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DocuSign Envelope ID:8F6AD7AB-CE9D-40C4-B5FA-6FCBA99F62F3 <br /> (b) [check one of the following boxes] <br /> Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax have <br /> country" as set forth in G.8. l4]-54.1(6 (2)after December 3L2O0l; or <br /> [11 The Contractor or one of its affiliates has inc or reinc in a "tax haven country' <br /> as set forth in G.S. 143-50.1(o)(2) after December 31, 2001 but the United States is not th' <br /> priooipul market for the public trading of the stock of the corporation incorporated in the ta <br /> haven country. <br /> (3) Pursuant to G.S. 143-59.2(h), the undersigned hereby certifies that none of the Contractor's officers, director <br /> or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chaptbr <br /> 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 year. <br /> immediately prior to the date of the bid solicitation. <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 th <br /> Contractor; and <br /> ' <br /> (c) He or she understands that any person who knowingly submits a false certification in response to th <br /> requirements n[G.S. l435g.lmud 59.2 shall be guilty of a Class I felony. <br /> (5) Pursuant to G.S. 143C-6A-5, the undersigned hereby certifies that Contractor has not been identified, 000 <br /> has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursua // <br /> to G.S. 147-88.58. <br /> DocuSigned by: <br /> Conti-(J6;4)0144614 <br /> 7/18/2016 <br /> Signature of Contractor's Authorized Agent Date <br /> carol Holcomb Attorney <br /> o="u/•",d by. <br /> Print“ l��Q� �r»f�u�sAutborizod /\��uL Title <br /> .^,^vuuz� `` �o��� partner <br /> Sig,uu<urco noes Title <br /> Samantha H cabe 7/I0/2016 <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 dal- <br /> this document immediately thereafter. <br /> Contractor Certifications Required by North Carolina Law <br /> Rev. 6/16 Page 2 of <br />