Supplement No 1 to Local Public Agency Project Coordination Contract - INDOT - Bendix Drive

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Version 6-8-2017 Non -Collusion The undersigned attests, subject to the penalties for perjury, that he/she is the LPA, or that he/she is the properly authorized representative, agent, member or officer of the LPA, that he/she has not, nor has any other member, employee, representative, agent or officer of the LPA, directly or indirectly, to the best of his/her knowledge, entered into or offered to enter into any combination, collusion or agreement to receive or pay, and that he/she has not received or paid, any sum of money or other consideration for the execution of this Contract other than that which appears upon the face of this Contract. Furthermore, if the undersigned has knowledge that a state officer, employee, or special state appointee, as those terms are defined in IC §4-2-6-1, has a financial interest in the Contract, the Party attests to compliance with the disclosure requirements in IC §4-2-6-10.5. In Witness Whereof, LPA and the State of Indiana have, through duly authorized representatives, entered into this Contract. The PARTIES having read and understand the forgoing terms of this Contract do by their respective signatures dated below hereby agree to the terms thereof. LPA: City of South Bend Print or type name and title �tt Signature and date ZA Print or icnALL ` l� 6 iname and tit c m„.w Signature and date _ �I(L Print or type nameandtitle Signature and date LPA DUNS # STATE OF INDIANA Department of Transportation Recommended for approval by: Steven Duncan, Director Contract Administration Division Date: Executed by: (FOR) Joseph McGuinness, Commissioner Date: Department of Administration Lesley A. Crane, Commissioner Date: Attest State Budget Agency �udifor or Clerk]' —. This instrument prepared by: Autumn Castro 5/30/2019 Jason D. Dudich, Director Date: Approved as to Form and Legality: Curtis T. Hill, Jr., Attorney General of Indiana Date: Page 3 of 3 R)