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01 5pU TH BF�, <br />J <br />2 <br />CITY OF SOUTH BEND, INDIANA " E ° <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS - a2 <br />AND NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT AND 1865 <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />Spec B —2024 or Newer All Wheel Drive Police Patrol Utility Vehicles <br />BID NAME <br />FOR BIDS DUE April 23, 2024; 9:00 a.m. <br />Bidder ,,r �[ <br />Date: L� / CQL (Firm): J4Q kJ4 <br />Address: k-ni <br />City/State/Zip: (OfWe(Wit<Q1S"�U��`�_� Telephone Number: (')( ) b0(D —05Qy <br />Agent of Bidder (if Applicable): C� 11� e 6_.? <br />When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. <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 />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF t n ) <br />SS: <br />@O COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties <br />of perjury that: <br />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 <br />on account of such sale; and <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 />0 <br />