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WizentheprospectiveContractorisunabletocern/vtoanyofthestatenzentsbelow,itshallattachanexplanationtothisAffidavitCONTRACTOR’SNON-COLLUSIONANDNON-DEBARMENTAFFIDAVIT,CERTIFICATIONREGARDINGINVESTMENTWITHIRAN.EMPLOYMENTELIGIBILITYVERIFICATION,NONDISCRIMINATIONCOMMITMENTANDCERTIFICATIONOFUSEOFUNITEDSTATESSTEELPRODUCTSORFOUNDRYPRODUCTS(Mustbecompletedforallquotesandbids.Pleasetypeorprint)STATEOFIN)SS:St.JosephCOUNTYTheundersignedContractor,beingdulyswornuponhis/her/itsoath,affirmsunderthepenaltiesofperjurythat:1.Contractorhasnot,norhasanyothermember,representative,oragentofthefirm,company.corporationorpartnershiprepresentedbyhim,enteredintoanycombination,collusionoragreementwithanypersonrelativetothepricetobebidbyanyoneatsuchlettingnortopreventanypersonfrombiddingnortoinduceanynnetorefrainfrombidding,andthatthisbidismadewithoutreferencetoanyotherbidandwithoutanyagreement,understandingorcombinationwithanyotherpersoninreferencetosuchbidding.Contractorfurthersaysthatnopersonorpersons,firms,orcorporationhas,haveorwillreceivedirectlyorindirectly,anyrebate,fee,gift,commissionorthingofvalueonaccountofsuchsale;and2.Contractorcertifiesbysubmissionofthisproposalthatneithercontractornoranyofitsprincipalsarepresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromparticipationinthistransactionbyanyFederaldepartmentoragency;and3.Contractorhasnot,norhasanysuccessorto,noranaffiliateof,Contractor,engagedininvestmentactivitiesinIran.a.ForpurposesofthisCertification,“Iran”meansthegovernmentofIranandanyagencyorinstrumentalityofIran,orasotherwisedefinedatlnd.Code§5-22-16.5-5,asamendedfromtime-to-time.b.Asprovidedbymd.Code§5-22-16.5-8,asamendedfromtime-to-time,aContractorisengagedininvestmentactivitiesinIranifeither:i.Contractor,itssuccessororitsaffiliate,providesgoodsorservicesoftwentymilliondollars(S20,000,000)ormoreinvalueintheenergysectorofIran;orii.Contractor,itssuccessororitsaffiliate,isafinancialinstitutionthatextendstwentymilliondollars($20,000,000)ormoreincredittoanotherpersonforforty-five(45)daysormore,ifthatpersonwill(i)usethecredittoprovidesgoodsandservicesintheenergysectorinIran;and(ii)atthetimethefinancialinstitutionextendscredit.isapersonidentifiedonlistpublishedbytheIndianaDepartmentofAdministration.4.Contractordoesnotknowinglyemployorcontractwithanunauthorizedalien,norretainanyemployeenrcontractwithapersonthattheContractorsubsequentlylearnsisanunauthorizedalien.Version07/19/2023Contractor’sBidforPublicWorks-4