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When the prospective Contractor is unable to certify to any of the statements below, it shall attach an <br />explanation to this Affidavit. <br />CONTRACTORIS NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION <br />REGARDING, INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NOW <br />DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL <br />PRODUCTS OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATEOF Sl"A ✓-T ) <br />) SS: <br />S'i• �o� COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, company, <br />corporation or partnership represented by him, entered into any combination, collusion or <br />agreement with any person relative to the price to be bid by anyone at such letting nor to prevent <br />any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made <br />without reference to any other bid and without any agreement, understanding or combination with <br />any other person in reference to such bidding. Contractor further says that no person orpersons, <br />firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, <br />commission or thing of value on account of such sale; and <br />2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals <br />are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from participation in this transaction by any Federal department or agency; and <br />3. Contractor has not, nor has any _successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />a. For purposes of this Certification, "Iran" means the government of Iran and any agency or <br />instrumentality. of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended <br />from time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-6, as amended from time -to -time; a Contractor is <br />engaged in investment activities in Iran if either: <br />1. Contractor, its successor or its affiliate, provides goods or services of twenty <br />million dollars ($20,000,000) or more in value in the energy sector of Iran; or <br />11. Contractor, its successor or its affiliate, is a financial institution that extends <br />twenty. million dollars ($20,000,000) or more in credit to another person for forty <br />five (45) days or more, if that person will (I) use the credit to provides goods and <br />services in the energy sector in Iran; and (ii) at the time the financial institution <br />extends credit, is a person identified on list published by the Indiana Department <br />of Administration. <br />4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any <br />employee or contract with a person that the Contractor subsequently learns is an unauthorized <br />alien. Contractor agrees that helshelitshall enroll in and verify the work eligibility status of all of <br />Contractor's newly hired employees through the E-Verify Program as defined by LC: 22-5-1.7-3. <br />Contractor's documentation of enrollment and participation in the E-Verify Program is included <br />Version 1011712016 Contractor's Bid for Public Works - 4 <br />