Opening of Bids - Eight Cardiac Monitors Defibrillators - Physio-Control, Inc. - Part 1

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, 1111 1� e�131 CITY OF SOLIIH BE19Q, INDIANA SELLER'S BID FOR SALE OR LEASE OF MATERIALS AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND NOWDISCRI M I NATION COMMITMENT FOR SELLERS BID NAME Eight (8) More or Less Cardiac Mon itors/Def ibrillato rs FOR BIDS DUE , May 22, 2018 at 9:30 a.m. Bidder Date: 5/18/2018 Address: 118 H ftHows, F-fl-) NE City/State/Zip: 13ecimond,, WA 98052 Telephone Number: (100 _) A2-11112 WhC11 the PF'OSPedille COWMC100S Unable tocertifyto an.v of the statements below, it shall affach an explanation to this Affidavit. f it I WITO 104011110* e (Must be completed for all quotes and bids. Please type or print) STATE OF SS: K it G, COUNTY The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I . Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person fi-orn bidding nor to induce anyone to refrain from bidding, and that this bid is made Without reference to any other bid and without any agreement, understanding or combination with any other person in reference to Such bidding, Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account Of Such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 1 Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran.