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Consolidated Agreement FY15 Page 21 of 28 <br /> (4) The undersigned hereby certifies further that: <br /> (a) He or she is a duly authorized representative of the Contractor named below; <br /> (b) He or she is authorized to make, and does hereby make,the foregoing certifications on behalf of the <br /> Contractor; and <br /> (c) He or she understands that any person who knowingly submits a false certification in response to the <br /> requirements of G.S. 143-59.1and-59.2 shall be guilty of a Class I felony. <br /> Orange County Health Department <br /> Contractor's Name ff <br /> Signature of Contractor's orized Agent Date <br /> ' <br /> C( '( l _, � C' <br /> Printed Name of Contractor's Authorized Agent Title <br /> KZ'Yrl <br /> Signature of Witness Title <br /> i <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 <br /> date this document immediately thereafter. <br />