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Amendment No 1 to LPA - Safe Routes Our Lady of Hungary Proj 122-007 - INDOT
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Amendment No 1 to LPA - Safe Routes Our Lady of Hungary Proj 122-007 - INDOT
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12/12/2023 1:42:08 PM
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Board of Public Works
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Contracts
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12/12/2023
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12/12/2023 1:42 PM
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12/12/2023 1:42 PM
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Page 16 of 16 <br />Non-Collusion and Acceptance <br /> <br />The undersigned attests, subject to the penalties for perjury, that the undersigned is the LPA, or that the <br />undersigned is the properly authorized representative, agent, member or officer of the LPA. Further, to the <br />undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent <br />or officer of the LPA, directly or indirectly, has enter ed into or been offered any sum of money or other <br />consideration for the execution of this Contract other than that which appears upon the face hereof. <br />Furthermore, if the undersigned has knowledge that a state officer, employee, or special state <br />appointee, as those terms are defined in IC 4 -2 -6-1, has a financial interest in the Contract, the Party <br />attests to compliance 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 Co ntract by accessing State of Indiana Supplier 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 eq uivalent of having <br />placed my handwritten signature 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 Con tracts Database: <br />https://secure.in.gov/apps/idoa/contractsearch/ <br /> <br />In Witness Whereof, the LPA and the State have, through their duly authorized representatives, entered <br />into this Contract. Th e 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:\s2\______________________ <br /> <br />Title:\t1\______________________________ Title:\t2\_______________________ <br /> <br />Date:\d1\_________________________ Date:\d2\_____________________ <br /> <br /> <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 t o <br />IC 4 -13-2 -14.3(e) on March 20, 2023. <br />FA 23-12 <br />DocuSign Envelope ID: 3E34ABA9-007C-4C99-B6EF-E65A1FC05BEF <br />President, Board of Public Works <br />11/28/2023 | 13:41 EST <br />Director, Local Programs <br />11/28/2023 | 11:00 PST
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