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When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation <br />to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AFFIDAVIT, NON -DEBARMENT AFFIDAVIT, EMPLOYMENT <br />ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT FOR CONTRACTORS AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS <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 duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />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 <br />from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference <br />to any other bid and without any agreement, understanding or combination with any other person in <br />reference 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 of value on <br />account of such sale; and <br />2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals <br />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 />1 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 <br />time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged <br />in investment activities in Iran if either: <br />i. Contractor, its successor or its affiliate, provides goods or services of twenty million <br />dollars ($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, <br />if that person will (1) use the credit to provide goods and services in the energy sector in <br />Iran; and (ii) at the time the financial institution extends credit, is a person identified on <br />list 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 the <br />Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. <br />Contractor's documentation of enrollment and participation in the E-Verify Program is included and <br />attached as part of this bidlquote; and <br />Version 911/2016 Page - 14 Public Works Quote <br />