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CITY OF SOUTH BEND INDIANA % <br />SELLER'S BID FOR <br />SALE OR LEASE OF MATERIALS ' ' <br />n'Knc <br />Spec G Three (3) More or Less 2018 or Newer 28 Cubic Yard Front Lo�Y�i� <br />BID NAME Refuse Truck <br />FOR BIDS DUE April 10, 2818 at 9:30 a.m. <br />Bidder Central Indiana Truck Equipment <br />Date: Aril 5, 2018 (Firm): Corporation, <br />Address: 2128 S Hardinq Street <br />City/State/Zip: Indianapolis, IN 46221 Telephone Number: (317) 639-4207 <br />Agent of Bidder (if Applicabie): Zachary Vaught <br />When the prospective Contractor is unable to certify to any of thestatements below, it shall attach an explanation to this A fidavit <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 />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />1. Contractor 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 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, gift, 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 />:l <br />