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CITY OF SOUTH BEND, INDIANA <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS <br />SPEC R — ONE (1) OR MORE 2020 OR NEWER VACUUM AIR STREET <br />BID NAME SWEEPER <br />FOR BIDS DUE November 24, 2020; 9:00 a.m. <br />Date: 11/20/2020 <br />Bidder <br />(Firm): Brown Equipment Company <br />Address: 10603 Majic Port Lane <br />City/State/Zip: Fort Wa <br />Agent of Bidder (if Applicable): <br />e, IN 46819 Telephone Number: ( 800 ) 747-2312 <br />1SpU TFI eE%� <br />1. O p <br />W rrncr: Z, <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 Indiana ) <br />) SS: <br />Allen COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />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 bidding, <br />and that this bid is made without reference to any other bid and without any agreement, <br />understanding or combination with any other person in reference to such bidding. Contractor <br />further says that no person or persons, firms, or corporation has, have or will receive directly <br />or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and <br />2. Contractor certifies by submission of this proposal that neither contractor nor any of <br />its principals are presently debarred, suspended, proposed for debarment, declared ineligible, <br />or voluntarily excluded from participation in this transaction by any Federal department or <br />agency; and <br />Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />