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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 Arizona
<br />) SS:
<br />Maricopa COLJN`fY
<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 />Iran.
<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
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