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CONTRACTOR'S NON — COLLUSION AFFIDAVIT, NON - DEBARMENT AFFIDAVIT, NON- DISCRIMINATION COMMITMENT FOR CONTRACTORS, AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS The undersigned bidder or agent, being duly sworn on oath, says that he 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 quote by anyone at such letting nor to prevent any person from quoting nor to induce anyone to refrain from quoting, and that this quote is made without reference to any other quote and without any agreement. understanding or combination with any other person in reference to such quoting. He 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. The prospective contractor certifies, by submission of this proposal that neither it nor 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. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, handicap, national origin or ancestry. Breach of this provision may be regarded as a material breach of the contract. I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5- 16 -8 -1 et seq.). I hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products or foundry products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. OATH AND AFFIRMATION (Must be completed for all quotes. Please type or print) I hereby affirm under the penalties for perjury that the facts and information contained in the foregoing quote for public works are true and correct. M (Name of Organization) (Printed Name and Title of Person Signing) ACKNOWLEDGEMENT STATE OF )SS COUNTY OF Before me. a Notary Public, personally appeared the above -named and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this My Commission Expires: County of Residence: day of (Notary Public Signature) (Notary Printed Name)