Collusion and Acceptance. The undersigned attests, subject to the penalties for perjury, that the undersigned is the Consultant, or that the undersigned is the properly authorized representative, agent, member or officer of the Consultant. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Consultant, 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 Consultant attests to compliance with the disclosure requirements in IC 4-2- 6-10.5.
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. In Witness Whereof, Contractor and the Board have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] Alabama Statewide 911 Board By: ___________________________________ By: _________________________________ Printed Name: __________________________ Printed Name: ________________________ Title: _________________________________ Title: ________________________________ Date: _________________________________ Date: ________________________________
Collusion and Acceptance. The undersigned attests, subject to the penalties for perjury, that he/she is the Consultant, or that he/she is the properly authorized representative, agent, member or officer of the Consultant, that he/she has not, nor has any other member, employee, representative, agent or officer of the Consultant, directly or indirectly, to the best of the undersigned’s knowledge, entered into or 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 Contract other than that which appears upon the face of this Contract. In Witness Whereof, Consultant and the Authority have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below hereby agree to the terms thereof.
Collusion and Acceptance. You MUST have this clause in your contract. It is required by IC 5-22-16-6. THIS SHOULD BE THE FINAL CLAUSE BEFORE THE SIGNATURE PAGE. All Contracts, Amendments, Renewals, Addendums, Supplements, etc. must include this clause. The undersigned attests, subject to the penalties for perjury, that he/she is the Contractor, or that he/she is the properly authorized representative, agent, member or officer of the Contractor, that he/she has not, nor has any other member, employee, representative, agent or officer of the Contractor, directly or indirectly, to the best of his/her knowledge, entered into or 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 Contract other than that which appears upon the face of this Contract. In Witness Whereof, Contractor and the State of Indiana have, through duly authorized representatives, entered into this agreement. The parties having read and understand the foregoing terms of the contract do by their respective signatures dated below hereby agree to the terms thereof. Contractor: State of Indiana Agency: Signature: Signature: Printed Name: Printed Name: Title: Title: Date: Date: If an IOT signature is necessary but the signature block is left blank, a statement must be inserted that authority has been delegated to this agency per a letter from IOT dated ***. Indiana Office of Technology Xxxxx Xxxxxx, Chief Information Officer Date: Department of Administration Xxxx Xxxxxxx Commissioner Date: State Budget Agency Office of the Attorney General Xxxxxxxxxxx X Xxxx Xxxxxxx Xxxxxx Director Attorney General
Collusion and Acceptance. The undersigned attests, subject to the penalties for perjury, that he is the contracting party, or that he is the representative, agent, member or officer of the contracting party, that he has not, nor has any other member employee, representative, agent or officer of the firm, company, corporation or partnership represented by him, directly or indirectly, to the best of his knowledge, entered into or offered to enter into any combination, collusion or agreement to receive or pay, and that he has not received or paid, any sum of money or other consideration for the execution of this agreement other than that which appears upon the face of the agreement. /// The remainder of this page is intentionally left blank. /// MCO Contract Harmony Health Plan
Collusion and Acceptance. The undersigned attests, subject to the penalties for perjury, that the undersigned is the Sponsor, or that the undersigned is the properly authorized representative, agent, member or officer of the Sponsor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Sponsor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Agreement other than that which appears upon the face hereof. For the SPONSOR: For the INDIANA DEPARTMENT OF EDUCATION: Legal Name of the Organization (Signature) Xx. Xxxxx Xxxxxx SECRETARY OF EDUCATION By (Signature of authorized representative) type or print name of signee Date OFFICE OF THE ATTORNEY GENERAL Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on February 10, 2021. Title
Collusion and Acceptance. The undersigned attests, subject to the penalties for perjury, that the undersigned is the Sponsor, or that the undersigned is the properly authorized representative, agent, member or officer of the Sponsor. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Sponsor, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Agreement other than that which appears upon the face hereof. For the SPONSOR: For the INDIANA DEPARTMENT OF EDUCATION: LEGAL NAME OF THE ORGANIZATION (SIGNATURE) Xx. Xxxxx Xxxxxx SECRETARY OF EDUCATION BY (SIGNATURE OF AUTHORIZED REPRESENTATIVE) TYPE OR PRINT NAME OF SIGNEE DATE OFFICE OF THE ATTORNEY GENERAL Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on February 10, 2021. TITLE
