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Related Member Party's Certification <br /> The Related Member Party represents, warrants, and certifies the truth,and <br /> accuracy of the statements made below. These certifications shall be deemed to be made <br /> a part of the CPA and are incorporated therein, and governed by its terms and conditions. <br /> (i) attached hereto is a true and correct copy of the Related Member Party's latest <br /> NCUI 101 form (or Multiple Worksite Report Form 3020, if applicable) filed <br /> with the State; and a copy of the NCUI 101 form (or Form 3020)filed with <br /> the State prior to the expansion; <br /> (ii) it has retained permanent full time jobs and temporary <br /> full time jobs; <br /> (iii) it has created and retained New Jobs,5 which are net new positions <br /> for the Related Member Party's operations in the state, and no New Job (or <br /> employee)has been transferred from any existing North Carolina operations <br /> of the Company, the Related Member Party, or any of their affiliates; <br /> (iv) it has obtained all required environmental permits for the Project(Company <br /> should cross out if Related Member Party does not have responsibility for <br /> environmental permitting); <br /> (v) it makes available health insurance to all of its permanent full-time <br /> employees at the Facility in the amount required for eligibility for tax credits <br /> under the Article 3J (House Bill 2170 § 105-129.83); <br /> (vi) attached hereto is a true and correct copy of the Related Member Party's fixed <br /> asset report showing a description, acquisition date and cost for each asset <br /> acquired, disposed of, or transferred from the date of the Grant(Company <br /> should cross out if Related Member Party's investment is not applicable to <br /> this Grant); <br /> (vii) it has made some or all of the Target Investment in the amount of <br /> ; (Company should cross out if Related Member Party is <br /> not making Required Investment) <br /> 5 This is determined by obtaining the average number of new employees over.the quarter reported. The <br /> company should add the three figures that represent NEW JOBS ONLY during each of the three months of <br /> the quarter reported in the NCUI 101,and divide that number by three. DO NOT INCLUDE PART-TIME, <br /> TEMPORARY OR SEASONAL JOBS, OR JOBS THAT EXISTED PRIOR TO THE GRANT AWARD. <br /> BE PREPARED TO SUPPORT THIS NUMBER WITH ADDITIONAL DOCUMENTATION, <br /> INCLUDING IDENTIFICATION OF INDIVIDUAL FULL-TIME EMPLOYEES AND THEIR WAGES. <br /> One NC Company Disbursement Request <br /> AKG North America,Inc. <br /> Orange County <br />