2016-481-E DSS - Chatham Transit Network for non-emergency Medicaid transportation

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DocuSign Envelope ID:BD69DF46-15CD-49E6-8588-93617FCCFB94 more of the conditions of G,S. 105-164.8(b); and (b) [check one of the following boxes] Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax have country" as set forth inG.S. I4]-59.l(o) (2)after December 3(, 20Ol; or , Fl reincorporated as set forth in (].S. 143-59.1(c)(2) after December 31" 2001 but the United States is not dh. principal market for the public trading of the stock of the corporation incorporated in the ta haven country. (3) Pursuant to G.S. 143-59.2(h), the undersigned hereby certifies that none of the Contractor's officers, director ` or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapt.r 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 year.. immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies further that: (a) lie or she is a duly authorized representative of the Contractor named below; (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf ofth-, Contractor; and (c) He or she understands that any person who knowingly submits a false certification in response to t - requirements of G.S l43'59.laod'5y.2 shall bc guilty ofw Class lfelony. (5) Pursuant to the Orange County Living Wage Contractor's Policy: (a) The undersigned certifies that the Contractor pays the employees who perform services under this contract living wage (in Orange County currently $13.15 per/hr.) Check here | | if contractor pays eznploye.o pci-forming under this contract a living wage. If Contractor does riot pay employees a living wage,what is tl.e wage that employees performing services under this contract pail Chatham Transit Network Contract( `GU& 8/22/2016 !==20=x60n�5E524Es_ Signature of Contractor's Authorized Agent Date xnna Testerman Executive Di rector Printed N.ii Thäctor's Authorized Agent Title �@�kmok� Finance coordinator Signature o vy� ^s^�— Title Angie Blackmon 8/29/2016 Printed Name of Witness Date The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and da e this document immediately thereafter. Contractor Certifications Required by North Carolina Law Page 2 o 3