LPA Contract - Coal Line Trail, Phase III DES #2201235 Proj No. 123-007

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Page 16 of 16 Non-Collusion and Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the LPA, or that the undersigned is the properly authorized representative, agent, member or officer of the LPA. Further, to the undersigned's knowledge, neither the un dersigned nor any other member, employee, representative, agent or officer of the LPA, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Contract other than that which appears upon th e 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 Contract, the Party attests to compliance with the disclosur e requirements in IC 4 -2 -6 -10.5. Agreement to Use Electronic Signatures I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Cont ract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been 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://secure.in.gov/apps/idoa/contractsearch/ In Witness Whereof, the LPA and the State have, through their duly authorized representatives, entered into this Contract. The PARTIES, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the t erms thereof. CITY OF SOUTH BEND Indiana Department of Transportation By:\s1\ ___________________________ By:\s 2\______________________ Title:\t1\______________________________ Title:\t 2\_______________________ 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 Form approval has been granted by the Office of the Attorney General pursuant to IC 4 -13-2 -14.3(e) on March 20, 2023. FA 23-12 DocuSign Envelope ID: AAC65708-4C44-4919-80AA-162AC09AE04F 1/9/2024 | 09:48 EST President, Board of Public Works Director, Local Programs 1/9/2024 | 11:28 PST