Local Roads & Bridges Matching Grant Agreement - Locust Rd. Improvements

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Page 9 of 9 Non-Collusion, Acceptance The undersigned attes ts, 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 I agree, and it is my intent, to sign this Grant Agreement by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting t his Grant Agreement to the State of Indiana. I understand that my signing and submitting this Grant Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Grant Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Grant Agreement in this fashion I am affirming to the truth of the information contained therein. I understand that this Grant Agreement will not become binding on the State until it has b een approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: https://secu re.in.gov/apps/idoa/contractsearch/ 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 th ereof. CITY OF SOUTH BEND Indiana Department of Transportation By:\s1\ ___________________________ By:\s2\______________________ Title:\t1\______________________________ (for) Michael Smith, Commissioner Date:\d1\_________________________ Date:\d 2\_____________________ Electronically Approved by: Electronically Approved by: Department of Administration State Budget Agency By: (for) Rebecca Holwerda, Commissioner By: (for) Zachary Q. Jackson, Director 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 October 7, 2022. FA 22-55 This instrument was prepared by the undersigned attorney: Marjorie A Millman, #21748-36 DocuSign Envelope ID: 81EF8E99-C5EF-4AF2-990A-E80239E7DA0E President, Board of Public Works 6/13/2023 | 13:38 EDT 6/13/2023 | 16:19 PDT