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j,IvIlE'rJ tine p ospt� etive Contractoris ,Ilrnable to cerlif 10 [1"Y q1 tfJC'stQLt?rJJ£'latS �1t?l�1}i', it shalltJl�l�rJc:lt Girt f'LfJl�rllirJtrnJt tt]
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<br />CONTRACTOR'S NONCOLLUSION AND NONDEBARMETN I AF"FIDt1V'IT,
<br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIIGIBILITY
<br />VERIFICATION, NON_DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
<br />OF tINITED STATES STEEL PRODUCTS OR. FOUNDRY PRODUCTS
<br />(oust be completed for all gtaates and bids. Please t.y�pe or print
<br />STATE C?F T=. 1
<br />l SS;
<br />ST osc COUN`ry I
<br />The undersigned Contractor, being duly sworn upon his�herhts oath, affirms under the penalties of 1wraury that.
<br />J . Cat�trscctor has. not, nor has any other member, representative, car agent of the firm,
<br />ship represented by Jilin, entered into ally ;y combination, collusio
<br />company, corporation or partner
<br />or agreement with ally person relative to the, price to be bid by anyone: at such letting nor to prevent
<br />:any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made
<br />without reference to .any other bid and without any agreenlent. understanding or combination with
<br />ally c}tber person ill reference tc� such k�icidit�g, Cc}�Ztract�?r further ways that nc) peseta (7r persons,
<br />it s, or corporation has, have car will relceive directly or indirectly, any rebate, fee, gift,
<br />catntnission or thing of value on account of such sale; and
<br />24 Contractor certifies by submission of this proposal that neither contractor nor any of its
<br />principals are presently debarred, suspended, proposed lr, arrnent� declared Feclera.l departtalent�oren+:;� a
<br />ligiblel or
<br />voluntarily excluded from participation in tilts. transac.ti ,r]�'y ally
<br />and.
<br />3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment
<br />activities in Iran.
<br />a. For purpt�ses of this Certification. "Iran means the government of Iran and ,any agency or
<br />instrumentality at` Iran,ter as otl7errvise defiled at Lad. �C ode ��-2L-1 h-> as amendcd from
<br />time-to�tirne.
<br />b. As provided by Ind. Code � 5-21'2-1fi.='-8, as 11YYe11ded tr(}lll ki111e-to-time, tt Contractor is
<br />engaged in investment attivitic;s in Trata i.f eitl�cr;
<br />i, Contra€tar, its sucecs5or ar its rtlliliatG, provides goods Orservices aE twenty million
<br />dollars ('G,Z ,.f]tlt};vowj or mare in value in the energy sector of lion; or
<br />ii. r its affiliate, is a financial institution t17at extends twenty
<br />t'otttractor, its successor o
<br />million dollars (S20,tltif�,000) or more in credit to another person for fog ty-fi •e stt
<br />in
<br />days or more, if that person will (i) use the credit to pNcsvides goods and service
<br />the energy sector in Iran; and (ii )tat the time the financial :institution extends credit, is
<br />a person idtntit crl an list pttblisl cd l� the Indiana Department of Administration.
<br />Cc�ntractc}r does not knowingly cmPloyr or contract with an unauthorized alien, nor retain
<br />any ear,flc�yt'c c7r cantraa;t with a person. that the Contractor4ubsecluently learns ican ;P biue'4�'u`otks}{'iuo �
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<br />Version 11312025
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