Laserfiche WebLink
NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT AND <br />NONDISCRIMINATION COMMITMENT FOR SELLERS <br />SpTATE OF INDIANA ) <br />COUNTY <br />SS: 3 t V �5 6 �tGqu <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 seiler 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 �mdersigned 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 agl•ees not to discriminate against any employee or applicant for employment in <br />tine 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 />Dated this IZ day of �-i�r• 1 , 2021 <br />Seller {Firm) �%' ^^�lt' ,t•;r' .�s� t,( <br />-. <br />Signature of Seller or Agent <br />Subscribed and sworn to before me this t �-�'�� day of ��%Y%� 2 f � <br />My Commission Expires: ����? ���,�'� <br />County of Residence: 7e,'��'��;1'��„� <br />12 <br />Notary Public <br />