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' en the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation <br />to this Affidavit. <br />CONTRACTOR'S 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 />STATE OF Indiana ) <br />) SS: <br />St. Joseph COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties <br />of perjury that: <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, <br />company, corporation or partnership represented by him, entered into any combination, collusion <br />or 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 or persons, <br />Firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission <br />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 <br />principals are presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from participation in this transaction by any Federal department or agency; <br />and <br />3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, <br />engaged in investment activities in Iran. <br />a. For purposes of this Certification, "Iran" means the government of Iran and any <br />agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22- <br />16.5-5, as amended from time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a <br />Contractor is engaged in investment activities in Iran if either: <br />I. Contractor, its successor or its affiliate, provides goods or services of <br />twenty million dollars ($20,000,000) or more in value in the energy <br />sector of Iran; or <br />il. Contractor, its successor or its affiliate, is a financial institution that <br />extends twenty million dollars ($20,000,000) or more in credit to <br />another person for forty-five (45) days or more, if that person will (i) <br />use the credit to provides goods and services in the energy sector in <br />Iran; and (ii) at the time the financial institution extends credit, is a <br />Version 8/22/2017 Contractor's Bid for Public Works - 4 <br />