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CITY OF ,wBEND, <br />SELLER"$ BID FOR SALE OR LEASE OF MATERIALS <br />II III.' 7p wR AND '#' DEBARMENT AFFIDAVIT AND <br />BID NAME <br />FOR BIDS DUE January J4!.2&" <br />01/02/2020 Bidder Target Specialty Procuts <br />Date: (Firm): <br />Address: 640 44'h street SW,. <br />City/State/Zip: Grand Rapids M149548 Telephone Number: 1269 1 217-7623 <br />Agent of Bidder (if Applicable): Kris Louden <br />When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this 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 />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 firm, <br />company, corporation or partnership represented by him, entered into any combination, <br />collusion or agreement with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, <br />and that this bid is made without reference to any other bid and without any agreement, <br />understanding or combination with any other person in reference to such bidding. <br />Contractor further says that no person or persons, firms, or corporation has, have or will <br />receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account <br />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 />