Bid Opening - 2016 SB Police Vehicle Equipment - On-Duty Depot (A)

Home Browse Search

I $097 "4 �.z. O CITY OF SOUTH BEND, INDIANA 0 SELLER'S BID FOR SALE OR LEASE OF MATERIALS - - BID NAME 2016 South Bend Police Vehicle Equipment FOR BIDS DUE 9:30am on August 23 2016 .865 Bidder Date: q it _ (Firm): C)r5-,Q& eF T-rnd`-awt,c. Address: 7_ -t" g v� City/State/Zip: tj,2 b e5`Ji I Jz T- AJ T Telephone Number: (3/'7) 77j?-766/ Agent of Bidder (if Applicable): -�U When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Afbdavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NOW DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF + ( ) SS: ±k L_ OUNTY ) The undersigned Contractor, being duly swom upon his/her/its oath, affirms under the penalties of perjury that: Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or Bidder'Ver. 12 — 9/16/13