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 2022 SCM Template) in any way except as follows: A. Paragraph 1, Purpose of this Grant Agreement; Funding Source, has been modified. B. Paragraph 5, Grant Funding, has been modified. C. Paragraph 6, Payment of Claims, has been modified. D. Paragraph 7, Project Monitoring by the State, has been modified. E. Paragraph 8, Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified. F. Paragraph 10, Debarment and Suspension, has been modified. G. Paragraph 15, Information Technology Accessibility Standards, has been modified. H. Paragraph 19, Order of Precedence; Incorporation by Reference, has been modified. I. Paragraph 24, Federal and State Third-Party Contract Provisions, has been deleted. J. Paragraph 25, Provision Applicable to Grants with tax-funded State Educational Institutions: “Separateness” of the Parties, has been deleted. The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the undersigned is the properly authorized representative, agent, member or officer of the Grantee. Further, to the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state officer,

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 2022 2021 OAG/ IDOA Professional Services Contract Manual or the 2021 SCM Template) in any way except as follows: A. Paragraph 1, Purpose of this Grant Agreement; Funding Source, has been modified. B. Paragraph 5, Grant Funding, has been modified. C. Paragraph 6, Payment of Claims, has been modified. D. Paragraph 7, Project Monitoring by the State, has been modified. E. Paragraph 8, : Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified. F. Paragraph 10, Debarment and Suspension, has been modified. G. Paragraph 15, Information Technology Accessibility Standards, has been modified. H. Paragraph 19, Order of Precedence; Incorporation by Reference, has been modified. I. Paragraph 24, -modified HIPAA Compliance-added Amendments-added Federal and State Third-Party Contract Provisions, has been deleted. J. Paragraph 25, Provisions Grant Funding - modified Insurance - modified Implementation of and Reporting on Project - modified Order of Precedence - modified Payment of Claims - modified Project Monitoring by State Provision Applicable to Grants with tax-funded State Educational Institutions: “"Separateness” " of the Parties, has been deleted. Parties Purpose of Grant Agreement; Funding Source - modified Representation and Warranties of the Grantee - modified Termination for Breach – modified Travel The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the undersigned is the properly authorized representative, agent, member or officer of the Grantee. Further, to the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state officer,, employee, or special state appointee, as those terms are defined in IC § 4-2-6-1, has a financial interest in the Grant, the Grantee attests to compliance with the disclosure requirements in IC § 4-2-6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed, changed or deleted the State’s 's standard contract clauses (as contained in the 2022 2021 OAG/ IDOA Professional Services Contract Manual or the 2021 SCM Template) in any way except as follows: A. Paragraph 1, Purpose of this Grant Agreement; Funding Source, has been modified. B. Paragraph 5, Grant Funding, has been modified. C. Paragraph 6, Payment of Claims, has been modified. D. Paragraph 7, Project Monitoring by the State, has been modified. E. Paragraph 8, : Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified. F. Paragraph 10, Debarment and Suspension, has been modified. G. Paragraph 15, Information Technology Accessibility Standards, has been modified. H. Paragraph 19, Order of Precedence; Incorporation by Reference, has been modified. I. Paragraph 24, -modified HIPAA Compliance-added Amendments-added Federal and State Third-Party Contract Provisions, has been deleted. J. Paragraph 25, Provisions- deleted Grant Funding - modified Insurance - modified Implementation of and Reporting on Project - modified Order of Precedence - modified Payment of Claims - modified Project Monitoring by State- modified Provision Applicable to Grants with tax-funded State Educational Institutions: “"Separateness” " of the Parties, has been deleted. Parties- Deleted Purpose of Grant Agreement; Funding Source - modified Representation and Warranties of the Grantee - modified Termination for Breach -- modified Travel - deleted The undersigned attests, subject to the penalties for perjury, that the undersigned is the Grantee, or that the undersigned is the properly authorized representative, agent, member or officer of the Grantee. Further, to the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the Grantee, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Grant Agreement other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state officer,, employee, or special state appointee, as those terms are defined in IC § 4-2-6-1, has a financial interest in the Grant, the Grantee attests to compliance with the disclosure requirements in IC § 4-2-6-10.5.

State Boilerplate Affirmation Clause. I swear or affirm under the penalties of perjury that I have not altered, modified, changed, changed or deleted the State’s 's standard contract clauses (as contained in the 2022 2021 OAG/ IDOA Professional Services Contract Manual or the 2021 SCM Template) in any way except as follows: A. Paragraph 1, Purpose of this Grant Agreement; Funding Source, has been modified. B. Paragraph 5, Grant Funding, has been modified. C. Paragraph 6, Payment of Claims, has been modified. D. Paragraph 7, Project Monitoring by the State, has been modified. E. Paragraph 8, : Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified. F. Paragraph 10, Debarment and Suspension, has been modified. G. Paragraph 15, Information Technology Accessibility Standards, has been modified. H. Paragraph 19, Order of Precedence; Incorporation by Reference, has been modified. I. Paragraph 24, -modified HIPAA Compliance-added Amendments-added Federal and State Third-Party Contract Provisions, has been deleted. J. Paragraph 25, Provisions Grant Funding - modified Insurance - modified Implementation of and Reporting on Project - modified Order of Precedence - modified Payment of Claims - modified Project Monitoring by State Provision Applicable to Grants with tax-funded State Educational Institutions: “"Separateness” " of the Parties, has been deleted. Parties Purpose of Grant Agreement; Funding Source - modified Representation and Warranties of the Grantee - modified Termination for Breach – modified Travel 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. I agree, and it is my intent, to 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: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL VANDERBURGH COUNTY HEALTH DEPARTMENT Indiana State Department of Health By: By: Title: Health Officer, Vanderburgh County HealthTitDlee:partment Date: Date: Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Attorney General Grantee has agreed to participate in the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Health Resources and Services Administration (HRSA) COVID-19 Vaccination Program (the Program) as administered by the State of Indiana through the Indiana Department of Health established by I.C. 16-19-1-1. Grantee will be administering vaccine to eligible recipients, at no cost to the recipients. The purpose of this agreement is to provide financial compensation for the administrative costs born by the Grantee during their participation in the Program. For purposes of the initial phase of the Program, Grantee is administering the vaccine on behalf of the State.

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 standard contract clauses (as contained in the 2022 2019 OAG/IDOA Professional Services Contract Manual or the 2019 SCM Template) in any way except as follows: A. Paragraph 1▇▇▇▇▇▇▇▇▇ ▇, Purpose ▇▇▇▇▇▇▇ of this Grant Agreement; Funding Source, has been modified. B. Paragraph 5▇▇▇▇▇▇▇▇▇ ▇, Grant Funding▇▇▇▇, has been modified. C. Paragraph 3, Amount of Subaward, has been added. D. Paragraph 4, Representations and Warranties of the Subrecipient, has been modified. E. Paragraph 5, Implementation of and Reporting on the Project has been modified. F. Paragraph 6, Real Property, has been added. G. Paragraph 7, Requirements Applicable to Property/Equipment Purchased Using Grant Funds, has been added. H. Paragraph 8, Requests for Expenditures/Payment of Claims, has been modified. D. I. Paragraph 79, Project Monitoring by the State, has been modified. E. J. Paragraph 810, Compliance with Audit and Reporting Requirements; Maintenance of Records, has been modified. F. Paragraph 10K. ▇▇▇▇▇▇▇▇▇ ▇▇, Debarment ▇▇▇▇▇▇▇▇▇ and Suspension, has been modified. G. L. Paragraph 1518, Information Technology Accessibility StandardsInsurance, has been modified. H. M. Paragraph 1921, Order of Precedence; Incorporation by Reference, has been modified. I. N. ▇▇▇▇▇▇▇▇▇ ▇▇, ▇▇▇▇▇▇▇▇▇▇▇ for Convenience, has been modified. O. Paragraph 2426, Remedies Not Impaired, has been added. P. Paragraph 27, Severability, has been added. Q. ▇▇▇▇▇▇▇▇▇ ▇▇, ▇▇▇▇▇▇▇▇, has been added. R. Paragraph 29, Federal and State Third-Party Contract Provisions, has been deleted. J. modified. S. Paragraph 2530, Provision Provisions Applicable to Grants with tax-funded State Educational Institutions: “Separateness” of the Parties, has been deleted. The undersigned attests, subject to the penalties for perjury, that the undersigned is the GranteeSubrecipient, or that the undersigned is the properly authorized representative, agent, member or officer of the GranteeSubrecipient. Further, to the undersigned's knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the GranteeSubrecipient, 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 Agreement, the Subrecipient attests to compliance with the disclosure requirements in IC § 4-2-6-10.5.