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t r scfiv+ ' rr�`r cfar ��o f r c i �' I.Orly cphes&je Sao bdow, it shall anach an explarraflon to this Af ulavk <br />eirCONTRA TO W S NO N-COLLWON AND NON -DEBARMENT AFF1 DAVIT, <br />CERTIFICATION REG ARD INC,I.N STMENT III FRAN7 EM PL OYMENT ELI G 1131 LIT <br />ERI FICATION., NOK-DI sc R1 m I NATION OXM I T .ENT AND CERTIFI AT'I0 N OF US E <br />F UNITEDSTATE- TELL PRODUCTS OR FOUNDRY PRODUCTS <br />s . <br />ihd ids. Please type or print) <br />(Must be completed f�r,�l � . _ <br />i 1 <br />i It �r a <br />STATE OF <br />+... . _ <br />i <br />i _ • <br />The undersign Contractor, being daty sworn u a hi fits oath, aff" sunder the p alties f pc that: <br />If • Contractor has nod' nor has any other member,' represet�tativ�� a er�t �f the irrrt} <br />company, corporation or partnership represented by him, entered into any combination, collusion <br />or agreement with any person relative to the price to bid b anyone at such letting nor to prevent <br />any person from bidding nor to induce anyone refrain from bidding, and that this bid is trade <br />Without reference to any other bid and without any agreement, understanding or ccmb[nation with <br />any other person in reference to such bidding, Contractor finer says that no person or persons, <br />firs or oorporati on' has, have'or will t eive directly or i ndirecdy, any rebate, fee, gift, <br />f such Safe and . w � ", . . .s r �, *. <br />x <br />. n r thing of value on ac c out `�'� y . .. ' ' <br />�orruruss�o o � <br />. Contractor eertsies by submission of this proposal that neither contractor nor any of its <br />principals are presently deb d,• suspended.,' proposed for debarmen� declared ineligible, or <br />voluntarily excluded from participation in this tmnsa tion by any Federal d partrrient or agency; <br />and ' <br />3.: Contractor has nod nor has any successor to, nor an affiliate of, Connetor, engaged in investment <br />-activities in Irm. <br />a, FDr P arpoyes of this Certification, ;Iran'' means the govenunent of Iran and any agency or <br />iagri.wne##nttaIivy of tank or as otherwise defrmed at Ind. Code § 5- 2-I 6.5-5, as amended from <br />• �Lrrl4-��`�7.r. y <br />b, As provided by Ind. Code 5--I6f5-8, as amendcd from tame -to -time. a Contractor is <br />engaged irk investment activiti in liran if either: . <br />i. ontractar` successor or its afl'�1 i ate} pro�r ides foods or sear ices of twe nth million <br />do] lags ( 2 D, 000.00 0) or more in value in the energy wcwr of I ; or <br />ii. Contractor, its successor or its affiliate, is a financial institution that extends tymaty <br />mill ion dollars ($20,000,000) or more in crcdit to another person for fort,} -five (45) <br />days or more, if that person will (i) use the credit to provides goads and ser-vices in <br />the energy sector in frar- and 00 at the time the #inancW institution extends credit is <br />a person identified on list published by the Indiana Department of Administration. <br />4. contractor does not knowingly employ or contract with an unauthorized alien, nor retain <br />array employee or contract with a person that the Contractor subsequently tears is an unauthodzed <br />VeMbn 2114r2O22 Page - 12 PubHc Works Qualn <br />