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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer 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 standard contract clauses (as contained in the 2018 2019 OAG/ IDOA Professional Services Contract Manual or the 2018 2019 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx Xxxxxxx X. XxxxxxXxxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer 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 standard Boilerplate contract clauses (as contained in the 2018 2014 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: __________________________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. XxxxxXxxxxxx Xxxxxxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx Xxxxxxx X. Xxxx, Xx.Xxxxxxx, Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx XxxxxXxxx Xxxxxxxx, Chief Information Officer 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 standard Boilerplate contract clauses (as contained in the 2018 2013 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: __________________________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana State Agency] By: ___________________________________ By: _________________________________ Printed Name: __________________________ Printed Name: ________________________ Title: _________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ Date: ________________________________ Approved by: Approved by: Indiana Office of Technology Department of Administration By: __________________________________ (for) By: ________________________________(for) Xxxx Xxxxxxxx, Chief Information Officer Xxxxxxx Xxxxxxxxx, Commissioner Date: _________________________________ Date:________________________________ Approved by: APPROVED as to Form and Legality: State Budget Agency Office of the Attorney General _____________________________________ (for) Xxxxxx ___________________________________(for) Xxxxx X. XxxxXxxxxx, Xx.Director Xxxxxxx X. Xxxxxxx, Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer 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 standard Boilerplate contract clauses (as contained in the 2018 2013 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: __________________________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana State Agency] By: ___________________________________ By: _________________________________ Printed Name: __________________________ Printed Name: ________________________ Title: _________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ Date: ________________________________ Approved by: Approved by: Indiana Office of Technology Department of Administration By: __________________________________ (for) By: ________________________________(for) Xxxx Xxxxxxxx, Chief Information Officer Xxxxxxx Xxxxxxxxx, Commissioner Date: _________________________________ Date:________________________________ Approved by: APPROVED as to Form and Legality: State Budget Agency Office of the Attorney General _____________________________________ (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ __(for) Xxxxxx XxxxxXxxxx X. Xxxxxx, Chief Information Officer Date: _________________________________Director Xxxxxxx X. Xxxxxxx, Attorney General

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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ Exhibit 2 State of Indiana Additional Terms and Conditions Platform as a Service Engagements DEFINITIONS Data means all information, whether in oral, written, or electronic form, created by or in any way originating with the State, and all information that is the output of any computer processing, or other electronic manipulation, of any information that was created by or that in any way originated with the State, in the course of using and configuring the Services.

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 Boilerplate contract clauses (as contained in the 2018 2012 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as follows: _____________________________ way. Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Public Works Project Number:XXXXXXXXXXXX Contractor] [Indiana Agency] :XXXXXXXXXXXXXXXXXXXXX Department of Administration, By: _________________________________ Printed Name: Title: Date: By: _______________________________ _____________________________________ ___________________________________ Name and Printed Name: Xxxxxx Xxxxxxx Title: Acting Director, Printed Name and Title, Printed Public Works Division Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Office of Technology Department of Administration State Budget Agency By: ________________________________:N/A for Public Works Division Contracts (for) By: _______________________________ (for) Chief Information Officer Xxxxxx X. XxxxxXxxxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ Date: Approved by: APPROVED as to Form and Legality: State Budget Agency Office of the Attorney General ___________________________________PURSUANT to IC 4-13-2-14.1(a)(2)(B) Approval of the Budget agency is not required for contracts under $100,000.00. (for) Xxxxxx Xxxx X. XxxxXxxxx, Xx., Attorney General Director Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx XxxxxXxxxxxx X. Xxxxxxx, Chief Information Officer Date: _________________________________Attorney General

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 2018 2019 OAG/ IDOA Professional Services Contract Manual or the 2018 2019 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx Xxxxxxx X. XxxxxxXxxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ Exhibit A- Market Basket Pricing Exhibits This document is an exhibit to the Master Services agreement, and is deemed to be attached to and incorporated within the Master Services Agreement by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Master Services agreement shall be resolved by giving precedence and effect to the Master Services agreement. Exhibit B- Contractor MSRP Price List This document is an exhibit to the Master Services agreement, and is deemed to be attached to and incorporated within the Master Services Agreement by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Master Services agreement shall be resolved by giving precedence and effect to the Master Services agreement. EXHIBIT C: SERVICE LEVEL AGREEMENTS (SLAs) This document is an exhibit to the Master Services agreement, and is deemed to be attached to and incorporated within the Master Services Agreement by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Master Services agreement shall be resolved by giving precedence and effect to the Master Services agreement. The Contractor shall monitor and fulfill the following Service Level Agreements: Key Performance Indicator (KPI) A Key Performance Indicator (KPI) is a specific program for Contractor performance. The KPI measures the Contractor’s management performance, the Contractor’s overall performance, and other identified factors are that are critical to the KPI. Equally as important as the key performance indicators (KPI) are commonly accepted operating definitions that promote consistent use of the KPI. Thus, the KPI become mechanisms for building quality into the service offering and support in managing the appropriate service level. When used to develop an account scorecard, KPI becomes a primary mechanism for monitoring and measuring service performance. This KPI-based account scorecard shall address both financial and non-financial goals for a support service partnership. Associated tools (for example, a Customer Survey) can be mutually developed to gather multiple levels of feedback on the KPI as well as other service success factors. By mutually developing the scorecard and associated tools, the State of Indiana and the Contractor can immediately set the tone for a performance-based partnership. The KPI below is the account service performance scorecard. If additional management requirements are presented in the future, then the contract shall be amended to reflect the additional requirements. The tables shown below describe operating definitions and performance categories. The Contractor shall identify the actual outcome and supply original supportive documentation for all service level agreements and performance metrics. Account Scorecard Performance Categories: Client Satisfaction. Monitored through usage of Customer Survey (KPI Scorecard shown within Exhibit), and completed by the Purchasers on a quarterly basis. (See Key Performance Indicator – Account Service Performance Scorecard below.) Client Service Review Process # of Compliments Received: (#) # of Complaints Received: (#)

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 Boilerplate contract clauses (as contained in the 2018 2016 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: __________________________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only I agree, and it is my intent, to contracts processed through SCM] sign 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 State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Apple Inc. Indiana Agency] Office of Technology By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and : Title, Printed : Date: _____________________________ Date: ___________________________ Approved by: Electronically Approved by: Indiana Office of Technology By: (for) Xxxxxx Xxxxx, Chief Information Officer Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxxxxxxx, Commissioner Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved as to Form and Legality: Office of the Attorney General ___________________________________By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office Refer to Electronic Approval History found after the final page of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: _________________________________the Executed Contract for details.

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 Boilerplate contract clauses (as contained in the 2018 2012 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: _____________________________ Access to Records Audit HIPAA Compliance Payments Progress Reports Non-Collusion and Acceptance 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 § 4-2-6-10.5THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below hereby agree to the terms thereof. [Contractor] [Indiana Agency] Accepted By: _________________________________ Approved By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date«SIGNATORY» XXXXX XXXXXXX «TITLE_OF_SIGNATORY» CHIEF INFORMATION OFFICER «ENTITY_NAME» OPERATIONAL SERVICES COMMISSION «DBA» INDIANA STATE DEPARTMENT OF HEALTH DATE: _____________________________ DateDATE: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency Attested By: ________________________________Accepted By: «AUDITOR_NAME» «OTHER_SIGNATORY» AUDITOR «OTHER_SIGNATORY_TITLE» «AUDITOR_COUNTY» COUNTY «OTHER_SIGNATORY_ENTITY» DATE: DATE: Recommended and Approved By: XXXXXXX X. XXXXXXX XX, MD STATE HEALTH COMMISSIONER INDIANA STATE DEPARTMENT OF HEALTH DATE: Approved: Approved: (for) By: _______________________________ (for) Xxxxxx XXXXXX X. XxxxxXXXXXXX, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ DateCOMMISSIONER XXXX XXXXXXXX DEPARTMENT OF ADMINISTRATION CHIEF INFORMATION OFFICER STATE OF INDIANA INDIANA OFFICE OF TECHNOLOGY DATE: _________________________________ APPROVED DATE: Approved as to Form and Legality: Office of the Attorney General ___________________________________Approved: (for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx XxxxxXXXXXXX X. XXXXXXX XXXXXXXXXXX X. XXXXXX, Chief Information Officer Date: _________________________________DIRECTOR ATTORNEY GENERAL OF INDIANA STATE BUDGET AGENCY STATE OF INDIANA

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 Boilerplate contract clauses (as contained in the 2018 2013 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: __________________________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana State Agency] By: ____________________________________ By: _________________________________ Printed Name: __________________________ Printed Name: ________________________ Title: _________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ Date: ________________________________ Approved by: Approved by: Indiana Office of Technology Department of Administration By: __________________________________ (for) By: ________________________________(for) Xxxx Xxxxxxxx, Chief Information Officer Xxxxxxx Xxxxxxxxx, Commissioner Date: _________________________________ Date:________________________________ Approved by: APPROVED as to Form and Legality: State Budget Agency Office of the Attorney General _____________________________________ (for) Xxxxxx ___________________________________(for) Xxxxx X. XxxxXxxxxx, Xx.Director Xxxxxxx X. Xxxxxxx, Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer 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 standard contract clauses (as contained in the 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Collusion, Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned is the ContractorGrantee, or that the undersigned is the properly authorized representative, agent, member or officer of the ContractorGrantee. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the ContractorGrantee, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Contract 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 ContractGrant, the Contractor Grantee attests to compliance with the disclosure requirements in IC § 4-2-6-10.5. Agreement AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable to Use Electronic Signatures [Applicable only to contracts Grant Agreements processed through SCM] ) In Witness Whereof, the Contractor Grantee and the State have, through their duly authorized representatives, entered into this ContractGrant Agreement. The parties, having read and understood the foregoing terms of this ContractGrant Agreement, do by their respective signatures dated below agree to the terms thereof. [ContractorGrantee] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ EXHIBIT C – Annual Financial Report for Non-governmental Entities Guidelines for filing the annual financial report: Filing an annual financial report called an Entity Annual Report (E-1) is required by IC 5-11-1-4. This is done through Gateway which is an on-line electronic submission process. There is no filing fee to do this. This is in addition to the similarly titled Business Entity Report required by the Indiana Secretary of State. The E-1 electronical submission site is found at xxxxx://xxxxxxx.xxxxxxxxx.xxx/login.aspx The Gateway User Guide is found at xxxxx://xxxxxxx.xxxxxxxxx.xxx/userguides/E1guide The State Board of Accounts may request documentation to support the information presented on the E-1.

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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ EXHIBIT A: QPA Line Items & Pricing LINE ITEM PRODUCT DESCRIPTION COMPANY-SPECIFIC PRODUCT NUMBER UNIT PRICE

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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ EXHIBIT A DEFINITIONS AND ABBREVIATIONS This document is an exhibit to the Master Services agreement, and is deemed to be attached to and incorporated within the Master Services Agreement by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Master Services agreement shall be resolved by giving precedence and effect to the Master Services agreement. The following are explanations of terms and abbreviations appearing throughout this Contract. Other special terms may be used in this Contract, but they are more localized and defined where they appear, rather than in the following list. Account Management Team-The Account Management Team is the designated persons assigned by the State and by the Contractor for the administration of this Contract. The Account Management Team responsibilities are separate from the Operational Management Team. Administrative Reports- Reports provided by the State and the Contractor for the administration of this Contract to track dollars spent, agency usage, and overall performance. The Administrative Reports are separate from the Operational Reports. Armed Guard-Contractor Employee duly authorized, trained, and licensed to carry a firearm. Completed Scope of Work (Completed SOW) - A scope of work (SOW) document that has been written by the User Agency using the appropriate template, see Exhibit C. The Contractor signature must be first, then the User Agency signature. The SOW is executed or completed when the Vendor Contract Manager approves and signs the document. It is not executed or binding without the Vendor Contract Manager’s signature. DSR-Daily Situation Report (May also be referred to as Incident Report) Emergency Placement- This placement is requested by an agency due to emergency circumstances. Requests for Emergency Guards should be fulfilled within two (2) hours with a Guard that meets all requirements of the Master Agreement, Scopes of Work, Post Orders, and any other needs expressed in writing by the User Agency or the Vendor Contract Manager. Executed Scope of Work (Executed SOW) - A scope of work (SOW) document that has been written by the User Agency using the appropriate template, see Exhibit C. The Contractor signature must be first, then the User Agency signature. The SOW is executed or completed when the Vendor Contract Manager approves and signs the document. It is not executed or binding without the Vendor Contract Manager’s signature. Full Time Equivalent (FTE)-The State defines FTE as a measurement of an employee's productivity on a specific project or contract. An FTE of one would mean that there is one worker fully engaged on a project. If there are two employees each spending 1/2 of their working time on a project that would also equal one FTE. IAC-The Indiana Administrative Code. IC- Indiana Code. Implementation-The successful implementation of security Guard services as specified in this contract. Incident Report- Reports that are required to be completed by the attending Guard and provided to the State Site Designee should a situation or incident occur during the Guard’s shift, including but not limited to theft, a customer/client fall, fires, suspicious articles left unattended, alarms sounded, etc. These reports shall also be provided to the Vendor Contract Manager or other State Designees upon request. Installation-The delivery and physical setup of products and services requested in this contract. KPI- Key Performance Indicator Level 1 – Unarmed Guards - All Regions – Basic site monitoring, perimeter survey, public information assistance, holds a single post. Basic communication skills and requires direction in emergency situations. See Follow duties in the executed Scope of Work.

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 2018 2019 OAG/ IDOA Professional Services Contract Manual or the 2018 2019 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx Xxxxxxx X. XxxxxxXxxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Date: __________________________________ XXX 00-000, Xxxxxxxxxx B

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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 SCM Template) in any way except as follows: _____________________________ Non-Collusion and Acceptance 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. Agreement to Use Electronic Signatures [Applicable only to contracts processed through SCM] In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] INDIANA DEPARTMENT OF ADMINISTRATION By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Approved by: Approved by: Indiana Department of Administration State Budget Agency By: ________________________________(for) By: _______________________________ (for) Xxxxxx X. Xxxxx, Commissioner Xxxxx X. Xxxxxx, Director Date:________________________________ Date: _________________________________ APPROVED as to Form and Legality: Office of the Attorney General ___________________________________(for) Xxxxxx X. Xxxx, Xx., Attorney General Date: _________________________________ Approved by: Indiana Office of Technology By: __________________________________ (for) Xxxxxx Xxxxx, Chief Information Officer 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 2018 OAG/ IDOA Professional Services Contract Manual or the 2018 2022 SCM Template) in any way except as follows: _____________________________ None/Not Applicable. Non-Collusion and Acceptance 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 '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. Agreement to Use Electronic Signatures [Applicable only I agree, and it is my intent, to contracts processed through SCM] sign 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 State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/ In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [BLACK FOLKS CAMP TOO Indiana Agency] Department of Natural Resources By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and : President Title, Printed : 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 Xxxxxxx X. Xxxxx, Commissioner Xxxxx X. XxxxxxXxxxxxx, 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: _________________________________ Approved by: EXHIBIT A The Contractor is proud to be partnering with Indiana Office State Parks for an education program built upon the 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 Technology By: __________________________________ (for) Xxxxxx Xxxxxthose mutual undertakings and covenants, Chief Information Officer Date: _________________________________the parties agree as follows: