Common use of State Boilerplate Affirmation Clause Clause in Contracts

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK 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] Tippecanoe County Indiana Department of Transportation By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 2021 OAG/ IDOA Professional Services Contract Manual or the 2019 2021 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were Records-modified HIPAA Compliance-added Amendments-added Federal and State Third-Party Provisions-Deleted Grant Funding - modified Provision Applicable to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK NonGrants with tax-Collusion, Acceptance funded State Educational Institutions: “Separateness” of the Parties- deleted Purpose of Grant Agreement; Funding Source - modified Travel-Deleted Project Monitoring by the State-modified 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 '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 I agree, and it is my intent, to only sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to Grant Agreements processed through SCM) In Witness Whereofme and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL CITY OF WEST LAFAYETTE Indiana Department of Transportation Health By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner : Title: Date: Date: Electronically Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx Xxxxxxxx X. Xxxx, Xx.Xxxxxx, Attorney General Date: Form approval has been granted by General 1. PURPOSE OF THIS GRANT Attachment A is for the Office period of the Attorney General pursuant 7/1/20 to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-899/30/21. In Process

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation ByActive Contracts Database: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ Indiana Department of Administration By: COMPASS MINERALS AMERICA INC By: Title: Vice President Title: Vendor Manager Date: 8/9/2022 | 18:38 EDT Date: 8/10/2022 | 07:23 EDT Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General Date: Form approval has been granted This document is an exhibit to the Contract, and is deemed to be attached to and incorporated within the Contract by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Office Contract shall be resolved by giving precedence and effect to the Contract. INDOT District Salt Type INDOT Early Fill Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 60 - Vincennes Untreated Salt INDOT 14,000 $90.30 $100.30 $86.00 INDOT District Salt Type INDOT Seasonal Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 60 - Vincennes Untreated Salt INDOT 18,000 $90.30 $100.30 $86.00 INDOT District Salt Type Customer Name Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Pick Up) 60 - Vincennes Untreated Salt City of the Attorney General pursuant to IC 4Bedford - OneIndiana 600 $88.26 $86.00 60 - Vincennes Untreated Salt City of Evansville-13-2-14.3(e) on November 24, 2020 FA 20-89Vanderburgh County - OneIndiana 3000 $88.26 $86.00 60 - Vincennes Untreated Salt City of Huntingburg Street - OneIndiana 160 $88.26 $86.00 60 - Vincennes Untreated Salt City of Jasper - OneIndiana 500 $88.26 $86.00 60 - Vincennes Untreated Salt City of Vincennes - OneIndiana 400 $88.26 $86.00 60 - Vincennes Untreated Salt Daviess County Highway - OneIndiana 300 $88.26 $86.00 60 - Vincennes Untreated Salt Dubois County - OneIndiana 400 $88.26 $86.00 60 - Vincennes Untreated Salt Knox County - OneIndiana 200 $88.26 $86.00 60 - Vincennes Untreated Salt Perry County Highway - OneIndiana 200 $88.26 $86.00 60 - Vincennes Untreated Salt Town of Ferdinand - OneIndiana 45 $88.26 $86.00 60 - Vincennes Untreated Salt Town of Milltown - OneIndiana 75 $88.26 $86.00 60 - Vincennes Untreated Salt University of Southern Indiana - OneIndiana 100 $88.26 $86.00 60 - Vincennes Untreated Salt Vanderburgh County Highway - OneIndiana 2500 $88.26 $86.00 60 - Vincennes Untreated Salt Warrick County Highway - OneIndiana 600 $88.26 $86.00 60 - Vincennes Untreated Salt Warrick County Highway - OneIndiana 500 $88.26 $86.00 60 - Vincennes Untreated Salt Warrick County Highway - OneIndiana 500 $88.26 $86.00

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK 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] Tippecanoe County Indiana Department of Transportation By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 200000 XX 00-8900

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ By:\ By: ByEgis BLN CONSULTING USA, LLC Indiana Office of Energy Development Title: Name and President Title, Printed Xxxxxx XxXxxxxxxx, Commissioner : Executive Director Date:\4/11/2024 | 11:05 EDT Date: Date: 4/12/2024 | 09:45 EDT Electronically Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. XxxxxXxxxxxx Xxxx erda, Commissioner Xxxxxxx X. Xxxxxxx, Director DateElectronically Approved by: Date: APPROVED State Budget Agency Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. XxxxXxxxx, Xx.Acting State Budget Director By: (for) Xxxxxxxx X Xxxxxx, Attorney General Date: Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89General

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard 's Boilerplate contract clauses (as contained in the 2019 2014 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract other than that which appears upon the face hereof. FurthermoreI agree, if and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the undersigned secure password assigned to me and by electronically submitting this Contract 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 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 been approved by the GrantDepartment of Administration, 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 WhereofState Budget Agency, the Grantee and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST THE DETROIT SALT CO LLC Indiana Department of Transportation Administration By: By: Name and Xxxx Digitally signed by Xxxx Xxxxxx French DN: cn=Xxxx Xxxxxx, o=Indiana Department of Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: President July 28, 2015 Title: Date: Administration, ou=Contract Manager, xxxxx=xxxxxxx@xxxx.xx.xxx, c=US Date: 2015.07.28 11:56:17 -04'00' Approved by: Department of Administration By: (for) Xxxxxxx Xxxxxxxxx, Commissioner This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx Xxxxx X. Xxxxx, Commissioner Xxxxxxx X. XxxxxxxXxxxxx, Director Date: Date: APPROVED This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx Xxxxxxx X. Xxxx, Xx.Xxxxxxx, Attorney General Date: Form approval has been granted by This document will be reviewed and approved electronically. Please refer to the Office final page of the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89Executed Contract for details. Fort Xxxxx - 20 Untreated Town of Fremont 150 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Geneva 26 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Xxxxxxxx 100 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Lagrange 105 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Middlebury 320 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Rome City 35 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Shipshewana 175 72.31 Delivered Fort Xxxxx - 20 Untreated Town of South Xxxxxxx 100 72.31 Delivered Fort Xxxxx - 20 Untreated Town of St. Xxx 60 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Syracuse 150 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Waterloo 100 72.31 Delivered Fort Xxxxx - 20 Untreated Xxxxxxx County Highway 500 72.31 Delivered

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard 's Boilerplate contract clauses (as contained in the 2019 2014 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract other than that which appears upon the face hereof. FurthermoreI agree, if and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the undersigned secure password assigned to me and by electronically submitting this Contract 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 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 been approved by the GrantDepartment of Administration, 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 WhereofState Budget Agency, the Grantee and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation ByActive Contracts Database: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST XXXXXX SALT INC Indiana Department of Administration Xxxxxx By: Xxxxxxx X. Xxxxxx By: Xxxx Xxxxxx DN: cn=Xxxx Xxxxxx, o=Indiana Department of Administration, ou=Contract Title: Director, U.S. Gov't Bulk Deicing Sales & Marketing Date: 7/20/15 Title: Date: Manager, xxxxx=xxxxxxx@xxxx.xx.xxx, c=US Date: 2015.07.20 15:38:29 -04'00' Approved by: Department of Administration By: (for) Xxxxxxx Xxxxxxxxx, Commissioner This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: State Budget Agency By: (for) By: (for) Xxxxxx Xxxxx X. Xxxxx, Commissioner Xxxxxxx X. XxxxxxxXxxxxx, Director Date: Date: APPROVED This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx Xxxxxxx X. Xxxx, Xx.Xxxxxxx, Attorney General Date: Form approval has been granted by This document will be reviewed and approved electronically. Please refer to the Office final page of the Attorney General pursuant to IC 4Executed Contract for details. LaPorte - 40 Untreated INDOT 15,000 65.02 Delivered Seymour - 50 Untreated INDOT 16,900 75.04 Delivered 80.04 Delivered + Loaded INDOT District Salt Type INDOT Seasonal Quantity Needed Price Per Ton Delivery Method LaPorte - 40 Untreated INDOT 58,110 65.77 Delivered Seymour - 50 Untreated INDOT 24,900 75.54 Delivered 80.54 Delivered + Loaded INDOT District Salt Type Other State Agencies Quantity Needed Price Per Ton Delivery Method XxXxxxx - 40 Untreated DOC-13Indiana State Prison 50 65.77 Delivered XxXxxxx - 40 Untreated DOC-2Westville Correctional Facility 60 65.77 Delivered Seymour - 50 Untreated DOC-14.3(e) on November 24, 2020 FA 20-89Madison Correctional Facility 75 75.54 Delivered Seymour - 50 Untreated Madison State Hospital 75 75.54 Delivered

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were Amendments -added Grant Funding-modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK NonHIPAA Compliance-Collusion, Acceptance added 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 '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 Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ By: By: Name and Title: Xxxxxx Xxxxxxxx, Printed Xxxxxx XxXxxxxxxx, Commissioner President Xxxxxxxxxxx CoTuitnlet:y Commissioners Date: Date: Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General DateThe Vanderburgh County Health Department (VCHD) will expand the delivery of their Pre to 3 home visiting program for parents and families starting with pregnancy (first trimester) to the child’s 3rd birthday in the southwest region. Pre to 3 staff will provide weekly home visits and the evidenced-based Growing Great Kids (GGK) curriculum. The updated GGK curricula, Next Generation will launch in January, which focuses on secure attachment relationships and developmentally enriched, empathic parenting that supports family stress reduction and builds protective buffers in children. A client intake assessment includes a review of home safety, Adverse Childhood Experiences (ACEs), ASQ-3 and ASQ SE for physical and social-emotional development, interpersonal violence, depression (prenatally and postnatally), social determinants of health and preeclampsia. Services that will be provided include nurse support visits, health care access through referrals, lactation counseling, postpartum screenings, safe sleep classes and car seat checks, and connections to other services. Pre to 3 uses the evidence based GGK curriculum and client access is not limited by typical factors. Clients will be encouraged to remain actively engaged in the program for at least 90 days because previous data shows 90 day participation supports retention. After 30 days of no-contact and four CHW attempts to connect, clients receive a letter to notify enrollment has terminated. Goal 1: Form approval has been granted by Strengthen and expand the Office Vanderburgh County Health Department Pre-to 3 program capacity, reach and delivery. Objective 2: Implement a process to regularly share program information and progress with Pre to 3 partners and stakeholders. Objective 3: Beginning 1/15/2023, internal dashboards to track race and ethnicity of prenatal clients who receive prenatal care, aspirin therapy, obesity and smoking cessation support and shared with advisory board twice annually. Objective 4: Beginning 4/1/2023, met with county health departments in the Attorney General pursuant service area to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89identify referral agencies and develop standardized referral procedures.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were Records-modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK NonAmendments -added HIPAA Compliance-Collusion, Acceptance added 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 '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 Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner : commissioner Title: IDOH Chief of Staff Date: 9/23/2022 | 08:08 PDT Date: 9/23/2022 | 11:37 EDT Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General Date: Form approval has been granted by the Office Attachment A • Local Agency Sponsorship of the Attorney General pursuant to IC 4-13-2-14.3(eWIC Services • Scope of Work • FY2022 (October 1, 2022 – September 30, 2023) on November 24, 2020 FA 20-89• I. WIC Program Overview

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment Amendments -added HIPAA Compliance-added Provision Applicable to Grants with tax-funded State Educational Institutions: "Separateness" of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance Parties -Deleted 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 '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 Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner : Administrator Title: IDOH Chief of Staff Date: 7/14/2022 | 12:34 EDT Date: 7/14/2022 | 13:04 EDT Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General DateContract Amount: Form approval has been granted by $13,000 Grantee Name: Clark County Health Department Length of Contract: 07/01/2022 to 06/30/2024 Division: Health Issues and Challenges Program Type: LEAD The Indiana Department of Health (IDOH) receives funding from House Enrolled Act 1007 to prevent the Office prevalence of health issues and improve the Attorney General pursuant physical and behavioral health of all Indiana residents. This funding is supported through the American Rescue Plan Act (ARPA) and allows the IDOH to IC 4-13-2-14.3(e) implement programs focused on November 24health issues and challenges. The Division of Health Issues and Challenges requested applications to fund programs that focus on the improvement of chronic disease (diabetes, 2020 FA 20-89cardiovascular disease, asthma, and cancer), tobacco use, food insecurity/obesity, elevated blood lead level reduction, and disease prevention programs (community health workers/patient navigators and community paramedicine for chronic disease, immunizations, and substance use disorder).

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 2018 OAG/ IDOA Professional Services Contract Manual or the 2019 2018 SCM Template) in any way except as follows: Payment  #1 Form Contract/Duties of ClaimsContractor – updated  #2 Term – updated  #3 Consideration – updated  #28 Insurance – modified  #34 Notice to Parties – updated  #35 Order of Precedence; the Compliance with Audit and Reporting Requirements; Maintenance of Records were Incorporation by Reference – modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 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] Tippecanoe County Indiana Department of Transportation By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. XxxxxAgency, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) General, which approvals will be posted on November 24, 2020 FA 20-89the Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST Xxxxxx Corporation Indiana Department of Administration By: Xxx Xxxxx Title: Contracts Manager By: Title: Xxxx X. Xxxxxx Digitally signed by Xxxx X. Xxxxxx Date: 2018.10.19 Date: 10/19/2018 Date:

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 2021 OAG/ IDOA Professional Services Contract Manual or the 2019 2021 SCM Template) in any way except as follows: Payment of Claims; All modifications and deletions are identified within the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirementsdocument above. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable I agree, and it is my intent, to only sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to Grant Agreements processed through SCM) In Witness Whereofme and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCTS.GBL SHI International Corp. By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration State Budget Agency Title: Lead Contracts Specialist By: Title: Account Management Date: 6/15/2021 | 17:02 EDT Date: 6/16/2021 | 09:36 EDT Electronically Approved by: Indiana Office of Technology By: (for) Xxxxx X. Xxxxxx, Chief Information Officer Electronically Approved by: Department of Administration By: (for) Xxxxxx X. Xxxxx, Commissioner Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx Xxxxxxxx X. Xxxx, Xx.Xxxxxx, Attorney General Date: Form approval has been granted General A. Account Management and Customer Service 1. Account Management Structure The Contractor’s dedicated account management team shall include a dedicated account manager, national account manager, and customer service team. This team shall remain in place throughout the full contract term. The Contractor shall notify the State within 48 hours of notification of any staffing changes from proposed staffing as listed below. The State shall be provided the opportunity to approve or deny any new proposed personnel. The Contractor shall have a back-up plan in place at all times for all account management-related personnel and services. The Contractor shall communicate and maintain an up-to-date back-up plan for all account management team members. a) Dedicated Account Manager – The account manager shall serve as the central point of contact and have the authority to negotiate the contract between the State and Contractor. In addition, the account manager shall assist with account implementation and maintenance throughout the life of the contract. Daily inquiries such as product deliveries, missing orders, receiving an incorrect item, billing errors, and most customer- specific issues can be handled by the Office dedicated account manager. The dedicated account manager has access to information, including, but not limited to, order status, delivery information, backorder information, contracted pricing, standard offering item availability, and product information. The account manager shall also actively market the products and services of this contract to other governmental entities and local schools under the K-12Indiana program. The account manager shall also work with the State contract manager on the details and management of the Attorney General pursuant savings model for reporting purposes. The Account Manager or designee should be available by phone for emergencies such as disaster relief or disaster recovery to IC 4-13-provide assistance with customer service or expedited or urgent orders that need to be placed 24 hours a day, 7 days a week. The Account Manager shall be responsible for assisting with the maintenance of the contract and ensure contract compliance along with the Operations Manager. b) Field Solutions Manager – The Field Solutions manager will ensure contract compliance along with value added services that will be provided for Data Center Solutions. c) Inside Sales Team – The customer service team shall be responsible for assisting the ordering agencies with any issues related to, but not limited to, product information, order status, delivery information, backorder information, contracted pricing, market basket item availability and ensuring service level compliance. 2-14.3(e. Quarterly Business Reviews (QBR) The State and the Contractor shall agree upon the reporting model during the first 60 days of contract implementation. The State may request that the Contractor include, but is not limited to, service level agreements (SLA), performance metrics, transaction usage, product substitutions, pricing audit reports, K-12 usage and rebates, additional reporting fields/custom needs, etc. over the life of the contract. The Contractor shall be responsible for presenting the agreed upon reporting model to the State at the Quarterly Business Review (QBR), as well as, anytime upon the State’s request. The Contractor shall work with the State contract manager to develop a savings model that reflects the actual savings over the life of the contract. The Contractor shall report on November 24, 2020 FA 20-89the savings model at each QBR and shall provide updates as requested.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ XXXXXX SALT INC By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration By: Title: Director, Bulk Deicing U.S. Government SaTliteles: Vendor Manager Date: 8/3/2022 | 14:22 EDT Date: 8/3/2022 | 14:31 EDT Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General Date: Form approval has been granted Exhibit A – List of Awarded Entities & Pricing This document is an exhibit to the Contract, and is deemed to be attached to and incorporated within the Contract by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Office Contract shall be resolved by giving precedence and effect to the Contract. INDOT District Salt Type INDOT Seasonal Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 40 - LaPorte Untreated Salt INDOT 79,650 $73.92 $83.92 $72.00 50 - Seymour Untreated Salt INDOT 34,100 $79.47 $89.47 $78.00 INDOT District Salt Type Other State Agencies Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Pick Up) 40 - XxXxxxx Untreated Salt DOC-Indiana State Prison 50 $73.92 $72.00 40 - XxXxxxx Untreated Salt DOC-Westville Correctional Facility 100 $73.92 $72.00 50 - Xxxxxxx Untreated Salt DOC-Madison Correctional Facility 50 $79.47 $78.00 50 - Xxxxxxx Untreated Salt Madison State Hospital 50 $79.47 $78.00 INDOT District Salt Type Customer Name Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Pick Up) 10 - Crawfordsville Untreated Salt Avon Community Schools 140 $83.14 $83.00 10 - Crawfordsville Untreated Salt Xxxxx County - OneIndiana 50 $83.14 $83.00 10 - Crawfordsville Untreated Salt City of Attica - OneIndiana 100 $83.14 $83.00 10 - Crawfordsville Untreated Salt City of Crawfordsville Street - OneIndiana 700 $83.14 $83.00 10 - Crawfordsville Untreated Salt City of Frankfort - OneIndiana 300 $83.14 $83.00 10 - Crawfordsville Untreated Salt City of Lafayette - OneIndiana 4000 $83.14 $83.00 10 - Crawfordsville Untreated Salt City of West Lafayette - OneIndiana 750 $83.14 $83.00 10 - Crawfordsville Untreated Salt Xxxxxxxxx County - OneIndiana 900 $83.14 $83.00 00 - Xxxxxxxxxxxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx - OneIndiana 1000 $83.14 $83.00 00 - Xxxxxxxxxxxxxx Xxxxxxxxx Xxxx Xxxxxxxxxx Xxxxxx - XxxXxxxxxx 0000 $83.14 $83.00 10 - Crawfordsville Untreated Salt Town of Battle Ground - OneIndiana 100 $83.14 $83.00 10 - Crawfordsville Untreated Salt Town of Xxxxxxx - OneIndiana 24 $83.14 $83.00 10 - Crawfordsville Untreated Salt Town of Zionsville - OneIndiana 1300 $83.14 $83.00 00 - Xxxxxxxxxxxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $83.14 $83.00 00 - Xxxxxxxxxxxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $83.14 $83.00 40 - La Porte Untreated Salt Xxxxxxx County Highway - OneIndiana 100 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx xx Xxxxxx - OneIndiana 100 $72.15 $72.00 40 - La Porte Untreated Salt City of Hobart - OneIndiana 2800 $72.15 $72.00 40 - La Porte Untreated Salt City of Xxxx - OneIndiana 200 $72.15 $72.00 40 - La Porte Untreated Salt City of Logansport - OneIndiana 600 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx of Plymouth Street - OneIndiana 1000 $72.15 $72.00 40 - La Porte Untreated Salt City of Portage - OneIndiana 4000 $72.15 $72.00 40 - La Porte Untreated Salt City of Rochester - OneIndiana 25 $72.15 $72.00 40 - La Porte Untreated Salt City of South Bend - OneIndiana 7000 $72.15 $72.00 40 - La Porte Untreated Salt City of Valparaiso - OneIndiana 5000 $72.15 $72.00 40 - La Porte Untreated Salt Duneland School Corporation - K12Indiana 150 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx Xxxxxxx - OneIndiana 800 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxxx School Corporation - K12Indiana 325 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx XxXxxxx Xxxxxx - OneIndiana 4000 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxxxx Xxxxxx Highway - OneIndiana 1600 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx - OneIndiana 2000 $72.15 $72.00 40 - La Porte Untreated Salt Portage Township Schools - K12Indiana 200 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx Highway - OneIndiana 1500 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx Highway - OneIndiana 1500 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx Highway - OneIndiana 4000 $72.15 $72.00 40 - La Porte Untreated Salt Pulaski County - OneIndiana 250 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xx. Xxxxxx Xxxxxx Highway - OneIndiana 500 $72.15 $72.00 40 - La Porte Untreated Salt Xx. Xxxxxx Xxxxxx Highway - OneIndiana 1500 $72.15 $72.00 40 - La Porte Untreated Salt Xx. Xxxxxx Xxxxxx Highway - OneIndiana 2500 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xx. Xxxxxx Xxxxxx Highway - OneIndiana 50 $72.15 $72.00 40 - La Porte Untreated Salt Xx. Xxxxxx Xxxxxx Highway - OneIndiana 1000 $72.15 $72.00 40 - La Porte Untreated Salt Xx. Xxxxxx Xxxxxx Highway - OneIndiana 1500 $72.15 $72.00 40 - La Porte Untreated Salt Xxxxxx County Highway Department - OneIndiana 200 $72.15 $72.00 40 - La Porte Untreated Salt Town of Bourbon - OneIndiana 100 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx of Xxxxxxxxxx Xxxxxx - XxxXxxxxxx 0000 $72.15 $72.00 40 - La Porte Untreated Salt Town of Flora - OneIndiana 80 $72.15 $72.00 40 - La Porte Untreated Salt Town of Xxxxxxxx - OneIndiana 3000 $72.15 $72.00 40 - La Porte Untreated Salt Town of Highland - OneIndiana 2500 $72.15 $72.00 40 - La Porte Untreated Salt Town of Xxxxxx - OneIndiana 800 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx xx Xxx Xxxxxxxx - OneIndiana 200 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xx Xxxxxx - 1400 $72.15 $72.00 Salt OneIndiana 40 - La Porte Untreated Salt Town of Schererville - OneIndiana 100 $72.15 $72.00 40 - La Porte Untreated Salt Town of Schererville - OneIndiana 2000 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxx of Walkerton Water - OneIndiana 250 $72.15 $72.00 40 - La Porte Untreated Salt Valparaiso Community Schools 150 $72.15 $72.00 00 - Xx Xxxxx Xxxxxxxxx Xxxx Xxxxx Xxxxxx Xxxxxxx - XxxXxxxxxx 0000 $72.15 $72.00 50 - Seymour Untreated Salt Center Grove Comm School Corp - K12Indiana 150 $78.21 $78.00 50 - Xxxxxxx Untreated Salt City of Madison - OneIndiana 500 $78.21 $78.00 50 - Seymour Untreated Salt Xxxxx County Highway Dept 3500 $78.21 $78.00 50 - Seymour Untreated Salt Dearborn County Dept. of Transportation - OneIndiana 4000 $78.21 $78.00 00 - Xxxxxxx Xxxxxxxxx Xxxx Xxxxx Xxxxxx Road - OneIndiana 2000 $78.21 $78.00 00 - Xxxxxxx Xxxxxxxxx Xxxx Xxxxxxxx Xxxxxx Highway - OneIndiana 1000 $78.21 $78.00 00 - Xxxxxxx Xxxxxxxxx Xxxx Xxxxxxx Xxxxxx Highway - OneIndiana 1000 $78.21 $78.00 50 - Seymour Untreated Salt Jefferson County Highway - OneIndiana 160 $78.21 $78.00 50 - Seymour Untreated Salt Xxxxxxx County Highway Department - OneIndiana 300 $78.21 $78.00 50 - Seymour Untreated Salt Monroe County Highway - OneIndiana 2000 $78.21 $78.00 00 - Xxxxxxx Xxxxxxxxx Xxxx Xxxxxx Xxxxxx Highway - OneIndiana 1100 $78.21 $78.00 50 - Seymour Untreated Salt Xxxxxx County - OneIndiana 750 $78.21 $78.00 50 - Xxxxxxx Untreated Salt Town of Edinburgh - OneIndiana 200 $78.21 $78.00 50 - Xxxxxxx Untreated Salt Town of Lanesville - OneIndiana 50 $78.21 $78.00 50 - Xxxxxxx Untreated Salt Town of Nashville - OneIndiana 40 $78.21 $78.00 50 - Xxxxxxx Untreated Salt Town of New Whiteland - OneIndiana 60 $78.21 $78.00 50 - Seymour Untreated Salt Washington County Highway - OneIndiana 200 $78.21 $78.00 This document is an exhibit to the Attorney General pursuant Contract, and is deemed to IC 4-13-2-14.3(e) on November 24be attached to and incorporated within the Contract by reference. Any inconsistency, 2020 FA 20-89conflict, or ambiguity between this exhibit and the Contract shall be resolved by giving precedence and effect to the Contract. These specifications, terms, and conditions apply to salt for INDOT and Other State Agency locations identified within this solicitation. These specifications will not apply to the Local Governmental Entities included in this solicitation.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 OAG/ IDOA Professional Services Contract Manual or the 2019 2022 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirementsNone/Not Applicable. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract 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 GrantContract, the Grantee Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements processed through SCM) In Witness Whereofsign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract 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 Grantee State Budget Agency, and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ BLACK FOLKS CAMP TOO Indiana Department of Transportation Natural Resources By: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner : President Title: CFO Date: 4/3/2023 | 12:14 PDT Date: 4/3/2023 | 15:25 EDT Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General Date: Form approval has been granted by The Contractor is proud to be partnering with Indiana State Parks for an education program built upon the Office Black Folks Camp Too – ROI (Return On Inclusion) mission, messaging and training. The Black Folks Camp Too - UNITY BLAZE logo will be used to promote Unity in Indiana State Parks and Beyond. In consideration of those mutual undertakings and covenants, the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89parties agree as follows:

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard 's Boilerplate contract clauses (as contained in the 2019 2014 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeContractor, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeContractor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement Contract other than that which appears upon the face hereof. FurthermoreAgreement to Use Electronic Signatures I agree, if and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the undersigned secure password assigned to me and by electronically submitting this Contract 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 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 been approved by the GrantDepartment of Administration, 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 WhereofState Budget Agency, the Grantee and the State haveOffice of the Attorney General, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood which approvals will be posted on the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation ByActive Contracts Database: By: Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST COMPASS MINERALS AMERICA INC Indiana Department of Administration By: Title: Date: Xxx X. Xxxxxxxxxx Vice President 07/29/2015 By: Title: Date: Xxxx Digitally signed by Xxxx Xxxxxx French DN: cn=Xxxx Xxxxxx, o=Indiana Department of Administration, ou=Contract Manager, xxxxx=xxxxxxx@xxxx.xx.xx v, c=US Date: 2015.07.29 14:32:18 -04'00' Approved by: Department of Administration By: (for) Xxxxxxx Xxxxxxxxx, Commissioner This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: State Budget Agency By: (for) By: (for) Xxxxxx Xxxxx X. Xxxxx, Commissioner Xxxxxxx X. XxxxxxxXxxxxx, Director Date: Date: APPROVED This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx Xxxxxxx X. Xxxx, Xx.Xxxxxxx, Attorney General Date: Form approval has been granted by This document will be reviewed and approved electronically. Please refer to the Office final page of the Attorney General pursuant to IC 4Executed Contract for details. INDOT District Salt Type Local Entities Quantity Needed Price Per Ton Delivery Method XxXxxxx - 40 Untreated Xxxxxxx County Highway 600 65.92 Delivered XxXxxxx - 40 Untreated Cass County Highway 1,100 65.92 Delivered LaPorte - 40 Untreated City of Delphi 175 65.92 Delivered LaPorte - 40 Untreated City of Hobart 2,000 65.92 Delivered LaPorte - 40 Untreated City of Xxxx 150 65.92 Delivered LaPorte - 40 Untreated City of Lake Station 900 65.92 Delivered XxXxxxx - 40 Untreated City of Logansport 600 65.92 Delivered XxXxxxx - 40 Untreated City of Michigan City 5,400 65.92 Delivered XxXxxxx - 40 Untreated City of Plymouth Street 1,000 65.92 Delivered XxXxxxx - 40 Untreated City of Portage 6,000 65.92 Delivered LaPorte - 40 Untreated City of Rochester 80 65.92 Delivered LaPorte - 40 Untreated City of Valparaiso Clerk 6,000 65.92 Delivered XxXxxxx - 40 Untreated Duneland School Corporation 120 65.92 Delivered LaPorte - 40 Untreated Xxxxxx County Highway 420 65.92 Delivered XxXxxxx - 40 Untreated Lake Central School Corporation 250 65.92 Delivered XxXxxxx - 40 Untreated Lake County Highway (1100 E. Monitor St) 4,000 65.92 Delivered LaPorte - 40 Untreated Lake County Highway (18211 Wicker Blvd) 2,000 65.92 Delivered LaPorte - 40 Untreated XxXxxxx County 3,000 65.92 Delivered LaPorte - 40 Untreated Xxxxxxxx County Highway 1,500 65.92 Delivered LaPorte - 40 Untreated Portage Township Schools 100 65.92 Delivered LaPorte - 00 Xxxxxxxxx Xxxxxx Xxxxxx Highway (1200N 250E) 1,500 65.92 Delivered LaPorte - 40 Untreated Xxxxxx County Highway (1955 S. State Rd. 2) 1,500 65.92 Delivered LaPorte - 40 Untreated Xxxxxx County Highway (254 West Highway 8) 3,500 65.92 Delivered XxXxxxx - 40 Untreated Pulaski County 250 65.92 Delivered XxXxxxx - 00 Xxxxxxxxx Xx. Xxxxxx Xxxxxx Highway (1009 Washington St) 1,000 65.92 Delivered XxXxxxx - 40 Untreated St. Xxxxxx County Xxxxxxx (00000 Xxxxxxxxx Xx) 1,770 65.92 Delivered XxXxxxx - 40 Untreated St. Xxxxxx County Xxxxxxx (00000 Xxx Xx) 1,770 65.92 Delivered XxXxxxx - 00 Xxxxxxxxx Xx. Xxxxxx Xxxxxx Highway (3301 Riverside Dr) 1,770 65.92 Delivered XxXxxxx - 00 Xxxxxxxxx Xx. Xxxxxx Xxxxxx Highway (4141 W Xxxxxxx) 1,000 65.92 Delivered XxXxxxx - 40 Untreated St. Xxxxxx County Xxxxxxx (00000 Xxxxxxxxx Xx) 1,770 65.92 Delivered XxXxxxx - 00 Xxxxxxxxx Xx. Xxxxxx Xxxxxx Highway (67266 S.R. 23) 1,770 65.92 Delivered XxXxxxx - 40 Untreated Xxxxxx County Highway Department 1,250 65.92 Delivered XxXxxxx - 40 Untreated Town of Bourbon 120 65.92 Delivered LaPorte - 40 Untreated Town of Bremen 100 65.92 Delivered LaPorte - 40 Untreated Town of Camden 25 65.92 Delivered LaPorte - 40 Untreated Town of Cedar Lake 800 65.92 Delivered LaPorte - 40 Untreated Town of Chesterton Street 2,000 65.92 Delivered LaPorte - 40 Untreated Town of Flora 100 65.92 Delivered LaPorte - 40 Untreated Town of Xxxxxxxx 3,000 65.92 Delivered LaPorte - 40 Untreated Town of Hebron 100 65.92 Delivered LaPorte - 40 Untreated Town of Highland (Untreated) 1,500 65.92 Delivered LaPorte - 40 Untreated Town of Xxxxxx 500 65.92 Delivered LaPorte - 40 Untreated Town of Merrillville 2,800 65.92 Delivered LaPorte - 40 Untreated Town of New Carlisle 140 65.92 Delivered LaPorte - 40 Untreated Town of North Xxxxxx 100 65.92 Delivered LaPorte - 40 Untreated Town of Xxxxxx 800 65.92 Delivered LaPorte - 40 Untreated Town of Schererville 1,800 65.92 Delivered LaPorte - 40 Untreated Town of Walkerton Water 250 65.92 Delivered LaPorte - 40 Untreated Tri-13Creek School Corporation 175 65.92 Delivered LaPorte - 40 Untreated White County Highway 1,600 65.92 Delivered Vincennes - 60 Untreated City of Evansville-2Vanderburgh County (2009 N. Kentucky Ave) 2,125 72.75 Delivered Vincennes - 60 Untreated City of Evansville-14.3(eVanderburgh County (3521 Xxxxxx Ave) on November 24, 2020 FA 202,125 72.75 Delivered Vincennes - 60 Untreated City of Huntingburg Street 180 72.75 Delivered Vincennes - 60 Untreated City of Jasper Street 1,000 72.75 Delivered Vincennes - 60 Untreated City of Vincennes 500 72.75 Delivered Vincennes - 60 Untreated City of Washington 300 72.75 Delivered Vincennes - 60 Untreated Daviess County Highway (400W Walnut St) 150 72.75 Delivered Vincennes - 60 Untreated Daviess County Highway (5247 E 100 N) 50 72.75 Delivered Vincennes - 60 Untreated Xxxxxx County 500 72.75 Delivered Vincennes - 60 Untreated Evansville Vanderburgh School Corporation 250 72.75 Delivered Vincennes - 60 Untreated Perry County Highway 300 72.75 Delivered Vincennes - 60 Untreated Town of Bloomfield 40 72.75 Delivered Vincennes - 60 Untreated Town of Darmstadt 100 72.75 Delivered Vincennes - 60 Untreated Town of Ferdinand (Untreated) 40 72.75 Delivered Vincennes - 60 Untreated Town of Milltown 80 72.75 Delivered Vincennes - 60 Untreated University of Southern Indiana 120 72.75 Delivered Vincennes - 60 Untreated Vanderburgh County Highway 2,000 72.75 Delivered Vincennes - 60 Untreated Xxxxxxx County Highway 1,700 72.75 Delivered Crawfordsville - 10 Untreated INDOT 15,500 88.90 Delivered + Loaded Fort Xxxxx - 20 Untreated INDOT 32,500 76.76 Delivered + Loaded Greenfield - 30 Untreated INDOT 36,852 95.65 Delivered + Loaded Vincennes - 60 Untreated INDOT 18,300 81.39 Delivered + Loaded Vincennes - 60 Untreated INDOT 18,300 73.45 Pick Up INDOT District Salt Type INDOT Seasonal Quantity Needed Price Per Ton Delivery Method Crawfordsville - 10 Untreated INDOT 30,900 88.90 Delivered + Loaded Fort Xxxxx - 20 Untreated INDOT 40,900 76.76 Delivered + Loaded Greenfield - 30 Untreated INDOT 17,335 95.65 Delivered + Loaded Vincennes - 60 Untreated INDOT 12,500 81.39 Delivered + Loaded Vincennes - 60 Untreated INDOT 12,500 73.45 Pick Up INDOT District Salt Type Other State Agencies Quantity Needed Price Per Ton Delivery Method Crawfordsville - 10 Untreated DOC-89Short Term Offender Program 150 84.65 Delivered Greenfield - 30 Untreated DOC-Correctional Industrial Facility / IR 60 97.40 Delivered Greenfield - 30 Untreated Indiana State Fair Commission 125 97.40 Delivered

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2019 2021 OAG/ IDOA Professional Services Contract Manual or the 2019 2021 SCM Template) in any way except as follows: Payment of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were Records-modified HIPAA Compliance-added Amendments-added Federal and State Third-Party Provisions Grant Funding - modified Insurance - modified Implementation of and Reporting on Project - modified Order of Precedence - modified Payment of Claims - modified Project Monitoring by State Provision Applicable to include statutory Grants with tax-funded State Educational Institutions: "Separateness" of the Parties Purpose of Grant Agreement; Funding Source - modified Representation and program requirements. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Acceptance Warranties of the Grantee - modified Termination for Breach – modified Travel 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 '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 I agree, and it is my intent, to only sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to Grant Agreements processed through SCM) In Witness Whereofme and by electronically submitting this Contract 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 Grantee State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL VANDERBURGH COUNTY HEALTH DEPARTMENT Indiana 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] Tippecanoe County Indiana Department of Transportation Health By: By: Name and Title: Health Officer, Printed Xxxxxx XxXxxxxxxx, Commissioner Vanderburgh County HealthTitDlee:partment Date: Date: Electronically Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx Xxxxxxxx X. Xxxx, Xx.Xxxxxx, Attorney General Date: Form approval Grantee has been granted agreed to participate in the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Health Resources and Services Administration (HRSA) COVID-19 Vaccination Program (the Program) as administered by the Office State of Indiana through the Indiana Department of Health established by I.C. 16-19-1-1. Grantee will be administering vaccine to eligible recipients, at no cost to the recipients. The purpose of this agreement is to provide financial compensation for the administrative costs born by the Grantee during their participation in the Program. For purposes of the Attorney General pursuant to IC 4-13-2-14.3(e) initial phase of the Program, Grantee is administering the vaccine on November 24, 2020 FA 20-89behalf of the State.