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WIven the prospective Coodractor is ginable 14) c-dorij& tt) any qf'Osestatentents below, itshallatlach an expilination to this A.ffidavil.
<br />CON']"RACTOWS NON -COLLUSION AND NON-DEBARMEN"I" AFFWAVY. F,
<br />WITH IRAN, EM'PLOYMEN,r EuwBiu'ry,
<br />CERTIFICIATION REGARDIN(fi INVESTMENT If"ICATION OF USE
<br />VERIFICATION NON-DISCRIMINA:TION COMN11"I'MENT XND1 CERT
<br />OF UNITED STATES STEEL PRODUCT'S OR FOUNDRY PRODUCTS
<br />(Must be completed fior all quotes and bids, Please type or print)
<br />S1 ATE, OF '� 11-1.
<br />cou4"ry
<br />'I'he rand erslgrwed C" ontractor, being dWy swoni upon his/her/hs oath., affinns ander the penalties ofpertury that�
<br />I . (""ontnactor has, not, nor has, any other member, representative,, or agent of the firm,
<br />cornpany, corporation or partnership represented by h4n, entered into any cornbination, col1w.,ion
<br />or agreenient with any person relative to the price to be bid Ib.y ara yone at such letfing nor to
<br />prevent any, person, froin biddng tior to indUce anyone to reftain from bidding, and that this Hd
<br />is rnade w4hout reference to any other bid and without any agreement, understanding or
<br />cd,')rnbination, with any other person in r6crence to such bidding. Contractor ftirther says that no
<br />person, or persons, firms, or corporadon has, have or will receive directly or indirectly', any
<br />rebate, fie, gall:, conirnission or thing ofvalue on account of such sale, and
<br />2,, Contractor certifies by submission c& ffiis pr(')posal that neither contractor nor any of its
<br />principals are presently debarred, suspended, proposed ftrrr debwrnent, declared inehglble, or
<br />voluntarily excluded 'from participation in this transaction by any 1--'i',-,dera1 depinnient or agency:
<br />and
<br />3, Contracfor has run,, nor has any SL1CcLsm.)r to, nor an affifiate of, engaged in
<br />investment activilies in fran.
<br />a. F"OT' PLWPOSeS Offllk Cerd fication, "Iran" rneans the governniewr of fran and any agency or
<br />instrurnentafity of1ran, or as othenvisie defitwd at hi& (ode § 5-2246,5-5, as amended from.
<br />flrne-to-dme.
<br />b, As j.'wovided by Ind. Ccrde § 5-22-� 6,5-8, as amended prong firne-to-fime' a Contractor k
<br />engaged in investment activides in Iran ife,Ither:
<br />i. ("Ontractor, its succcsor or its affiliate, provides goods or services of twenty inflHir..)n
<br />dollars ($20,00(l,000) or niore in vaWe in the energ p secAor of Iran: oar
<br />il. Contractor, 4s sw',,.cessoror its affiflare, is as financial 4IStiftition that extends tiventy
<br />aidlion dollars 620,000,000) or niore hi credit to another person for fiorly-nve (45)
<br />days or rnore, ifthal person wifl (i) use the credit to provides goods and services 41
<br />Non CoHmqon Affidava Noi� Iran Fcun 20k,',
<br />
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