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When the prospective Contractor is unable to certify to any of the statements below, it shall attach an <br />explanation to this Affidavit. <br />CONTRACTOR'S NON -COLLUSION AFFIDAVIT, NON -DEBARMENT AFFIDAVIT, <br />EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT FOR <br />CONTRACTORS AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS <br />OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF *tl09A } <br />MICHIGAN } SS: <br />Berrien COUNTY } <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties <br />of perjury 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. <br />Contractor further says that no person or persons, firms, or corporation has, have or will <br />receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account <br />of such sale; and <br />2 Contractor certifies by submission of this proposal that neither contractor nor any of its <br />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 />3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran. <br />a. For purposes of this Certification, "Iran" means the government of Iran and any agency <br />or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as <br />amended from time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor <br />is engaged in investment activities in Iran if either: <br />i. Contractor, its successor or its affiliate, provides goods or services of twenty <br />million dollars ($20,000,000) or more in value in the energy sector of Iran; or <br />Contractor, its successor or its affiliate, is a financial institution that extends <br />twenty million dollars ($20,000,000) or more in credit to another person for <br />forty-five (45) days or more, if that person will (i) use the credit to provides <br />goods and services in the energy sector in Iran; and (ii) at the time the financial <br />institution extends credit, is a person identified on list published by the Indiana <br />Department of Administration. <br />4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain <br />any employee or contract with a person that the Contractor subsequently learns is an <br />Version 10/31/2017 Page - 18 Public Works Quote <br />