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01 DA 0 Im h mois] ImIlmonw-m I DR A Eel 0 11 1 0 <br />� 0 to] 0 a am" a I J, I I mov Im mfiep� I T1 I IN km:g � I a aoi wj:41444 z <br />BID NAME Eight (8) More or Less Cardiac Monitors/Defibrillators <br />FOR BIDS DUE May 22, 2018 at 9:30 a.m. <br />Bidder <br />Date: May 1. 2018 —(Firm): ZOLL Medical Corporallon <br />Address: 269 Mill Road <br />City/State/Zip: Chelmsford, MA 01824 Telephone Number: (978)421-9655 <br />Agent of Bidder (if Applicable): Randy Curran, Territory Manager <br />Wheir lite prospective Contractor is unabte to certify to any of the stateinenu below, it shall attach an evplanatian to this 11fifidavit. <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 Massachusetts <br />) SS: <br />Middlesex OUNTY <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 refidin 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 on <br />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 />1 Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in [ran, <br />