Award Proposal - VPA Electrical Services Contract - Martell Electric LLC

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When the prospective Contractor is unable to cerlify to any of tit estalemeuts below, it stall attach an explartrrtiorl to UtisAffi(lavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVICT, CERTIFICATION.REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON -)DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. PIease type or print) STATE OF INDIANA ) ) SS: ST JOSEPH COUNTY ) The undersigned Contractor; being duly sworn upon his/her/its oath, affirms under the'penalties of perjury that: I , Contractor has not, nor has any other member, representative; or agent of the firth, company; corporation or partnership represented by him, entered into any combination, collision or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certi cs by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarinent, declared ineligible, or voluntarily .excluded from participation in this transaction by any Federal departmotit or agency; and 3. Contractor has not, riot• has any successor to, nor all afftliate of, Contractor, engaged in investtnerit activities in Iran. a. For purposes of this Certification, ".ran" means the governmentof Iran and ally agency or instrunrcntality of Iralr, or as otherwise defined at Ind. Code § 5=22-16.5-5, as amended from time -to -time. b. As provided by Ind.. Code § 5-22-16.5-8, as amended from tune -to -tithe, a Contractor is engaged in investmeiit activities ill Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value iii the energy sector of Ilan; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more ill credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in Non -Collusion Non -Debarment Affidavit Non han Noinf