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When thepowspective Contractor is unable to certijjr to any of the statements below, it shall attach an explanation to this Affidavit. <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF Indiana } <br />St. Joseph COUNTY ss� <br />The undersigned Contractor, being duty sworn upon his/her/its oath, affirmsunder the penalties of perjury <br />that: <br />I Contractor has not, nor has any other member, representative, or agent of the firm, company, <br />corporation or <br />OWN AMAMARMI <br />611 W 141 <br />2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals <br />are�lresentiv debarred, suspended, org_Qosed for debarinent. declared ineligibi ,mvw <br />participation in this transaction by any Federal 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 />a. For purposes of this Certification, "Iran" means the government of Iran and any agency <br />or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as <br />amended from time -to -time, <br />provided by Ind. Code § 5-22-16.5-8, as aniended from tirrie-to-time, a Contractor <br />is engaged in investment activities in Iran if either: <br />WWI <br />million dollars ($20,000,000) or more in value in the energy sector of Iran; <br />,*r <br />Contractor, its Successor or its affiliate, is a financial institution that extends <br />twerity fflffliNl dollars ($20,000,000) m niore in credit to another person for <br />tl')rty-five (45) days or more, if that person will (i) use the credit to provides <br />goods and serviecs in the energy sector in Iran; and (H) at the tirne the <br />financial institution extends credit, is a person identified on list published by <br />the Indiana Department of, dministratio t, <br />Version 4/2/2019 Contractor's Bid for Public Works -0, <br />