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James A. Mueller, Merribw
<br />Attest- [Aida M., MaTfin, Clerk
<br />IP'hen ffie pimyeeefive ( ipdraekpr h; unable 9do tywqq r its dqp el"Ilde INlow, id "Whall amocli wo exl4awfidon #o AA A lidee vie.
<br />(,"ONTRACTOR'S NOIN-COLL L'SION AND NON-VERARAVENTAFFIDwil', CERTIFICATION
<br />REGARDING INVESTMENT WITH IRAN,, ENIPLOVMENT ELIGIBILITY VERIFICA'HON, NON-
<br />DISCRI51INATION COMMITMENTAND CERTIFICAT90N OFUSE OFUNITED STATES STEEL
<br />PRODUCIS Oft VOUNDRV PRODR.W"S
<br />I'Wuv be eop??P�Cwd tin, "d) quojes aW bh1y, a)qw ox print)
<br />STATE OF-
<br />)SSS:
<br />2�_ COUNTY
<br />The k1n&rSig"ed G iffllg dfAfiy SWW" VIrAM wJ0111, 'Aff'ijv1T(' the ryen'Mflics of rfz�jlory
<br />that.
<br />I , Contraclor has not, nor has arty 0101CIF Iftlenflyer, wilruseploaltive, Or agent of 11W finnan, company,
<br />corporation or parlpimship represeuded 1by hion, cntemA into any comm Notafion, collusion or agwenDent wiffi
<br />any person 1-clalive to the gy.fice w The Wid 1by anyone &Lsuch it ift.'ing Tim to 1 rewull any PCISson from bid"drng
<br />P
<br />nor to induce anyone to refrain fivnn biddtoig-wki tbag this Will fs rju& without reference to any another' in and
<br />without any agxremeral, understanding or coanbination widD any oq1ter person in refeFence ro such bidding.
<br />Contractor fiarther says that no person or pffsons, fomDs, or, corixtrafion: has, have or will m6ve diffectly or
<br />indirectly, any reb.hle, fe, gifi, cognunission or AingojrN.fiRuE�e 04M 2L �Cejabna of such safe l and
<br />2. Contracgor cerfifirs by subanission olf ahis jpwpod (hat neither cankactiar nor any of i4s pfiincipals
<br />are prescittly debarred, suspoided, pixygmsed fordebanurnt, declaned inefigible, or vounlafilyexclufded fium
<br />participation in this transaction by any FcdcrM dcparmwnli or agetwy; and
<br />3. Conkfactoir [vais not, nor hzs' any ""u"Ceessfalf tva, iam, aam ;&DRUate ef, Conftaktmr, (engaged in
<br />investment activities in frin.
<br />a. For purposes of this C,'ertification, "iran" nwarts the governawnt of Iran a#-vJ any agency,
<br />or insirtruncoda1hy of inan, or, as offitrwisic defincd at Ind. 0xRe § 5-22-165-5, as
<br />amended froan fialw-W-fialne,
<br />b. As provided by Ind. Code§ 5-22-16.5-8�, as apnended fix)m tint e-lo-fione, as Contractor
<br />is engaged in investment activifics, in Iffan ifeiaher-
<br />1. Contractor, its Slocces&ox oi- ids "affiliate, pmvides geods oo- seivices of Twerily
<br />million dollars- (S20,M.,(W) OT 11AW9V ion value in file claqgy sector, of Iran;
<br />or
<br />tL Contractor, itssuiccessar or its aftikiaxe. isat financiat jVJSLfittjafion drat exlends
<br />twenty Aniffion dollars (S20,0(W,040� or on in crrdit to anoffici- 11nn'on Iror
<br />forty-five (45) days, or nioTe, if flyM perAin wifl (i) use the credit to provides
<br />goods and services in the cnergysec4or in Inin-11 and (ii) at the 4hre dhe
<br />fin,ancial insfionion extends ewdit, is a pctson idcnfified on list published by
<br />Aw Indiana Depailmerift, of
<br />Version AWIP2016 CvP&q?e,,cT's Bk& ter' PkNk WcwVs - 3
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