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yor•'rn o <br />i <br />CITY OF SOUTH BEND, INDIANA <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS Y <br />AND NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT AND + 1565 <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />Spec C - Seven (7) Seven More or Less 2025 or Newer'/. Ton Four Wheel Drive Pick Up <br />BID NAME Trucks <br />FOR BIDS DUE August 12, 2025; 9:00 a.m. <br />Bidder <br />Date: 08.10g Ids (Firm): QVIp Nahil _0f0Tj6t -fnn I_L( <br />Address: <br />G <br />City/State/Zip: VDT PA I & 15(L Telephone Number: () 533 - -]d 17 <br />Agent of Bidder (if Applicable): <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 />STATEOF Pt'VInS Vah[a) <br />) SS: <br />I QWYLVI(C COUNTY ) <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of <br />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 on <br />account of such sale; and <br />Contractor certifies by submission of this proposal that neither contractor nor any of its <br />principals are presently debarred, suspended, proposed for debarment, declared ineligible, <br />or voluntarily excluded from participation in this transaction by any Federal department or <br />agency;and <br />0 <br />