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 2019 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK 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.

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 OAG/2020 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: inapplicabledeleted, modified modified, or added Sections are identified in the body of this Contract. THE REMAINDER OF THIS PAGE HAS BEEN IS INTENTIONALLY LEFT BLANK 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 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- 6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2018 OAG/IDOA Professional Services Contract Manual or the 2019 2018 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK 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.

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 2018 OAG/OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. 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- 6-10.5.

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 standard contract clauses (as contained in the 2018 OAG/OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. 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- 6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2018 OAG/2019 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: inapplicable, Compliance with Audit and Reporting Requirements; Maintenance of Records-modified or HIPAA Compliance-added Sections are identified in the body of this Contract. REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK Amendments-added 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 '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- 6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract 's Boilerplate grant clauses (as contained in the 2018 OAG/2015 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM TemplateManual) in any way except as followsfor the following clauses which are named below: inapplicable, modified or added Sections are identified in Representations and Warranties of the body Grantee Implementation of this Contract. REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK Reporting on the Project Payment of Claims Project Monitoring by the State Order of Precedence Termination for Breach HIPAA Compliance Non-Collusion and 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- 6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s 's standard contract clauses (as contained in the 2018 OAG/2020 OAG/ IDOA Professional Services Contract Manual or the 2019 2020 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body Clause 12 – Confidentiality of this Contract. REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK State Information (modified) Clause 34 – Notice to Parties (modified) Clause 36 – Order of Precedence (modified) 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- 6-10.5.

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 standard contract clauses (as contained in the 2018 OAG/2019 OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK BLANK. 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- 6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed or deleted the State’s standard contract clauses (as contained in the 2018 OAG/OAG/ IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: inapplicable, modified or added Sections are identified in the body of this Contract. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK 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- 6-10.5.