Agreement - Local Roads & Bridges Matching Grant - 2019 Community Crossings Round 2 - INDOT

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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 properly 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 Agreement 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 IC § 4-2-6-1, has a financial interest in the Grant, the Grantee attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable to only to Grant Agreements processed through SCM) In Witness Whereof, the Grantee and the State have, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Y,- t' Name and Ti I N`e � Pr inted Date: Approved by: Indiana Department of Administration Lesley A. Crane, Commissioner Date: APPROVED as to Form and Legality: Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on September 13, 2019. FA 19-45 This instrument was prepared by the undersigned attorney: Attorney: Indiana Department of Transportation 100 N. Senate Avenue Indianapolis, IN 46204 Indiana Department of Transportation Joseph McGuinness, Commissioner Date: Approved by: State Budget Agency IN Date: Date: Page 10 of 10 07/19 Zachary Q. Jackson, Director (for)