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CITV OF SOUTH BEND. IN DIANA <br />SELLER'S BID FOR SALE OR LEASE OF MATERIALS <br />BID NAME <br />FOR BIDS DUE <br />Bladar <br />Date: 5/6/25 (Firm): Polydyn® Inc. <br />Aaarass: One Chemical Plant Road <br />City/statatzip: Riceboro, GA 3'1323 Telephone Number. ( 800)848-7659 Opt. 2 <br />Agent of Binder (if Applicable): <br />Wheu th¢ prospective Coutrac<or is unable to cetvtJy to any of the statetuents below, t<shall aaach au explauatton m this Ajjldavit. <br />CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, <br />CERTIFICATION REGARDING INVESTMENT WITB IRAN, EMPLOYMENT <br />ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND <br />CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY <br />PRODUCTS <br />(Must be completed for all quotes and bids. Please type or print) <br />STATE OF Georgia ) <br />Liberty ) SS: <br />COLINTY ) <br />The undersigned Contractoq being duly sworn upon his/her/its oath, affirms under the penalties o£perjury <br />tnar <br />1. Contractor has not, nor has any other membey 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, giR, commission or thing of value on <br />account of such sale; and <br />2. Contractor certifies by submission of this proposal that neither contractor nor any <br />of its principals are presently debarred, suspended, proposed £or debarment, declared <br />ineligible, or voluntarily excluded from participation in this transaction by any Federal <br />department or agency; and <br />3. Contractor nas not, nor has any successor tq nor an atHliate o£, Contractor, engaged in <br />investment activities in Iran. <br />a. For purposes o£this CettiPacation, "Iran" means the government o£Iran and any agency <br />or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as <br />amended @om time -to -time. <br />