|
Men theprospective Contractor Is tillable to cerl.6 to any of the statementsfielopt,, It shall attach all eXplalladoll to thIsAffldavil.
<br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
<br />CERTIFICATIOXRE, GARDIN.G INVESTMENT RZAM EMPLOYMENT ELIGIBILITY
<br />VERIFICATION, NON-DISCRIMINATION COMMITMENT
<br />T AND CERTIFICATION OF USE
<br />OP UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
<br />(Must be completed for -all quotes alidbid.5. Please type or print)
<br />STATE OF .Indiana
<br />St. Jose -ph
<br />The undersigned C. ontraetor; being duty sworn upon his/her/its oath, :affirms under the'pwaltie§ of pet jury that.
<br />li Contractor has not, nor has any other member; representative-, or agent of the fhlni.
<br />company, corporation or -partnership represented by him dof er6d into any -combination, collusion
<br />or. agreement with any petsdo t0400 to the 04cp to: be bid by WVOP. at such. totting: W to
<br />pteyiant: any per$on1roM bidding not to induce anyone to refrato fTom bidding, and that this bid
<br />is, made without roferpmee to any other bid and without any agreement, -understanding or
<br />combination with :any other person in reference to such biddirig, Coiitradtot furffier says that no.
<br />person or peksons, firms, of corpo.iatlot has, have or WI dif jr6c060, directly of indirectly,, any 1. .
<br />whate, fee, gift, commission orlhing of value onaccount of such sale; and
<br />2. Contractor certjfies by submission of this proposal that neither contractor nor any of its
<br />principals are _presently debarred, suspeAded, ptopo8.ed for dobarment,. declared ineligible, or
<br />voluntarily excluded fkoffi particiipAtion iii this transaction byany Fodetal dop%-ftndol otAgoicy;
<br />and
<br />3.
<br />A111'ate of, dqouaotor, Ojft...gged In
<br />Cottractorhas not, Osoito, :not-414 affiliate .01, nor as, 40Y 000
<br />investment activities -in Iran.
<br />a. For pulposes of this Ceftifoation "Ira ineans the govdihin6tit, of Trab and any agency Ny or
<br />ingtrulnenWity.of Iran, or as otberwise defined at Ind. Code §542216.5,5. as amended from
<br />b. Asprovided `by LidiCode §-S-.2,2-16.5-8,asamended :fi-omtime -.to-tlmeaContractol-is
<br />engage4 it, inv6shnbnt acovitios. -in L-aii if either.
<br />I — -
<br />CoAtt"r1lig.speoes or its affiliate, "d ral
<br />dollars ;($20,UOU,000) or:nioi°e in vdlile ilt-the energy sector of than, ai
<br />. g o�pj*qvj D.sgqod.s., or services of'two
<br />ii. CohtractOits Sup essor0k its affitiaw, is a fiftgn qjai Institution that extend8 two4ty
<br />million dollars ($20j000,000'
<br />days or more, ifthat person. will (i),usp ffie. credit to provides goods and services in
<br />Non-Collusimi Non -Debarment Affidavk Noll IF84 Fohn
<br />
|