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DocuSign Envelope ID: 3068A826-D9DD-44A9-A383-16200B061238 <br /> Agreement No.23-1439-39187 <br /> GRANT AGREEMENT <br /> fp4 t <br /> j r <br /> Cj <br /> BETWEEN <br /> THE STATE OF ILLINOIS, ILLINOIS DEPARTMENT OF TRANSPORTATION <br /> AND <br /> CITY OF DECATUR <br /> The Illinois Department of Transportation (Grantor)with its principal office at <br /> 2300 South Dirksen Parkway, Springfield, IL 62764 <br /> and City of Decatur (Grantee)with its principal office at <br /> 1 Gary K Anderson Plaza, Decatur, IL 62523 <br /> and payment address (if different than principal office)at Same <br /> hereby enter into this Grant Agreement(Agreement). Grantor and Grantee are collectively referred to herein as "Parties" <br /> or individually as a "Party." <br /> PART ONE-THE UNIFORM TERMS <br /> RECITALS <br /> WHEREAS, it is the intent of the Parties to perform consistent with all Exhibits and attachments hereto and pursuant <br /> to the duties and responsibilities imposed by Grantor under the laws of the State of Illinois ("State")and in accordance <br /> with the terms, conditions and provisions hereof. <br /> NOW, THEREFORE, in consideration of the foregoing and the mutual agreements contained herein, and for other <br /> good and valuable consideration, the value, receipt and sufficiency of which are acknowledged, the Parties hereto agree <br /> as follows: <br /> ARTICLE I <br /> AWARD AND GRANTEE SPECIFIC INFORMATION AND CERTIFICATION <br /> 1.1 DUNS Number, SAM Registration: Nature of Entity. Under penalties of perjury, Grantee certifies that <br /> 075613000 is Grantee's correct DUNS Number, HCL3MP6L8XV5 is Grantee's correct UEI, <br /> if applicable; Grantee has an active State registration and SAM registration; and 376001308 is Grantee's <br /> correct FEIN or Social Security Number. Grantee further certifies, if applicable: (a)that Grantee is not subject to backup <br /> withholding because (i) Grantee is exempt from backup withholding, or(ii)Grantee has not been notified by the Internal <br /> Revenue Service (IRS)that Grantee is subject to backup withholding as a result of a failure to report all interest or <br /> dividends, or(iii)the IRS has notified Grantee that Grantee is no longer subject to backup withholding; and(b) Grantee is <br /> a U.S. citizen or other U.S. person. Grantee is doing business as a (check one): <br /> ❑ Individual ❑ Pharmacy-Non Corporate <br /> ❑ Sole Proprietorship ❑ Pharmacy/Funeral Home/Cemetery Corp. <br /> ❑ Partnership ❑ Tax Exempt <br /> ❑ Corporation(includes Not for Profit) ❑ Limited Liability Company(select applicable <br /> ❑ Medical Corporation tax classification) <br /> ® Governmental Unit ❑ P=partnership <br /> ❑ Estate or Trust ❑ C =corporation <br /> If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form <br /> with this Agreement. <br /> State of Illinois <br /> GRANT AGREEMENT FISCAL YEAR 2023/1 18 22 <br /> Page 1 of 41 <br />