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CONTRACTOR'S NON-COLLILJSION AND NON-DLBARMENTAFFIDAVIT, C ERTI F [CATION
<br />REGARDING INVESTMENT WITH IRAN, ErVII'l.,OYN'IEN'I'ELIG]BtLI-I'N'N7E[ZIFICA'I'ION, NON-
<br />DISCRIMINATION COMMITMENT AND CERTIPICATION OF USE OF UNITED STATES STEEL
<br />PRODUCTS OR FOUNDRY PRODUCTS
<br />((lust be completed for all quotes and bids. Please type or print)
<br />STATE OF
<br />CouNTY SS:
<br />The Undersigned Contractor, being, duly sworn Up011 his/her/its oath, affirms Under the penalties of pe1jury
<br />that:
<br />1. Contractor has not, not' has any other member, representative, or agent of the firm, company,
<br />corporation or partnership represented by him, entered into any combination, collusion or agreement with
<br />any person relative to the price to be bid by anyone at SLICII letting nor to prevent any person from bidding
<br />nor to induce anyone to refrain from bidding, and that this bid is made Witl1OLl( reference to any other bid and
<br />without any agreement, understanding or combination with any other person in reference to such bidding.
<br />Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
<br />indirectly, any rebate, fee, gift, commission or thing of vakle,011 account Of SLICII sale; and
<br />2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
<br />are presently debarred, SLIspended, Proposed for debarment, declared ineligible, or voluntarily excluded from
<br />participation in this transaction by any Federal department or agency-, and
<br />3. Contractor has not, nor has any successor to, not- all affiliate of', Contractor, engaged in
<br />investment activities in Iran.
<br />For purposes of this Certification, "Iran" meatis the government of Iran and any agency
<br />or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
<br />amended from time -to -time.
<br />b, As provided by Ind. Code § 5-22-16.5-8, as amended fi-orn tune -to -time, a Contractor
<br />is engaged in investment activities in Iran if either:
<br />i. C()lltrGlCtOl-, its SLICCCSSOI-01- its affiliate, provides goods or services of twenty
<br />million dollars ($20,000,000) or more ill vague in the energy sector of Iran;
<br />or
<br />Contractor, its SLICCeSSOr Or its affiliate, is a financial institution that extends
<br />twenty ilifflion dollars ($20,000,000) or more in credit to another person for
<br />forty-five (45) days or i-nore, if that person Will (i) LISC the credit to, provides
<br />goods and services in the energy sector in Iran- and (ii) at the time the
<br />financial institution extends credit, is a person identified oil list Published by
<br />the Indiana Department of Administration,
<br />4. Conti -actor does not knowingly employ or contract with an unauthorized alien, nor retain any
<br />employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
<br />Contractor agrees that he/she/it shall enroll in and verify the Nvork eligibility status of all of Contractor's
<br />newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractors
<br />(10CLInientation of enrollment and Participation ill the 1.",-Velffy Program is included and attachcd as part of
<br />this bid/quote; and
<br />Version 7/01/2016 Special Provisions - 10
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