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DocuSign Envelope ID: 536C9702-1997-4E72-A2EA-3629ACE96C23 <br /> **#*Contractor,Vendor or Bidder-Return This Form WithAH Other Required Documentation***** <br /> IRAN DIVESTMENT ACT CERTIFICATION REQUIRED BY N.C.G.S. <br /> 143C-6A-5(a) <br /> �rs�Sctl ?;I)) .t.NL, <br /> Name of Contractor,Vendor or Bidder: i{,AN� ,p, <br /> As of the date listed below,the contractor, vendor or bidder listed above,and all subcontractors <br /> utilized by the contractor, vendor or bidder listed above, is not listed on the Final Divestment <br /> List created by the State Treasurer pursuant to N.C.G.S. l43-6A-4. <br /> The undersigned hereby certifies that he or she is authorized by the contractor,vendor or bidder <br /> listed above to make the foregoing statement. <br /> SZ36- 1U <br /> S ignature Date <br /> Wf86, \-:Z-LS 1 resie\ejV <br /> Printed Name Title <br /> Notes to persons signing this faire. <br /> N.C.G.S. 143C-6A-5(a)requires this certification for bids or contracts with the State of North <br /> Carolina,a North Carolina local government,or any other political subdivision of the State of <br /> North Carolina.The certification is required at the following times: <br /> ❑When a bid is submitted <br /> ❑W hen a contract is entered into(if the certification was not already made when the vendor <br /> made its bid) <br /> When a contract is renewed or assigned <br /> N.C.G.S, 143C-6A-5(b)requires that contractors with the State,a North Carolina local <br /> government,or any other political subdivision of the State of North Carolina must not utilize <br /> any subcontractor found on(he State Treasurer's Final Divestment List.The State Treasurer's <br /> Final Divestment List can be found on the State Treasurer's website at the address <br /> -www.nctreasurer.comllrtl1 and will be updated every 180 days. <br /> *** *Contractor,Vendor or Bidder-Return This Form With All Other Required.Documentation***** <br /> • <br />