]
[]
[null,null,"Wyliczony koszt kwalifikowany zadania stanowi minimalny koszt kwalifikowany do poniesienia przy wnioskowanej kwocie dotacji, uwzględniający wskaźnik G gminy (zgodnie z ust. 5.2 pkt 1-3 \"Procedury dofinansowania przedsięwzięć dotyczących usuwania azbestu i wyrobów zawierających azbest przez WFOŚiGW w Rzeszowie\")"]
[]
[]
[]
[]
[null,null,"4. Plan finansowania zadania w zł:"]
[]
[null,null,null,null,null,"dotacja WFOŚiGW  ",null,null,null,null,null,null,null,{"$f":"Harmonogram!$H$11","v":0},null,null,null,null,null,null,null,null,{"$f":"Harmonogram!M10","v":1}]
[null,null,null,null,null,"dotacja NFOŚiGW",null,null,null,null,null,null,null,{"$f":"Harmonogram!$I$11","v":0}]
[null,null,null,null,null,"inne źródła finansowania/środki własne",null,null,null,null,null,null,null,{"$f":"Harmonogram!$K$11","v":{"$error":"#N/A"}}]
[]
[]
[null,null,"5. Dotacja zostanie przeznaczona na finansowanie zadania p.n.: "]
[null,null,"Usuwanie wyrobów zawierających azbest z terenu Gminy ",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!G1","v":"GMINA"}]
[null,null,"6. Termin płatności nastąpi do 30 dni od złożenia dokumentacji rozliczeniowej."]
[]
[]
[]
[null,null,"\n7. Przewidywany efekt rzeczowy i ekologiczny:\n"]
[null,null,"Planowana minimalna ilość odpadów do unieszkodliwienia:",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!$D$11","v":0},null,"Mg"]
[null,null,"Wyliczona minimalna ilość odpadów zawierających azbest do unieszkodliwienia stanowi iloraz wnioskowanej kwoty dofinansowania i jednostkowego kosztu 350 zł/Mg (na podstawie ust. 5.2 pkt 4 \"Procedury dofinansowania przedsięwzięć dotyczących usuwania azbestu i wyrobów zawierających azbest przez WFOŚiGW w Rzeszowie\")"]
[]
[null,null,"CZĘŚĆ III. OŚWIADCZENIA (proszę zaznaczyć stosowne oświadczenia)"]
[]
[null,null,"Oświadczam, że Gmina wywiązuje się:\n- z obowiązku uiszczania opłat za korzystanie ze środowiska i administracyjnych kar pieniężnych wynikających z ustawy Prawo Ochrony Środowiska,\n- ze świadczeń publicznoprawnych na rzecz Zakładu Ubezpieczeń Społecznych,   \n- ze świadczeń publicznoprawnych na rzecz Urzędu Skarbowego,\n- z zobowiązań w stosunku do Funduszu wynikających z wcześniej zawartych umów."]
[null,null,"Oświadczam, że Gmina wywiązuje się z zobowiązań cywilnoprawnych na rzecz NFOŚiGW;"]
[null,null,"Oświadczam, że na terenie Gminy  przeprowadzono inwentaryzację wyrobów zawierających azbest;"]
[null,null,"Oświadczam, że Gmina posiada Uchwałę Rady Gminy zatwierdzającą Gminny program usuwania azbestu lub w przypadku gdy gmina nie posiada własnego programu a należy do związku gmin, który posiada program – uchwałę zatwierdzającą Związkowy program usuwania azbestu oraz oświadczenie wójta (dot. akceptacji Związkowego programu w części dot. gminy);"]
[null,null,"Oświadczam, że wioskowane zadanie jest zgodne z gminnym programem usuwania azbestu i wyrobów zawierających azbest lub przyjętym przez gminę programem związku międzygminnego, którego gmina jest członkiem;"]
[null,null,"Oświadczam, że przy wyborze przedsięwzięć do dofinansowania Gmina weryfikowała stopień pilności usunięcia i unieszkodliwienia lub zabezpieczenia odpadów zawierających azbest;"]
[null,null,"Oświadczam, że Gmina umieści ogłoszenie o zamówieniu w Biuletynie Informacji Publicznej Gminy;  "]
[null,null,"Oświadczam, że Gmina dokona weryfikacji dokumentów potwierdzających uprawnienie Wykonawcy do wykonywania działalności związanej z usuwaniem wyrobów zawierających azbest;  "]
[null,null,"Oświadczam, że zadanie nie zostało zakończone przed dniem złożenia wniosku."]
[null,null,"Świadomi odpowiedzialności karnej wynikającej z art. 233 § 1 Kodeksu karnego za składanie fałszywych zeznań oświadczamy, że zawarte we wniosku dane są zgodne ze stanem faktycznym i prawnym. Wiarygodność podanych we wniosku danych stwierdzamy własnoręcznym podpisem.\n"]
[]
[]
[null,null,"....................................",null,null,null,null,null,null,null,null,null,"..............................................................................."]
[null,null,"/Miejscowość, data/",null,null,null,null,null,null,null,null,null,"(pieczęć firmowa i podpisy osób upoważnionych do zaciągania zobowiązań majątkowych)"]
[]
[]
[]
[null,null,"Wykaz dokumentów do wniosku o dotację (W-AZBEST)"]
[null,null,"Do wniosku o  dotację należy załączyć wymienione niżej dokumenty:"]
[null,null,"1. Harmonogram finansowo-rzeczowy (załącznik nr 1 do wniosku)."]

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[]
[]
[]
[]
[]
[]
[]
[null,null,null,"Oświadczamy, że w przypadku niniejszego podatek VAT  stanowi / nie stanowi koszt ponoszony na jego realizację i przysługuje / nie przysługuje*  prawo jego odliczenia / odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2018.2174 z późn. zm.)"]
[]
[]
[]
[]
[]
[null,null,"Oświadczamy, że w przypadku niniejszego podatek VAT  stanowi / nie stanowi koszt ponoszony na jego realizację i przysługuje / nie przysługuje*  prawo jego odliczenia / odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2018.2174 z późn. zm.)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"stanowi ",null,"przysługuje",null,"odliczenia"]
[null,null,null,null,null,null,null,"nie stanowi",null,"nie przysługuje",null,"odzyskania"]

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["Kod gminy",null,null,null,"GMINA","Wskaźnik G \n na 2021 r."]
["18","14","02",2,"ADAMÓWKA",920.02]
["18","21","01",2,"BALIGRÓD",1141.68,null,null,null,null,"Przedział"]
["18","20","01",3,"BARANÓW SANDOMIERSKI",1223.05,null,null,null,null,0,0.85]
["18","17","02",2,"BESKO",931.78,null,null,null,null,1501,0.59499999999999997]
["18","10","02",2,"BIAŁOBRZEGI",1252.5,null,null,null,null,2001,0.34]
["18","13","01",2,"BIRCZA",979.6]
["18","16","02",3,"BŁAŻOWA",883.65]
["18","16","03",3,"BOGUCHWAŁA",1575.63,null,null,"Gmina ","Wskaznik G","%"]
["18","18","02",2,"BOJANÓW",827.48,null,null,{"$f":"Harmonogram!G1","v":"GMINA"},{"$f":"VLOOKUP(I10,E1:F161,2,FALSE)","v":"Wskaźnik G \n na 2021 r."},{"$f":"VLOOKUP(J10,K4:L6,2,TRUE)","v":{"$error":"#N/A"}}]
["18","11","02",2,"BOROWA",1136.28]
["18","03","02",3,"BRZOSTEK",861.09]
["18","02","01",3,"BRZOZÓW",1157.8599999999999]
["18","05","02",2,"BRZYSKA",787.4]
["18","17","03",2,"BUKOWSKO",1173.92]
["18","04","03",2,"CHŁOPICE",931.31]
["18","16","04",2,"CHMIELNIK",1199.05,null,"Wskaźnik G - podstawowych dochodów podatkowych  na 1 mieszkańca gminy przyjęty do obliczania subwencji wyrównawczej na 2020 r."]
["18","07","01",2,"CHORKÓWKA",1101.28]
["18","09","02",3,"CIESZANÓW",1283.8900000000001]
["18","21","02",2,"CISNA",2655.19]
["18","06","01",2,"CMOLAS",857.4]
["18","03","03",2,"CZARNA pow. bieszczadzki",1109.8699999999999,null,null,"Oświadczam, że Gmina dokona weryfikacji dokumentów potwierdzających uprawnienie Wykonawcy do wykonywania działalności związanej z usuwaniem wyrobów zawierających azbest;  "]
["18","10","03",2,"CZARNA pow. dębicki",1383.28]
["18","01","03",2,"CZARNA pow. łańcucki",1456.11]
["18","11","03",2,"CZERMIN",1241.07]
["18","19","01",2,"CZUDEC",1336.34]
["18","03","04",2,"DĘBICA",1870.46]
["18","03","01",1,"DĘBICA - MIASTO",2071.54]
["18","05","03",2,"DĘBOWIEC",800.07]
["18","02","02",2,"DOMARADZ",816.48]
["18","13","02",2,"DUBIECKO",789.84]
["18","07","02",3,"DUKLA",1141.45]
["18","02","03",2,"DYDNIA",1065.76]
["18","16","05",2,"DYNÓW",782.2]
["18","16","01",1,"DYNÓW - MIASTO",1068.01]
["18","06","06",2,"DZIKOWIEC",616.66999999999996]
["18","13","03",2,"FREDROPOL",964.82]
["18","19","02",2,"FRYSZTAK",1012.52]
["18","14","03",2,"GAĆ",1033.05]
["18","11","04",2,"GAWŁUSZOWICE",1009.1]
["18","16","06",3,"GŁOGÓW MAŁOPOLSKI",2039.89]
["18","20","02",2,"GORZYCE",1554.06]
["18","20","03",2,"GRĘBÓW",1310.42]
["18","08","02",2,"GRODZISKO DOLNE",1123.93]
["18","02","04",2,"HACZÓW",917.53]
["18","12","01",2,"HARASIUKI",698.76]
["18","09","03",2,"HORYNIEC-ZDRÓJ",1061.24]
["18","16","07",2,"HYŻNE",859.2]
["18","15","01",2,"IWIERZYCE",1204.3699999999999]
["18","07","03",3,"IWONICZ-ZDRÓJ",1085.3599999999999]
["18","12","02",2,"JAROCIN",783.71]
["18","04","04",2,"JAROSŁAW",1206.49]
["18","04","01",1,"JAROSŁAW - MIASTO",1801.3]
["18","02","05",2,"JASIENICA ROSIELNA",890.03]
["18","05","04",2,"JASŁO",1053.8599999999999]
["18","05","01",1,"JASŁO - MIASTO",2007.95]
["18","07","10",2,"JAŚLISKA",754.63]
["18","14","04",2,"JAWORNIK POLSKI",917.28]
["18","07","04",3,"JEDLICZE",1694.51]
["18","12","03",2,"JEŻOWE",750.15]
["18","03","05",2,"JODŁOWA",763.41]
["18","16","08",2,"KAMIEŃ",865.8]
["18","14","05",3,"KAŃCZUGA",1097.1099999999999]
["18","06","02",3,"KOLBUSZOWA",1532.83]
["18","05","05",3,"KOŁACZYCE",803.5]
["18","17","04",2,"KOMAŃCZA",1457.94]
["18","07","05",2,"KORCZYNA",1205.5]
["18","13","04",2,"KRASICZYN",1544.29]
["18","16","09",2,"KRASNE",1883.35]
["18","05","06",2,"KREMPNA",884.95]
["18","61","01",1,"KROSNO - MIASTO",2143.58]
["18","07","06",2,"KROŚCIENKO WYŻNE",1329.51]
["18","12","04",2,"KRZESZÓW",912.01]
["18","13","05",2,"KRZYWCZA",758.22]
["18","08","03",2,"KURYŁÓWKA",855.64]
["18","04","05",2,"LASZKI",896.49]
["18","21","03",3,"LESKO",1226.8599999999999]
["18","08","04",2,"LEŻAJSK",1125.1099999999999]
["18","08","01",1,"LEŻAJSK - MIASTO",1784.57]
["18","09","04",2,"LUBACZÓW",970.17]
["18","09","01",1,"LUBACZÓW - MIASTO",1339.5]
["18","16","10",2,"LUBENIA",1209.1500000000001]
["18","01","05",2,"LUTOWISKA",2397.61]
["18","10","04",2,"ŁAŃCUT",1222.6600000000001]
["18","10","01",1,"ŁAŃCUT - MIASTO",2100.73]
["18","06","03",2,"MAJDAN KRÓLEWSKI",739.85]
["18","10","05",2,"MARKOWA",1299.4100000000001]
["18","13","06",2,"MEDYKA",1319.76]
["18","07","07",2,"MIEJSCE PIASTOWE",1116.17]
["18","11","05",2,"MIELEC",1609.32]
["18","11","01",1,"MIELEC - MIASTO",2396.86]
["18","09","05",3,"NAROL",781.82]
["18","19","03",2,"NIEBYLEC",970.91]
["18","12","05",3,"NISKO",1644.28]
["18","06","04",2,"NIWISKA",891.8]
["18","20","04",3,"NOWA DĘBA",1861.73]
["18","08","05",3,"NOWA SARZYNA",1294.68]
["18","05","07",2,"NOWY ŻMIGRÓD",764.82]
["18","02","06",2,"NOZDRZEC",751.29]
["18","09","06",3,"OLESZYCE",1251.55]
["18","21","04",2,"OLSZANICA",965.93]
["18","13","07",2,"ORŁY",1161.8]
["18","05","08",2,"OSIEK JASIELSKI",769.3]
["18","15","02",2,"OSTRÓW",1371.01]
["18","11","06",2,"PADEW NARODOWA",1180.26]
["18","04","06",2,"PAWŁOSIÓW",1253.96]
["18","03","06",3,"PILZNO",1570.18]
["18","04","07",3,"PRUCHNIK",995.98]
["18","11","07",3,"PRZECŁAW",1176.1600000000001]
["18","13","08",2,"PRZEMYŚL",1374.77]
["18","62","01",1,"PRZEMYŚL - MIASTO",1649.24]
["18","14","06",2,"PRZEWORSK",1028]
["18","14","01",1,"PRZEWORSK - MIASTO",1854.28]
["18","18","03",2,"PYSZNICA",1404.94]
["18","18","04",2,"RADOMYŚL NAD SANEM",1041.6600000000001]
["18","11","08",3,"RADOMYŚL WIELKI",1171.53]
["18","04","08",2,"RADYMNO",1106.19]
["18","04","02",1,"RADYMNO - MIASTO",1390.33]
["18","10","06",2,"RAKSZAWA",1076.6300000000001]
["18","06","05",2,"RANIŻÓW",910.41]
["18","04","09",2,"ROKIETNICA",1289.2]
["18","15","03",3,"ROPCZYCE",1535.66]
["18","04","10",2,"ROŹWIENICA",883.55]
["18","12","06",3,"RUDNIK NAD SANEM",1063.32]
["18","07","08",3,"RYMANÓW",1093.08]
["18","63","01",1,"RZESZÓW - MIASTO",2286.89]
["18","17","05",2,"SANOK",1243.6600000000001]
["18","17","01",1,"SANOK - MIASTO",1681.14]
["18","15","04",3,"SĘDZISZÓW MAŁOPOLSKI",1295.44]
["18","14","07",3,"SIENIAWA",1072.81]
["18","05","09",2,"SKOŁYSZYN",1074.22]
["18","16","11",3,"SOKOŁÓW MAŁOPOLSKI",1001.79]
["18","21","05",2,"SOLINA",3124.31]
["18","18","01",1,"STALOWA WOLA - MIASTO",2179.2600000000002]
["18","09","07",2,"STARY DZIKÓW",1508.08]
["18","19","04",3,"STRZYŻÓW",1077.3499999999999]
["18","13","09",2,"STUBNO",873.88]
["18","16","12",2,"ŚWILCZA",1352.96]
["18","64","01",1,"TARNOBRZEG - MIASTO",1584.81]
["18","05","11",2,"TARNOWIEC",986.98]
["18","14","08",2,"TRYŃCZA",1440.71]
["18","16","13",2,"TRZEBOWNISKO",2280.7399999999998]
["18","11","09",2,"TUSZÓW NARODOWY",1355.07]
["18","16","14",3,"TYCZYN",1456.86]
["18","17","06",2,"TYRAWA WOŁOSKA",878.97]
["18","12","07",3,"ULANÓW",841.72]
["18","01","08",3,"USTRZYKI DOLNE",1310.78]
["18","11","10",2,"WADOWICE GÓRNE",1251.31]
["18","04","11",2,"WIĄZOWNICA",1170.33]
["18","09","08",2,"WIELKIE OCZY",968.43]
["18","15","05",2,"WIELOPOLE SKRZYŃSKIE",705.36]
["18","19","05",2,"WIŚNIOWA",869.51]
["18","07","09",2,"WOJASZÓWKA",1076.69]
["18","17","07",3,"ZAGÓRZ",1257.51]
["18","18","05",3,"ZAKLIKÓW",1105.8]
["18","18","06",2,"ZALESZANY",1466.04]
["18","17","08",2,"ZARSZYN",1025.4000000000001]
["18","14","09",2,"ZARZECZE",841.96]
["18","10","07",2,"ŻOŁYNIA",1236.03]
["18","13","10",2,"ŻURAWICA",1435.7]
["18","03","07",2,"ŻYRAKÓW",1700.1]