2015-349-E DSS - KAH Care, LLC dba Right at Home to provide employees to perform in-home services for OC DSS clients $75,000

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DocuSign Envelope ID:89EE68A1-29FA-417C-9C6F-034CDOD2C779 Right at Home 4905 Pine Cone Drive,SUITE 2 1 P 919.237.2333 www.randch.com In Ilanla Can F Aaalalanoa DURHAM,NC 27707 1 F 919.237.2152 info @randch.00m ATTACHMENT E OVERDUE TAXES Orange County Department of Social Services Contract#68-2017 KAH Care,L.L.C.dba Right at Home Date: June 30, 2015 To: Orange County Department of Social Services Certification: I certify that the KAH Care, LLC does not have any overdue tax debts,as defined by N.C.G.S. 105-243.11, at the federal, State, or local level. I further understand that any person who makes a false statement in violation of N.C.G.S. 1430-6-23(c)is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-10-1(b). Sworn Statement: Kenneth Helmuth being duly sworn says that he is the Board Chair of KAH Care, LLC of Durham in the State of North Carolina; and that the foregoing certification is true,accurate and complete to the best of our knowledge and was made and subscribed by him. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Board Chair Sworn to and subscribed before me on the day of the date of said certification. y Commission Expires: (Notary Signatdre and Sea) DOUGLAS E. KOENIG NOTARY Durham County North Carolina My Commission Expires May 23,2018 G.S. 105-243.1 defines:Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer.The term does not include a tax debt,however,if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement."