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A WE When the prospective Contractor is unable to cerlij.jl to anY ofthe statements helow, it shall attach an explanation to thisAffielavit. ��R] waaigjiRkilhuYlv ol 11111111 111! IIIIINN I ENIII @I (Must be completed for all cluotes and bids. Please type or print) . . . . . ..... .. . .. . .... ... ......... STATFcar ..JN j 140A , a 9 SS: PJJ&4 COUNTY The undersigned Contractor, beitig dilly SW01-11 LI11011 his/her/its oath, affirms mider the penalties of pet jury 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 ODY combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person froni 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, llot• all affiliate of, Contractor, engaged in Investment activities ill Iran. a. For purposes of this Certificatim, "Irmi" incarls the government of Iran and my agency or instrumentality of Iran, or as otherwise defined at hid, Code § 5-22-16.5-5, as amemled from tilile-to-time. b. As provided by bid. Code § 5-22-16,5-8, as amemled from time -to -time, a Contractor is engaged ill iiivestineiit activities ill Iran if either: i. COI]tl'aCtOl', its SLICCeSS01' OritS affiliate, provides goods or services of twenty inillioii dollars ($20,000,000) or more ill value In the ellergy sector of Irall; or ii. ('011tra0t0l', its SLICCCSSOI' Ol'its affiliate, is a financial illStiulti011 that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) clays or 111ore, if that persoll will (i) use the credit to provides goods and services in Non -Collusion Non -Debarment All-Wav4 Non Inmi Form