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CONTRACTOR'S CERTIFICATION REGARDING INVESTMENT WITH IRAN, NON - DEBARMENT AFFIDAVIT, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT FOR CONTRACTORS Please type or print STATE OF ) SS: COUNTY ) The undersigned Contractor, being duly sworn upon his/her /its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5- 22- 16.5 -5, as amended from time -to -time. b. As provided by Ind. Code § 5- 22- 16.5 -8, as amended from time -to. -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty -five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. ` 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 1 voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he /she /it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E -Verify Program as defined by I.C. 22- 5- 1.7 -3. Contractor's documentation of enrollment and participation in the E -Verify Program is included and attached as part of this bid/quote; and 4. Contractor shall require his/her /its subcontractors performing work under this. public contract to certify that the subcontractors do not knowingly employ or, contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is F- Certification Iran Investment, ENcrify, Diversityjuly 2012.doc