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RIGGS MOWERS & MORE Fax:5742549801 filar 20 2017 02:32pni <br />P002/007 <br />CITY OF SOUTH BEND, INDIANA_ <br />SELLER'S BII) FOR SALE OR LEASE OF MATERIALS <br />AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />BID NAME Spec H ---Teri Qq)_More or Less Commercial Riding Mowers <br />FOR BIDS DUE April 11, 2017 at 9:30 a.m. <br />Bidder <br />Date: AA I Its i I.1 (Firm): <br />r <br />.Y_ w_......-_---- __._. lZ4c � �nbo I��'aur I__--���i�`''_-tn�----------• <br />Address: <br />City/State/Zip: M;�wck4t TiU % 5W Telephone Number: <br />Agent of Bidder (if Applicable): <br />When the pros wetive Contractor is unable to c:ertlfy to any of the statements below, it shall attach an explanation to this Affidavit. <br />CONTRACTOR'S NON --COLLUSION AND NON-DYKBARMENrl AF IDAVII', <br />CERTIFICATION IIEGARDING INVESTMENT WITH 11ZA.N, EMPLOYMENT <br />rLIGI131LITY'VE111 ICATION, NON-I)tSCRIMINATION COMMITMEN-I' AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUGI'S <br />(Must be Completed for all quotes and bids. Please type or print) <br />STATE OF' <br />15A_,cou TY ) <br />The undersigned Contractor, being duly sworn upon his/leer/its oath, affirms under the penaEtics of perjury <br />that: <br />1. Contractor has not, nor has any other nrenrber, representative, or agent of the firnr, <br />cornpany, corporation or partnership represented by hint, entered into any conbination, <br />collusion or agreement with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person ttom bidding nor- to induce anyone to reli-ain from <br />bidding, and that this bid is made without reference to any other bid and without any <br />agreement, understanding or combination with any other person in reference to such <br />bidding. Contractor for-ther says that no person or persons, fin-ns, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value <br />on account of such sale; and <br />2. Contractor certifies by subn)ission of this proposal that neither contractor nor any <br />of its principals are presently debarred, suspended, proposed for debarment, declared <br />ineligible, or voluntarily excluded front participation in this transaction by any Federal <br />departrxrent or agency; and <br />3. Contractor has not, nor has any successor to, nor tin affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />4 <br />