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State Certification Contract Number 00028582/Page-1 8 of 19 <br /> Contractor Certifications Required by North Carolina Law <br /> Instructions <br /> The person who signs this document should read the text of the statutes cited herein and consult with counsel <br /> and other knowledgeable persons before signing. The text of G.S. 143-59.1 can be found online at: <br /> http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter 143/GS 143-59.1.pdf <br /> The text of G.S. 143-59.2 can be found online at: <br /> hU://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/B-ySecfon/Chapter 143/GS 143-59.2.1) <br /> The text of G.S. 105-164.8(b)can be found online at: <br /> htip://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/ChVter 109GS 105-164.8.pdf <br /> Certifications <br /> (1) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below is not <br /> an"ineligible Contractor"as set forth in G.S. 143-59.1(a)because: <br /> (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under <br /> Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the <br /> sales met one or more of the conditions of G.S. 105-164.8(b); and <br /> (b) [check one of the following boxes] <br /> ® Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax <br /> haven country" as set forth in G.S. 143-59.1(c)(2) after December 31,2001; or <br /> ❑ The Contractor or one of its affiliates has incorporated or reincorporated in a"tax haven <br /> country" as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but the United <br /> States is not the principal market for the public trading of the stock of the corporation <br /> incorporated in the tax haven country. <br /> (2) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor's officers, <br /> directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any <br /> violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities <br /> Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. <br /> (3) The Contractor shall require its subcontractors, if any, to make the same certifications before they <br /> perform any work under the contract. <br /> (4) The undersigned hereby certifies further that: <br /> (a) He or she is a duly authorized representative of the Contractor named below; <br /> Page 1 of 2 <br />