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NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT AND <br />NONDISCRIMINATION COMMITMENT FOR SELLERS <br />STATE OF INDIANA) <br />) SS: <br />COUNTY ) <br />The undersigned seller or agent, being duly sworn on oath, says that it has not, nor has any <br />other member, representative, or agent of the firm, company, corporation or partnership represented <br />by him, entered into any combination, collusion or agreement with any person relative to the price to <br />be offered by any person nor to prevent any person from making an offer nor to induce anyone to <br />refrain from making an offer and that this offer is made without reference to any other offer. <br />The prospective seller certifies, by submission of this proposal, that neither it nor its principals <br />are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from participation in this transaction by any Federal department or agency. <br />The undersigned seller agrees that the following nondiscrimination commitment shall be made <br />a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any <br />of its agencies, boards or commissions: <br />Seller agrees not to discriminate against any employee or applicant for employment in <br />the performance of this contract with privileges of employment, or any matter directly <br />or indirectly related to employment, because of race, religion, color, sex, handicap, <br />national origin or ancestry. Breach of this provision may be regarded as a material <br />breach of the contract. <br />Ab <br />Dated this <br />day of D V. <br />Seller (Firm)Z4� S/ <br />Signature of Seller or Agent <br />4a7C i kVr�y��-t <br />Subscribed and sworn to before me this ��> day of f 11'4t/2M6Q - , 20- . <br />My Commission Expires: <br />County of Residence: T_ <br />Notary Public <br />_�+"�'°•� BRIAN A. WUJCIK <br />* ` Commission Numbu 0715479 <br />SEAL <br />My Commission Expiros <br />20 OF ANIVA 27, 2026 <br />IM <br />