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Contract Number 00027858 / Page 33 of 33 <br /> (c) He or she understands that any person who knowingly submits a false certification shall be guilty <br /> of a Class T felony.. <br /> Orange County, NC <br /> Contractor's _Name n -, <br /> Signature of Contract s uthor zed Agent Date / <br /> l r 7 ti - 1 <br /> Printed Name o ontractor's Authorized`Agent Title . <br /> Signature of ALN itness }� Title <br /> a— -C--) Y`-' //1 - /Z <br /> Printed Name of Witness Date <br /> The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document <br /> immediately thereafter <br /> Page 2 of 2 <br />