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WhentheprospectiveContractorisunabletocertifytoanyofthestatementsbelow,itshallattachanexplanationtothisAffidavitCONTRACTOR’SNON-COLLUSIONANDNON-DEBARMENTAFFIDAVIT,CERTIFICATIONREGARDINGINVESTMENTWITHIRAN,EMPLOYMENTELIGIBILITYVERIFICATION,NONDISCRIMINATIONCOMMETMENTANDCERTIFICATIONOFUSEOFUNITEDSTATESSTEELPRODUCTSORFOUNDRYPRODUCTS(Ivtustbecompletedforallquotesandbids.Pleasetypeorprint)STATEOF))SS:cvte-COUNTY)TheundersignedContractor,beingdulyswornuponhis/her/itsoath,affimmunderthepenaltiesofperjurythat:I.Contractorhasnot,norhasanyothermember,representative,oragentofthefinn,company,corporationorpartnershiprepresentedbyhim,enteredintoanycombination,collusionoragreementwithanypersonrelativetothepricetobebidbyanyoneatsuchlettingnortopreventanypersonfrombiddingnortoinduceanyonetorefrainfrombidding,andthatthisbidismadewithoutreferencetoanyotherbidandwithoutanyagreement,understandingorcombinationwithanyotherpersoninreferencetosuchbidding.Contractorfurthersaysthatnopersonorpersons,firms,orcorporationhas,haveorwillreceivedirectlyorindirectly,anyrebate,fee,gift,commissionorthingofvalueonaccountofsuchsale;and2.Contractorcertifiesbysubmissionofthisproposalthatneithercontractornoranyofitsprincipalsarepresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromparticipationinthistransactionbyanyFederaldepartmentoragency;and3.Contractorhasnot,norhasanysuccessorto,noranaffiliateofContractor,engagedininvestmentactivitiesinIran.a.ForpurposesofthisCertification,“Iran”meansthegovernmentofIranandanyagencyorinstnimentalityofIran,orasotherwisedefinedathid.Code§5-22-16.5-5,asamendedfromtime-to-time.b.AsprovidedbyInd.Code§5-22-16.5-8,asamendedfromtime-to-time,aContractorisengagedininvestmentactivitiesinIranifeither:i.Contractor,itssuccessororitsaffiliate,providesgoodsorservicesoftwentymilliondollars(S20,000,000)ormoreinvalueintheenergysectorofIran;orii.Contractor,itssuccessororitsaffiliate,isafinancialinstitutionthatextendstwentymilliondollars($20,000,000)ormoreincredittoanotherpersonforforty-five(45)daysormore,ifthatpersonwill(i)usethecredittoprovidesgoodsandservicesintheenergysectorinIran;and(ii)atthetimethefinancialinstitutionextendscredit,isapersonidentifiedonlistpublishedbytheIndianaDepartmentofAdministration.4.Contractordoesnotkrrnwinglyemployorcontractwithanunauthorizedalien,norretainanyemployeeorcontractwithapersonthattheContractorsubsequentlylearnsisanunauthorizedalien.