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0., <br />CITY OF SOUTH BEND, INDIAN <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS <br />AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />1865 <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />-Size Four Door Hybrid Sedan Automobiles <br />BID NAME Spec P — Two (2) more or less 2018 or Newer Mid <br />FOR BIDS DUE May 8, 2018 at 9:30 a.m. <br />B idder <br />Date: (Firm): <br />Address: (D Lk 0 <br />Ci.ty/State/Zip: 50LL_VK g6k)(). qW qW.q Telephone Number: <br />Agent of Bidder (if Applicable): <br />When theprospective Contractor is unable to cedifj� to any oj'the statements below, it shall attach an explanation to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION RE GARDING 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 />-npleted for all quotes and bids. Please type or print) <br />(Must be coi <br />STATE OF fk P- <br />SS: <br />COUNTY <br />...The undersigned Contractor, being duty sworn upon his/her/its oath, affirins under the penalties of perjury <br />that: <br />-iber, representative, or agent of the firm, <br />1. Contractor has not, nor has any other men <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 />-n bidding nor to induce anyone to refi-ain from <br />letting nor to prevent any person froi <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 ally <br />of its principals are presently debarred, suspended, proposed for debarment, declared <br />Itarily eXCILided from participation in this transaction by any Federal <br />ineligible, OF V01111 <br />department or agency; and <br />3. Contractor has not, nor has iny successor to, nor an affiliate of, Contractor, engaged in <br />-nent activities in ]ran. <br />... investi <br />4 <br />