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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 />Grantee : City of South :Bend, Local unit <br />By: <br />Printed Nlame _ ° <br />Title: a r?J? o 6., V K'A,5 <br />Date: //0 °//.:era ''. <br />The State <br />Indiana Department of Transpo <br />Recommended by: <br />Travis Underhill, Deputy Commissioner <br />Date: <br />(fo`r) <br />Joseph McGuinness, Commissioner <br />Date: <br />APPROVED as to form and legality: <br />Office of the Attorney General <br />Form approval has been granted by the <br />Office of the Attorney General pursuant to <br />IG 4-13-2-14.3(e) on (December 12, 2017 <br />FA 17--66 <br />This Instrument was prepared by: <br />7 <br />Attested by: �.. A_x � �` o <br />Printed N4mt , <br />Title: ,r. C%.yam A e"._ _r.11 <br />Date: 1.. ...._m <br />Indiana (Department of Administration <br />Jessica Robertson, Commissioner <br />Date: <br />State Budget Agency <br />Jason D. Dudich, Director <br />Date: <br />Page 9 of 9 <br />(for) <br />(for) <br />IN1DOT attorney, on <br />