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Of "hen Ore prospecds,,o 0)nlrachw is mmable to rerfifr to dyr is sal larrach an explamajon to ejj.jj� jj
<br />CON' "RA CTOR 'S NON-COI,,8'S,10,N'A,��*S"])' Nt,,),N-DEBA, VIEN'l�'AFFII),AV'�ll',,
<br />CER111FICAlIGN IUA;ARDING JNVES'FINTENT' WFUH IRAN, EN[PLOYNIEN't'
<br />ELIGIBILITY VERIFICA"I'U)N, N'ON.DI,SCRi,'II,,NA,'I."�ION COMMITMENT AN'])
<br />CER171FICATION OF ()SE OFL)NITED-wrATES S17UE,L P110DUCI'S, 0 R FOLAI)KY
<br />PRODUC17S
<br />(Mustbe contpleted An aN qpows and WsRhase type or pjjw�),
<br />STATE
<br />ss�
<br />C70UNIN )
<br />The undasWned Mum; being dut swwo upon 10MMM omk adkms under the penWdeg of popq
<br />that;
<br />I, ConAractor has not, nor Naas ally other member; represeribfivc, (n, q,,;ent ofthe firm,
<br />eoiry,�rmy, Corporation or partnershij�r represent al hY hirn, allmvd ima amy combitmhon,
<br />Collusion or, a-groement with any pors,(ni rc,1njj)/e 1�0 t1j,c p-i�Ce M,Ae 19d Q? anyone at such
<br />letting nor, to prevent any peman front bkldij;ig nor to fi.iduce anyonic to fj.qjjj
<br />bidding, and th,at this bid, is, made withoutrefererice to w,.ry (Alier bid and withot.it al,ty
<br />A9r,'eN'neW, undenstanAing or co,mbination wUh aura y other persm, in ret'' "sauce trr sus hi
<br />bidding. Coritrwlor 11imber sal m that no pemon or pasmm, An, or empmadon haN ha,,vc
<br />or Mll receive direcoy or hWhreay, auy rebate, gift, ,irrjiqiss i or thing of value on
<br />account of sudi sate; and
<br />2. Contractor cediRes by suNnWon 4�4 tliis prc)posal that neither Qontractor no'r any
<br />of hs prAdpols art-c pjev,ej:ttjy debarred, Suspended, proj)osed for delmrnwnt, declared
<br />in,efigible, or voluntarily excludcd J`Irorrr pat-ficil"alion in this transactiort by may Federal
<br />departirwrit: or agerxcy, arid
<br />3. C'(1,ntrador has not, Tarr Ims any successor to, an affiliate of", Contractor, engage(j jr,j
<br />invesil'Inent ac6,vkies in pram
<br />aa�["or Purpose S " of It CeMfimtion, "Inin"Ineans the goNi,ernrnew: of1ran and any, a,gelrcy,
<br />or of Irmli, or as defitncd Ot 1rul, Code § .5-22-165 5, ara
<br />'unend''M 1,T0111 tiara's-to-tin'le,
<br />K As provided b3i Ind, Codc § 5-22-16.5-8, as nimen&,d fix:tn a Comractor
<br />1 engaged W inveshowent activij,jes, in Iran, if either:
<br />Contractor , ils success,Of CIE' its Wlfil taW, prmido,v goods or serviQe� oftwo.r)ty
<br />million dollars (520M4tOJWO) or, arjjore in vihxe in the ever semor of Imn;
<br />011,
<br />rr(7onu.ador, its guceQssor 01, it's, affilhate, i's a fin"I'lacial institution 111aa extends
<br />VwoUy arflJi(,qj&jbxS (SM,000,00o) or 1.11(ge in, crodit wariolber porson, fi",irr
<br />Vers,1011 10131 121n 17 , Page . 8 PUwk WOM UUMe
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