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