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When the prospective Coutmetor is tuiahle to cerlf to form rf the.stalemenis below, it shall affach tut ekrttttttrliott to tltisAffidailit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING . NVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY <br />VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE <br />OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCT'S <br />(Must be cotnpleted for all quotes and bids. I'lease tyke or print) <br />STATE OF <br />SS: <br />COUNTY ) <br />The undersigned Contractor, being duly sworn npnla leis/laee/its oath, affirms render the penalties of pcl jul•y that: <br />1. Contractor has not, not- has ally other merriber, representative, or agent of the firm, <br />company, corporation or partnership represented by hina, 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 <br />prevent any person from bidding not' to induce anyono to refrain fronn bidding, and that this bid <br />is trade without reference to any other bid and without any agreement, understanding or <br />combination with any other person in referctace to such bidding. Contractor further says that no <br />person or persons, firins, of corporation has, have or will receive directly or indirectly, any <br />rebate, flee, gift, conunission or thing of value ota accottllt 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 debarnient, declared ineligible, or <br />voluntarily excluded fi•orn participation in this transaction by any Federal department or agency; <br />and <br />1 Contractor has not, llor' has any successor to, nor all affiliate of', Contractor, eltgaged ill <br />ilives trnent activities in Iran. <br />a. For purposes of this Certification, "Iran" ),cads the government of Iran and any agelicy or <br />instroltrcntality of Iran, or as otherwise defined at Ind. Code 5-22-16.5-5, as an7eoded from <br />time-to�tinae. <br />b. As provided by Ind. Code § 5--22--16.5-8, as aniended fi-ona tiiile-to-time, a Contractor is <br />enraged in investment activities ill Irala if either; <br />I. Contractor, its socc;essor or its affiliate, provides goods or services of twenty taaillioll <br />dollar's ($20,000,000) or more in value ill the energy sector of Iran; or <br />rl. Contractor, its successol' or Its affiliate, is a fmanclal instltl.itioia that extends tweilty <br />million dollars ($20,000,000) or more in credit to another person for forty-five (45) <br />days or more, if that person will (i) use the credit to provi(es goods and services in <br />Van•('ulinsion Nun-I?ebanttcnlnraidivii Note Fran Form <br />