Laserfiche WebLink
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this A ffidavit. <br />CONTRACTOR'S NON-COLLUSION AND NON-DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING <br />INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION <br />COMMITMENT AND 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 __________________ ) <br />) SS: <br />COUNTY ___________________ ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of <br />perjury that: <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, company, <br />corporation or partnership represented by them, entered into any combination, collusion or <br />agreement with any person relative to the price to be bid by anyone at such letting nor to prevent <br />any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made <br />without reference to any other bid and without any agreement, understanding or combination with <br />any other person in reference to such bidding. Contractor further says that no person or persons, <br />firms, or corporation has, have or will receive directly or indirectly, any re bate, fee, gift, commission <br />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 its principals <br />are presently debarred, suspended, proposed for debarment, declared ineligi ble, or voluntarily <br />excluded from participation in this transaction by any Federal 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 or <br />instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from <br />time-to-time. <br />b. As provided by Ind. Code 8 5-22-16.5-8, as amended from time-to-time, a Contractor is <br />engaged in investment activities in Iran if either: