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Contractor agrees not to discriminate against or intimidate any employee or applicant for <br />employment in the performance of this contract with privileges of employment, or any matter <br />directly or indirectly related to employment, because of race, religion, color, sex handicap, <br />national origin or ancestry. Breach of this provision may be regarded as material breach of <br />contract. <br />1, the undersigned bidder, or agent as contractor on a public works project, understand my <br />statutory obligations to the use of steel products or foundry products made in the United States <br />(I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will <br />use steel products or foundry products on this project if awarded. I understand that violations <br />hereunder may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for <br />public works are true and correct. <br />, Dated this "11 Z> day of -:5, 20 <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />D /k Z <br />Printed Name and Title <br />Subscribed and sworn to before me this c day of 20 <br />My Commission Expires 01:JA b <br />Notary OubliiJ)— <br />County of Residence e2 S e-" <br />Hazel Mead <br />m. Resident OP <br />St. Joseph County <br />My GornmissbnExpires 4/1012024 <br />b®r <br />F-Non-Collusion Non -Debarment Affidavit Non Iran Form 2012 <br />