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When the prospective Seller is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. <br />SELLER'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING <br />INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION <br />COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR <br />FOUNDRY PRODUCTS <br />(Must be completed for all quotes and Proposals. Please type or print) <br />STATE OF ILLINOIS ) <br />) SS: <br />MARION COUNTY ) <br />The undersigned Seller, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: <br />1. Seller has not, nor has any other member, representative, or agent of the firm, company, corporation <br />or partnership represented by him, entered into any combination, collusion or agreement with any person <br />relative to the price to be Proposal by anyone at such letting nor to prevent any person from Proposing nor <br />to induce anyone to refrain from Proposing, and that this Proposal is made without reference to any other <br />Proposal and without any agreement, understanding or combination with any other person in reference to <br />such Proposing. Seller further says that no person or persons, firms, or corporation has, have or will receive <br />directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and <br />2. Seller certifies by submission of this proposal that neither Seller nor any of its principals are <br />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. Seller has not, nor has any successor to, nor an affiliate of, Seller, engaged in investment <br />activities in Iran. <br />a. For purposes of this Certification, "Iran" means the government of Iran and any agency <br />or 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 Seller is <br />engaged in investment activities in Iran if either: <br />i. Seller, its successor or its affiliate, provides goods or services of twenty <br />million dollars ($20,000,000) or more in value in the energy sector of Iran; <br />or <br />ii. Seller, its successor or its affiliate, is a financial institution that extends <br />twenty million dollars ($20,000,000) 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 Iran; 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. Seller does not knowingly employ or contract with an unauthorized alien, nor retain any employee <br />or contract with a person that the Seller subsequently learns is an unauthorized alien. Seller agrees that <br />he/she/it shall enroll in and verify the work eligibility status of all of Seller's newly hired employees through <br />Version 09/29/2021 Seller's Proposal for Public Works - 4 <br />