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Page 16 of 16 <br /> <br />Non-Collusion <br /> <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 <br />other member, employee, representative, agent or officer of the LPA, directly or indirectly, to the best of <br />his/her knowledge, entered into or offered to enter into any combination, collusion or agreement to receive <br />or pay, and that he/she has not received or paid, any sum of money or other cons ideration for the execution <br />of this Contract other than that which appears upon the face of this Contract. Furthermore, if the <br />undersigned has knowledge that a state officer, employee, or special state appointee, as those terms <br />are defined in IC §4 -2-6-1, has a financial interest in the Contract, the Party attests to compliance <br />with the disclosure requirements in IC §4 -2 -6-10.5. <br /> <br /> <br />Agreement to Use Electronic Signatures <br /> <br />I agree, and it is my intent, to sign this Contract by accessing State of Indiana Suppl ier Portal using the <br />secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I <br />understand that my signing and submitting this Contract in this fashion is the legal equivalent of having <br />placed my handwritten s ignature on the submitted Contract and this affirmation. I understand and agree <br />that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the <br />information contained therein. I understand that this Contract will not become binding on the State until it <br />has been approved by the Department of Administration, the State Budget Agency, and the Office of the <br />Attorney General, which approvals will be posted on the Active Contracts Database: <br />https://fs.gmis.in.gov/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCTS.GBL <br /> <br />In Witness Whereof, the LPA and the State have, through their duly authorized representatives, entered <br />into this Contract. The PARTIES, having read and understood the foregoing terms of this Contract, do by <br />their respective signatures dated below agree to the terms thereof. <br /> <br />CITY OF SOUTH BEND Indiana Department of Transportation <br /> <br />By:\s1\ ___________________________ By:\s 2\______________________ <br /> <br />Title:\t1\______________________________ Title:\t 2\_______________________ <br /> <br />Date:\d1\_________________________ Date:\d 2\_____________________ <br /> <br /> <br /> <br /> <br />Electronically Approved by: Electronically Approved by: <br />Department of Administration State Budget Agency <br /> <br /> <br />By: (for) Rebecca Holwerda, Commissioner By: (for) Zachary Q. Jackson, Director <br /> <br />Form approval has been granted by the <br />Office of the Attorney General pursuant to <br />IC 4 -13-2 -14.3(e) on March 22, 2022. <br />FA 22-16 <br />DocuSign Envelope ID: 97E20084-65D4-4BAA-95DC-EB1FEEEBDCB9 <br />President, Board of Public Works <br />3/31/2022 | 13:54 EDT 4/2/2022 | 08:30 PDT <br />Director, Local Programs