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BID NAME <br />FOR BIDS DUE <br />CITY OF SOUTH BEND NDIANA <br />ELLR"S BID FOR SALE OR LEASE OF MATERIALS <br />AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />Spec R - Twenty -Nine 29 Brand New Leaf Boxes <br />July 23, 2019 9:30 a.m„ <br />Date: Jul 19 2019 Bidder (Firm): Best ui t Co. Inc. <br />Address: 5550 Poindexter Dr. <br />City/State/Zip: Indpls. , IN 46235 Telephone Number: 317 823-3050 <br />Agent of Bidder (if Applicable): Ben Wanner <br />When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this <br />Affidavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT <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 />) SS: <br />Marion 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 <br />firm, company, corporation or partnership represented by him, entered into any <br />combination, collusion or agreement with any person relative to the price to be bid by <br />anyone at such letting nor to prevent any person from bidding nor to induce anyone to <br />refrain from bidding, and that this bid is made without reference to any other bid and <br />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 <br />has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing <br />of value 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 />2 <br />