Laserfiche WebLink
Version 6-8-2017 <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 other <br />member, employee, representative, agent or officer of the LPA, directly or indirectly, to the best of his/her <br />knowledge, entered into or offered to enter into any combination, collusion or agreement to receive or pay, <br />and that he/she has not received or paid, any sum of money or other consideration for the execution of this <br />Contract other than that which appears upon the face of this Contract. Furthermore, if the undersigned <br />has knowledge that a state officer, employee, or special state appointee, as those terms are defined in <br />IC §4-2-6-1, has a financial interest in the Contract, the Party attests to compliance with the <br />disclosure requirements in IC §4-2-6-10.5. <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 dr type name and title <br />Signature a6d date <br />Print or � lae name ant title <br />St nature and riate <br />l <br />p r . ��t type rn L�.. 1e <br />�, <br />ode /( <br />na <br />........... <br />_..�......_____.......................................... w.� <br />i gnaturc and date <br />LPA DUNS # <br />Attest <br />Auditor or Clerk Treasurer <br />This instrument prepared by: <br />Brenda E. Fox <br />Dcceri er 12, 2018 <br />STATE OF INDIANA <br />Department of Transportation <br />Recommended for approval by: <br />Steven Duncan, Director <br />Contract Administration Division <br />Date: <br />Executed by: <br />Joseph McGuinness, Commissioner <br />Date: <br />Department of Administration <br />Leslie A. Crane, Commissioner <br />Date: <br />State Budget Agency <br />Jason D. Dudich, Director <br />Date: <br />Approved as to Form and Legality: <br />Curtis T. Hill, Jr., Attorney General of Indiana <br />Date: <br />Page 12 of 12 <br />