Laserfiche WebLink
CITY OF SOUTH BEND INDIANA <br />SELLER'S BID FORSALE OR, LEASE OF MATERIALS <br />AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />FOR BIDS DUE �. IITe�rch 201,�eer Dr��rartrt�er�t Materials <br />BID NAME 2019 Street and <br />:0 a.mMI qp Time <br />Bidder <br />( } _. .. _......o., Inc. <br />Date: _ arc 6, 2 1 Fim, : Rieth-Rile ry Construction C <br />Address;: 25200 State Road 23 <br />Qly/State/Zip, South Bend In. 46614 Telephone Number: ber: _(574) 288 8321 <br />Agent of Bidder (if Applicable): Joshua A McCormick, Sales Manager <br />��. <br />When the prospective Contractor is unable to certify to any of the statements below, itshaIt attach an explanation to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IlL N, EMPLO M;I 'NT <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 Indiana ) <br />St. Joseph COUNTY ) <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 refrain 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, corrunission or thing of value <br />on 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 />3, Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />