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: (for) 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 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 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, Collusion and 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. 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 (Agreement to Use Electronic Signatures [Applicable to only to Grant Agreements contracts processed through SCM) ] In Witness Whereof, the Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [GranteeContractor] Tippecanoe County [Indiana Department of Transportation Agency] By: By: (for) Name and Title, Printed Xxxxxx XxXxxxxxxxName and Title, Commissioner Printed Date: Date: Approved by: Approved by: Indiana Department of Administration State Budget Agency By: (for) By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx Xxxxx X. XxxxxxxXxxxxx, 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 Approved by: Indiana Office of the Attorney General pursuant to IC 4-13-2-14.3(eTechnology By: (for) on November 24Xxxxxx Xxxxx, 2020 FA 20-89Chief Information Officer

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: (for) 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 Boilerplate contract clauses (as contained in the 2019 2011 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. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. Non-Collusion, Collusion and Acceptance The undersigned attests, subject to the penalties for perjury, that the undersigned he/she is the GranteeContractor, or that the undersigned he/she is the properly authorized representative, agent, member or officer of the Grantee. FurtherContractor, to the undersigned’s knowledgethat he/she has not, neither the undersigned nor has any other member, employee, representative, agent or officer of the GranteeContractor, directly or indirectly, has to the best of the undersigned’s knowledge, entered into or been offered to enter into any combination, collusion or agreement to receive or pay, and that he/she has not received or paid, any sum of money or other consideration for the execution of this Grant Agreement Contract other than that which appears upon the face hereofof this Contract. 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 Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below hereby agree to the terms thereof. [Grantee] Tippecanoe County Contractor: Witness: By: Attested By: Printed Name: Title: Date: Agency Name: By: Printed Name: Title: Date: Indiana Office of Technology Department of Transportation By: Administration By: (for) Name and TitleXxxxx X. Xxxxxxxx, Printed Chief Information Officer 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 Commissioner Date: Date: APPROVED as to Form and Legality: State Budget Agency Office of the Attorney General By: (for) Xxxxxx (for) Xxxx Xxxxx, Director Xxxxxxx X. Xxxx, Xx.Xxxxxxx, 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 20-89Director

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, Collusion and 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) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation By: By: (for) Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Corporation Indiana Department of Administration State Budget Agency By: (for) Xxx Xxxxx Title: Contracts Manager By: (for) Title: Xxxx X. Xxxxxx Digitally signed by Xxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Xxxxxx Date: 2018.10.19 Date: APPROVED as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General 10/19/2018 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; 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, Collusion and 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) 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://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCTS.GBL In Witness Whereof, the Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County SHI International Corp. By: Indiana Department of Transportation Administration 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) Name and TitleXxxxx X. Xxxxxx, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Chief Information Officer 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 the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on November 24, 2020 FA 20-89EXHIBIT A Implementation and Administration

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 Parties -Deleted 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 '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) 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 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 CLARK COUNTY HEALTH DEPARTMENT INDIANA DEPARTMENT OF HEALTH By: By: Title: 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 Transportation By: Administration By: (for) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxx erda, Commissioner Date: Date: Electronically 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 Electronically Approved as to Form and LegalityLegality by: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx.Xxxxxxxx X Xxxxxx, Attorney General DateATTACHMENT A Contract 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 Purpose 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. [Modified] 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 SCM Template) in any way except as follows: Payment inapplicable, modified or added Sections are identified in the body of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirementsthis Contract. Process THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. Non-Collusion, Collusion and Acceptance In 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 Process Agreement to only Use Electronic Signatures I agree, and it is my intent, to Grant Agreements 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County XXXXX COUNTY Indiana Department of Transportation By: By: (for) Child Services By:\s1\ \t1P\resident, Board of Commissioners Name and Title, Printed Xxxxxx XxXxxxxxxxPrinted: Date:\d1\ By:\s2\ Xxxxx J, Commissioner Date: Date: Stigdon, Director Date:\d2\ Electronically Approved by: Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) Xxxxxx X. Xxxxx, Commissioner 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 2417, 2020 2020. FA 20-8984 In Process In Process In Process In Process In Process In Process In Process In Process In

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, Collusion and 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) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County XXXXXX SALT INC By: Indiana Department of Transportation 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) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxx erda, Commissioner Date: Date: Electronically 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 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 Exhibit B – INDOT & Other State Agencies Specifications This document is an exhibit to the Attorney General pursuant Contract, and is deemed to IC 4-13-2-14.3(ebe attached to and incorporated within the Contract by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Contract shall be resolved by giving precedence and effect to the Contract. INDIANA DEPARTMENT OF TRANSPORTATION (INDOT) on November 24and OTHER STATE AGENCIES (OSAs) 2022/2023 SALT SPECIFICATIONS & SPECIAL PROVISIONS FOR UNTREATED SODIUM CHLORIDE & SODIUM CHLORIDE TREATED WITH MAGNESIUM CHLORIDE These specifications, 2020 FA 20-89terms, 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 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, Collusion and 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 State Budget Agency, and the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable to only to Grant Agreements processed through SCM) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County COMPASS MINERALS AMERICA INC Indiana Department of Transportation 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) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxxxxxxx, Commissioner Date: Date: This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: 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 4Executed Contract for details. Exhibit A = List of Awarded Entities 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 Exhibit A = List of Awarded Entities 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 Exhibit A = List of Awarded Entities INDOT District Salt Type INDOT Early Fill Quantity Needed Price Per Ton Delivery Method Crawfordsville - 10 Untreated INDOT 15,500 84.65 Delivered Crawfordsville - 10 Untreated INDOT 15,500 88.90 Delivered + Loaded Fort Xxxxx - 20 Untreated INDOT 32,500 72.51 Delivered Fort Xxxxx - 20 Untreated INDOT 32,500 76.76 Delivered + Loaded Greenfield - 30 Untreated INDOT 36,852 91.40 Delivered Greenfield - 30 Untreated INDOT 36,852 95.65 Delivered + Loaded Vincennes - 60 Untreated INDOT 18,300 77.14 Delivered 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 84.65 Delivered Crawfordsville - 10 Untreated INDOT 30,900 88.90 Delivered + Loaded Fort Xxxxx - 20 Untreated INDOT 40,900 72.51 Delivered Fort Xxxxx - 20 Untreated INDOT 40,900 76.76 Delivered + Loaded Greenfield - 30 Untreated INDOT 17,335 91.40 Delivered Greenfield - 30 Untreated INDOT 17,335 95.65 Delivered + Loaded Vincennes - 60 Untreated INDOT 12,500 77.14 Delivered 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 Exhibit B = INDOT Specifications INDIANA DEPARTMENT OF TRANSPORTATION (INDOT) SPECIFICATIONS & SPECIAL PROVISIONS 2015/2016 SALT BID FOR TREATED/UNTREATED SODIUM CHLORIDE **SPECIAL PROVISIONS**

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 Duties of ClaimsContractor; the Compliance with Audit Consideration; Term; Indiana Veterans Owned Small Business Compliance; Minority and Reporting RequirementsWomen’s Business Enterprises Compliance; Maintenance of Records were modified and Notice to include statutory and program requirementsParties. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Non-Collusion, Collusion and 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) 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://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL In Witness Whereof, the Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana SPECTRUM GAMING GROUP FL LLC INDIANA GAMING COMMISSION By: By: Title: Managing Director Title: Executive Director Date: 2/8/2022 | 13:45 EST Date: 2/8/2022 | 14:13 EST Electronically Approved by: Department of Transportation By: Administration By: (for) Name and TitleXxxxxxx Xxxx erda, 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 20-89Commissioner

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, Collusion and 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 State Budget Agency, and the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable to only to Grant Agreements processed through SCM) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County XXXXXX SALT INC Indiana Department of Transportation Administration Digitally signed by Xxxx 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) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxxxxxxx, Commissioner Date: Date: This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: 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 4Executed Contract for details. Exhibit A = List of Awarded Entities INDOT District Salt Type INDOT Early Fill Quantity Needed Price Per Ton Delivery Method LaPorte - 40 Untreated INDOT 15,000 65.02 Delivered 70.02 Delivered + Loaded 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 70.77 Delivered + Loaded 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(eMadison Correctional Facility 75 75.54 Delivered Seymour - 50 Untreated Madison State Hospital 75 75.54 Delivered Exhibit B = INDOT Specifications INDIANA DEPARTMENT OF TRANSPORTATION (INDOT) on November 24, 2020 FA 20-89SPECIFICATIONS & SPECIAL PROVISIONS 2015/2016 SALT BID FOR TREATED/UNTREATED SODIUM CHLORIDE **SPECIAL PROVISIONS**

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, Collusion and 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) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County Indiana Department of Transportation 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) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxx erda, Commissioner Date: Date: Electronically 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 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 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 Boilerplate contract clauses (as contained in the 2019 OAG/ 2012 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. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. Non-Collusion, Collusion and 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. 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 Contractor and the State of Indiana have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood understand the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below hereby agree to the terms thereof. [GranteeContractor] Tippecanoe County Indiana Department of Transportation [State Agency] By: By: (for) Name and Printed Name: Printed Name: Title: Title: Date: Date: Approved by: Approved by Indiana Office of Technology Department of Administration Xxxx Xxxxxxxx, Printed Xxxxxx XxXxxxxxxxChief Information Officer Xxxxxxx Xxxxxxxxx, 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 Xxxxx X. XxxxXxxxxx, Xx.Director Xxxxxxx X. Xxxxxxx, 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 contract clauses (as contained in the 2019 OAG/ 2018 OAG/IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: Payment inapplicable, modified or added Sections are identified in the body of Claims; the Compliance with Audit and Reporting Requirements; Maintenance of Records were modified to include statutory and program requirementsthis Contract. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK Non-Collusion, Collusion and 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. 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) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [GranteeContractor] Tippecanoe County Indiana Department of Transportation Child Services By: By: (for) Xxxxx X. Xxxxxxx, Director Name and Title, Printed Xxxxxx XxXxxxxxxx, Commissioner Date: Date: Approved by: Approved by: Indiana Department of Administration Indiana 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 2425, 2020 2019. FA 2019-8976

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed 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 Grantee, or that the undersigned is the properly authorized representative, agent, member member, or officer of the Grantee. Further, to the undersigned’s 's knowledge, neither the undersigned nor any other member, employee, representative, agent 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 sign this Grant Agreements processed through SCM) Agreement by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Grant Agreement to the State of Indiana. I understand that my signing and submitting this Grant Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Grant Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Grant Agreement in this fashion I am affirming to the truth of the information contained therein. I understand that this Grant Agreement 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 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 CITY OF WESTFIELD Indiana Department of Transportation By: By: Title: (for) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxxx, Commissioner Date:\d1\ Date: Date: Electronically Approved by: Electronically Approved by: Indiana Department of Administration State Budget Agency By: (for) Xxxxxxx Xxxxxxxx, Commissioner By: (for) Xxxxxx X. Xxxxx, Commissioner Xxxxxxx X. Xxxxxxx, Director Date: Date: APPROVED 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 24September 21, 2020 2023. FA 2023-8945 This instrument was prepared by the undersigned attorney: Xxxxxxx Xxxxxxxx, #20005-49 ATTACHMENT A PROJECT DESCRIPTION Des. No.: 2301541 Program: Local Roads and Bridges Matching Grants Type of Project: Pavement Replacement Location: Route Name From To OAK RIDGE RD Legacy Oaks Drive ~250' N 161st Street ~565' S OAK RIDGE RD 161st Street ~430' N 169th Street XXXX XX 151st Street 161st Street GRASSY BRANCH RD Mere Boulevard ~145' S 186th Street 156TH ST Oak Ridge Road Monon Hill Court ~285' W DARTOWN XX XX 32 ~165' S 175th Street LIBERTY BLVD Pawtucket Drive Spring Mill Road LIBERTY BLVD Liberty Drive Spring Mill Road ALEXANDRIA DR Liberty Boulevard (N) Xxxxxxxxxx Drive (Excludes RAB) PAWTUCKET DR Liberty Drive Xxxxxxx Drive ~887' W LIBERTY DR Liberty Boulevard Clearbrook Street XXXXXXXXXX DR Piedmont Drive Piedmont Drive CLEARBROOK ST Liberty Drive Piedmont Drive ATHENS PL Stockbridge Drive Stockbridge Drive STOCKBRIDGE DR New Haven Drive Athens Place PIEDMONT DR Alexandria Drive RAB Xxxxxxxxxx Drive PIEDMONT XX Xxxxxxxxxx Drive Alexandria Drive RAB PLAINVILLE DR Oak Ridge Road Channelburg Boulevard RICHTERS BLVD 161st Street Palmyra Drive PALMYRA DR Dandborn Drive Plainville Road DANBORN DR Palmyra Drive Channelburg Boulevard XXXXXX LN Plainville Drive Plainville Drive MARENGO TR Dandborn Drive Palmyra Drive ETNA DR Palmyra Drive Marengo Trail AMBIA CIR Marengo Trail Terminus PALMYRA GRN Palmyra Drive Palmyra Drive HYMERA GRN Palmyra Drive Palmyra Drive ETNA GRN Palmyra Drive Palmyra Drive DANBORN GRN Palmyra Drive Palmyra Drive Application ID: 13167 A general scope/description of the Project is as follows: Milling and resurfacing of various roads throughout the City of Westfield that includes full -depth HMA patching and thermoplastic pavement markings. Each road has its own unique solution. The roads in this application are part of the 2024 Resurfacing project and their limits are as follows: Pawtucket Drive (Liberty Drive to Xxxxxxx Drive ~887'W in Centennial Subdivision), Liberty Drive (Liberty Boulevard to Clearbrook Street in Centennial Subdivision), Clearbrook Street (Liberty Drive to Piedmont Drive in Centennial Subdivision), Liberty Boulevard (N) (Pawtucket Drive to Spring Mill Road in Centennial Subdivision), Liberty Boulevard (S) (Liberty Drive to Spring Mill Road in Centennial Subdivision), Alexandria Drive (Liberty Boulevard (N) to Xxxxxxxxxx Drive in Centennial Subdivision), Athens Place (Stockbridge Drive to Stockbridge Drive in Centennial Subdivision), Stockbridge Drive (New Haven Drive to Athens Place in Centennial Subdivision), Piedmont Drive (Xxxxxxxxxx Drive to Xxxxxxxxxx Drive in Centennial Subdivision), Xxxxxxxxxx Drive (Piedmont Drive to Piedmont Drive in Centennial Subdivision), Plainville Road (Oak Ridge Road to Channelburg Boulevard in Countryside Subdivision), Dandborn Green (Palmyra Drive to Palmyra Drive in Countryside Subdivision), Etna Green (Palmyra Drive to Palmyra Drive in Countryside Subdivision), Richters Boulevard (161st Street to Palmyra Drive in Countryside Subdivision), Hymera Green (Palmyra Drive to Palmyra Drive in Countryside Subdivision), Palmyra Drive (Dandborn Drive to Plainville Road in Countryside Subdivision), Dandborn Drive (Palmyra Drive to Channelburg Boulevard in Countryside Subdivision), Xxxxxx Xxxx (Plainville Drive to Plainville Drive in Countryside Subdivision), Marengo Trail (Dandborn Drive to Palmyra Drive in Countryside Subdivision), Elna Drive ( Palmyra Drive to Marengo Trail in Countryside Subdivision ), Ambia Circle (Marengo Trail to Terminus in Countryside Subdivision ), Oak Ridge Road (Legacy Oak Drive ~250? N to 161st Street ~565? S), Oak Ridge Road (161st Street ~430? N to 169th Street), 156th Street (Oak Ridge Road to Monon Hills Court ~285? W), Gray Road (151st Street to 161st Street), Grassy Branch Road (Mere Boulevard~145? S to 186th Street), Dartown Road (SR 32 ~165' S to 175th Street) The maximum amount of state funds allocated to the Project is $1,000,000.00.

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 '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, Collusion and 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 State Budget Agency, and the disclosure requirements in IC § 4-2-6-10.5. AGREEMENT TO USE ELECTRONIC SIGNATURES (Applicable to only to Grant Agreements processed through SCM) 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 Grantee Contractor and the State have, through their duly authorized representatives, entered into this Grant AgreementContract. The parties, having read and understood the foregoing terms of this Grant AgreementContract, do by their respective signatures dated below agree to the terms thereof. [Grantee] Tippecanoe County THE DETROIT SALT CO LLC Indiana Department of Transportation Administration By: By: Xxxx Digitally signed by Xxxx Xxxxxx French DN: cn=Xxxx Xxxxxx, o=Indiana Department of Title: 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) Name and Title, Printed Xxxxxx XxXxxxxxxxXxxxxxx Xxxxxxxxx, Commissioner Date: Date: This document will be reviewed and approved electronically. Please refer to the final page of the Executed Contract for details. Approved by: 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(eExecuted Contract for details. Exhibit A = List of Awarded Entities INDOT District Salt Type Local Entities Quantity Needed Price Per Ton Delivery Method Crawfordsville - 10 Untreated Avon Community Schools 140 81.01 Delivered Crawfordsville - 10 Untreated Xxxxx County 600 81.01 Delivered Crawfordsville - 10 Untreated City of Xxxxxxxxxxxxxx Xxxxxx 000 81.01 Delivered Crawfordsville - 10 Untreated City of Frankfort 300 81.01 Delivered Crawfordsville - 10 Untreated City of Lafayette (137 N. Railroad St) on November 24, 2020 FA 20-89250 81.01 Delivered Crawfordsville - 10 Untreated City of Lafayette (260 S. 3rd Street) 4,500 81.01 Delivered Crawfordsville - 10 Untreated City of Xxxxxxxxx (0000 Xxxxx Xx) 2,500 81.01 Delivered Crawfordsville - 10 Untreated City of Lafayette (504 W. 800 S.) 170 81.01 Delivered Crawfordsville - 10 Untreated City of Lafayette (705 South River Rd) 2,200 81.01 Delivered Crawfordsville - 10 Untreated Xxxxxxxxx County (Untreated) 1,600 81.01 Delivered Crawfordsville - 10 Untreated Xxxxxx County 750 81.01 Delivered Crawfordsville - 10 Untreated Town of Xxxxxxx 30 81.01 Delivered Crawfordsville - 10 Untreated Town of Brownsburg 1,600 81.01 Delivered Crawfordsville - 10 Untreated Town of Danville 1,200 81.01 Delivered Crawfordsville - 10 Untreated Town of Williamsport 60 81.01 Delivered Crawfordsville - 10 Untreated Town of Zionsville 1,100 81.01 Delivered Crawfordsville - 10 Untreated Vigo County Xxxxxxx (00000 S Xxxxxxxx Xx) 2,500 81.01 Delivered Crawfordsville - 10 Untreated Vigo County Highway (3250 E Xxxxxxxxx Ave) 2,500 81.01 Delivered Fort Xxxxx - 20 Untreated Xxxxx County Highway 250 72.31 Delivered Fort Xxxxx - 20 Untreated City of Angola Clerk (Untreated) 900 72.31 Delivered Fort Xxxxx - 20 Untreated City of Auburn 900 72.31 Delivered Fort Xxxxx - 20 Untreated City of Columbia City 600 72.31 Delivered Fort Xxxxx - 20 Untreated City of Elkhart 3,400 72.31 Delivered Fort Xxxxx - 20 Untreated City of Xxxxxxx 250 72.31 Delivered Fort Xxxxx - 20 Untreated City of Gas City 50 72.31 Delivered Fort Xxxxx - 20 Untreated City of Goshen 1,600 72.31 Delivered Fort Xxxxx - 20 Untreated City of Hartford City 250 72.31 Delivered Fort Xxxxx - 20 Untreated City of Huntington 400 72.31 Delivered Fort Xxxxx - 20 Untreated City of Kendallville 450 72.31 Delivered Fort Xxxxx - 20 Untreated City of Ligonier 300 72.31 Delivered Fort Xxxxx - 20 Untreated City of Xxxxxx Street 1,500 72.31 Delivered Fort Xxxxx - 20 Untreated City of Nappanee 100 72.31 Delivered Fort Xxxxx - 20 Untreated City of Wabash Street 300 72.31 Delivered Fort Xxxxx - 20 Untreated City of Winchester 250 72.31 Delivered Fort Xxxxx - 20 Untreated DeKalb County Highway 1,200 72.31 Delivered Fort Xxxxx - 20 Untreated Elkhart County Highway 2,000 72.31 Delivered Fort Xxxxx - 20 Untreated Elkhart County Xxxxxxx (00000 CR 50) 2,000 72.31 Delivered Fort Xxxxx - 20 Untreated Xxxxxxx Xxxxxx Xxxxxxx (00000 CR17) 2,000 72.31 Delivered Fort Xxxxx - 20 Untreated Xxxxxxx Xxxxxx Xxxxxxx (00000 CR35) 2,000 72.31 Delivered Fort Xxxxx - 20 Untreated Huntington County Highway 800 72.31 Delivered Fort Xxxxx - 20 Untreated Kosciusko County 2,000 72.31 Delivered Fort Xxxxx - 20 Untreated Noble County 800 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Albion 120 72.31 Delivered Fort Xxxxx - 20 Untreated Town of Xxxxxx 80 72.31 Delivered Exhibit A = List of Awarded Entities 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 Exhibit B = INDOT Specifications INDIANA DEPARTMENT OF TRANSPORTATION (INDOT) SPECIFICATIONS & SPECIAL PROVISIONS 2015/2016 SALT BID FOR TREATED/UNTREATED SODIUM CHLORIDE **SPECIAL PROVISIONS**