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<br /> <br /> <br />CITY OF SOUTH BEND, INDIANA <br />SELLER’S BID FOR SALE OR LEASE OF MATERIALS <br />AND NON-COLLUSION AND NON DEBARMENT AFFIDAVIT AND <br />NON-DISCRIMINATION COMMITMENT FOR SELLERS <br />BID NAME <br /> <br />Ductile Iron Pipes, Valves, and Hydrants <br />FOR BIDS DUE November 24, 2020, 9:00 a.m., Local Time <br />Date: <br />Bidder <br />(Firm): <br />Address: <br />City/State/Zip: Telephone Number: ( ) <br />Agent of Bidder (if Applicable): <br /> <br />When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. <br /> <br />CONTRACTOR’S NON-COLLUSION AND NON-DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT <br />ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br /> <br />(Must be completed for all quotes and bids. Please type or print) <br /> <br /> <br />STATE OF ___________ ) <br /> ) SS: <br /> COUNTY ) <br /> <br />The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury <br />that: <br /> <br />1. Contractor has not, nor has any other member, representative, or agent of the firm, <br />company, corporation or partnership represented by him, entered into any combination, <br />collusion or agreement with any person relative to the price to be bid by anyone at such <br />letting nor to prevent any person from bidding nor to induce anyone to refrain from <br />bidding, and that this bid is made without reference to any other bid and without any <br />agreement, understanding or combination with any other person in reference to such <br />bidding. Contractor further says that no person or persons, firms, or corporation has, have <br />or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value <br />on account of such sale; and <br /> <br />2. Contractor certifies by submission of this proposal that neither contractor nor any <br />of its principals are presently debarred, suspended, proposed for debarment, declared <br />ineligible, or voluntarily excluded from participation in this transaction by any Federal <br />department or agency; and <br /> <br />11/23/2020 Core and Main <br />731 W. Ireland Rd <br />South Bend, In 46614 574 231-8739 <br />Indiana <br />St. Joesph