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Non -Collusion, Acceptance <br />The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the <br />undersigned is the properly authorized representative, agent, member or officer of the Grantee. Further, to <br />the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, <br />agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or <br />other consideration for the execution of this Grant other than that which appears upon the face <br />hereof. Furthermore, if the undersigned has knowledge that a state officer, employee, or special <br />state appointee, as those terms are defined in Ind. Code § 4-2-6-1, has a financial interest in the Grant, <br />the Grantee attests to compliance with the disclosure requirements in Ind. Code § 4-2-6-10.5. <br />In Witness Whereof, Grantee and the State have, through their duly authorized representatives, entered <br />into this Grant. The parties, having read and understood the foregoing terms of this Grant, do by their <br />respective signatures dated below agree to the terms thereof. <br />IN WITNESS WHEREOF, Grantee and the State have, through their duly authorized <br />representatives, entered into this Grant Agreement. The parties, having read and understood the foregoing <br />terms of the Grant Agreement, do by their respective signatures dated below hereby agree to the terms <br />thereof. <br />Grantee : City of South Bend Local Unit <br />APPROVED <br />By: Board of Pub ic Works Attested by: <br />Printed Name: Printed Name: <br />Title: !i Title: <br />Date: 1 ..k� .._.. - , <br />Date: �> <br />The State <br />Indiana Department of Transportation Indiana �,/eof Ad <br />partment of Administration <br />Recommended by: <br />Chris Kiefer, Chief of Staff <br />Date: <br />(for) <br />Brandye Hendrickson, Commissioner <br />Date: <br />APPROVED as to form and legality: <br />Office of the Attorney General <br />Fornr approval has been granted by the <br />Office of the Attorney General pursuant to <br />IC 4-13-2-14.3(e) on June 8, 2016. <br />FA 16-17 <br />This Instrument was prepared by: <br />(for) <br />Jessica Robertson, Commissioner <br />Date: <br />State Budget Agency <br />(for) <br />Brian E. Bailey, Director <br />Date: <br />Page 9 of 9 <br />