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When (be prospeclive Contrucloris unable tar verfify le) anY (ffthe walenmniv helow, il shall aucich an explanafion to ihis,41fielavit.
<br />CONTRACTOR'S NON-COLLLISION AND NON-DEBARMENTAFFIDAVII, '
<br />CERTIFICATION REGARDING INVESTMEN'TWITH IRAN, EMPLOYMENT ELIGIBILITV
<br />VERIFICATION, NON-DISCRIMINATION CONIN11"I'MENTAN'D CERT11"ICATION OF USE
<br />OF UNITED STATES STEEL PRODUCTS OR FOUNDRYPRODUCTS
<br />(NlUst be corrilfleted flor all quoles and bids, Please type or print)
<br />STATLOF
<br />ss�
<br />The Undersigned Contractor, being duly sworn lipon his/ficr/its oath. a11)111`111S, Linder the PellalfieS OfperjLffy thm:
<br />I. Contractor has not, nor has any, otlier nicniber, representative, or agent of the firm,
<br />company, corporation or partnership represented by him, entered into any combinaOon, collusion
<br />or agreenient with any person relatk,re to the price to lie bid by anyone at such letting nor to
<br />prevent arly person [Torn bidding nor to induce anyone to rel"rain frot�n Hdding., and that this bid
<br />is made without reference to any other bid and without any agreement, understanding or
<br />con,ibination with any offier person in refierence to such bidding, Contractor further says that no
<br />person or pusons. 1"inns, or corporation has, have or xv,M receive directlY or indirectly, any
<br />rebate, pie, gift, corninission Or thin� 01'V',dUC Oil UCOUnt of'such sale-, and
<br />2. Contractor certifies by submission of' thk Proposal that neither Coll tracto r nor any of its
<br />principals are presently debarred, suspended. proposed lor debarment, declared ineligible, or
<br />VOILIntarily CXCILtded frorn participation 61 this transaction by any Federal department or agency;
<br />and
<br />I 3 Contractor has not, nor has any successor to. nor an affili.,ne of" Cotilinclor, engaged in
<br />ifivestil,lem activilies in hwl,
<br />,,i:.For purposes of this Certification, "Iran" means the govern tile lit of lran and any ag,clicy or
<br />instrunicnialilly of fran, or as otherwise deft rid at hid. Code § 5-22-16.5-5, as amended froill
<br />fitile-to-d tile,
<br />b. As provided by lrid. Code § 5-22-W5-8. as amended from linic-lo-bile., a Contractor is
<br />engaged in ivivestmem, activilies ill lrarr ifeither:
<br />j. ( , olitnictor, its successor (it- its affitiate, provides goods or services of twenty tnilhon
<br />dollars, (S20,000,000) or inore in value in the e[lergy wetor of Iran: or
<br />ii. Contractor' its successor or ors affil iatc. is a finialicial irisduttion that extends twevily
<br />million dollars (S20,000,000) or more in credit to anothcr person for forty-five (45)
<br />days or niore, iflhal person w1h (0 wsc the croJit to provides goods and services in
<br />Non-G(fltusim M-m-Debarmml AlMlIn UNon Iran f oi mi
<br />
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