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Version 2-11-2016 <br />Non -Collusion <br />The undersigned attests, subject to the penalties for perjury, that he/she is the LPA, or that he/she is the <br />properly authorized representative, agent, member or officer of the LPA, that he/she has not, nor has any <br />other member, employee, representative, agent or officer of the LPA, directly or indirectly, to the best of <br />his/her knowledge, entered into or offered to enter into any combination, collusion or agreement to receive <br />or pay, and that he/she has not received or paid, any sum of money or other consideration for the execution <br />of this Contract other than that which appears upon the face of this Contract. <br />In Witness Whereof, LPA and the State of Indiana have, through duly authorized representatives, <br />entered into this Contract. The PARTIES having read and understand the forgoing terms of this Contract do <br />by their respective signatures dated below hereby agree to the terms thereof. <br />LPA: City of South Bend <br />Print or type name and title <br />twpROVED <br />H+�-•rd — <br />Signature and date of Public wp <br />STATE OF INDIANA <br />Department of Transportation <br />Recommended for approval by: <br />Robert D. Cales, Director <br />Contract Administration Division <br />AN i'Q Z 17 Date: <br />Print or type nixie lJr <br />Executed by: <br />Ivy <br />Signature and date (FOR) <br />Brandye Hendrickson, Commissioner <br />Print or type name andiiH ' '- - - • -- - Datc: <br />Signature and date <br />LPA DUNS # <br />Department of Administration <br />Jessica Robertson, Commissioner <br />Date: <br />Attest <br />State Budget Agency <br />Auditor or Clerk Treasurer <br />Brian E. Bailey, Director <br />Date: <br />Approved as to Form and Legality: <br />This instrument prepared by: <br />Ellen Hite (FOR) <br />December 12, 2016 Gregory F. Zoeller, Attorney General of Indiana <br />Date: <br />Page 3 of 3 <br />