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CITY OF SOUTH BEND 1NDIANA <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS <br />k ? 'F <br />2018 Contract for the Trucking of Belt Pressed Biosolids for Land <br />BID NAME Application <br />FOR BIDS DUE March 13, 2018 at 9:30 a.m. <br />Bidder <br />Date: 03/23/2018 (Firm): TRUCKS R US, INC <br />Address: 23942 STATE ROAD 2 <br />SOUTH BEND, IN <br />City/State/Zip: 46619 Telephone Number: 574-340-8470 <br />Agent of Bidder (if Applicable): JAMES BURGER -PRESIDENT <br />I-Vheu the prospective Coutractor is unable to certifj) to any of the statements below, it shall attach an expkruatiou to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT <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 JOSEPH COUNTY ) <br />The undersigned Contractor, being duly sworn upon Isis/her/its oath, affir111s under• the penalties of perjury <br />that: <br />l . Contractor has not, nor has any other member, representative, or agent of the fit -III, <br />company, corporation or partnership represented by him, entered into any combination, <br />collusion or agreement 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 refrain from <br />bidding, and 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, gilt, commission 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. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />Yer, 13 --- 0101115 <br />