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WhentheprospectiveContradorisunabletocerhfttoanyofthestatementsbelow,itshallaftachtinexptanationtothisAffidavitCONTRACTOR’SNON-COLLUSIONANDNON-DEBARMENTAFFIDAVIT,CERTIFICATIONREGARDINGINVESTMENTWITHIRAN,EMPLOYMENTELTGIBILITYVERIFICATION,NONDISCRIMINATIONCOMMITMENTANDCERTIFICATIONOFUSEOFUNITEDSTATESSTEELPRODUCTSORFOUNDRYPRODUCTS(Mustbecompletedforallquotesandbids.Pleasetypeorprint)STATEOF_I&J_—))SS:sUJot-COUNTY)TheundersignedContractor,beingdulyswornuponhis/her/itsoath,aflinusunderthepenaltiesofperjurythat:1.Contractorhasnot,norhasanyothermember,representative,oragentofthefirm,company,corporationorpartnershiprepresentedbyhim,enteredintoanycombination,collusionoragreementwithanypersonrelativetothepricetobebidbyanyoneatsuchlettingnortopreven1tanypersonfrombiddingnortoinduceanyonetorefrainfrombidding,andthatthisbidismadewithoutreferencetoanyotherbidandwithoutanyagreement,understandingorcombinationwithanyotherpersoninreferencetosuchbidding.Contractorfurthersaysthatnopersonorpersons,firms,orcorporationhas,haveorwillreceivedirectlyorindirectly,anyrebate,fee,gift,commissionorthingof’valueonaccountofsuchsale;and2.Contractorcertifiesbysubmissionofthisproposalthatnethercontractornoranyofitsprincipalsarepresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromparticipationinthistransactionbyanyFeder&departmentoragency;and3.Contractorhasnot,norhasanysuccessorto,noranaffiliateof,Contractor,engagedininvestmentactivitiesinIran.a.ForpurposesofthisCertification,“Iran”meansthegovernmentofIranandanyagencyorinstrumentalityofIran,orasotherwisedefinedathid.Code§5-22-16.5-5,asamendedfromtime-to-time.1,,Asprovidedbylnd.Code§5-22-16.5-8,asamendedfromtime-to-time,aContractorisengagedininvestmentactivitiesinIranifeither:i.Contractor,itssuccessororitsaffiliate,providesgoodsorservicesoftwentymilliondollars($20,000,000)ormoreinvalueintheenergysectorofIran;orii.Contractor,itssuccessororitsaffiliate,isafinancialinstitutionthatextendstwentymilliondollars($20,000,000)ormoreincredittoanotherpersonforforty-five(45)daysormore,ifthatpersonwill(i)usethecredittoprovidesgoodsandservicesintheenergysectorinIran;and(ii)atthetimethefinancialinstitutionextendscredit,isapersonidentifiedonlistpublishedbytheIndianaDepartmentofAdministration.4.Contractordoesnotknowinglyemployorcontractwithanunauthorizedalien,norretainanyemployeeorcontractwithapersonthattheContractorsubsequentlylearnsisanunauthorizedalien.
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