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When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation 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 (Must be completed for all quotes and bids. Please type or print) STATE OF ------IN ) <br />__ M_a_ri_on __ COUNTY <br />) SS: <br />) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: 1.Contractor has not, nor has any other member, representative, or agent of the firm, company,corporation or partnership represented by him, entered into any combination, collusion or agreement withany person relative to the price to be bid by anyone at such letting nor to prevent any person from biddingnor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid andwithout any agreement, understanding or combination with any other person in reference to such bidding.Contractor further says that no person or persons, firms, or corporation has, have or will receive directly orindirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and2.Contractor certifies by submission of this proposal that neither contractor nor any of its principalsare presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded fromparticipation in this transaction by any Federal department or agency; and3.Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investmentactivities in Iran.a.For purposes of this Certification, "Iran" means the government of Iran and any agency orinstrumentality oflran, or as otherwise defined at Ind. Code § 5-22 -16.5-5, as amended fromtime-to-time.b.As provided by Ind. Code§ 5-2 2-16.5-8, as amended from time-to-time, a Contractor is engaged in investment activities in Iran if either:03029045.0000 i.Contractor, its successor or its affiliate, provides goods or services of twenty milliondollars ($20,000,000) or more in value in the energy sector of Iran; orii.Contractor, its successor or its affiliate, is a financial institution that extends twentymillion dollars ($20,000,000) or more in credit to another person for forty-five (45)days or more, if that person will (i) use the credit to provides goods and services inthe energy sector in Iran; and (ii) at the time the financial institution extends credit,is a person identified on list published by the Indiana Department of Administration.00 41 13-9