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 2022 SCM Template) in any way except 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 Boilerplate contract clauses (as contained in the 2016 OAG/ IDOA Professional Services Contract Manual) in any way except for the following clauses which are named below: __________________________________________ The undersigned attests, subject to the penalties for perjury, that the undersigned is the Contractor, or that the undersigned is the properly authorized representative, agent, member or officer of the Contractor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Contractor, 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 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 Contract, the Contractor attests to compliance with the disclosure requirements in IC 4-2-6-10.5.
State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, or changed the State's Boilerplate clauses (as defined in the 2016 OAG/ IDOA Professional Services Contract Manual) in any way except for the following clauses which are named below: The following clauses were deleted by agreement of the parties:
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 Boilerplate contract clauses (as contained in the 2012 OAG/ IDOA Professional Services Contract Manual) in any way.
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 Boilerplate contract clauses (as contained in the 2020 OAG/ IDOA Professional Services Contract Manual) in any way except for the following clauses which are named below: deleted, modified, or added Sections are identified in the body of this Contract. The undersigned attests, subject to the penalties for perjury, that the undersigned is the Contractor, or that the undersigned is the properly authorized representative, agent, member, or officer of the Contractor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Contractor, 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 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 Contract, the Contractor attests to compliance with the disclosure requirements in IC § 4-2-6-10.5.
State Boilerplate Affirmation Clause. The State Educational Institution affirms under the penalties of perjury that it has not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2022 SCM Template) in any way except as follows: _____________________________ The undersigned attests, subject to the penalties for perjury, that the undersigned is the State Educational Institution, or that the undersigned is the properly authorized representative, agent, member or officer of the State Educational Institution. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the State Educational Institution, 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 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 Contract, the State Educational Institution attests to compliance with the disclosure requirements in IC § 4-2-6-10.5.
State Boilerplate Affirmation Clause. [OMITTED – NOT APPLICABLE] The undersigned attests, subject to the penalties for perjury, that the undersigned is the Party, or that the undersigned is the properly authorized representative, agent, member or officer of the Party. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Party, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this 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 Agreement, the Party attests to compliance with the disclosure requirements in IC §4-2-6-10.5.
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 2022 SCM Template) in any way except as follows: Amendments -added Grant Funding-modified HIPAA Compliance-added Compliance with Audit and Reporting Requirements; Maintenance of Records-modified Provision Applicable to Grants with tax-funded State Educational Institutions: "Separateness" of the Parties -Deleted All references to Grant Application removed 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.
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 2022 SCM Template) in any way except as follows:
A. Paragraph 1, Purpose of this Grant Agreement; Funding Source, has been modified.
B. Paragraph 5, Grant Funding, has been modified.
C. Paragraph 6, Payment of Claims, has been modified.
D. Paragraph 7, Project Monitoring by the State, has been modified.
E. Paragraph 8, Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified.
F. Paragraph 10, Debarment and Suspension, has been modified.
G. Paragraph 15, Information Technology Accessibility Standards, has been modified.
H. Paragraph 19, Order of Precedence; Incorporation by Reference, has been modified.
I. Paragraph 24, Federal and State Third-Party Contract Provisions, has been deleted.
J. Paragraph 25, Provision Applicable to Grants with tax-funded State Educational Institutions: “Separateness” of the Parties, has been 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 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,
