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BID NAME Ductile Iron Pi es Va <br />FOR BIDS DUE November 24, 202 , 9 <br />Date: // - a o - acD go <br />Address: G K0 S� H a r cW,, <br />City/State/Zip: -`1 ���n �U ���; s y <br />Agent of Bidder (if Applicable): <br />When the prospective Contractor is unable <br />CONTRACTOR'S NO <br />-C( <br />CERTIFICATION RE <br />AR] <br />ELIGIBILITY VERIFICATI <br />CERTIFICATION OF USE <br />OF <br />(Must be <br />STATE OF_ L d.- lam, <br />A%rC,I COUNTY <br />The undersigned Contractor, <br />that: <br />SS: <br />es, and Hydrants <br />D a.m. Lo al Time <br />dder <br />irm): bt f i 1, t L S" Cam, n n <br />;I <br />QTelephone Number: ( 31-7 ) -7 V3 -`i G <br />to any o the statements below, it shall attach an explanation to this Affidavit <br />)LLUSI N AND NON -DEBARMENT AFFIDAVIT, <br />)ING INN ESTMENT WITH IRAN, EMPLOYMENT <br />DN, NON-DISCRIMINATION COMMITMENT AND <br />UNITEE STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br />J for all quotes and bids. Please type or print) <br />dully sworn upon his/her/its oath, affirms under the penalties of perjury <br />1. Contractor has <br />iot, <br />or has an <br />company, corporation <br />or p <br />rtnershil <br />collusion or agreemen <br />with <br />any per <br />letting nor to prevent <br />any <br />person f <br />bidding, and that this <br />bid <br />s made <br />agreement, understanding <br />r combi <br />bidding. Contractor fuither <br />says that <br />or will receive directly <br />or indirectly, <br />on account of such sal <br />; an <br />2. Contractor cert <br />of its principals are 1 <br />ineligible, or voluntar <br />department or agency; <br />.y e cluded <br />ind <br />f other member, representative, or agent of the firm, <br />represented by him, entered into any combination, <br />on relative to the price to be bid by anyone at such <br />:)m bidding nor to induce anyone to refrain from <br />ithout reference to any other bid and without any <br />ration with any other person in reference to such <br />io person or persons, firms, or corporation has, have <br />any rebate, fee, gift, commission or thing of value <br />i of this proposal that neither contractor nor any <br />suspended, proposed for debarment, declared <br />participation in this transaction by any Federal <br />