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14 zx a? <br />ppryy �p AtIY, <br />Spec H — One (1) or More New Positive Displacement Hydro -Excavating Machine with <br />BID NAME Tandem Axle Cab & Chassis <br />FOR BIDS DUE Septembgr Q. 2020 9:30a.m. <br />Bidder <br />Date: Stmmrnbpr 72„_.._. (Firm):, I Ii Vae Certir <br />Address: 117Indust Rd <br />City/State/Zip: Marietta, OH 4575Q Telephone Number: (740)374-2306 <br />Agent of Bidder (if Applicable). m,Daniel Coley.___,_,..m,,, <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 ..Ohio_ _._.._.,.._..... ) <br />SS:. <br />Washington COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />th at: <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 <br />bidding, and that this bid is made without reference to any other bid and without any <br />agreement, understanding or combination with any other person in reference to such <br />bidding. Contractor further says that no person or persons, firms, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on <br />account 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 />Ver. 2 4/ 16/ 12 <br />