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Contractor agrees not to discriminate against or intimidate any employee or applicant for <br />employment in the performance of this contract with privileges of employment, or any matter <br />directly or indirectly related to employment, because of race, religion, color, sex handicap, <br />national origin or ancestry. Breach of this provision may be regarded as material breach of <br />contract. <br />I, the undersigned bidder or agent as contractor on a public works project, understand my <br />statutory obligations to the use of steel products or foundry products made in the United States <br />(I.C. 5- 16 -8 -1). I hereby certify that I and all subcontractors employed by me for this project will <br />use steel products or foundry products on this project if awarded. I understand that violations <br />hereunder may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for <br />public works are true and correct. <br />Dated this Z day of -inn 20i <br />k An . 0-6 irnmt'ssI ncr5 <br />Contractor idder (Firm <br />LORYL.TIMMER OAV t '' <br />S ''' C00n Signature of Contractor/Bid'r or Its Agent <br />My Commission Expires /` <br />'• September 23, 2017 /A „ A T • ,(ui � _ - (A m M\ <br />Printed Name and Title <br />Subscribed and sworn to before me this 21�; day o 0_ .20 <br />My Commission Expires 20 - — J <br />Nota ublic <br />County of Residence <4 . :T k <br />F- Non - Collusion Non - Debarment Affidavit Non Iran Form 2012 <br />