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BID NAME Spec AJ'- Repair & Installation of Overhead Doors for Al'l City Departments <br />FOR BIDS DUE December 12, 2017 at9:30 a.m. <br />Bidder <br />Date: 12/11/2017 (Firm)! Overhead Door Company of South Bend/Mishawaka <br />Address: 58745 ExeLutive Drive, Mishawaka, IN <br />City/State/tip: 46544 - Telephone Number; ( 574 ) 259-2822 <br />Agent of Bidder (if Applicable): Alfred G. Mathes <br />When the prospective Contractor is ratable to certify to any ofthe statenjentsbelove, it shall attach an ex1ilanation to this Affido0t. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTM ENT WITH IRAN, EM PLOYM ENT <br />ELIGIBILITY VERIFICATION, NON. -DISCRIMINATION COMMITMENT AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF Indiana <br />) SS: <br />St, losephn— COUNTY <br />The undersigied Contractor, being duly sworn upon his/her/its oath, affirins tinder the penalties of perjury <br />that: <br />I . Contractor has not, nor has any other mernber, representative, or agent of the tiri-ri, <br />company, corporation or partnership represented by him entered into any combination, <br />collusion or agreeimnt with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person from bidding nor to induce anyone to refi-ain fi-orn <br />bidding, and that this bid is made without reference to any other bid and without any <br />agreement, taiderstanding or combination with any other person in reference to such <br />bidding. Contractor further says that no person or persons,, ffii-is, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, ba, cornnission or thing of value <br />on account of such sale; and <br />2. Contractor certifies by submission 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 from participation in this, transaction by any Federal <br />department or agency; and <br />3. Conti -actor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities, in Iran, <br />4 <br />