Matching Grant Agreement - INDOT - Reconstruction of N Ironwood Dr from McKinley to SB Ave

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Non -Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the undersigned is the property authorized representative, agent, member or officer of the Grantee. Further, to the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state officer, employee, or special state appointee, as those terms are defined in Ind. Code § 4-2-6-1, has a financial interest in the Grant, the Grantee attests to compliance with the disclosure requirements in Ind. Code § 4-2-6-10.5. In Witness Whereof, Grantee and the State have, through their duty authorized representatives, entered into this Grant. The parties, having read and understood the foregoing terms of this Grant, do by their respective signatures dated below agree to the terms thereof. Grantee : City of South Bend, Local Unit APP40,V'sp By: B*ft.d Pt4lic 'works Printed Name: Title: FFR 1.1 IMB s d.--i Date: The State Indiana Department of Transpo Recommended by: Travis Underhill, Deputy Commissioner Date: Joseph McGuinness, Commissioner Date: APPROVED as to form and legality: Office of the Attorney General Forin approval has been granted by the Office of the Afforney Creneratpursuant to IC 4-13-2-14.3(e) on December 12, 2017. FA 17-66 This Instrument was prepared by: Attested 6, by!, Printed Natu6� 141 Title: C Date: / I _3 Department of Administration Jessica Robertson, Commissioner Date: State Budget Agency Jason D. Dudicb, Director Date: (for) (for) INDOT attorney, on Page 9 of 9