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When fheprap pective Contractor as unable to certify to any apj`t e statements below, it shall attach an explanation to Ihis Affidavit.
<br />C O I"i. "IrC. R'S i O-C O.L.,LIJSI.O AliD .NON E A.
<br />CERTIFICATION RE(.' :DING INVESTMENT WITH MAN, �+:1 P[JOY ENT ELF IIL:iT"
<br />.E . FIC AI.".ION, .S Ct - CSC IA."I'IO C O MMI"I' ENT AND EI.C.]'IFICA1.e10 F USE
<br />OF UNITED 5.17M.'lES STEEL PRODUCT'S T'S OR ID+OUNDR PRODUCyTS
<br />(Must be completed for all quotes and bids. Mease type or p:)rirnt)
<br />STATE OF .....,Ilugum.�..,...
<br />SS:
<br />The undersigned Contractor, ntra ctor, being duly sworn rr j,')on$ his/her/its oath, affirms under the: penalties of perjury that:
<br />p . Contractor ntra ctor has not, nor has any other member, be;r, representative, or agent of the firm,
<br />company, corppuprau.tionn or partnership represented by him, entered into any combination, collusion
<br />or agreement with any person n :relative" to the price to be bid by anyone tat such letting nor to prevent
<br />any person from bidding ; Apr to induce anyone to refirairn from bidding, and that this bid is made
<br />without refer e nee to any other bid and without any agreement, understanding or combination with
<br />any other person in reference to such bidding. Contractor further says that no person or persons,
<br />firms, or corporation has, have or 'will receive directly or indirectly,, any rebate, fee, gift,
<br />commission or thing ofvalue on account of such sale; and
<br />2. Contractor ctor certifies by submission of this proposal that neither contractor for nor any of its
<br />principals are presently debarred, suspended, proposed for a lenppaa.nprrrne;mnt, declared ineligible, or
<br />voluntarily excluded from participation in this transaction n by anyFederal department or agency-,
<br />and
<br />. Contractor tn.aas not, nor has any successor to, nor an affiliate of, Contractor, engaged ged in irnvestrnnernt
<br />activities in Iran.
<br />an. For purposes of this Certification, "Iran" means the government nt opf lfaamr and any. ageamgy or
<br />instrumentality lity of traam, or as otherwise defined at Ind. Code § 5....22.... p 6.5....5, as amended nde'd t'iolnn
<br />time to time.
<br />b. As provided by Ind. Code § 5....22....16 5.... , as aanme;nded :trorn time to -time, a Contractor ctor is
<br />engaged in investment activities in prawn if either:
<br />i. C onntrae,tor, its successor or its af't':llaate, provides goods or services oftwenty million
<br />dollars ($20,000,000) or nnnore in value in the energy sector apt" ICram; or
<br />ii. C antra ctor-, its successor or its affiliate, is as financial institution that extends twenty
<br />naitpio n dollars ( 20,000,000) or more irncredit to another person for forty-five (45)
<br />days or more, if that person will (i) use the credit to provides goods and services in
<br />ttpen energy sector in Iran; aurnei (ii) at the time the financial institution e.Ktends credit, is
<br />aa. person identified on list ppn.utpti.shed by the Indiana Department of Administration.
<br />4, Contractor does not knowingly ly employ or contract ct with an unauthorized alien, n, nor retain
<br />any rnn ploye e, or contract with as 1personn that the Contractor for subsequently enntly learns is an unauthorized
<br />alien. n. Contractor agrees es that he/she/it shall enroll in and verify the work. eligibility status ofaalt of
<br />Version 41212019 IPage -12 IPubfic Works Quote
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