Laserfiche WebLink
<br />Version 8 – 02/25/14 <br /> <br />CITY OF SOUTH BEND, INDIANA <br />SELLER’S QUOTE FOR SALE OR LEASE OF MATERIALS <br />AND NON-COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br /> <br />QUOTE NAME 124-012 2024 Lamppost Program <br />FOR QUOTES DUE <br />March 15th, 2024 at 9:00am South Bend Time – submit electronic quotes to <br />labreha@southbendin.gov <br />Date: March 1st, 2024 <br />Firm: Gama Sonic <br />Solar Lighting <br />Address: 6185-F Jimmy Carter Blvd. <br />City/State/Zip: Norcross, GA. 30071 Telephone Number: (727) 688-5030 <br />Agent of Firm (if Applicable): Matt Cohen- Director, Commercial Sales <br /> <br />When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. <br /> <br />CONTRACTOR’S NON-COLLUSION AND NON-DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT <br />ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br /> <br />(Must be completed for all quotes and bids. Please type or print) <br /> <br /> <br />STATE OF Georgia ) <br /> ) SS: <br />Gwinnett COUNTY ) <br /> <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br /> <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, <br />company, corporation or partnership represented by him, entered into any combination, <br />collusion or agreement with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person from bidding nor to induce anyone to refrain from <br />bidding, and that this bid is made without reference to any other bid and without any <br />agreement, understanding or combination with any other person in reference to such <br />bidding. Contractor further says that no person or persons, firms, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on <br />account of such sale; and <br /> <br />2. Contractor certifies by submission of this proposal that neither contractor nor any <br />of its principals are presently debarred, suspended, proposed for debarment, declared <br />ineligible, or voluntarily excluded from participation in this transaction by any Federal <br />department or agency; and <br /> <br />3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in <br />investment activities in Iran.