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Wlien the prospective Contractor is unable to certi& to anti, ojthe statements below, it shall attach an eocplanation to this Affidavit <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 Indiana <br />St Joseph )SS.. <br />COUNTY ) <br />The undersigned Contractor. being dull sNvom upon his/her/its oath. affinus under the penalties of perjury <br />that: <br />1. Contractor has not_ nor has any other member_ represcrtuitive, or agent of the firm. company. <br />corporation or partnership represented b-, hum. entered into am combination, collusion or agreement %� ith <br />any person relative to the price to be bid by an} one at such letting nor to prevent any person from bidding <br />nor to induce anN one to refrain from bidding. and that this bid is made �� ithout reference to any other bid and <br />without am- 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 />indirecth-, an` rebate, fee, gift_ conunission or Clung 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 debannent. declared ineligible. or yohmtarih excluded from <br />participation in this transaction b� any Federal department or agency-. and <br />3. Contractor has not. nor has any successor to, nor an affiliate of. Contractor_ engaged in <br />investment 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 Contractor <br />is engaged in investment activities in Iran if either: <br />i. Contractor. 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. Contractor, its successor or its affiliate_ is a financial institution that extends <br />tyventy million dollars ($20.000.000) or more in credit to another person for <br />forty-five (45) days or more. if that person w111 (1) 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. Contractor does not knowingly employ or contract with an unauthorized alien_ nor retain any <br />employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. <br />Version 1/3/2025 Contractor's Bid for Public Works -4 <br />