Opening of Quotes - Century Center Office Furniture Project no 118-104B - Office Interiors

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CITY OF SOUTH BEND INDIANA'" SELLER'S QUOTE FOR SALE OF MATERIALS tlf6 11 W ,way, . BID NAME PROJECT NO. 118-104B CENTURY CENTER OFFICE FURNITURE"°' - FOR BIDS DUE Mal/ 28, 2019 by 9:30am Bidder Date: May 1 Aot 1) (Firm): _......._ 1' C (6 Address: City/State/Zip: F - ,� '� � , �o Telephone Number: qc)C) Agent of Bidder (if Applicable): When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF � V)d, c,-via ) ) SS: . J COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor 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 bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor 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; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of 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; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran.