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Opening of Bids - High Street Sidewalk Improvements Proj No. 123-012 - Premium Concrete Srvs.
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Opening of Bids - High Street Sidewalk Improvements Proj No. 123-012 - Premium Concrete Srvs.
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5/14/2024 3:45:39 PM
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Board of Public Works
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Projects
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5/14/2024
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When the prospective Contractor is «noble to ceriify to any uj Ine stalenrenls below, it shall attach an explanation to this A/frdnvil. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION <br />REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- <br />DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL <br />PRODUCTS OR FOUNDRY PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF SN Dâ–º A M A ) <br />) SS: <br />COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br />I. Contractor 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 />ndirectly, 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. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in inveshment <br />activities in h'an. <br />a. For put'poses of this Certification, "Iran" means the government of Iran and any agency or <br />insttmnentality of b'an, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from <br />time -to -time. <br />b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is <br />engaged in investment activities in Iran if either: <br />i. Contractor, its successor or its affiliate, provides goods or services of twenty million <br />dollars ($2Q,OOQ000) or more in value in the energy sector of h'an; or <br />ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty <br />million dollars ($20,000,000) or more in credit to another person for forty-five (45) <br />days or more, if that person will (i) use the credit to provides goods and services in <br />the energy sector in h'an; and (ii) at the time the financial institution extends credit, <br />is a person identified on list published by the Indiana Department of Administration. <br />4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any <br />employee or conhact with a person that the Contractor subsequently learns is an unauthorized alien. <br />Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's <br />newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's <br />documentation of enrollment and participation in the E-Verify Program is included and attached as part of <br />this bid/quote; and <br />Version 07/19/2023 Contractor's Bid for 0ublic Works - 4 <br />
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