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When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY <br />VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE <br />OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF Georgia ) <br />) SS: <br />DeKalb COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or <br />partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price <br />to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, <br />and that this bid is made without reference to any other bid and without any agreement, understanding or combination with <br />any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, <br />have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and <br />2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently <br />debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this <br />transaction by any Federal department or agency; and <br />Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in <br />an. <br />a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality <br />of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in <br />investment activities in Iran if either: <br />Contractor, its successor or its affiliate, provides goods or services of twenty million dollars <br />($20,000,000) or more in value in the energy sector of Iran; or <br />ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars <br />($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person <br />will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time <br />the financial institution extends credit, is a person identified on list published by the Indiana <br />Department of Administration. <br />4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract <br />with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it <br />shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E- <br />Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the <br />E-Verify Program is included and attached as part of this bid/quote; and <br />