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Spec A�( — Two (2) more or less 2018 or Newer 18,000 lb. Four Wheel Drive Chassis with <br />BID NAME <br />FOR BIDS DUE <br />Date: l '- <br />Address: N <br />7 at 9:30 a.m. <br />Bidder f <br />(Firm): L.ckl4e . S �U't.0 .F,), <br />City/state/Zip: Telelhone Number: <br />Agent of Bidder (if Applicab e): <br />When the prospective Contract r is unable to cert & to any of the statements below, it shall attach an explanation to this Affldavit. <br />CON ' TRAC OR SNON-COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFIC TION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT <br />ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND <br />CERTIFICATIO OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br />be completed for all quotes and bids. Please type or print) <br />STATE OF ) <br />SS: <br />COtfNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />1. Con actor 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, <br />collusion oi agreement with any person relative to the price to be bid by anyone at such <br />letting nor lo prevent any person from bidding nor to induce anyone to refrain from <br />bidding, an 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 further says that no person or persons, firms, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value <br />on account p f such sale; and <br />2. Coni <br />of its print <br />ineligible, c <br />department <br />actor certifies by submission of this proposal that neither contractor nor any <br />als are presently debarred, suspended, proposed for debarment, declared <br />voluntarily excluded from participation in this transaction by any Federal <br />agency; anal <br />M <br />