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When the prospective Contractor is unable to certify to any of the statements below,it shall attach an eaplanation to this Affidavit <br />CONTRACTOR’S NON-COLLUSION AND NON-DEBARMENT AFFIDAVIT,CERTIFICATION <br />REGARDING INVESTMENT WITH IRAN,EMPLOYMENT ELIGIBILITY VERIFICATION,NON <br />DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL <br />PRODUCTS OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids.Please type or print) <br />STATE OF IN ) <br />)SS: <br />St.Joseph COUNTY ) <br />The undersigned Contractor,being duly sworn upon his/her/its oath,affirms under the penalties of peijury <br />that: <br />1.Contractor has not,nor has any other member,representative,or agent of the firm,company, <br />corporation or partnership represented by him,entered into any combination,collusion or agreement with <br />any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding <br />nor to induce anyone to refrain from bidding,and that this bid is made without reference to any other bid and <br />without any agreement,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 receive directly or <br />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 its principals <br />are presently debarred,suspended,proposed fUr debarment,declared ineligible,or voluntarily excluded from <br />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,“fran”means the government of Iran and any agency <br />or instrumentality of Iran,or as otherwise defined at hid.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; <br />or <br />ii.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 <br />fmancial institution extends credit,is a person identified on list published by <br />the Indiana Department of Administration. <br />4,Contractor does not knowingly employ or contract with an unauthorized alien,nor retain any <br />employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. <br />VersIon 0912912021 Contractor’s Bid for Public Works -4