Laserfiche WebLink
Pien the prospective Contractor is unable to certify to mtp of the statements below, it shall attach an eeplanation to this Affirlrndt. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION <br />REGARDING INVESTMENT WITH ❑RAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- <br />DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNFPED STATES STEEL <br />PRODUCTS OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />sTATe of �N > <br />SS: <br />St. Joe COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />I. Conhactor 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 />or 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 for debarment, declared ineligible, or voluntarily excluded from <br />participation in this transaction by any federal department or agency; and <br />3. Conll-actor has <br />noT, nor <br />has any successor to, <br />nor an affiliate of, <br />Contractor, <br />engaged in <br />nvestment activities in <br />Iran. <br />a. For purposes of this Certification, "Iran" means the government of h-an and any agency <br />CA r instrumentality of Iran, or as otherwise defined at Ind. 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,OOQ000) or more in value in the energy sector of Iran; <br />or <br />Contractor, its successor or its affiliate, is a financial institution that extends <br />twenty million dollars ($2Q000,000) 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 hran; and (ii) at the time the <br />financial 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 09/29/2021 Contractor's Bid for Public Works - 4 <br />