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CITY OF SOUTH BEND, INDIANA <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />BID NAME Ductile Iron Pipes Valves, and Hydrants <br />FOR BIDS DUE November 24,2020,9:00 a.m., Local Time <br />Bidder <br />Date: Novew r 7,3., 7,o2o (Firm): I'Q�('Q(`ASON Ul/a}Prwns�S <br />Address: lD*li D li,/Pr Plow GoyfT <br />City/State/Zip: Sow+(i40) Telephone Number: (57N) ZB2—Z3Z3 <br />Agent of Bidder (if Applicable): _DQ,f%rn tJtAV'f f <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 lvtdiakn4 ) <br />) SS: <br />To5eek COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <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 <br />on 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 />